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Inspection on 04/07/05 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 4th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

The atmosphere within the home is warm and friendly. Care is delivered by appropriately skilled staff who treat residents with dignity and respect. The home offers a wide variety of activities that are suitable for the varying capabilities of residents and the actual building provides a spacious and pleasant environment for people to live.

What has improved since the last inspection?

The manager and staff have worked hard to meet the requirements identified at the previous inspection. Training has been provided for staff in the process of recording care within the homes documentation. The ratio for staff with NVQ Level2 or equivalent has increased and now meets the standard. Staff commented that training opportunities have improved. The home has met the majority of the requirements issued at the last inspection.

What the care home could do better:

Despite staff receiving training in the recording of care within the homes documentation, one assessment had not been amended to show changes that had occurred with that residents care. The home must ensure that the "resident requirement" form is kept under review and amended as necessary to ensure that staff are fully aware of any changes to a residents care. No other requirements were made at this inspection.

CARE HOMES FOR OLDER PEOPLE St Georges Park Care Centre School Street St Georges Telford TF2 9LL Lead Inspector Rosalind Dennis Unannounced 4 July 2005 10:00 th 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 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 E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service St Georges Park Care Centre Address School Street, St Georges, Telford, TF2 9LL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01952 616300 01952 616345 Modelfuture Limited Mrs Christine Armstrong Older People 71 Category(ies) of Dementia (32) registration, with number Old Age (33) of places Physical Disability (6) St Georges Park Care Centre E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 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 upto 6 residents with a physical disability on the first floor. 2) The manager, Mrs Armstrong, is to undertake the Registered Managers Award prior to August 2005. Date of last inspection 26/01/05 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 is owned by Ashborne Limited, the responsible person is Mrs Mary Davies. 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 E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 4th July 2005 and lasted for a period of six hours. The inspection focused primarily on Derwent Unit, which is the general nursing unit, Rydal Unit will be assessed at the next inspection. The inspection involved a tour of communal and individual bedrooms on Derwent Unit, observing activity within the home, looking at care records and observation of documents. The inspector spoke with four residents on Derwent Unit and four members of staff that work at the home. The manager and unit manager for Derwent Unit were on duty at the time of inspection and offered their fullest co-operation throughout the inspection. Since the last inspection in October 2004 the home has received three additional visits. One of these visits was undertaken in April 2005 following a serious incident at the home involving the use of bed rails. This incident is still under investigation by the Health and Safety Executive and therefore the outcome of this investigation is not yet available. What the service does well: What has improved since the last inspection? The manager and staff have worked hard to meet the requirements identified at the previous inspection. Training has been provided for staff in the process of recording care within the homes documentation. The ratio for staff with NVQ Level2 or equivalent has increased and now meets the standard. Staff commented that training opportunities have improved. The home has met the majority of the requirements issued at the last inspection. St Georges Park Care Centre E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 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 E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection St Georges Park Care Centre E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 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 standard(s) 3 and 4. The home does not provide intermediate care therefore standard 6 is not applicable. The home has a satisfactory admissions procedure that provides for an effective needs assessment for each resident. The home has an admission procedure that is effective in ensuring that individuals moving into St Georges know that the home will meet their needs. Staff individually and collectively have the skills and experience to deliver the care which the home offers to provide. EVIDENCE: Three care files on Derwent and two files on Rydal that were examined contained comprehensive and complete needs assessments. The assessment forms part of the resident’s plan of care for daily living. In addition to the initial assessment, risk assessments are also conducted and these were present on all files seen for example; nutrition, pressure sore risk, falls risk, moving and handling and risk management plans for clients that are assessed as needing bed rails. All documents showed evidence of at least a monthly review and any action taken as a result of this review was also documented. St Georges Park Care Centre E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 Page 9 Individual files contain a life story/social profile of the resident that