Inspection on 11/12/07 for St Lukes Care Home

This inspection was carried out on 11th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

St Lukes Care Home 16/12/09

St Lukes Care Home 04/07/06

St Lukes Care Home 23/09/05

St Lukes Care Home 24/05/05

St Lukes Care Home 11/10/04

St Lukes Care Home 26/04/04

St Lukes Care Home 09/03/04

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

CARE HOMES FOR OLDER PEOPLE St Lukes Care Home Palace Fields Avenue Palacefields Runcorn Cheshire WA7 2SU Lead Inspector Anthony Cliffe Unannounced Inspection 14:15P 11 , 13 and 14 December 2007 th th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Lukes Care Home Address Palace Fields Avenue Palacefields Runcorn Cheshire WA7 2SU 01928 791552 01928 759244 stlukes@c-i-c.co.uk www.c-i-c.co.uk. Community Integrated Care 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) Sandra Watkins Care Home 60 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (60), Learning disability (2), Physical disability of places (2) St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of service users must not exceed 60 * 60 of the service users may be DE(E) dementia aged 65 years and over. * Within the total number of 60 service users DE(E) a maximum of 10 service users may be DE, dementia aged under 65 years. * 2 of the service users may be PD, physical disability under 65 years diagnosed with dementia. * 2 named service users may be LD, learning disability aged under 65 years diagnosed with dementia. 4th July 2006 Date of last inspection Brief Description of the Service: St. Luke’s is a purpose built establishment for the provision of nursing care for up to sixty residents diagnosed with dementia inclusive of 2 places registered for physical disability. This service is provided within four separate suites located over two floors, each unit has its own lounge, dining room, utility kitchen and staff team. Each unit provides accommodation for a maximum of 15 residents. The design features include passenger lifts, safety alarmed exit doors, single level flooring with external access, grab rails, and adaptations in all communal areas, bathrooms and toilets. Externally there is a central patio area and sensory garden accessible to all residents. St Luke’s is located in a large residential area on the outskirts of Runcorn. The home is on a main bus route and rail links are within two miles of the home at Runcorn East station. The service is provided by Community Integrated Care, a not for profit organisation. Fees range from £435 to £620 per week. St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on the 11th, 13th and 14th of December 2007 and lasted fourteen and a half hours. A Regulatory Inspector carried out the visit. This visit was just one part of the inspection. Other information received was also looked at. Before the visit the home manager was also asked to complete a questionnaire to provide up to date information about services provided. Questionnaires were provided for residents, families, and health and social care professionals to find out their views. During the visit various records and the premises were looked at. A number of residents, staff and visitors were also spoken with and they gave their views about the service. An observation of the care and level of interaction between residents, their environment, with staff and one another was done within a communal lounge for two hours. The purpose was to get first hand experience of sitting alongside people for a couple of hours during a regular part of the day. What the service does well: The service provides a calm, welcoming atmosphere for both residents and visitors. Residents were seen to move freely around the suite in which they lived and activities have been devised in various parts of the building so that residents have a communal space to walk around to aid mobility and a change of environment. Outside there was a sensory garden for residents to use. There was a range of activities organised in and out of the home and the activities organisers were seen as an important asset to the staff team. Residents receive a very good standard of care and the observational practice completed during the inspection, observation of staff practice and comments from staff; relatives and health professionals support this. Care staff practices were good and staff was very patient, always took time to ask residents questions rather than deciding for them. Residents’ surveys said staff listened to them and they were kind and friendly Residents were encouraged to be active, but could also sit quietly if they wished. It was seen that staff respect people as unique individuals and maintained each persons dignity. St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 6 Residents were confident in their environment and were experiencing a good quality of life. Residents’ were valued as people and their personhood recognised. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available for residents and their representatives so they can make a choice about where they live. Residents’ needs are assessed prior to moving in so appropriate care can be provided to them. EVIDENCE: St.Lukes accommodates mainly people from the Runcorn area of Halton and is welcoming to anyone from outside the area or with a disability, different ethnic or cultural needs or sexual orientation. Residents or their relatives were provided with a copy of the service users’ guide and statement of purpose on request and copies of this and the most recent inspection report were available. Service user guides were not put in each bedroom. This contained details of the facilities and services provided to residents. Information could be provided in different formats on request to head office. Residents were given a handbook, which provided information on moving in, settling in, care and support, finances, wellbeing, notes on personal care plan and useful contacts. All residents have the same standard contract St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 