Inspection on 28/01/08 for St Helens Care Home

This inspection was carried out on 28th January 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 Helens Care Home 19/05/10

St Helens Care Home 20/01/09

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 09/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE St Helens Care Home 6 Manor Road St Helens Auckland Bishop Auckland Durham DL14 9DL Lead Inspector Miss Nic Shaw Key Unannounced Inspection 28th, 29th January & 6th February 2008 10.00a 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.V360037.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.V360037.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 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) Mrs Beverley Denise Grimes 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.V360037.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th February 2007 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 care for older people with mental health needs, mainly dementia, and on the ground floor there are two separate units, one which provides nursing care for nineteen younger people with enduring mental health problems, one which provides a service to people with dementia. 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 £402.50 for people with dementia funded by the local authority to £480.25 if privately funded. For younger adults the weekly fee is £920. St Helens Care Home DS0000000749.V360037.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 1 star. This means that the people who use this service experience adequate quality outcomes. Before the visit: We looked at: • Information we have received since the last full visit on 14th February 2007. • 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 28th & 29th January & 6th February 2008. 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 • Spent time observing what happens in the home for people with dementia. We told the manager what we found at the end of each visit. What the service does well: There is good information available to help people decide if St Helens is the right place for them to live. Care plans for younger people are good and provide information about what people like to do and how staff should help people to remain independent. Younger adults have opportunities to take part in activities in the home and in the community. Some younger adults went on holiday last year. Younger adults are able to make choices about how to spend their time. St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 6 There are good procedures in place for responding to abuse. There is a pleasant well maintained garden which people can safely use in the warmer weather. The majority of staff have completed the NVQ level 2 qualification in care and there are good recruitment procedures so that only suitable people are employed to work in the home. The manager is a qualified nurse and has many years experience of managing a care home. There are good quality assurance systems in place to hep make sure care standards are improved in the home. There are good procedures for monitoring how many accidents there have been and looking to see how the number of these can be reduced. Service users said “It’s a nice place” “There are good meals” “The Pilipino staff will bend over backwards for you” Relatives said: “I’d give it 9 out of 10” “I couldn’t think of a better place” “The rooms are very clean” “The staff are friendly and cheerful and my mother is always clean and tidy”. What has improved since the last inspection? After looking at the social work assessment and completing their own assessment, the manager writes to prospective service users confirming that St Helen’s is able to meet their care needs. Copies of contracts or terms and conditions are now provided to service users, and/or their relatives, so that they have all the information they need before making a choice to move in. All staff have had training in the protection of vulnerable adults, which is renewed every year. Doors are no longer wedged open so that they offer people protection in the event of a fire. The home has safety certificates to confirm the electrical and gas installations are safe. St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 7 What they could do better: Information, such as the Service User Guide and complaints procedure need to be available in a format suitable to meet the needs of people who have a visual impairment. For people with dementia, care plans need more information, particularly about people’s past lifestyles, routines, likes and dislikes, so that their health and personal care needs are fully met in the way that they prefer. The service users’ weight should be regularly checked to make sure their nutritional needs are being met and to make sure they are not unwell. People with dementia must be treated with respect and should not be talked about as though they were not there. Staff should not write about people in terms of their behaviour in the daily records such as “wandersome and interfering”, as this does little to promote person centred care, (that is treating each person as an individual and valuing and respecting their similarities and differences). There needs to be lots more activities for people with dementia and staff need to make sure people are able to make choices in their daily lives, for example, what to eat and where to spend their day. Mealtimes need looking at, as this is not a nice experience for some people with dementia. For example, tables should be nicely presented so that they are familiar and “homely” for people and staff should sit and support people on a 1:1 basis and not stand “feeding” two or three people at the same time. One person said that they did not feel safe in the home. This needs looking at by the manager. The building also needs attention. Some parts of it, such as bathrooms, are bare and institutional and not very homely. The environment must be changed to help people with dementia remain independent. The manager