Inspection on 25/04/08 for St Giles Private Nursing Home

This inspection was carried out on 25th April 2008.

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

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

Other inspections for this house

St Giles Private Nursing Home 06/09/06

St Giles Private Nursing Home 27/01/06

St Giles Private Nursing Home 13/07/05

St Giles Private Nursing Home 08/02/05

St Giles Private Nursing Home 16/07/04

St Giles Private Nursing Home 16/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE St Giles Private Nursing Home 122 Tile Cross Road Garretts Green Birmingham West Midlands B33 0LT Lead Inspector Michelle McCarthy Key Unannounced Inspection 25th April 2008 08:50 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 Giles Private Nursing Home DS0000024893.V363234.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 Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Giles Private Nursing Home Address 122 Tile Cross Road Garretts Green Birmingham West Midlands B33 0LT 0121 770 8531 0121 770 8146 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) Restful Homes Group Ltd Jill Louise Burton Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies 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: Old age, not falling within any other category Code OP (48) 2. The maximum number of service users who can be accommodated is: 48 6th September 2006 Date of last inspection Brief Description of the Service: St Giles is registered for 48 older people, who require nursing care. St Giles is situated in Garrets Green, close to public transport links and has facility for off road parking. The home is purpose built and the accommodation is spread over two floors. All bathrooms are on suite with toilet and washbasin. Bathing facilities are shared, with a mixture of assisted baths and floor draining showers on both floors of the building. Dining facilities and lounges are communal and the home also has a hairdressing salon. Kitchen and laundry facilities are based on site. The home is a non-smoking environment and a shelter is provided outside for this purpose. St Giles employs an activities coordinator and a wide range of activities are on offer. Information included in the service users guide states that fees start from £550 per week. St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection visit. This is the most thorough type of inspection when we look at all aspects of the service. We concentrated on how well the service performs against the outcomes for the key national minimum standards and how the users experience the service. Before the inspection, we looked at all the information we have about this service, such as information about: • • • concerns, complaints or allegations incidents previous inspections and reports. We do this to see how well the service has performed in the past and how it has improved. We undertook an annual service review (ASR) of the home in March 2008. This raised concerns about how the home is being managed and how this affects outcomes for people living at St Giles. We brought forward the key inspection date so that a full review of the services offered by St Giles could be made. The visit to the home was made on Friday 25th April 2008 between 8.50am and 7.10pm. 44 people were living in the home on the day of our visit. It was the assessment of the home manager that the majority of people living in the home had high dependency nursing care needs. We used a range of methods to gather evidence about how well the service meets the needs of people who use it. This included talking to people who use the service and observing their interaction with staff where appropriate. We also looked at the environment and facilities provided and checked records such as care plans, risk assessments, staffing rotas and staff files. Three people using the service were identified for case tracking. This is a way of inspecting that helps us to look at services from the point of view some of the people who use them. We track peoples care to see whether the service meets their individual needs. Our assessment of the quality of the service is based on all this information, plus our own observations during our visit. At the end of the visit we discussed our preliminary findings with the home manager and the provider. St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 6 The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. What the service does well: What has improved since the last inspection? What they could do better: We made several requirements that the provider must comply with to improve the quality of outcomes for people using the service. St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 7 Care plans must be available for each of the identified needs of people living in the home and contain details of the actions required to meet each need. This is to make sure people get the care they need. Systems must be in place to minimise the risks to the health or well being of residents who have an increased risk of developing pressure sores. This is to make sure the health and well being of people living in the home is maintained. Arrangements must be made to make sure that medicines are stored within the recommended temperature limit. This is to make sure medicines remain stable and effective. Accurate records relating to medicine management must be maintained. This is to protect people living in the home from the risk of harm from medication errors. Accidents and incidents that adversely affect the health or well-being of residents must be notified to us in line with current guidance. This is to comply with legislation and keep us informed of events in the home. 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 Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 8 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 Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 9 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): Standard 3 was assessed. Quality in this outcome area is good. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined the case files of three people identified for case tracking to assess the pre-admission assessment process. The manager said that it was usual for her or a senior member of the nursing staff to visit people who are considering moving into the home to undertake an assessment of their needs and abilities. Each of the files examined contained information gathered during a preadmission assessment that identified all of the person’s needs. St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 10 Files also contained pre-admission information provided by professional health and social care agencies and incorporated into care plans. Information gathered about the needs and abilities of people living in the home is used to develop care plans to meet these needs. There are opportunities for prospective residents or their representatives to visit the home before moving in. One resident told us, ‘My relatives visited the home before I moved in. It was lively and there was lots going on. They knew I’d be happy here because I enjoy being with other people and socialising.’ St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 11 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): Standards 7, 8, 9 and 10 were assessed. Quality in this outcome area is adequate. People are treated respectfully and their personal care needs are met. Care plans are not always developed for identified needs which puts residents at risk of not having their needs met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living in the home looked well cared for and were clean, their hair had been combed and nails were trimmed and clean. They were well presented and wore clothes that were suited to the time of year. It was evident from our observation that the personal care needs of people living in the home are met. One resident told us, ‘It’s such a relief to get out of hospital and find this place. I feel so much more like myself since I’ve moved here’. The care files of three people identified for case tracking were examined. St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 12 Care files were standardised, well organised and documented detailed information about each person. This should mean that staff have good access to information about the needs of people living in the home and the actions they need to take to meet those needs. Care plans were available for most of the identified needs of each person and supplied staff with the information needed to make sure these needs were met safely and appropriately. For example, one person with a urethral urinary catheter inserted had a care plan describing the specific care required with evidence that the catheter had been changed every 3 months, as planned. Care plans had not been developed for some of the needs of residents. For example, staff identified during assessment that a person had lymphoedema (severe swelling) of their legs; a care plan was not developed to monitor or minimise their symptoms or discomfort. This puts this person at risk of deterioration in their health and well being. The service uses risk assessment tools to identify whether residents are at risk of developing pressure sores, poor nutrition or have an increased risk of falls. When the outcome of the assessment identifies an increased risk, action is not always taken to minimise the risk. For example, one person admitted to the home with a pressure sore and identified as having a high risk of compromised tissue viability did not have a care plan to minimise the risk. We observed that there was no pressure relieving equipment, such as a specialist mattress, in use for this person. This puts this person at risk of deterioration in their health and well being. Care plans to minimise identified risks were available in other case files. Other shortfalls were identified in the way the service manages people at risk of developing pressure sores. For example, the care plan for one resident with a high risk stated that ‘regular’ repositioning was necessary but did not include instructions about the frequency. Repositioning records were maintained and showed intervals of two, three or four hours. We asked two staff working in the area about the frequency of repositioning for this person. One staff member told us, ‘it depends, sometimes it’s every hour, sometimes it’s every two hours’, the other staff member told us it was ‘every two or three hours’. The failure to give staff written direction about the frequency of repositioning leaves this person at increased risk of an oversight of care. Each person’s care file contained a record of contact with or visits by Health Care Professionals. These confirmed that people living in the home have access to Health Care professionals such as the GP, Dietician, Optician, Chiropodist and Tissue Viability Nurse Specialist. For example, staff observed that one person with very complex needs had developed pressure sores and made a referral to the tissue viability nurse specialist. The specialist advice was recorded in the case file along with wound assessment charts to monitor the St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 13 progress of the wound. This means that staff took appropriate action to maintain this person’s health and prevent further deterioration. Staff maintain separate records for wound care. This was not always cross referenced in care plans which made it difficult for us to find the information. Wound care records were detailed but confusing; records were maintained in a way that made it difficult to ascertain the current treatment for each wound, particularly where residents had more than one wound. Systems for recording wound care plans should be reviewed so that clear instructions are available for staff about the actions they need to take to treat the wounds. The care file of one person observed to have bedrails in place on their bed contained a risk assessment for their use and documented the decision to use the bedrails in the best interests of the person. This means that staff had given consideration to the best way of maintaining this person’s safety. We examined the systems for the management of medicines in the home. A monitored dosage (‘blister packed’) system is used. Medication is safely stored in locked trolleys, which are kept in locked clinical rooms (one upstairs and one downstairs). Clinical rooms were tidy and organised. Daily clinical room temperature recordings are not