9 with Community Integrated Care (CIC). A representative from CIC’s finance department meets with residents where possible and their families to look through the service users’ guide and discuss any queries or answer questions about services or finances. Contracts were signed at this stage. Five residents’ surveys were returned prior to the site visit. Four of these recorded that residents had been provided with information on St. Lukes before they moved in and the other one had not but St.Lukes had been recommended by the social worker from the local council that arranged the placement. A survey recorded a positive experience of visiting St.Lukes and said, ‘they showed us around and explained all that they had to do. We were completely satisfied’. Two personal files were examined of residents who moved into St. Lukes. The residents had met with the manager, deputy or registered nurse to discuss their care prior to moving in. Information was gathered and this was recorded. This included information on their physical and mental health. Copies of these documents were on residents’ files. Copies of social workers assessments and care plans along with information from the NHS services that had been involved in their care prior to moving in were retained in residents’ personal files. St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Completed records of care, liaison with health and social care professionals and good medicine management is consistent so residents’ health and welfare needs are met. EVIDENCE: The personal files of four residents were examined. Each care plan had a pre admission assessment and an assessment completed by staff from St.Lukes and additional information from social workers or NHS services involved in their care. From looking at surveys received from residents, relatives and health professionals. Reading residents’ support plans, observing staff working practices and talking with residents, staff and visitors, residents’ needs were met. Each residents’ support plan had information about their physical and mental health needs. These generally identified residents’ needs and contained guidance for staff to follow on providing support, help and care to them. Support plans recorded some information around residents’ routines and preferences about their care and maintaining their dignity. For example a support plan to assist a resident with their personal care described the resident St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 11 liked to be shown clothing that staff had chosen as he could no longer choose his clothes and that he always liked to wear a shirt with a tie as this was his normal attire. Information was recorded about dietary preferences, likes and dislikes and wishes in the event of his death. Another residents support plan to help her sleep described her routines and choices. For example she liked Ovaltine before bedtime and two pillows to sleep on to aid a restful sleep. Where residents were identified as being aggressive their support plans specified that only staff that had completed non-physical intervention training could assist in their care. Where residents were known to be aggressive staff were directed to use a calm softly spoken approach to residents and follow the agreed routines of allowing residents to calm down if they became aggressive For some residents the manager had done individual research with their families for underlying causes as to why they became inexplicably aggressive. A way of helping one resident to calm done by the use of confectionary had been identified and had been incorporated into their support plan. The outcome of this was that the resident received personal care with aggressive incidents reducing to non. Though residents support plans were informative they were not written from the residents’ perspective of their care or recorded how residents wished to be cared for. They reflected person centred thinking but did not use a person centred plan reflecting residents’ lifestyle choices and promoting their dignity, choice and independence. The support plans conveyed a sense of respecting and supporting the residents. An example of this was that a resident’s support plan incorporated advice from the speech and language therapist on the use of thickened fluids. The plan was around maximising his independence and identified what aids and support he needed to eat and drink. However a speech and language therapist said in a healthcare professional survey returned prior to the site visit that there was insufficient information of person centred care, for example finding out about each residents’ life history and incorporating this into their daily routine’. When this was looked into during the site visit the staff had looked at all residents’ dietary preferences but support plans were written about ‘eating and drinking’ and did not reflect individual routines or dietary preferences. Six health professionals surveys returned prior to the site visit were very complimentary about healthcare at St.Lukes. Surveys were returned from commissioners of care, a General Practitioner, dietician, continence advisor, speech and language therapist and social worker. The surveys recorded that staff were very good at promoting residents’ healthcare needs and identifying when referrals to healthcare professionals was needed. One survey said staff did not always follow the advice given from speech and language therapists but there was no evidence to support this other than the manager responding St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 12 to issue raised about the appropriateness of meals being made available to residents with swallowing problems and pureed diets. A Survey from a commissioner of care said staff at St.Lukes, ‘listens to the concerns of the PCT and acts upon suggestions to improve care. Encourages staff to attend case reviews and contribute to discussions’. Residents admitted from the local NHS Trust under the Care Programme Approach (CPA) had a risk assessment completed by the PCT. The care home received a copy of this prior to a resident moving in. The named nurse from the NHS that completed the risk assessment then followed up the resident for one month after moving in to monitor them settling in and update the CPA risk assessment or care plan if necessary. The manager said this system had been in place for nearly a year and no residents had to be readmitted to an NHS facility due to the collaborative work with the NHS Trust. There was a General Practitioner who provided a twice weekly surgery at St.Luke’s. This included reviews of health care, health checks, reviews of medicines and liaison with the staff at St.Luke’s about the end of life care pathways when a resident was placed on this. Residents and relatives surveys returned prior to the site visit said that residents’ healthcare needs were always or usually met. Relatives present during the site visit said that healthcare was excellent and staff were proactive at contacting General Practitioners and keeping relatives informed. Relatives said that additional equipment had been purchased by CIC such as specialist armchairs for their relatives. A relative said that she wished her husband to remain at St.Lukes if his health deteriorated and said, “I’m happy for him to end his days here, he will be treated with dignity and respect where staff have time for him and who know him”. Medicines management and administration was examined. The home had recently changed to another pharmacist to supply medicines. The manager explained that there were ‘teething errors’ with its introduction and a meeting had been arranged with the supplying pharmacist to discuss these. Minor errors were noted on medicine administration records. A monitored dosage system was used throughout the care home. Stocks of medicines were replaced monthly. Receipts of supplied medicines were recorded. Where medicines were supplied in original packages and not supplied each month the stocks of these were transferred from one month to the next so staff knew when to reorder medicines. Records were maintained for the destruction of medicines. Controlled drugs records were checked on one unit and no errors found. The manager and deputy manager audited medicines as part of the quality assurance system. St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported in making choices about their lifestyle but activities could more individualised to match residents expectations and preferences so they have more choice and control over their lives. EVIDENCE: St.Lukes is a member of the National Association of Provision of Activities for older people. There were two full time activities coordinators. They produced a quarterly newsletter for residents and visitors with information about planned and forthcoming events. They met with activities coordinators from other care homes operated by Community Integrated Care to develop their role and share ideas and support one another. Records of activities were seen from October to December 2007. A variety of events had been planned and taken place. For example Relatives support group meeting followed by a bingo and buffet. Church services, musical entertainers, old time music concert and memorial services for residents. Records referred to activities arranged on each of the four suites. These included use of the relaxation room, board games, trips out into the local St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 14 community, external entertainers, sensory stimulation, beauty therapy, church services, reminiscence, one to one trips out with residents, relaxation and exercise, cookery and bingo. Over the Christmas period the activities organisers had arranged for local schools and community and church choirs to visit. Each unit was having a Christmas party. Residents’ support plans recorded regular participation in social activities but they did not always detail if residents had enjoyed the activity and if or how they had benefited from it. Five residents and eight relatives surveys were returned prior to the site visit. Three of the residents said activities were always arranged, one said usually and one said sometimes. Residents said they enjoyed singing, dancing, painting and going out. Relatives surveys said St.Lukes had ‘excellent’ activities organisers and there were numerous activities arranged in and out of the home. The majority of these were group activities but the activities organisers took individuals out. Relatives said they would like to see staff more involved in activities within the suites on a more individualised basis and activities based on individual lifestyle and recreational choices. Two relative’s survey said that personal care and keeping people independent should be seen as an activity and this was where care staff should focus on individual activities. The activities coordinators were seen in relaxation and exercise and taking residents out as well as a number of events organised around Christmas. Staff said they could access the homes mini bus more easily and it was available to use. Staff said the manager had informed them that they were to be provided with more resources to do activities within the suites. An observation of the care and level of interaction between residents, their environment, with staff and one another was done within a communal lounge for two hours. The purpose was to get first hand experience of sitting alongside people for a couple of hours during a regular part of the day within a communal area. The care of four people was looked at. During this two-hour observation the four people remained within the communal area. Care staff practices were good and staff were very patient, always took time to ask residents questions rather than deciding for them and people were encouraged to participate in the exercise group but could also sit quietly if that was their wish. It was seen that staff respect people as unique individuals and maintained each persons dignity. From