must also make sure the home is safe, for example, items such as wheelchairs should not be stored in bathrooms as this creates a potential trip hazard. Staffing levels need looking at as staff working upstairs had little time other than to assist service users with basic care needs. Staff need more training in dementia so that they know how to meet the different needs of the service users. The manager needs to make sure that the health and safety of service user is promoted at all times. For example, by making sure that service users with dementia are not left sitting in a position where they may hurt themselves, such as with their head resting on the edge of a table or their feet stuck between the footrests of their wheelchair. St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 8 Service users said: “There are not many activities” “There are no trips out” [On the last day of the inspection a senior manager from the organisation was visiting the home. It was positive to note that in response to concerns raised about the service a detailed action plan was immediately developed and sent to CSCI telling us what they will be doing to improve things. The manager has also held a meeting with staff to discuss some of the issues raised during the inspection and begun to implement changes to improve the service.] 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.V360037.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.V360037.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, 2, 3 and 4 (Older People) and 1, 2, 3 and 5 (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. Good information is available to help prospective service users make an informed choice about where to live. However, this needs to be made available in alternative formats to meet their diverse communication needs of prospective service users. 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. St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 11 EVIDENCE: The home offers a service to people with a diverse range of needs, from younger adults with needs in relation to their mental health, to older people who have advanced dementia. A separate Service User Guide has been developed for each client group. One service user, who has a visual impairment, commented that this had not been made available to them in an alternative format, such as Braille. 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 service also completes its own pre-admission assessment documents. Relatives confirmed they had been provided with a contract. Copies of these are held in the home. St Helens Care Home DS0000000749.V360037.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 and 20 (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 there is good information in the care plans for younger adults about their health and social care needs this is not the case for people with dementia. Therefore guidance is not available to ensure that the staff provide continuity of care to everyone. Furthermore, staff care practices do not preserve the dignity and privacy of people with dementia. Medication administration procedures protect the service users. St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 13 EVIDENCE: Each service user has a care plan. For people with dementia the care plans are based on a medical model of care, focusing upon health care needs or “problems and risks”. There was little information about each individual’s social and previous lifestyles, which is crucial when attempting to provide person centred care. Some of the wording used in the daily records, for example: “wandersome and interfering”, “nil physical aggression observed”, “usual wanderings” are brief an do not show that staff treat people as valued individuals, as people are being describing in terms of their behaviour. It also does not describe the care being delivered. Some of the wording is also difficult to understand for example “develop a therapeutic relationship” and “use active listening techniques”. Risk assessments for nutrition status, moving and handling, falls prevention, continence promotion, and mental health are available. These are completed on admission and then should be completed monthly or when peoples needs have changed. However, some of this information had not been dated and therefore it could not be confirmed when a re-assessment had taken place. One service user’s nutritional risk assessment confirmed that they were at high risk in this area. However, their weight had not been checked for three months because the scales were out of use. In another person’s care plan it stated they should be weighed weekly, but there were no records available to show that this had happened. Care staff who support people with dementia do not have access to the care plans. These are written by the nurse and kept in the office. Therefore it is difficult to understand how care staff can effectively ensure that the service users needs are met. In practise some of the interventions documented in the care plans were not carried out by staff. For example, it stated in one service user’s care plan that they must be observed at all times as they were at risk of falling out of their wheelchair. During the inspection this person was left unobserved and slipped down their wheelchair. The care plan also stated that they should not be left unobserved as other service users may be at risk. On a second occasion they were left unobserved in the lounge for some time. During this time they were approached by another service user, which may have placed them at risk. There is little evidence that the relatives and the service users with dementia are involved in the care planning process. Relatives said they had not seen the St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 14 care plan. However, younger adults commented that they were “aware” of what was in their care plan, and there was some written evidence that the care plans had been discussed with them. For people with dementia care plans did not show