Inspection on 10/02/06 for St Giles Residential Home

This inspection was carried out on 10th February 2006.

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.

Other inspections for this house

St Giles Residential Home 18/09/06

St Giles Residential Home 03/08/05

St Giles Residential Home 08/09/04

St Giles Residential Home 18/06/04

St Giles Residential Home 25/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St Giles Residential Home St Giles Mews Vicarage Road Stony Stratford Milton Keynes Buckinghamshire MK11 1HT Lead Inspector Mrs Rosemarie James Unannounced Inspection 10th February 2006 09:30 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 Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 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 Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Giles Residential Home Address St Giles Mews Vicarage Road Stony Stratford Milton Keynes Buckinghamshire MK11 1HT 01908 566077 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) Milton Keynes Council Mrs Anne Walker Care Home 35 Category(ies) of Dementia (35) registration, with number of places St Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: St Giles is a purpose built residential care home for elderly people suffering from dementia, it is run by Milton Keynes Council.. Accommodation is over two floors, the first floor accessed via a shaft lift. All of the bedrooms have washbasins in the room, ensuite facilities are not provided. The home has 3 separate lounge areas, each with its own dining area. A laundry is provided on site. Gardens are well maintained. The home is well situated for access to the local amenities. Public transport links are close by. St Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the summary of an inspection carried out at St Giles on the 10th February 2006 commencing at 12.30pm. The inspector was Mrs Rosemarie James. During the inspection progress on the requirements from the inspection carried out in August 2005 were looked at. Five of the seven requirements had been met and work undertaken on the remaining two. At this inspection the key standards not assessed at the August inspection were looked at. This involved discussions with the manager, looking at some records, meeting the residents, a discussion with a visitor, and observing staff practices. Although the standards pertaining to the environment were not assessed at this visit, a tour of the home was undertaken. The inspector would like to thank the manager, staff team and the residents for the hospitality shown during this enjoyable inspection visit. The home was given 48 hours notice of this inspection visit. What the service does well: The management team are very experienced in providing ‘specialist’ care to older persons with advanced dementia. All the residents met with on the day of the inspection looked very well cared for with appropriate clothing, tidy hair, clean nails and glasses. The home deserve particular credit for the care they have been providing to a resident who has had to remain in bed for the past 3 years, there was no pressure damage and she looked extremely comfortable and cared about. The home works closely with the day centre situated on the same site. This means that residents coming in for respite care or on a permanent basis are already known to the staff team at St Giles. St Giles is a very welcoming place and as a consequence the residents receive a lot of visitors. Milton Keynes Council (who own the home) has a very positive attitude to training. As a result the staff team at this home have numerous training opportunities which helps to ensure they are able to meet the at times challenging and diverse needs of this client group. The environment is pleasant and homely. St Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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 Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 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 Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 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): 1&6 The homes admission procedures ensures all parties have the information necessary to help them decide if St Giles is an appropriate placement for an individual needing residential care because of a dementia type illness. EVIDENCE: St Giles is situated on the same site as a day centre that provides day care for people with dementia. It is almost always the case that a prospective resident (permanent or respite) are known to the staff team at the home because of their attendance at the day centre. A pre admission visit to the home is always arranged and the manager will meet with family members to show them around the home and to answer any questions they may have. Literature is also provided that includes: a leaflet about the home, a copy of the latest inspection report summary and the Statement of Purpose (SOP). The SOP is reviewed annually; it was last reviewed May 2005. Because St Giles is a specialist home for people with dementia it would not be possible for prospective resident to make an informed choice themselves about whether or not St Giles was the place they wanted to live. However, the St Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 Page 9 introductory visit(s) help with orientation and aid settling in, while the literature helps family members to decide whether admission is right for their relative. A requirement was made in the report following the August 05 inspection that pre admission assessments should be undertaken for respite care residents prior to each admission. It is pleasing to be able to report that the manager has been working closely with care managers, attending two team meetings of Mental Health Services explaining the need for up to date assessments when placing individuals for respite care. As a result, up to date assessments are now available for each admission. The manager is further aiding the assessment process with her direct input as appropriate. In the week prior to the inspection the Manager attended a joint Day Centre / respite care review giving her a complete up to date picture of that individuals needs ready for the service users next respite admission to the home. With regard to Standard 6, the manager confirmed that the home do not provide an intermediate care service. St Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: Key standards 7,8,9 & 10 were assessed at the last inspection with 8 & 10 being met and requirements set for standards 7 & 9. The requirements were followed up at this inspection and the findings were as follows: As a result of the new pre admission assessment of respite care service users, up to date and more informative care plans are in place. The care file for one service user currently in the home was made available for inspection purposes. It included: information / progress reports, a personal