the findings of the observation it was noted that 60 of the time residents well being was positive and that people were confident in their environment and were experiencing a good quality of life. All the interactions between staff and St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 15 residents were noted to be good. There was a high level of engagement with residents during this period on average 66 of the time seen. Staff was actively engaged with residents throughout the whole of the observation period. A staff team of three were on duty in each group of fifteen residents. General observations at this time were that the room was warm and music was playing in the background. Several residents were singing/humming or tapping their feet to the music. Most of the residents showed pleasure at this. Staff encouraged them to join in the exercise if they wished to. Residents were served drinks and staff helped them when necessary. During the observation some residents got up and moved about and some did not return. There were exceptions where specialist chairs were used for certain residents. Residents could freely move from one area of the suite to the other and when they appeared in an area they were welcomed into it. Relatives’ surveys and relatives present at the time of the site visit said they always felt welcomed. There was an active relatives support group. A relative said, “They look after you as well as your relative and listen to families needs as well as being supportive”. Residents and relatives surveys said that they generally enjoyed the meals but a relative’s survey said mealtimes could be more flexible and based around individual routines and fresh fruit could be made more easily available. Following a complaint a catering committee was formed with a representative from each suite, catering staff and liaison with the relatives support group. A questionnaire was devised for residents and staff to complete and comment on the variety of the menu available and as a result of this the menu was changed. Feedback from the catering committee was that the new menu was well received. Meals were seen being served. This was a hot meal of either cheese bake or sausages with vegetables and potatoes. An alternative choice was available. Staff served up both choices and took these to residents who could choose the main meal and vegetables. St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and concerns were acted on so they were taken seriously. The staff group were knowledgeable about safeguarding procedures so residents were protected from abuse. EVIDENCE: There were two recorded complaints since the last site visit. These had been investigated using the CIC complaints procedure. There were detailed records demonstrating a full investigation of the concerns raised. The complainants were involved throughout the complaints. The manager used a variety of methods to assist the complainants to confirm their concerns and the complaints could be substantiated and were acknowledged. Following a complaint the menu was revised and a catering committee formed to improve the residents’ dietary choices. Residents’, relatives’ and health professionals’ surveys returned said that they knew about the complaints procedure and who to speak to if they had any concerns and these were always or usually responded to. A relative’s survey said, ‘Have spoken to the nurse in charge of the unit of any concerns we have had and these have been addressed. The manager is always available and we know we can approach her’. A health professional survey and letter said that concerns were responded to with ‘openness’. St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 17 Each unit had the community integrated care flow chart for staff to follow should an incident of abuse arise. Staff referred to this when adult protection was discussed. Staff had completed training in awareness of indicators of adult abuse during their induction and through follow up mandatory training. The training facilitator demonstrated that arrangements for staff had been made to attend training when necessary. The manager said that a training programme had been developed at St.Lukes to help staff understand the impact of dementia on individuals and to try and understand why residents behaved aggressively. A new member of staff said she had no experience of working in a dementia care home and had undertaken the training that helped her to communicate more positively with residents. She said, “ We did some training they developed here to help you understand the difficulties of dementia and the impact it has upon the person and their family. It was really good and helps you see and deal with people and not just seeing them as people with difficult behaviours”. Another staff member said had done further training since she returned from maternity leave. She said she had done some training on dealing with violent behaviour when she had to bring in personal items or photographs or memories she didn’t want to leave behind. She said this had helped her understand why people became aggressive. She said St.Lukes was the best care home she had worked in. She said, “ Everyone knows their job. It’s spotless and doesn’t smell of urine. I know what to do if I see someone abusing a resident and have had training. All the staff are very good as some residents can be aggressive but experience and training helps you remain calm. All staff are like this they are a great staff team”. St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, comfortable and well-maintained environment, which is equipped to meet their needs. EVIDENCE: Since the major refurbishment in 2005 the décor had been maintained and enhanced as pictures, matching furniture and curtains were purchased. The building continued to be maintained to a very high standard. Bedrooms were decorated as they became vacant. On Laurel unit the main lounge had been repainted. The building is registered to accommodate sixty people but the occupancy