Inspection on 20/01/09 for St Helens Care Home

This inspection was carried out on 20th January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Helens Care Home 19/05/10

St Helens Care Home 28/01/08

St Helens Care Home 14/02/07

St Helens Care Home 13/10/05

St Helens Care Home 25/04/05

St Helens Care Home 07/10/04

St Helens Care Home 24/05/04

Similar services:

The Highlands

Blenheim House

1 Lanark Close

Beaconsfield Court Care Home

Ann Charlton Lodge

The Gardens Care Home

Westmoor View Nursing Home

Ashlea Mews Residential Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE St Helens Care Home 6 Manor Road St Helens Auckland Bishop Auckland Durham DL14 9DL Lead Inspector Nic Shaw and Clifford Renwick Key Unannounced Inspection 20th January 2009 9:30am X10029.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 Helens Care Home DS0000000749.V374073.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 and Care Homes for Adults 18 – 65*. 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 Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Helens Care Home Address 6 Manor Road St Helens Auckland Bishop Auckland Durham DL14 9DL 01388 606093 01388 607962 homemanager.sthelens@activecarepartnerships. co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd 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) Care Home 48 Category(ies) of Past or present alcohol dependence (5), registration, with number Dementia (6), Dementia - over 65 years of age of places (29), Mental disorder, excluding learning disability or dementia (19), Physical disability (4) St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th February 2008 Brief Description of the Service: St Helens is a forty-eight bedded home that provides 24hr care for older people with dementia. It also provides care for younger people who have mental health needs. The accommodation is purpose built and consists of three units. Upstairs provides nursing and residential care for older people with mental health needs, mainly dementia, and on the ground floor there is one unit which provides nursing care for nineteen younger people with enduring mental health problems. Each unit consists of a lounge, dining room, bathroom and toilet facilities. There is a passenger lift to the first floor. All bedrooms are single occupancy. There is a spacious garden and a car parking facility is provided adjacent to the home. The home is situated in St Helen’s West Auckland near Bishop Auckland. It is close to local shops, pubs, and places of worship. The weekly fees payable range from £437.50-£480.25 for residential dementia care and from £541.50-£595.06 for nursing dementia care. For younger adults the weekly fee is £910. St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken.” Before the visit: We looked at: • Information we have received since the last full visit on 6th February 2008. • How the service has dealt with any complaints & concerns since the last visit • Any changes to how the home is run • The provider’s view of how well they care for people • The views of people who use the service and their relatives. The Visit: An unannounced visit was made on 19th January 2009. During the visit we: • Talked with people who use the service, staff &the manager • Looked at how staff support the people who live here • Looked at information about the people who use the service and how well their needs are met • Looked at other records which must be kept • Checked that staff had the knowledge, skills and training to meet the needs of the people they care for • Looked around parts of the building to make sure it was clean, safe and comfortable • Checked what improvements had been made since the last visit An expert by experience also came with us to help with the inspection. (An expert by experience is a person who has first hand experience of using services). They spent time talking to the younger adults with mental health needs and their comments have been included in the report. We told the manager what we found at the end of the visit. St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Care plans are improving for people with dementia and they are now readily available so care staff can read them. Work has begun on pain risk management plans for people who are not able to say when they are in pain and records are now kept of weight loss and gain. St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 7 These steps are important so staff can take action quickly to address the service users’ health care needs. All service users were treated with dignity and respect when we visited. There are now two activities co-ordinators, one who has been employed solely to work with people with dementia. The mealtime experience for people with dementia has much improved. Staff now sit with people offering the support that they need. People are not rushed to finish their meals and a third member of staff is available to help during this time. People with dementia are now offered choices by staff. Staff do this by finding out about people’s previous lifestyles and preferences and also by asking them what they would like to eat at mealtimes. There have been improvements to the environment for people with dementia, such as tactile boards and reminiscence material and some areas have been re-decorated. The manager has also begun to introduce training in the needs of people with dementia. She is also looking at ways of making sure staff work as a team, for example: by making sure keyworkers are included in care plan reviews. What they could do better: Although care plans have generally improved some of those for people with dementia need further development. This is to ensure that staff know what to do to meet the service users’ health and personal care needs. It is recommended that the activities programme continue to develop to offer stimulation, for example reminiscence work and exercise. Mealtimes could also be better with tablecloths on tables and menus in different formats, such as pictures, to help people make choices. Although there have been some improvements to the environment the refurbishment and re-decoration must continue to make sure service users are provided with a well maintained