what strategies had been put in place to maintain people’s independent living skills. For younger adults the care plans were person centred and focused upon the person as a whole. In addition to care plans addressing personal and mental health care needs, there was information about how to support people to lead a fulfilled lifestyle and the support they needed to achieve this. There was also good information about addressing the service user’s sexual needs. Service users have access to all NHS facilities. There are regular visits from GP’s and other health professionals including, opticians and chiropody services. The home has comprehensive medication policies and procedures for staff to follow. Qualified nurses administer medication. Medication is stored in a locked, secure room. However, this room was very untidy, jammed full of many items including excess medication, “ensure plus drinks”, which were on the floor, bandages, catheters, alcohol, a flask, cups and a used dressing box. The medication fridge could not be easily accessed because of the number of items stored in here and there was very little room for nurses to work when dealing with the medication. 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 were examined. Some people with dementia had been prescribed “as and when” required medication for pain. However, given that the majority of people on the first floor of the home have advanced dementia, they would not be able to tell staff when in pain. There were no pain management plans in place to make sure people received their medication when they needed it. Some service users who have dementia are not treated with dignity and respect. Certain staff, when assisting one person to walk, were “forceful” with them, constantly telling them to “come on, if you don’t you’ll fall”. During lunch, some people, as a result of their short term memory loss, stood up from the table. Staff responded to this by telling them that they could not eat their lunch standing up. Another service user, who got up to leave the dining room, St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 15 was told they could not have their meal in the lounge. One service user who was not eating their meal was told “your capable of eating on your own”. Staff said, in front of everyone “I had to take them to the toilet”. During the inspection an optician was visiting the home. Eye examinations were not carried out in a private area but in the communal dining room. In contrast younger adults said that they were treated with respect and that staff would “go that extra mile”. St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 16 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): 12, 13, 14 and 15 (Older People) 12, 13, 15 and 17 (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 younger adults enjoy a variety of activities, the range of activities available to people with dementia is poor and therefore opportunities to lead a fulfilling lifestyle are limited. 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. St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 17 Although younger adults are able to exercise control and choice over their lives, this is not the case for some people who have dementia, which prevents them remaining independent. Although service users receive a varied menu, eating food in the home is not an enjoyable experience for some people with dementia and does not promote their general health and wellbeing. EVIDENCE: There is an activities co-ordinator who divides their time between the three different units in the home. Younger adults have the opportunity of taking part in a range of community activities. For example, one person is supported to attend a local club for people with a visual disability and another person attends a club for people who are deaf. Last year some of the younger people enjoyed a holiday to Lanzarote and in-house activities include games of bingo. There is a pool table which people can use, and a small kitchen area where service users are encouraged to develop their independent living skills. One service user said that they had access to the internet. The home has its own transport so people can enjoy trips further away, although some of the younger adults did comment that there were not enough drivers. The activities co-ordinator spends three afternoons a week with people with advanced dementia. There was very little information about people who have dementia, their likes, interests and social histories, which is very important when developing activities for people with dementia. In one person’s care plan, who has dementia and can become agitated, it stated that “on-going activities” should be provided to alleviate boredom. However, there was little evidence of any planned activities for this person, other than regular visits and trips out with their relative. The majority of service users living on the first floor of the home have little to do through the day other than watch TV, sit passively or “wander” through the lounges and along corridors. The main events of the day consist of being taken to and from the dining room, lounge and toilet. Staff were busy caring for service users’ physical and healthcare needs, and had little time to arrange group or individual activities. There was little engagement with staff other than to assist people with personal care needs. St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 18 There is no DVD player, although there was a video recorder. One service user asked staff if they had any Max Bygraves videos. However, the only ones available were Billy Connolly and Open All Hours. Two relatives in surveys commented that the home could improve by providing more activities for everyone. 