does not usually rise above fifty-six residents as double bedrooms were used for single occupancy. St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 19 The staff and relatives’ support group had raised £15000 through fundraising and a further £15000 was provided by a government grant to build a conservatory. This was proposed to be built onto Aspen unit and will provide recreational and visiting facilities for residents and relatives. Planning permission from the local council had been granted and the building work was due to commence in January 2007. Signage throughout the home was very good with residents’ bedrooms having a memory box next to the door. These contained pictures of themselves or of someone or something personal to them they recognised. All the public areas were clean and well maintained. Housekeeping was of a very high standard with no odours noted anywhere. Domestic staff had completed an NVQ level qualification in housekeeping. Residents’ bedrooms were personalised with photographs and electrical items as well as their own furniture where permissible. Residents’ and relatives’ surveys said the building was always clean, that domestic staff worked very hard and residents’ bedrooms were always spotlessly clean. St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff were adequate so residents’ needs were met. Staff recruitment was safe so residents were protected. The induction and training programme was robust so a skilled workforce protected residents’ welfare. EVIDENCE: Staffing levels were appropriate and the manager confirmed that staffing numbers were determined by the dependency of residents and could change. Each unit had an appropriate mix of qualified and unqualified staff. The unit manager on each unit was experienced in the care of the residents for that unit. Relatives’ surveys said that there was a high turnover of staff, staffing numbers on the suites could be improved, staff were inexperienced, regular staff were needed and more male staff were needed. A survey said that agency and bank staff where used but this did not detract form residents’ care. At the time of the site visits there were no trends such as a high rate of unexplained accidents or adult protection referrals to support these views. St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 21 Three staff had commenced employment and the records of two of them were examined. They had been supervised through an induction programme, which included training on the protection of vulnerable adults. Records contained appropriate identification documentation and completed POVA First and Criminal Record Bureau disclosures. Files had two written references. Files contained copies of the induction programme. The personal identification numbers of a registered nurse was checked with the Nursing and Midwifery Council. Staff completed the induction programme supervised by the care and learning coordinator. Induction programmes ran on a continued basis until completed due to the use of computer based learning. The care and learning coordinator verified that staff was given timescales for the completion of training and she was able to check individual progress. Induction on day one included a tour of the building, fire procedures and completion of the home induction covering health and safety, looking at relevant policies and procedures and registration for E learning. Day two was based on training in dementia care and non-violent crisis intervention and deescalation, which incorporates role-play and discussion. The induction at St.Luke’s included training developed there by the manager and deputy as part of the deputy’s degree in social science under the heading ‘Changing the Boundaries of Practice’. The teaching package was called ‘Violence and Verbal De escalation’ and looked at how violence could be part of a cycle of behaviour. It involved looking at incidents of challenging and aggressive behaviour that had led to safeguarding referrals, residents’ interactions and how staff responded to them. From this the teaching package was developed. The E learning package was started before staff attended the companies’ twoday mandatory induction course. It consisted of three sections. Section 1 covered the values of care and developing as a carer and is made up of reading and assessment. Section 2 covered the role of the carer and confidentiality and section 3 induction theory. This covered health and safety, moving and handling, first aid. Induction covered person centred learning with an introduction to person centred planning, risk assessment and recognising and responding to abuse. Section two of person centred learning covered training on mental health, learning disability, dementia and death, dying and bereavement. E Learning also covered existing staff training for mandatory training updates and informed them when staff training was due to be renewed. Staff training was ongoing with staff booked for training on dementia care, record keeping, responding to abuse and medicine awareness. St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 22 NVQ training followed within six months of induction being completed and E learning allows staff to complete induction at their own pace. E learning could be accessed at home by staff or when on duty. Staff was paid for work completed at home. Staff was rostered to complete E learning a part of their duty and examples were seen on staff rotas. During induction staff had six week and three month supervision. The home has a care and learning coordinator. She was part of the management team and had 12 hours a week to plan, implement and coordinate training. Training was planned on a 1 to 1 basis or in groups. Training was provided both in house and by outside agencies. For example the local Primary Care Trust (PCT) provided training in public health and infection control for two staff. The training coordinator was also a trainer for the nonphysical crisis intervention used by staff to manager aggressive behaviour. Staff