enables staff to deliver care in a personalised way. The inspector spoke with four residents on Derwent Unit who commented positively about the care they receive. Observation of the homes training matrix and individual staff training and development records confirms that the staff have the knowledge and skills to meet the needs of the current residents. St Georges Park Care Centre E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10. Residents have risk assessments and care plans in place that identify their needs and the safe ways to meet them, however by not amending the needs assessment/care plan in a timely way staff may not be provided with all the information they need to fully meet the residents needs. EVIDENCE: The manager confirmed that staff have recently received training via the divisional nurse regarding company procedure on the recording of care within the homes documentation. The procedure for assessing and initiating care plans was discussed with the manager and unit manager for Derwent as the intention is for staff only to complete additional care plans if a problem arises or if the care required deviates from the assessment. The section on the main assessment titled “Normal day care needs” therefore forms the basis of the individuals care plan. Each assessment had been reviewed on a monthly basis, however in one file the assessment had not been amended regarding wound care. Documentation within this clients wound chart showed that the resident had a Grade 3 pressure sore and the corresponding section on the assessment reported that the skin status was dry with no reference made to a wound lesion. This could St Georges Park Care Centre E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 Page 11 cause confusion to a member of staff not familiar with the resident and therefore could result in the residents needs not being met. 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. Bed rail risk assessments had been completed, and documented permission/consent for use had been obtained from either the resident or their significant other. Wound care charts showed regular evaluation. The manager was advised to ensure that consent is obtained prior to taking photographs of wounds and this was implemented before the inspector left the premises. Evidence was contained within files of contact from other health care professionals. All residents care files are kept securely in the nurse’s office on both units. Staff on Rydal Unit were observed treating residents with dignity and respect and four residents on Derwent Unit that were spoken with confirmed that staff treated them well and with respect. St Georges Park Care Centre E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12. The home provides social and recreational activities that provide variation and interest for people living at the home. EVIDENCE: The home has a full time activities co-ordinator who provides activities for residents on both units. Notice boards around the home detail up to date information about the range of activities that are available for residents to take part in if they choose. Residents are also issued with individual copies of the activities programme. All activities listed appeared appropriate for the residents within the home. Residents on Derwent were keen to show and discuss the activities programme and spoke positively regarding the activities co-ordinator, his enthusiastic approach and commitment to his role. Residents confirmed that their choice to take part is always acknowledged. The activities co-ordinator documents in care plans and this was evident in the files examined on both Derwent and Rydal Unit. St Georges Park Care Centre E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 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 standard(s) 16 and 18. The arrangements for the protection of residents from abuse are satisfactory. The home has a complaints system that ensures that concerns are listened to and acted upon. EVIDENCE: The home has a policy in place with regard to the protection of adults from abuse. The manager confirmed that the home works with the framework of the local area adult protection procedure and a copy of this guidance was observed to be readily available within the home. Three members of staff confirmed that they would report any allegation or suspicion of abuse immediately and through discussion with the inspector demonstrated their awareness of the adult protection policy including whistleblowing. The local area adult protection procedure has been initiated and followed for two recent incidents within the home. One incident was not upheld and the Health and Safety Executive are in the process of investigating the other incident. The manager has offered her fullest co-operation on both occasions. A full complaints procedure is available within the home. The manager maintains a record of any complaints received by the home and this record was observed to include action taken to address the complaint and the outcome. One complaint recently received by CSCI is currently unresolved. Residents reported that they would notify the manager or other senior staff if they were unhappy with any aspects of the home or care provision. St Georges Park Care Centre E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 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 standard(s) 19. The standard of the environment on Derwent Unit is good providing residents with an attractive, clean and homely place to live. (Rydal Unit not fully assessed). EVIDENCE: Derwent Unit was observed to be clean and individual and communal rooms were decorated to a satisfactory standard. Residents spoke of their satisfaction with their bed –rooms and with the level of