place to live. This should include looking at how the home can be improved for those people who have a visual disability. Staff training in the specific needs of people who have a visual disability is recommended as they provide a service for one person with needs in this area. The manager needs to make sure she gets two references from suitable referees, for example: the manager where a person used to work. She also needs to make sure that nurses have renewed their registration with the midwifery council so that she knows they can continue to practise as a nurse. St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 8 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 Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 (Older People) and 1& 2 (Younger Adults 18-65). Quality in this outcome area is good Good information is available to help prospective service users make an informed choice about where to live. The admissions process ensures that people are adequately assessed prior to care being offered. This means that service users are offered the right type of care at the home. EVIDENCE: There is a range of information available for people to read about the service including the Statement of Purpose, Service User Guide, home’s brochure and a newsletter. This information would be provided in alternative formats if requested. St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 11 For prospective service users, funded by the local authority, the manager obtains a copy of the needs assessment and care plan from the care manager so that she can decide whether St Helens is able to meet their needs. In addition to this the manager or deputy manager arranges to visit prospective service users in their own home, or current place of residence, in order to complete a pre-admission assessment with them. This assessment involves the prospective service user, a family member, social worker, nurse or advocate where possible. During this initial visit the manager told us that she discusses with the prospective service user their current needs, skills, preferred interests and how St Helens would be able to meet their needs. A trail stay is always offered in order to find out if St Helens is suitable. St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 (Older People) and 6,9,16,18,19 and 20 (Younger Adults 18-65) Quality in this outcome area is good. We have made this judgement using a range of evidence, including a visit to this service. There is good information in the care plans for younger adults about their health and social care needs and information in the care plans for people with dementia is improving. However, further work is needed to make sure everyone receives care and support in a way that they prefer. Staff care practices preserve the dignity and privacy of people with dementia. St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 13 Medication administration procedures protect the service users. EVIDENCE: We talked to staff about care plans and what involvement they had in developing these. They said the care plan contained all of the information that they needed to know about how to support people. And although care staff do not write the care plans, (this is done by the nurse in charge), they can read them at any time. A range of standardised assessments are in place that lead to the care plans being developed and cover areas such as mobility and risk of falling, nutritional needs, risk of developing pressure sores, continence and pain. Service users’ weights are monitored each month. The care plans we looked at varied in quality. Some provided clear instructions to staff on how someone is to be supported. For example: in one there was good information about how to communicate with this person by using tactile prompts and body language in order to avoid triggering a behaviour that challenges. However, in another care plan, for an older person, who from the evaluations it was clear now requires much support from staff, the care plan had not been up-dated to reflect their current health care needs. In this person’s care plan the daily records stated, “pressure area care maintained”, but there was no care plan in place about a pressure sore and therefore it was not clear why this was being monitored. In a third person’s care plan it stated that a pressure sore should be monitored daily, but there were gaps in the records and no body map completed. Service users have access to all NHS facilities. There are regular visits from GP’s and other health professionals including, opticians and chiropody services. Service users told the expert by experience that when they need a doctor, staff arrange a visit as soon as they can. Medication is stored in a locked, secure room. The staff monitor the temperature of the medication room and the medication fridge to make sure that medicines are stored correctly. Staff see the prescriptions and there is a photograph of each service user to make sure that medications are given to the right person. There were no gaps on the Medicine Administration Records, (MAR), which we looked at. St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 14 During our visit time was spent with the service users who live on the Auckland unit which is on the first floor. At the time of our visit there were 9 people living here. Staff were respectful in their approach towards the service users and ensured that their privacy was respected. Personal and intimate care tasks were carried out in the privacy of service users’ own bedrooms. Staff referred to service users by their chosen form of address and it was evident that a good rapport existed between staff and service users. The expert by experience commented on the good communication skills of one particular member of staff. Staff spoke of the different types of needs that people currently have and the strategies that are in place to support them. It was good to note that staff could speak with confidence about individual people’s needs and also that they had good background knowledge of people’s previous lifestyles before they moved into the home. Service users wore their own clothes and staff supported them to make choices on a daily