profile, physical health assessment, mental health assessment, nutritional screening and weight records. The daily reporting on residents well being has also changed. The recording format is different with a new record sheet starting every week. The old one is read by the team leaders and signed off by them allowing the monitoring of a residents progress and the standard of record keeping. The manager reported that a considerable amount of training had been undertaken in report writing. The examples seen at this inspection were informative. However, there were one or two judgemental entries that were not appropriate. St Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 Page 11 Following concerns raised at the last inspection about hand written entries on the MAR sheets, the manager has spoken with her supplying pharmacist and the GP’s. As a result, for any resident coming into the home, staff will contact the GP to confirm that the medication the resident brought in with them was correct. Two staff then records this information on the MAR sheet. It has been made a recommendation of this report that a written record of the staff’s conversation with the GP is noted. St Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14 & 15 The use of personal profiles assist’s staff in ensuring the social, cultural, religious and recreational need of the residents are met. The homes warm hospitality ensures visitors are welcome and as a result that residents remain in contact with relatives and friends. Wherever possible residents are enabled to exercise choice and control over their lives. Satisfactory catering arrangements ensure the residents receive a balanced healthy diet in surroundings and at times suitable to them. EVIDENCE: Because of the mental frailty of the residents at this home it can be difficult to establish what their expectations of residential care are and what would satisfy their social, cultural, religious and recreational interests and needs. Obtaining personal profiles has certainly helped. The one shown to the inspector was very informative and gave the staff a good insight into past interests etc. A programme of activities is advertised in the home and will include such things St Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 Page 13 as: the hairdresser, manicures, film sessions, dominoes and games that involve a certain amount of physical activity. Every week the home pay for entertainers to visit the home and this was the case on the afternoon of the inspection. It has to be said however, that the staff team themselves have some very talented members who entertained the residents beautifully until the programmed entertainer arrived. The home encourages local community contact. This was evident over the Christmas period with visitors from local schools and churches to sing carols. At the time of this inspection the home were accommodating three residents from a different ethnic background, one of whom had special religious needs. The Church is involved in her care and her religious needs form part of her care plan. Father Giles (C of E) visits the home regularly and administers to the religious needs of the residents on a one to one basis. This works well as the memory span of the majority of the residents would make the sitting through a service difficult. The manager reported that all the residents currently living at the home have family and / or friends that stay in contact or though for some this contact might be infrequent. The visitor’s book certainly indicated that visitors were a frequent event at this home. St Giles is a very welcoming home and those visitors in the home on the afternoon of the inspection had a good rapport with the manager and her staff. The inspector had the opportunity to speak at some length to one visitor who was full of praise for the home and for how they cared for his wife. He finds the staff very approachable and confirmed that he is always kept informed of his wife’s wellbeing. He was particularly complimentary of the effort put in by staff to make Christmas such an enjoyable time. Because of the mental frailty of the residents at St Giles helping them to exercise choice and control over their lives is very difficult. Exercising choice and control is levelled at the individual residents ability and may be simple things like choosing what dress or shirt to wear or whether or not they wanted to attend the afternoon’s entertainment. The residents are offered three meals a day with drinks and snacks available in-between. Fresh fruit is available on the individual units every evening. Breakfast is a moveable feast being served when an individual rises from bed. Lunch and tea times are set although arrangements can and are made if these times do not suit. Meals are served via hot trolleys on the individual units. Dining areas were welcoming and attractive. No complaints about the food were raised during the inspection. St Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 Page 14 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 & 18 The homes complaints procedure is well advertised via a brochure available to all interested parties and staffs are trained in how to respond to complaints. Relatives can therefore feel confident their concerns will be acted upon. Staff are trained in abuse awareness but have learned from a recent experience that this alone does not always ensure residents are protected. EVIDENCE: The home work to the Councils Complaints policy. Copies of the complaints leaflet are given to all interested parties. The manager decides what is reported on under the procedure and the seriousness of the concern will have a part to play in this. It has been made a recommendation of this report that all those concerns not reported on should be recorded in the home and that these records should be available for inspection purposes. Changing how minor complaints are dealt with should not be seen as a criticism of current practice but as a safeguard and as a way of monitoring the homes performance. The inspector has every confidence in the senior staff team that all concerns no matter how minor are addressed. Staffs are trained in abuse awareness. However, a recent adult protection issue acted as a timely reminder for staff that they should always be on their guard against abuse and that they should take nothing for granted. It is acknowledged that this has been a very difficult time for the home. Lessons have been learned and credit is given to the steps taken to address an identified problem area. St Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 Page 15 St Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 Page 16 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): EVIDENCE: All the key standards were assessed at the last inspection. It is pleasing to be able to report that the requirements resulting from the environment standards set in August 