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Inspection on 26/10/05 for St Georges Park Care Centre

Also see our care home review for St Georges Park Care Centre for more information

This inspection was carried out on 26th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users observed at the time of this inspection appeared well cared for, clean and comfortable. Records and discussions with staff demonstrated that considerable efforts are made to promote positive outcomes for people with quite complex, demanding and sometimes challenging medical and mental conditions. At the time of this inspection, the home was clean, comfortable and pleasant smelling other than one bedroom where alternative flooring is to be provided. The home provides a very good choice in terms of menus, with nutritional needs appropriately high profile in caring for people with dementia. The home provides a good range of activities.

What has improved since the last inspection?

Training opportunities have increased and more than the 50% required level of staff have acquired the NVQ2 award, with nine more going through the assessment. Staff stated that teamwork has improved and that improved staffing levels have allowed more time to be spent with residents. New easy and dining chairs have been acquired.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE St Georges Park Care Centre School Street St Georges Telford Shropshire TF2 9LL Lead Inspector Deb Holland Unannounced Inspection 25th October 2005 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 Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 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 Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Georges Park Care Centre Address School Street St Georges Telford Shropshire TF2 9LL 01952 616300 01952 616345 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) Modelfuture Limited, Mrs Christine Armstrong Care Home 71 Category(ies) of Dementia (32), Old age, not falling within any registration, with number other category (33), Physical disability (6) of places St Georges Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 71 Nursing beds which may include a maximum of 10 residential beds, including 32 older people with dementia on the ground floor and up to 6 residents with a physical disability on the first floor. The Manager Mrs Armstrong is to undertake the Registered Managers Award prior to August 2005. 4th July 2005 2. Date of last inspection Brief Description of the Service: St Georges Park is a care home located in St Georges, Telford, Shropshire. St Georges Park is registered to provide personal care with nursing for older people, some of whom suffer from dementia. The home has all single room accommodation. St Georges Park Care Centre is registered to provide care for Older People who are frail and require nursing care, it is divided into two units, Rydal situated on the lower floor which can accommodate a maximum of 31 older people who have dementia and Derwent situated on the first floor which can accommodate a maximum of 40 older people requiring general nursing care. St Georges Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was conducted by two inspectors over a period of some three hours. The inspection focused on issues identified through an adult protection process (which is ongoing), a complaint received by CSCI relating to someone who was cared for by the home on a respite basis, and a notification of admission to hospital of a service user with a Grade 4 pressure sore. The inspection also considered some of the key standards which were not assessed during an earlier inspection in July 2005. The communal environment, service areas, kitchenettes and the majority of individual bedrooms were inspected and relevant records were scrutinised. In addition to talking to service users, where this was possible, five staff completed feedback forms, and a range of staff – kitchen staff, cleaners, carers and nurses were spoken to. Three visitors were also seen. All were very positive and spoke of improvements having been made. The only suggestion made by people was that communication between staff, and between staff and relatives, could improve. What the service does well: What has improved since the last inspection? Training opportunities have increased and more than the 50 required level of staff have acquired the NVQ2 award, with nine more going through the assessment. Staff stated that teamwork has improved and that improved staffing levels have allowed more time to be spent with residents. New easy and dining chairs have been acquired. St Georges Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Georges Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 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 Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards not inspected on this occasion EVIDENCE: Key standard 3 and standard 4 were assessed in July 2005. Key standard 6 does not apply as the home does not provide intermediate care St Georges Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9. Standard 10 was assessed in July 2005 Care plans are in place but are not comprehensive and not clearly reviewed, creating the potential for important issues, such as access to relevant health professionals, to be missed or not followed up. Service users’ safety is promoted by the medication system in place. EVIDENCE: The home’s care planning documentation includes core care plans and additional care plans which are used to address more short term needs, such as wounds and infections. These are listed within the record but filed elsewhere once the acute need no longer exists. Core care plans are reviewed on the plan itself, requiring the date, comments and signature of the nurse involved but short term care plans note the date of review, which is written up in the review and evaluation notes – which also serve as the daily record. In the documentation inspected, the plans themselves set out the actions which should be taken by care staff but did not cover all aspects of the individual’s needs. The home’s own policy is that the identification of pain associated with a pressure area should trigger a pain control plan but this was not the case in St Georges Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 Page 10 the records examined. Review records for the core care plans are unclear with dates simply crossed through with no comments or signature. Food, fluid and turn charts were observed in bedrooms for residents that were identified as at risk from pressure sore formation or nutritionally at risk. Fluid and call bells were seen within reach. Eleven very frail, poorly service users were seen to be comfortable, well looked after with fluid and turning charts up to date. All staff spoken to were of the view that outcomes for service users are good and that improved staffing levels have