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. Younger adults said that they were able to choose how to spend their days. They are able to get up when they want to have breakfast when they like. Some service users who have advanced dementia are not able to exercise choice about where and how they spent their day. The environment has not been adapted to help people maintain their independence and make choices. For example, although bedroom doors are painted different colours, there is nothing else to help people find their personal space if they wanted to spend time in private, such as a photograph or picture from the past, familiar to them. One service user had difficulty getting into their bedroom as the lock on the door was the type that requires a small coin to open and very difficult to use. (This latter issue was addressed at the time of the inspection). Younger adults said that they had keys to their bedrooms and could choose to spent time in private. On two days during the inspection a modern radio station was playing upstairs rather than music that would be familiar to the people living there. There are dining rooms on all three units. Although there is a menu board, the home does not have a menu displayed either in large print or in picture style to help people with dementia choose what they would like to eat. The cook said that they were aware of the service users likes and dislikes. They said that people downstairs are asked what they want to eat. However, meals for people with dementia are provided based upon the staff and their understanding about people’s likes and dislikes, which is not recorded in the care plans. The mealtime experience on the first floor of the home was not a pleasant one. Tables were bare and people with dementia were not offered a choice of what to eat at the time the meal was served. Many people did not eat their lunchtime meal, alternatives were not offered. St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 19 Staff did not offer assistance in a discrete, sensitive manner, rather stood over people telling them to “open their mouths”. At one point one member of staff was assisting three people at the same time. Staff later said that a member of staff had to accompany a service user to hospital over lunch and therefore staffing levels were lower than usual. Nevertheless people with dementia were not treated with dignity and respect at this time. Younger adults said that the food was “good” depending on whose was on duty. They also said that they were usually offered two choices and could have bacon sandwiches for breakfast if they wanted. St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 20 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 (Adults 18-65). We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is adequate. The home has an adequate complaints system so people know that their views will be listened to and acted upon. Although staff training helps to ensure that the service users are protected from abuse, people are not adequately protected. EVIDENCE: The home has a complaints procedure, however, this is not available in alternative formats, such as Braille, for those people who have a visual impairment. Relatives and younger adults said that they would have no hesitation in making a complaint to the manager if they were unhappy. During the inspection one service user complained about the type of lock on their bedroom door. The manager quickly addressed this issue. St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 21 Two complaints have been made since the last inspection. Records showed that these had been fully investigated by the manager. There have been twenty one notifable incidents involving service users since the last inspection. The manager has taken the appropriate action in relation to these, referring nineteen of them to the Local Authority through the safeguarding adults procedure. Four have resulted in an investigation, the outcomes of which have been managed appropriately by the service. During the inspection, as previously mentioned, a service use was left unsupervised on two occasions even though it had been identified in their care plan that they could pose a risk to other service users. One younger adult said that they did not feel safe because of the behaviour of other service users. This had also been identified as an area of concern in their review meeting minutes. Staff have had training in “safeguarding adults” provided by the organisation, and this is up-dated every year. However, care practices such as use of key pads are focused on keeping people safe and may be regarded as a form of restraint when not fully risk assessed for each individual and recorded in their care plan. The manager has a copy of the Local Authority Safeguarding Adults policy and procedure and clearly knows how to refer to the Local Authority. St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 22 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 (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. St Helens does not offer all service users a homely, safe, well maintained environment. Although the home offers a service to people with dementia the building has not been fully adapted to meet the specialist needs of this group of people. St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 23 EVIDENCE: The home is a large purpose build building. It is divided into three units each with its own lounge and dining areas. Each operates independently of one another and are separated by a key pad system. Downstairs the environment is homely for people, with ornaments, candles and other items on display. However, upstairs, where people with advanced dementia live, it is bare and institutional. There was nothing in the environment for people to engage with such as books, magazines, or rummage boxes. Some of the radiator covers were rusted and one had come loose from the wall in the lounge, a potential hazard. Paintwork on doors was damaged by wheelchairs and trolleys. Bathrooms throughout the home were cold and institutional. Upstairs one bathroom was being used to store items such as a headboard and wheelchair, a potential trip hazard should a service user try and use these areas independently. Before the inspection there was an incident