maintained but a thermometer in the upstairs clinical room showed a temperature of 25°C and a thermometer in the downstairs clinical room showed a temperature of 27°C. Medicines must be stored below 25°C to maintain their stability. This was discussed with the provider who committed to take action to rectify this. A medicines fridge is available in each treatment room with daily recordings of the temperature, which were within recommended limits. The facility for storing controlled drugs (CD) is satisfactory. There is one CD cupboard to store CDs for both floors. The contents of the controlled drug cabinet were audited against the controlled drug register and the quantities were correct. We observed that oramorph (liquid morphine medicine) prescribed for one person was incorrectly entered in the CD register under another residents name. Nursing staff had undertaken daily audits of the contents of the CD cupboard and had not detected their own error. Accurate records must be maintained to comply with legislation and protect people from the risk of potential medicine administration errors. An audit of the medication prescribed for people involved in case tracking demonstrated that medicines had been accurately administered as prescribed and medicine administration records were accurately maintained. We observed good practice in the administration of medicines during a medicine administration ‘round’. For example, the nurse checked the MAR St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 14 sheet before dispensing medicines from the trolley and administering to each individual in turn. Staff had a sensitive, kind and caring attitude towards the people living in the home. Personal care was provided in private, residents were spoken to respectfully by staff and addressed by their preferred names. St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 were assessed. Quality in this outcome area is good. The lifestyle people experience in the home matches their preferences; they are supported to maintain their independence and enduring interests that enhances their quality of life. Residents benefit from a nutritious and varied diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each of the residents’ files examined contained a biography recording the person’s life history, their enduring interests and relationships. This should assist staff to deliver ‘person centred’ care. Staff spoken to were familiar with the preferences of residents and the type of activities that might engage and stimulate each individual. A record of group and individual activities is maintained in the home. An activities co-ordinator is employed in the home and works 25 to 30 hours each week. At the time of our inspection visit the activities co-ordinator was on St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 16 leave. Some of the care staff were undertaking her duties either on a voluntary basis or as overtime. The care staff numbers were not depleted. We observed residents participating in a craft session working with paper mache which was evidently an ongoing project. A sing-song session took place in the upstairs lounge. In the evening we observed staff supporting residents to use a ‘Wii’ (a wireless handheld computer game) that simulated a game of bowls. The provider and manager told us that they do not have a planned programme of activities, but are led by residents as to the activities preferred on a daily basis. One resident told us, ‘I’m really happy here. It’s fun and lively.’ The home has an open visiting policy. People are encouraged to maintain links with their family and friends. Residents told us that visitors are made welcome and the visitor’s record demonstrated that people can visit when they want to. We observed the lunch time meal service in the first floor dining room which was served at 12.30 pm. The meal was served from a heated trolley brought up from the kitchen. Meals were delivered to people who chose to eat in their room. A monthly residents’ forum was initiated in February 2008 encouraging people to get together and discuss the way the home is run. This allows people to make suggestions and be involved in some decision making about what happens in the home. For example, the daily ‘alternative menu’ that is now available resulted from a suggestion made at the residents’ forum. Dining tables were attractively set with green linen tablecloths covered with wipe clean lace cloths, condiments and floral arrangements. The mealtime was evidently a social occasion with residents coming together and chatting over their meal. Seven people attended the dining room. The day’s choice of meal was fish or fried egg accompanied by chips and peas. Gateaux was offered for dessert. People are offered the choice of menu during each morning. An alternative menu list is available for people who do not have a preference for either of the day’s choices. One resident had expressed a preference for curry, which was provided from the alternative menu. Residents made positive comments about the food provided in the home. One person told us, ‘the food is great. There’s so much choice.’ Staff told us that six people accommodated on the first floor of the home needed assistance to eat their meals. There were sufficient staff available to offer sensitive and timely assistance. St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 17 The Environmental Health Officer’s inspection undertaken in February 2008 awarded the home four out of five stars EHO indicating a very good level of compliance for food hygiene. St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. Quality in this outcome area is good. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a formal complaints policy which is accessible to people living in the home and their families. People are encouraged to raise their concerns with the manager or senior staff on duty. Residents told us that they would initially raise concerns with their relatives or representatives who would speak to the manager on their behalf, but they said they felt they could go to the manager or deputy and they would be listened to. Residents were observed to be familiar with the senior staff on duty and felt confident to make requests. This suggests residents would be confident in raising concerns with staff. One resident told us, ‘I’ve never had cause to complain or raise concerns but if I did I’d tell Josh (the provider) or the manager.’ St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 19 We have received a number of complaints about services offered by the home since the last inspection. Complaints have been received from family members and professionals. Complaints detail concerns about the poor standard of care, failure to implement treatment and poor management of residents resulting in deterioration in their health and wellbeing. We referred the concerns raised to the provider for investigation. A record of complaints and concerns received by the home is maintained along with the action taken by the home regarding each issue raised. Evidence was available that the manager and provider makes a timely and objective response to concerns raised. Social Services implemented their Adult Safeguarding procedures since the last inspection and investigated concerns raised the care of six residents. The outcome of the investigation established that the home had dealt appropriately with all the concerns raised. The home has an adult protection policy to give staff direction in how to respond to suspicion, allegations or incidences of abuse. Staff have had training in recognising signs and symptoms of abuse. It was evident through discussions with the manager that she is aware of local Social Services and Police procedures and her responsibilities for responding to allegations of abuse. During a discussion with one resident about their experience of living in the home, they told us, ‘The best thing about living here is that I feel safe here.’ St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were assessed. Quality in this outcome area is good. The home is well maintained providing a safe, attractive, homely and clean place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides accommodation over two floors. There is a dining room and communal lounge on each floor. The public areas in the home were clean, bright and airy. Residents were observed making use of all the communal spaces, although people who prefer to remain in their own rooms are accommodated. St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 21 Some of the specialist chairs looked worn; parts of the vinyl covering on some chairs was worn, exposing the foam. This was discussed with the provider who made a commitment to repair or replace. Several bedrooms, including the people involved in case tracking, were viewed. Rooms were comfortable, cosy and well decorated with ensuite facilities. All the rooms were personalised with people’s own belongings and looked as though it belonged to the person. During our tour of the home an unpleasant smell was noted in one area. The manager asked domestic staff to take action to resolve it. It was evident that staff addressed the issue, caused by the challenge of managing the urinary incontinence of a particular resident; when we returned to the same area later in the day the smell had gone. Equipment is available to assist residents and staff in the delivery of personal care, which includes assisted baths, moving and handling equipment including hoists. Pressure relieving equipment such as cushions and various types of mattress are available for people who have an identified need for them. The home has systems in place for the management of dirty laundry. The laundry is fully equipped and each resident has their own laundry storage box to hold their named clothing following the laundering process. Discussions with residents confirmed that a good laundry service was provided. One person told us, ‘My daughter was going to do my washing but they (the staff) said – let us do it here. They do a good job of looking after my clothes.’ It was identified during the last inspection that bath hoists required a general clean. It was observed during this inspection that the underside of the seat of bath hoists continue to need cleaning. The provider said he would arrange to have these steam cleaned. Systems are in place to manage the control of infection. Protective clothing such as plastic gloves and aprons were available and arrangements are in place for the disposal of waste. St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 were assessed. Quality in this outcome area is good. There are sufficient staff on duty to meet the needs of people living in the home. Residents benefit from being cared for by competent staff and are protected by robust recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager told us that the usual staffing complement for the home is 8am – 2.30pm 2.30pm – 9pm 9pm – 8am 2 registered nurses and 6 or 7 care staff 2 registered nurses and 6 care staff 2 registered nurses and 3 care staff St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 23 In addition the manager is supernumerary and there are sufficient laundry, catering, cleaning, maintenance and administrative staff to ensure that care staff do not spend undue lengths of time undertaking non-caring tasks. For example, • • • • • • The kitchen is staffed between 7am and 7pm every day of the week, There are domestic staff on duty every day of the week, The laundry is staffed for 8 hours every day of the week, The home employs a maintenance person for 25½ hrs each week, The manager is supported by a full time administrator, The home employs an activities co-ordinator for 25-30 hours each week. Three weeks of the home’s duty rota between 7th April and 26th April 2008 was examined and demonstrated that the staffing levels set by the home (in the table above) are consistently achieved. It was evident from the outcomes achieved for residents that there are sufficient staff on duty to meet their needs. Staff spoken to confirmed that the staffing arrangements enabled them to meet the needs of residents. One staff member told us, ‘The best thing about the home is that it’s run with the residents at heart, their needs are first and foremost, nothing is too much trouble to get them what they need.’ One resident told us, ‘The staff do everything I need; they really look after me.’ Training records show that seven out of 22 care staff permanently employed in the home have a qualification in care at NVQ (National Vocational Qualification) level two or above. The manager told us that a further six care staff are currently working towards the award. This means that 32 of care staff in the home are qualified at NVQ level two or above which falls below the National Minimum Standard for 50 of care staff to have this qualification. Once all care staff have completed the course, the home will have 59 of care staff employed with an NVQ in care that should mean that people are cared for by competent staff. The personnel files of two recently recruited staff were examined and both contained evidence that satisfactory pre-employment checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) and satisfactory references were obtained before staff started working in the home. Robust recruitment practices safeguard people living in the home from the risk of abuse. St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 24 One recently employed care assistant confirmed that pre employment checks were made before they started working in the home. They told us they had an induction period when they were not in the ‘working numbers’ but ‘shadowed’ an experienced care assistant. A training matrix is maintained and used to record staff training and to identify any gaps in learning. Records examined demonstrate that all staff receive mandatory training in moving and handling, infection control, abuse awareness, fire safety and food hygiene. This should mean that staff are updated in safe working practice. St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 25 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): Standards 31, 33, 35 and 38 were assessed. Quality in this outcome area is good. The home is managed by an experienced and competent person to ensure the service is run in the best interests of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has been in post for over a year and is experienced in the care of older people. She is a registered nurse and is working towards registered manager’s award (NVQ level 4). There are clear lines of accountability within the home with the Deputy manager reporting to the manager who in turn is supported by the provider. St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 26 The home’s Quality Assurance file contained evidence that management reviews the service provided in the home and identifies areas for improvement. Action plans are developed for making improvements and are reviewed to monitor progress against the objectives set. The personal monies of people living in the home are kept securely in separate bags and accurate records of income and expenditure are kept. An audit of one resident’s personal monies was found to be correct. Information included in the AQAA told us that several people were admitted to hospital since the last inspection. The manager had not informed us of these events. The service must notify us of any event that adversely affects the health or well-being of any resident. We referred the manager to the guidance on our website about making notifications under regulation 37. Incidents and accidents that happen in the home are recorded and were available for examination. The manager completes a monthly accident audit to analyse any patterns that occur. Information sent to us in the AQAA tells us that equipment is serviced or tested as recommended by the manufacturer or other regulatory body. Evidence was sampled at random to confirm this. For example, labels on hoists indicate they were checked in December 2007 and are due again in June 2008. Labels on portable electrical appliances indicate they were checked in August 2007 and were due again in August 2008. A fire risk assessment was made in June 2007. The fire alarm is serviced every quarter and is tested weekly. In February 2008 we received information about the intent of the home’s gas supplier to cut off the gas supply which could have had an impact on the safety of people living in the home. When we talked to the provider he explained that the organisation were involved in a dispute with their energy provider about the cost of the gas supply and were trying to change their provider. The provider paid the outstanding gas bill to prevent the gas supply from being disconnected but the dispute with the supplier remains unresolved. St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 28 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 12 Requirement Care plans must be available for each of the identified needs of people living in the home and contain details of the actions required to meet each need. Care plans must be developed and implemented when new or changed needs or risks are identified. This is to make sure people get the care they need. 2 OP8 12 Systems must be in place to minimise the risks to the health or well being of residents who have an increased risk of developing pressure sores. This is to make sure the health and well being of people living in the home is maintained. 3 OP9 13(2) Arrangements must be made to make sure that medicines are stored within the recommended temperature limit. This is to make sure medicines St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 29 Timescale for action 30/04/08 30/04/08 30/04/08 remain stable and effective. 4 OP9 13(2) Accurate records relating to medicine management must be maintained. This is to protect people living in the home from the risk of harm from medication errors. 5 OP38 37 Accidents and incidents that adversely affect the health or well-being of residents must be notified to us in line with current guidance. This is to comply with legislation and keep us informed of events in the home. 30/04/08 30/04/08 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 OP22 OP26 Good Practice Recommendations The provision of specialist seating in the home should be reviewed and worn or torn chairs should be repaired or replaced. The bath hoists require a general clean, particularly underneath to ensure standards of hygiene are maintained. St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Giles Private Nursing Home DS0000024893.V363234.R01.S.doc Version 5.2 Page 31 - 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. 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