from the kitchen, laundry, domestic and registered nurses had been trained as moving and handling facilitators so the home had sufficient appropriately trained staff in this area. All hotel service staff had completed an NVQ level 2 qualifications in housekeeping. Of the fifty-two care staff employed twenty-nine held an NVQ level 2 or 3 qualification. Twelve staff was undertaking a level 2 or 3 NVQ qualification. NVQ assessors were provided by the two agencies the company used to provide NVQ training to staff. The company provide a management development programme with the deputy manager undertaking the NVQ level 4 registered managers’ award. The deputy manager said she had been supported to complete her degree in social sciences. The deputy manager and learning coordinator confirmed they were supervised by the manager for both clinical and staff management. The learning coordinator was undertaking a mentorship course with John Moores University to provide post registration support to newly qualified registered nurses. St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Robust quality assurance systems, financial procedures and maintenance of the building are maintained so residents’ welfare is promoted and they are protected. EVIDENCE: The home manager has been in post for two years. She was a registered mental nurse and held the registered manager award. A deputy manager had been appointed who was a registered mental nurse. In addition a care and learning coordinator had been appointed to coordinate and plan training and support care and domestic staff through NVQ training. A full time administrator supported the management team. The manager was seen as being pivotal to the running of St. Luke’s. The home has the Investor’s In People award. St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 24 Relatives’ surveys said the manager listened to concerns and responded to them. A relative said during the site visit that there was always a nice warm and friendly atmosphere and the manager was always available to talk to if needed but regularly spoke to visitors. Another visitor said that relatives were supported and they had relatives meetings. She said in the last two years the management of St.Luke’s had changed ‘beyond all recognition’ with staff very positive. She said “Even the staff that grumble about everything seem happy and enjoying their job”. A staff member said she said she had regular supervision with the manager or deputy every six to eight weeks. “We sit and talk about problems both at work and home and discus training. If we don’t do things right they are talked through. There is no blame, the managers talk things through they are easy to talk to and approachable. They are the best managers I’ve worked with and supportive around family circumstances”. Compliments were received in writing from visitors and health professionals. A relative wrote thank you card saying ‘ Just a small appreciation for all the care and kindness you have extended over the last two difficult years. Thank you for the time you gave my husband and thank you for always putting a smile on his face. Thank you for the support you gave me and always listening so patiently to my concerns. Under the sad circumstances he could not have been anywhere better. You must be very proud of St.Luke’s and its wonderful staff. Many warm thanks. A healthcare commissioner from Halton and St.Helens NHS Primary Care Trust wrote to a director of CIC complimenting the care of a resident at St.Lukes and said at his last review it was clear that the care the resident received from his care workers was of a very high standard. Both his mother and the commissioner where impressed by the professionalism and commitment to caring the care staff showed at the review. A director for CIC wrote to the manager following recent visits from commissioners. He wrote that the commissioners had individually gave positive feedback on their visits and were left with the impression that St.Lukes provides an excellent standard of care’. Another care home manager carried out visits required by regulation 26 of the Care Homes Regulations. The manager and deputy were responsible for audits that complimented the quality assurance system. Each month they randomly completed audits of a number of care plans and medicine administration records of individual residents. As part of the quality assurance system there were audits of accidents, equipment, water temperatures, the building, staffing, sickness, cleanliness and health and safety as some examples. Another care home manager then audits the care home each month using the original data gathered by the manager. St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 25 There was a relatives support meetings held at least three times a year. The last meeting took place in October 2007 and another planned for January 2008. Heads of department and staff meetings were held at least monthly and included catering and housekeeping. No personal monies other than personal allowances were held on behalf of residents. Relatives were billed directly for additional services such as chiropody or hairdressing. Residents’ personal allowances were safely secured and records for credits and debits maintained. Staff personnel and induction records and talking to staff verified that staff had regular planned supervision. Information provided by the provider in the Annual Quality Assurance assessment and records held on site were examined. All the required maintenance and health and safety checks of the building and equipment had been completed. St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 3 X 3 St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations 2. OP12 St Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Northwest Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Lukes Care Home DS0000005148.V347441.R01.S.doc Version 5.2 Page 29 - 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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