where a service user had drank some antibacterial hand wash. Despite this, hand wash gel and imperial liquid soap were found left in a toilet area. Other than bedroom doors being painted different colours there was very little in the environment to help people with dementia. Photographs of people as they are now had been placed on some people’s bedroom doors, but for people with advanced dementia and short term memory this will be of little help to them as they will not recognise themselves as they are now. The sluice room was piled high with incontinence aids, some left lying on the floor. There is an accessible well maintained garden and one service user who lives on the ground floor said they enjoyed gardening in the better weather. Bedrooms are generally decorated and furnished appropriately and people have brought small items with them, making their own room reflective of their lifestyles. One younger adult said that they had their own computer and had access to the internet. They said they were happy with their bedroom. One person had recently been transferred to a bedroom on the first floor. They commented that they did not like the colour of their bedroom. It was painted yellow and they said that it reminded them of a public toilet. Although bedrooms are usually refurbished when they become vacant, the carpet in this room was shabby. St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 24 There is no maintenance and refurbishment programme for the home. Senior staff within the organisation have identified this as a need during a recent audit of the service. The home has an infection control policy. The majority of staff have received training in infection control. There has been one outbreak in the home since the last inspection which has been managed appropriately by the home, with the support of the Health Protection Agency. Relatives commented that the home was always clean and that there were never any odours. Service users said that the home was “tip top”. There is a separate laundry. It has sufficient washing and drying equipment, however the paintwork in here is badly damaged. . St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 25 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 not sufficient at peak times and staff do not work as a team. This prevents staff from providing person centred care. Staff training is adequate, however, specialist training is not provided to meet the diverse needs of the service users, which prevents staff from effectively meeting the care needs of people with dementia. Staff recruitment procedures protect the service users. St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 26 EVIDENCE: Service users have high care needs and many people with dementia require assistance particularly at mealtimes. Some service users, as identified in their care plans, need constant support and supervision in order to ensure the protection of other service users. Care staff are not involved in care planning. This means that the staff team do not plan and work together to make sure that individuals receive a person centred approach to care. On the three days of the inspection, on the first floor of the home, staff concentrated on attending to service users personal, nutritional and health care needs. Staff did not have the time to provide anything more than basic care. At the time of the inspection visit there were six night staff vacancies, which were being covered by agency staff. One relative commented “I think there should be more staff”. Younger adults said that sometimes there was not a member of staff in the lounge on the ground floor, even though this is the policy of the home. Service users said “the staff are lovely, they are helpful and will do anything for you”. Relatives said “the staff are sympathetic, I feel like part of a family”. The manager is developing a training programme. The majority of staff have completed the NVQ level 2 qualification in care, however, none of the care staff have completed training in dementia care. Staff files showed that the company’s recruitment procedures are followed. All contained completed application forms, interview records, two written references, terms and conditions of employment and induction records. Criminal Record Bureau checks are carried out and these records are held securely. St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 27 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 (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. St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 28 The home operates a good quality assurance system. This is based on the views of service users, were they are able to communicate their wishes, so that they know their rights and views will be listened to. However, management systems do not ensure the health, safety and welfare of the service users. EVIDENCE: The manager is a qualified nurse and has a number of years extensive management experience. Relatives said that “she’s very good at listening” and staff said “Bev (the manager) is alright, if something is broken she will sort it, she’s good like that”. Service users said “the boss is a lovely lady, she made me crisp toast with jam on”. As part of the quality assurance system the manager obtains feedback about the service by arranging service user meetings. Younger adults said that they had just had a meeting where they suggested they have a takeaway night and the option of a cooked breakfast at weekends. They said they could approach management and felt listened to. Questionnaires are also sent to service users and their relatives and the results of these are displayed within the home. 