basis. St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is Good 12, 13, 14 and 15 (Older People) 12, 13, 15 and 17 (Younger Adults 18-65). We have made this judgement using a range of evidence, including a visit to this service. Younger adults generally enjoy a variety of activities, and the range of activities available to people with dementia has improved. Therefore service users have opportunities to lead a fulfilling lifestyle. Service users are able to maintain family and other contacts to a good degree should they wish. This ensures they do not become socially isolated. Service users are able to exercise control and choice over their lives, as far as is possible, which enables them to remain independent. St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 16 Service users receive a varied menu, and eating food in the home is a much improved experience for people with dementia, which promotes their general health and wellbeing. EVIDENCE: There is an activity programme in place though there were no specific activities that focused on providing stimulation to those service users who have dementia, for example reminiscence work. The manager is aware of this and aims to address this by providing the activities co-ordinator with training in dementia. There are now two activities coordinators. The second one has been employed solely to work with people with dementia. When we visited service users this activities coordinator spent time carrying out hand massages and aromatherapy. The activities coordinator said that when the weather is good trips out are arranged on a regular basis. These have included visiting garden centres, museums, shopping trips, the theatre, Whitby and the Lake District. However, on this day there were no activities carried out in the Auckland unit before lunch, although staff did spend time sitting with service users and engaging them in conversation. Younger adults commented that they would like more trips out in the mini bus, but realised that this was restricted by whether there was a driver on duty. It was good to see that the television did not dominate the room upstairs and the service users appeared to enjoy the presence of staff and the conversations that were held. On the day of our visit it was a dark, wet day in mid-January. When we asked younger adults how they spent their time on days like this one said that they became very bored and very stressed. However, they did say they enjoyed the organised bingo sessions (fortnightly) and going for walks with staff on fine days. Another younger adult said they were bored on days such as this but talked of a trip in the home’s mini bus last year to Redcar. Staff said that they always supported service users to make choices despite their level of disability or capacity. For example: at mealtimes staff said that they always ask service users what they would like to eat from the choices available on the menu. One service user prefers to eat with their fingers and staff support this by providing a range of foods that are suitable to be eaten in this manner. Although this is good practise, this could be expanded further by proving a bigger range of finger foods. St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 17 Staff are using the background information that they have collated in the life story books for people with dementia. This information is detailed and includes a lot of information about a person’s previous lifestyle, their likes and dislikes and hobbies and interests they may have had. Staff stated that this information was useful in supporting people to make choices. In relation to choice and independence one younger adult said they did no cooking, cleaning or washing of their clothes but that this was their choice. Another person said that they could make a cup of tea in the skills kitchen during the night if they wished. Two older people had moved into the home when part of the ground floor was a designated area for older people. The whole of the ground floor now accommodates younger adults. When these changes were implemented the decision of these two older people to remain downstairs, and not move upstairs, was respected by staff. One younger person described themselves as ‘lonely’ and very reliant on the staff for conversation. However, they went on to say that staff will always go that “extra mile”. For example: one member of staff takes them out shopping on their day off. One younger person said they had their own computer and Internet access. They are encouraged by staff to be independent by shopping for their food online. Visitors were seen to come and go throughout the inspection. They are able to use the lounges or service user’s bedrooms for visits. There are no restrictions regarding visiting times. We had lunch with the service users on the Auckland unit and it was noticeable that there were no menus to refer to in the dining room. Staff stated that they had informed service users about what food was available and had ensured that the cook was aware of what they had chosen to eat. As almost everyone who resides on the Auckland unit has dementia the absence of menus does not fully support people in making choices. Having menus available in both written and pictorial formats could provide service users with appropriate cues and prompts when staff are asking them what they would like to eat. The cook brought the meal to the dining room in a hot lock trolley. He then served all of the meals to the staff, who in turn took the meals to the table. All meals are plated, unless someone required their meal to be served in a different way. St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 18 Although staff stated that service users had been asked what they would like this was not followed up in the dining room when giving out the meal so the option of what vegetables to have was not fully explored with service users. A choice of two cold fruit juice drinks were made available to the service users but again, the element of how service users are supported to choose what to drink, was not fully explored and hot drinks such as a cup of tea were not offered. The tables that were used did not have table clothes and the coasters and placemats that were