enabled them to spend more time with residents. One record inspected was for a service user whose diabetes and associated needs had particularly challenging for the home to manage since admission in early 2004. Pressure areas, frequently with infection, were identified in the care plan. There was evidence of treatment, review and involvement of the tissue viability nurse. However, the records available had not always been completed fully and photographs had not been utilised as a means of monitoring progress or, in this case, significant deterioration leading to hospital admission and surgery. These circumstances are subject to an internal inquiry by the provider’s own Nursing Directorate and a copy of their eventual report was requested. Evidence of equipment being provided for the promotion of tissue viability was seen throughout the home. The home has a continence link carer who liaises with the local continence advisor. The documentation for a service user admitted recently with Grade 2 sores included a plan to prevent future deterioration and promote tissue viability. The events which triggered the adult protection process relate to family members who stated that they had found their mother soaked in urine and unattended on one occasion, in addition to other concerns about her health needs being met. This service user was seen during the inspection and was dressed appropriately with clean hair and nails. There was no odour in the room and the bed was clean. Turning charts had been completed through the night. Records for this service user showed contacts with specialist medical services, but issues relating to lack of effective liaison regarding chiropody and ophthalmic services are being followed up by the home within an adult protection investigation and a report is expected to be presented in November. Storage, administration and recording of medication on the first floor of the home was inspected and found to be satisfactory. Only qualified staff administer medication. St Georges Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14 and 15. Standard 12 was inspected in July 2005 The home enables people to keep in touch with relatives and the community. The dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users’ tastes and choices EVIDENCE: Contact between service users and their families is supported and people were seen coming and going during this visit. Three visitors were spoken to during the inspection. All three made positive comments about improvements at the home. The home handles small amounts of money for those people who can no longer manage themselves, but does not act as agent or appointee for anyone. Personal possessions were evident in many of the rooms, including pieces of furniture and the manager confirmed that people could bring in whatever they wanted. The day’s menu was on display on arrival at the home in the main reception area, although none were seen in the unit dining rooms, which might be more helpful for residents wishing to see what’s on offer. A good range of options were available and when a service user refused any of those available, another meal was provided. The meal sampled tasted good. There are a range of options for people requiring supplements and an awareness of the need to boost food intake for people with dementia through the day. An issue St Georges Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 Page 12 regarding diet for the person with diabetes, referred to earlier in this report, was addressed by the home following concerns expressed by the family about how nursing staff were wrongly attempting to control his blood sugar through restricted food intake. Although Standard 12 was not inspected in full, it was evident that activities do take place and an activities diary is produced. The home has an activities organiser who works 30 hours per week. St Georges Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Standards 16 and 18 were assessed in July 2005 The home has an appropriate complaints procedure but it appears that staff are unaware of the procedure or unwilling to engage in dealing with complaints at early stage, leading to the potential for matters to remain unresolved or to escalate to more formal processes and/or access to CSCI EVIDENCE: The home has an appropriate complaints procedure, seen on display in the home, and there are logging processes. However, daily records for one service user showed that family members had raised concerns and a member of staff believed that these had been confirmed in writing. This information had not reached the complaints log and presumably the family had not had a response from the home. Comments were also made by another family during a protection of vulnerable adults meeting regarding the response of staff to a complaint when it appears that staff indicated that only certain members of staff could deal with their concerns. The written complaint received by CSCI also stated that the nurse on duty had stated that complaints forms were not available. These events suggest a need for further training within the staff group about the procedure and their own responsibilities and responses when concerns are raised. St Georges Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24, 25 and 26 The standard of the environment is generally good, providing people with a comfortable place to live. Kitchenettes are in need of cleaning and organising, and the current refreshment trolleys and utensils are unpleasant and unacceptable, neither promoting dignity or a reflection of good hygiene standards EVIDENCE: Routine maintenance is identified and noted in a log, seen in reception. The home has just appointed a full time maintenance man and there are plans for the ground floor to be redecorated over the next twelve months. New armchairs and dining chairs have been purchased this year. The local fire officer visited the home in March 2005 and was satisfied with fire safety provision within the home. All the rooms at the home have en-suite facilities. The bathroom identified as being used as a store room earlier this year has now been cleared and is St Georges Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 Page 15 available for use. It is anticipated that a level access “wet room” to provide a shower will be provided in the next twelve months. The majority of the home’s bedrooms were seen at this inspection and all appeared comfortable and well provisioned. Carpeting has been replaced in some rooms with vinyl covering to cope with continence difficulties. The manager stated that this was also the plan for the only room in which a strong urine odour was identified during this inspection, where regular carpet cleaning was failing to deal with the problem. Otherwise no offensive odours were identified and in fact some areas of the home were particularly sweet smelling. The complaint received by CSCI stated