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 demonstrated that receipts and double signatures are 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. The manager has identified that night staff need more frequent fire drills and has developed a system to ensure they receive one every month. Some moving and handling practices did not make sure people were safe. Staff were seen lifting a service user up under their arms, which is not good practise. On the first day of the inspection one service user had their head resting on the edge of the dining table, which could cause bruising and damage to their skin. Another person had their foot wedged between the footrests of their wheelchair. These matters were brought to the attention of the manager at the time of the visit. An appropriate record of accidents is maintained and there are good systems in place for monitoring the occurrence of these. However, from September to St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 29 November 2007 there were 120 accidents. In order to reduce the number of these pressure mats have been purchased and night staff have been requested to increase their observations during the night. The frequency of these must continue to be closely monitored by the manager. There have been three recent avoidable incidents in the home. One where a service user drank anti-bacterial soap, another where a service user drank some washing up liquid that had been left in a cup and the third where a service user tripped over a cable. Staff are provided with training in health and safety matters, however, the above incidents demonstrate a lack of awareness of potential risks to service users in the environment. St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 30 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 3 3 3 4 3 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 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 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 X 37 X 38 2 St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement For people with dementia care plans must be developed to ensure that all aspects of their health, personal and social care needs are met. All staff must have access to the care plans. This to ensure that continuity of care is provided. Records must be maintained of weight loss and gain. This is to ensure that staff can take appropriate action quickly to address the health care needs of service users. . For people unable to communicate when they are in pain, pain risk management plans must be developed. This is to ensure they receive their prescribed medication when they need it. . The manager must ensure that people with dementia are treated with dignity and respect at all times ensuring that their well being is fully promoted. For example: staff should not “rush” people when DS0000000749.V360037.R01.S.doc Timescale for action 31/08/08 2 OP8 17(a) Schedule 3(k) 31/03/08 3 OP8 OP9 12(1)(a) 30/11/08 4 OP10 12(4)(a) 31/03/08 St Helens Care Home Version 5.2 Page 32 5 OP12 16(2)(n) 6 OP14 12(2) assisting them to walk, known as “outpacing”. A range of activities must be offered to people with dementia, to ensure that opportunities to lead fulfilling lifestyles are provided. The manager must ensure that people with dementia are helped to exercise choice and control over their lives as part of living an independent lifestyle. For example: • Staff should not “force” people to do something, or deny them choice, as was the case during lunch for people with dementia. The environment must be adapted to help people with dementia find their way around. 31/07/08 31/07/08 • 7 OP15 12(4)(a) 8 YA22 22(2) Menus should be available in a format that people with dementia can understand and/or staff should offer a choice of what to eat at the time of the meal. A review of the mealtime 30/04/08 arrangements must be carried out to ensure that people with dementia are provided with their meals in pleasing surroundings. The complaints procedure must 31/05/08 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. DS0000000749.V360037.R01.S.doc Version 5.2 Page 33 • St Helens Care Home 9 OP18 YA23 13(6) 10 OP19 11 OP19 OP38 12 OP19 OP24 13 OP27 YA33 The rationale for using key pads to prevent people from leaving the building must be clearly documented in the individual’s care plan. 23(2)(a)&(p) The environment must be adapted to meet the needs of people with dementia. The manager must make reference to relevant up-to-date guidance to help her achieve this. 13(4)( c ) Steps must be taken to maintain a safe environment for service users at all times. For example items should not be stored in bathrooms and where hazards have been identified, such as people drinking antibacterial soap, then steps must be taken to eliminate such risks. 23(2)(b) A maintenance and refurbishment programme must be developed and implemented (as identified by senior staff within the organisation). This is to ensure service users are provided with a well maintained environment. 18(1)(a) Staffing levels must be reviewed at peak times to ensure care is provided to service users in a person centred way and to ensure the safety of service users. 18(1)(c) 13(4(c) 30/11/08 30/09/08 06/02/08 30/09/08 31/05/08 14 15 OP30 OP38 Training must be provided so 30/09/08 that staff can meet the diverse needs of people with dementia. Staff must not use unsafe 06/02/08 moving and handling techniques. St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 34 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 YA1 Good Practice Recommendations The Service User Guide must be made available in alternative formats suitable to meeting the diverse communication needs of service users. Care plans should be written in plain English so that everyone can understand them. Service users and or their relatives should also be fully involved in the development of the care plans. All written information should be dated as this will help with the reviewing process. A homely environment should be provided for people. Particular attention needs to be given to bathrooms. 2. OP7 3. 4. OP37 OP19 St Helens Care Home DS0000000749.V360037.R01.S.doc Version 5.2 Page 35 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.V360037.R01.S.doc Version 5.2 Page 36 - 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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