used were not suitable as on two occasions two service users mistook them for an item of food. Possibly the design and colour caused some confusion and this could be avoided with the introduction of a more plainer coaster and place mat. Nevertheless the meal itself was well presented and it was tasty and of a good portion. It was nice to see the cook ask service users if they wanted second helpings. It was also good to see that food that had to be blended was presented in an way that made the food still look appetising, with each item being blended separately. Although there are normally three staff working on the Auckland unit, at lunchtime an extra member of staff joined the team to assist those service users who required support to eat their meal. The meal was unhurried and staff sat with those service users who required support. Some people required intensive staff support and it was good to see that staff spoke to people whilst assisting them to eat which made the whole approach more personal for the service user. One younger adult said the food was “moderate” compared to another place where they lived. However, another younger adult said the quality and quantity of food provided was good and plentiful. The expert by experience commented that there was no fresh fruit available on the ground floor for people to help themselves. St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 (Older People) and 22 and 23 (Younger Adults 18-65). Quality in this outcome area is Good. We have made this judgement using a range of evidence, including a visit to this service. The home has a good complaints procedure so people know that their views will be listened to and acted upon. And staff training helps to ensure that the service users are protected from abuse. EVIDENCE: The home has a complaints procedure, however, this is not yet available in alternative formats, such as Braille, for those people who have a visual disability. The complaints procedure is displayed on entry to the home and in the Service User Guide. There have been four complaints in the last year. We looked at the complaints record, which showed that these had been thoroughly investigated by the manager. There have been seven safeguarding referrals made in the last year, which clearly demonstrate that staff know the procedure to follow to ensure service St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 20 users are fully protected. These have mainly involved incidents between service users, five of which have resulted in safeguarding investigations. The outcome of the investigations has resulted in a care plan review of those involved. All staff have completed training in safeguarding adults. arranged for all staff to attend further training in this. The manager has No one we spoke to reported feeling unsafe or threatened in this home. St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26(Older People) and 24 and 30 (Younger Adults 18-65). Quality in this outcome area is adequate. We have made this judgement using a range of evidence, including a visit to this service. Although progress has been made in adapting the environment for people with dementia St Helen’s does not fully offer all service users with a well maintained place to live. EVIDENCE: St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 22 The manager confirmed that they are in the process of refurbishing the building and this has also involved changing the use of some of the rooms and also giving consideration to improving the access and main entrance of the home. The manager also told us that there is now a maintenance programme in place for the home, however, in the last twelve months re-decoration has only involved communal and dining areas and corridors upstairs. On the ground floor of the home workmen were starting to re-decorate this area. It was noted that they took care to ensure that this work had as little impact on the service users as possible. The bedrooms seen here were clean and well personalised. There is also a small ‘skills kitchen’ where service users can make a cup of tea or even a simple meal whenever they wish and even during the night. There is also a separate smoking room. All doors and woodwork are to be painted as part of the refurbishment and steps are being taken to enhance the upper floor units so that those people with dementia can find their way around the building. At present items such as boards on the wall that people can touch, coat stands and coat hooks, pictures of old newspapers and other similar kinds of memorabilia have assisted in providing areas of interest throughout the corridors. Service users do relate to this and much of the memorabilia is interesting in that it makes reference to the local area in which the home is situated. One person with dementia we spoke to has their own key to their bedroom. They commented that they liked their bedroom. There is little in the way to help those people who have a visual disability around the building and the manager should consider this as a future development of the service. The manager told us that nearly ¾ of the staff team have completed training in infection control. The home smelt clean and fresh. There were no noticeable health and safety hazards. St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 (Older People) and 32, 34 and 35 (Adults 18-65). Quality in this outcome area is adequate. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are sufficient and staff work as a team. This ensures staff provide person centred care. Staff training is improving and includes specialist training in order to meet the diverse needs of the service users. This ensures staff can effectively meet the care needs of people with dementia. Staff recruitment procedures do not fully protect the service users. EVIDENCE: St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 24 On duty when we visited was a Registered Mental Nurse and two care staff on the ground floor where younger adults live and one Registered General Nurse and two care staff where people with dementia, assessed as needing nursing care, live. There was also a senior and two care staff where people with dementia, assessed as needing residential care, live. The manager and deputy manager were also on duty and were in addition to the above staff numbers. As we previously mentioned the manager has reviewed staffing levels at mealtimes to make sure that the needs of those people who require intensive support at this time are met. The manager has developed a training programme and training arranged over the next three months includes infection control, moving and handling, health and safety, fire awareness and food safety. Training called “Yesterday, Today, Tomorrow” (this is specialist training in dementia care) has also been arranged. Some staff said that they had already completed this training and found it to be beneficial. Staff have not had specific training in the needs of people with a visual disability, which would be beneficial. All of the staff have completed either an NVQ level 2 or 3 qualification in care. The manager is arranging for all staff to have training in care planning. And, in order to ensure staff work as a team, she is arranging for keyworkers to be involved in each service users care plan review. Staff files showed that the company’s recruitment procedures are not followed. For example: in one staff file there was only one reference and in another, although there were two references, these were not from a person in a senior position to them. In one nurses staff file their registration with the National Midwifery Council had expired on 31/03/08 with no evidence that this had been followed up to ensure they could continue to practices as a nurse. St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38(Older People) and 37, 39 and 42 (Younger Adults 18-65). Quality in this outcome area is Good. We have made this judgement using a range of evidence, including a visit to this service. St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 26 Good management systems ensure the health, safety and welfare of service users. There is a good quality assurance system. This is based on the views of service users, where they are able to communicate their wishes, so that they know their rights and views will be listened to. EVIDENCE: It was evident that the new manager, with the support of the deputy manager, in the short space of time that she has been at St Helens, has worked hard to improve the service for service users. She provided us with good information, before we visited, about what has improved in the home in the last year and it is clear she knows what needs to be done to improve things further. The new manager has worked for the company since 2006 and has previous experience of managing care homes for people with dementia. She is a Registered General nurse level 1 and is in the process of applying to complete the Registered Managers Award. She is trained to Health and Safety supervisory level and has achieved the certificate to train staff in dementia care. She is in the process of registering with us to be the registered manager of this home. There are monthly service user and relatives’ meetings. Service user satisfaction questionnaires are also used to obtain feedback about the service. Staff meetings are held every 6-8 weeks. There was a staff meeting on the day of our inspection where a fire drill had been arranged to take place. There is a comprehensive internal audit system. This involves a monthly audit carried out by the manager, which in turn is validated by senior staff within the organisation. The personal allowance records were not looked at in detail on this occasion, but the administrator confirmed that that receipts and double signatures continue to be maintained for all transactions. The home carries out internal maintenance checks and has contractors to service equipment. Maintenance staff carry out regular checks of fire fighting equipment, alarms and emergency lighting. Appropriate records are kept of all accidents and incidents. St Helens Care Home DS0000000749.V374073.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 3 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 X 37 X 38 3 St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 28 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 OP19 YA24 Regulation 23(2)(d) Requirement All areas, both communal and private, that service users have access to must be decorated to a reasonable standard. This is to ensure service users benefit from a well maintained place in which to live. Revised requirement from 30/09/08: Two appropriate written references must be sought before appointing a member of staff. This is to ensure that service users are fully protected. Steps must be taken to ensure that all nurses employed to work in the home have up-to-date confirmation of registration with the National Midwifery Council. This is to ensure that service users are fully protected. Timescale for action 31/08/09 2 OP29 YA34 19 31/03/09 3 OP30 YA35 19 31/03/09 St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 29 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 OP7 Good Practice Recommendations Care plans should continue to develop to ensure that all service users health needs are fully addressed. The activities programme for people with dementia should continue to develop to ensure people are stimulated. For example: reminiscence work and exercise as well as trips out. The mealtime arrangements for people with dementia should continue to improve. For example: the provision of menus in a range of formats and tables cloths on tables. Fresh fruit should be freely available so people can help themselves. The complaints procedure should be made available in a format suitable to people who have a visual impairment. This is to ensure everyone knows how to make a complaint. The environment should be adapted to meet the needs of people who have a visual disability. This is to ensure that the welfare and independence of service users is fully promoted. Training should be provided on the needs of people who have a visual disability. 2 OP12 3 OP15 4 OP16 5 YA24 6 YA35 St Helens Care Home DS0000000749.V374073.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Helens Care Home DS0000000749.V374073.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. 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!