cleanliness throughout the unit. The local fire officer visited the home in March 2005 and was satisfied with fire safety provision within the home. All areas of Derwent Unit appeared to be well maintained. An assessment of Rydal Unit will take place at the next inspection. St Georges Park Care Centre E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30. The home employs appropriately skilled staff in sufficient numbers to meet the needs of residents. EVIDENCE: The minimum required staffing levels are documented on the homes CSCI registration certificate in the reception area. Observation of the staffing rotas confirms that levels on the rota meet condition of registration, however the home does appear to have regular episodes of short notice staff sickness, which can result in the home not having required levels on duty if replacement staff cannot be found. Two members of staff felt levels particularly within the dementia care unit are not satisfactory; this was brought to the attention of the manager and discussed. On the day of inspection the home was not full and staffing levels checked by the inspector appeared sufficient to meet the needs and dependency of the current residents. This standard will be reviewed again at the next inspection. Residents on Derwent commented that they felt the level and competence of staff was sufficient to meet their needs. The home has individual training and development records for staff and a training matrix is used to identify any shortfalls in training and to establish when updates are due. Induction training meets the required level and staff are supported in achieving their NVQ Level 2 in care. The home currently has 58 of staff with NVQ Level 2 and some staff have attained Level 3. Observation of training records confirm that staff have received recent training St Georges Park Care Centre E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 Page 16 in dementia care, safe working practice topics including training on bed rail policy, resident welfare training and PEG feeding. Staff confirmed that opportunities for training had improved. Although it is acknowledged that staff have received training in dementia care it is strongly recommended that staff on Rydal Unit also receive training in dealing with violence and aggression. St Georges Park Care Centre E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The health, safety and welfare of residents is promoted by a safe and wellmaintained working environment. EVIDENCE: Comprehensive and up to date risk assessments were observed to be in place and appropriate. The home has a full time maintenance technician and all records pertaining to the maintenance and servicing of equipment were up to date. The company has recently reviewed and amended the actual documents that are used to record maintenance. The maintenance technician and manager have identified problems with recording onto these new records; this was discussed with the inspector who agreed that some of these documents lack clarity. As an example a form to identify were bed rails are located in the home is marked with date, room number and whether a bed rail set is present, the St Georges Park Care Centre E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 Page 18 maintenance technician has amended the form to include the actual ID number of the bed rail set in use in that room. The manager confirmed that issues regarding documentation have been forwarded to the regional manager for action. Following a recent incident involving the use of bed rails within the home, staff have signed to confirm that they have read the homes policy regarding the use of bed rails and the manager confirmed that training in the use of bed rails has been provided with further training provided by the bed rail manufacturers due to take place soon. Observation of staff training records show that staff have received training in safe working practice topics. A tour of Derwent Unit identified that the environment was safe and equipment well-maintained. St Georges Park Care Centre E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x COMPLAINTS AND PROTECTION 3 x x x x x x x STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 3 St Georges Park Care Centre E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 Page 20 Yes. Are there any outstanding requirements from the last inspection? 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 7 Regulation 15 Requirement The resident requirement form must be kept under review and amended to ensure that staff are fully aware of any changes to a residents care. That pre-exhisting homes provide communal space for each service user as at August 2002 and continue to do so. Compliance not assessed at this inspection, previous timescale of 14/02/05. The bathroom not in service user use on the ground floor must be adapted in order that it is suitable for use by the service users. Compliance not assessed at this inspection, previous timescale of 14/02/05. Timescale for action 4/08/2005 2. 20 23(g) The home states this has been completed. 3. 21 23 The home states this has been completed. 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 30 Good Practice Recommendations It is recommended that staff employed on Rydal Unit receive training in dealing with violence and agression. E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 Page 21 St Georges Park Care Centre St Georges Park Care Centre E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 2nd Floor, St Davids Court Union Street Wolverhampton WV1 3JE 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 E56 000022275 St Georges Park Care Centre v237883 UI 040705 Stage 4.doc Version 1.40 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!