that the home’s kitchenette, refrigerator and cups were “filthy”. Kitchenette areas were seen to need both thorough cleaning and organising and need new equipment such as containers for food. Some cutlery was unacceptably stained. Storage was disorganised and generally messy with one cupboard in a kitchenette containing staff personal belongings – bag and coat - plus cream cleaner and a tin of fruit. Other cupboards and drawers appeared similarly disorganised. Shabby plastic tubs containing a few broken biscuits in them and tea-stained lumpy sugar were seen and are clearly unacceptable and would be seen by family using the kitchen facilities. The tea trolleys themselves are badly in need of replacement, being shabby and stained. Generally the cups and flasks seen on the trolleys and in use, although said to be stained rather than dirty, were unacceptable and combined with the state of the trolley and the containers, presented very badly indeed. The insides of the refrigerators were not filthy and the nurse in charge of the unit stated that these are now cleaned regularly. Cleaning schedules are in place. The complainant’s allegation that beer was stored in one was found to be true. Cans of Guinness belonging to one of the service users are stored in the fridge and this is not seen as posing a risk to anyone else. The home’s laundry was seen to be clean and well organised. St Georges Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 29 Service users are protected by the home’s recruitment policy and practices. The home provides access to NVQ2 awards, promoting the skills of the care staff. EVIDENCE: The home has reached 50 of its care staff having achieved the NVQ2 Care award and a further nine are going through the award at present. The files for the two most recent recruits to the home were examined and contained all the required employment checks plus evidence of having received the home’s handbook, policies and procedures and a record of induction Although provision of training was not fully inspected, posters and information on notice boards throughout the home showed that training events were taking place including monitored dosage systems, fire awareness, resident welfare. St Georges Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 36 and 38. Standard 38 was also assessed in July 2005 The organisation has comprehensive internal quality monitoring systems but could be more pro-active in establishing the views of service users, relatives and relevant professionals EVIDENCE: There is a development plan for the home, which includes elements already referred to in this report, such as redecoration, provision of a shower room, new hoists. There is a comprehensive system of management audits, with the home manager required to conduct a monthly audit under various subject headings. The regional manager does a twice yearly full audit. Ms Armstrong also does weekly “walk abouts” with an expectation that unit managers do the same daily. Ms Armstrong also monitors weekly all pressure areas, wounds and any bruising identified along with monitoring accident records. The expectations for unit managers’ daily checks perhaps need to be clearer as it St Georges Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 Page 18 was identified on two units that “daily” recorded checks on hoist equipment had not been conducted for four or five days. Satisfaction surveys were sent out in May. Resident/relatives meetings are held every two months with another due in November but these are not well attended. Given the issues which have emerged through complaints and adult protection processes, this could usefully be repeated perhaps in a more proactive way to engage service users, their families and visiting professionals in providing the home with feedback as to its performance. Staff were clear in their feedback to inspectors that the home has improved, as were visitors. The CSCI July report was available in the home’s reception area. The only money belonging to service users which is handled by the home is a small “float” kept in the home’s safe for paying for things like the hairdresser or small purchases. These are either receipted and/or signed off by two people. No agency or appointee arrangements exist. Supervision, which had been in place, has lapsed in Ms Armstrong’s absence but is being reinstated. Records are kept to show occurrence and notes from individual sessions. This activity is essential alongside the named nurse/keyworker system to ensure that individual responsibilities are met with regard to service users’ welfare. Health and safety systems in the home were also assessed in July this year. Following an incident involving bed rails, staff at the home are very conscious of the risks involved in their use. Risk assessments were seen on service users’ files and no problems identified in their use during this visit. “Bumpers” were in place. Some people, identified as high risk for bed rails, are sleeping on low level beds with mattresses at each side – falls are not prevented but the consequences minimised. Testing of portable electrical equipment was evident through stickers on plugs. No problems were identified during a brief visit to the home’s kitchen. Hot water temperatures which were tested were satisfactorily controlled. St Georges Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 3 X 3 X X 3 3 2 STAFFING Standard No Score 27 X 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 2 X 3 St Georges Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 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 OP7 Regulation 15 Requirement The home must ensure that care plans address all aspects of a person’s health, personal and social care needs Care plans must be reviewed and, if necessary, updated at least monthly The home needs to ensure that staff are aware of the complaints procedure and able to deal appropriately with concerns or complaints when raised with them Kitchenettes need to kept clean and hygienic Tea trolleys, beakers and flasks need to be replaced and an effective means of maintaining cleanliness and hygiene needs to be identified The home needs to be more proactive in seeking views of service users, family/friends and stakeholders in the community Supervision needs to be prioritised so that care staff receive formal supervision at least 6 times per year Timescale for action 30/11/05 2 3 OP7 OP16 15 22 (3) 30/11/05 30/11/05 4 5 OP26 OP26 16 (2) (g) 16 (2) (g) 30/11/05 30/11/05 6 OP33 24 31/12/05 7 OP36 18 (2) 31/12/05 St Georges Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations Photographs should be used as a method of monitoring pressure sores, treatment and outcome unless resident consent cannot be obtained St Georges Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Georges Park Care Centre DS0000022275.V261732.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!