05 have been addressed. St Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 Page 17 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): 30 Staffs are encouraged to take advantage of Milton Keynes Council’s extensive training programme. As a result staff are trained and competent to do their jobs. EVIDENCE: Milton Keynes Council puts together a comprehensive annual training programme that for the year 2006/7 offers 98 courses. Topics include core skills such as: food hygiene, moving and positioning, first aid, medication administration, infection control and abuse awareness. Specialist courses are also available that includes: care planning and key working, complimentary therapies, a range of dementia care courses, reminiscence, and strokes – developing an understanding. The home has an excellent NVQ record with 22 staff members having their level 2, 19 staff members having attained their level 3 and one staff member their level 4. The manager has drawn up a training matrix. This was made available for inspection purposes and gives an immediate at a glance picture of the staff training situation at the home both what has been done and what needs doing. Training portfolios for some staff members are now in place, this is good practice and should be encouraged. At the last inspection two requirements were made under the staffing standards. One concerned recruitment records. Recruitment records are held centrally. CRB clearance confirmation and copies of contracts are now held at the home. However, although an improvement it does not fully comply with Schedule 4(6) of the Care Homes Regulations. It has been made a St Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 Page 18 recommendation of this report that further dialogue takes place between the Commission and Milton Keynes Council (who hold the records) to resolve this. A checklist on agency staff recruitment and training is now obtained. Insufficient staffing levels were also raised as an issue. Although agreement was not obtained with regard to a permanent increase in staffing, the manager has the full support of her service manager to raise staffing levels as the need arises. This appears to be working at the moment. A discussion took place about the ethnic mix of the staff group not reflecting the ethnic mix of the residents. This has posed some communication difficulties and cultural differences that need to be addressed. It has been made a recommendation of this report that this is discussed with the service manager with a view to some cultural awareness training and to seek the assistance of Milton Keynes Human Resources Department in addressing the ethnic mix inequality. St Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 Page 19 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 & 38 The whole ethos of this home and the knowledge and skills of the management team ensures it is run in the best interests of the residents. Systems are in place to ensure the financial interests of the residents are safeguarded. The policies, procedures and practice of the staff ensure the safety and welfare of the residents is promoted and protected. EVIDENCE: St Giles is a specialist home where the environment, staff competence, attitude and values ensure the home is run in the best interests of the residents. The Quality Monitoring Group ‘Heart of St Giles’ meet monthly and are made up of a care manager, district nurse, relatives and a staff member at the home. It is their job to quality assess the home and act on any shortfalls identified. St Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 Page 20 Recent projects have included the provision of a new door bell that can be better heard, dealing with an abundance of leaves at the front of the property and introducing a variety of visiting pets to the home. None of the residents at the home are currently able to manage their own finances. The home operates two systems to address this. Fifteen residents have their finances managed by staff at the home and MK Council. Their funds are held centrally and day-to-day expenses paid for out of a petty cash float that is reimbursed via an imprest account. Written records are kept and the system seems to work well. Small amounts of cash are held for the remaining residents in separate envelopes. The amounts are topped up by relatives and written records kept of expenditures made. All income and expenditure for both systems is documented and receipts maintained. A cross check of the second system was carried out at this inspection and the amounts tallied with the records of monies held. The fire safety officer visited on the morning of the inspection. The manager confirmed that he checked fire doors, safety equipment records, PAT, and the fire risk assessment. No areas of concern were noted although his report is awaited. Hot water temperatures are tested weekly and all are satisfactory following the recent installation of a new hot water system. All senior staff are first aid trained which ensures there is always a member of staff on duty with a current first aid certificate. All staff that is responsible for handling food has their food hygiene certificate. COSHH guidelines were displayed in the home and training was booked for the 20th February. Risk assessments form part of the residents care plans and generic assessments are in place for: the laundry, storage of latex gloves, smoking, manual handling and for all jobs undertaken in the home. These records were made available for inspection purposes. They are reviewed annually with some due for review. St Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 X 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 2 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 3 St Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 Page 22 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. Standard Regulation Requirement Timescale for action 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 OP9 OP16 Good Practice Recommendations It is recommended that when staff check out the medication brought in by residents with the resident GP this conversation is acknowledged on the MAR sheets. It is recommended that those concerns brought to the attention of staff at the home but which are not reported on under Milton Keynes Complaints procedure are documented in the home with a record of the action taken and the outcome. It is strongly recommended that the manager takes steps to address the ethnic mix inequality as detailed in the body of the report. 3 OP27 St Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Cambridge House 8 Bell Business Park Smeaton Close Aylesbury Bucks HP15 8GZ 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 Giles Residential Home DS0000032628.V282321.R01.S.doc Version 5.1 Page 24 - 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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