Inspection on 10/06/08 for St Margaret`s

This inspection was carried out on 10th June 2008.

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 Margaret`s 18/09/07

St Margaret`s 11/07/06

St Margaret`s 20/10/05

St Margaret`s 10/05/05

St Margaret`s 12/10/04

St Margaret`s 29/06/04

St Margaret`s 08/03/04

St Margaret`s 19/01/04

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

CARE HOMES FOR OLDER PEOPLE St Margaret`s Mylord Road Fraddon St Columb Cornwall TR9 6LX Lead Inspector Alan Pitts Unannounced Inspection 10th June 2008 09:00 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 Margaret`s DS0000009258.V364069.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 Margaret`s DS0000009258.V364069.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Margaret`s Address Mylord Road Fraddon St Columb Cornwall TR9 6LX 01726 861497 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) clydon@btconnect.com Blakeshields Limited Mr Christopher Lydon Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28), Physical disability (5), Terminally ill (5) of places St Margaret`s DS0000009258.V364069.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Total number of service users not to exceed a maximum of 28 Date of last inspection Brief Description of the Service: St. Margarets is situated on the main road within the village of Fraddon. It is a care home with nursing, and is currently registered for 28 residents within the category of old age not falling into any other category. This includes residents who may have physical disability (5), or be terminally ill (5). The home provides day care for 2 residents up to twice a week. A trained nurse is on duty over the 24 -hour period. There are communal facilities comprising a dining room and lounge areas. A passenger lift provides access to the first floor for those with mobility problems. The majority of rooms offer single accommodation. There is a new reception area. There is a small car parking area to the front of the building. There is a small patio and lawned area too. Fees range from £455.36 to £600 per week. St Margaret`s DS0000009258.V364069.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service potentially experience good quality outcomes. This unannounced inspection took place on the 10th June 2008 over a period of approximately 4 hours. The inspector met with the registered manager, staff, and residents, toured the building, and examined documentation. There has been a noticeable improvement since the last inspection, both in terms of action taken to address requirements and in respect of internal improvements to the environment. Overall, St Margarets provides individualised care that meets the expectations of the people that live there. Comments from residents were complimentary of the home, the staff, and the care provided. These comments were supported by the view of other health care professionals. What the service does well: What has improved since the last inspection? The home has worked hard to address most of the requirements and recommendations made at the last inspection. There has been improvement in the recording of residents’ lifestyle and in offering social/recreational activities. The new reception area is bright and welcoming, and access around the home has improved. St Margaret`s DS0000009258.V364069.R01.S.doc Version 5.2 Page 6 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 Margaret`s DS0000009258.V364069.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 Margaret`s DS0000009258.V364069.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): 3, 6 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home accepts admissions on the basis of a full care needs assessment. Standard 6 is not applicable, as the home does not provide intermediate care. EVIDENCE: The care documentation relating to the most recent admission to the home showed a care needs assessment had been carried out prior to admission. This is supported by the comments from one resident who said that the registered manager had been to visit them and arranged a visit to St Margarets. The home offers respite care, but not intermediate care. St Margaret`s DS0000009258.V364069.R01.S.doc Version 5.2 Page 9 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): 7, 8, 9, 10 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All residents have a suitable care plan, which is regularly reviewed. This provides a basis for consistent care being delivered by staff. Healthcare support was evident during the inspection, and residents can be assured they will receive suitable support from medical practitioners. Residents are protected by the homes’ adherence to its medication procedures. Staff work with the people that live there in a manner which respects their privacy and dignity. EVIDENCE: There is a care plan for each resident, which is comprehensive and informative. Care plans are supported by a variety of care needs assessments and daily records. The records show resident/family involvement in care decisions. The care plan format is suitable and care plans are regularly reviewed. Comments received from other health care professionals were also complimentary of the care provided by the staff. St Margaret`s DS0000009258.V364069.R01.S.doc Version 5.2 Page 10 Residents said they were satisfied with the healthcare support they received. This includes visits from GP’s, district nurses, chiropodists, dentists and opticians. One resident said “I have only to ask and I always get the support that is needed”. Each resident has a photograph held on their medication sheet to ensure their protection during the administration of meds. Records of medication received into the home and disposed of are kept. There are policies and procedures in place. Medicine Administration Records are free of unexplained gaps. Medicine Administration Records are hand written, and a recommendation was made at the last inspection to ensure that two initials are entered to show that the entry has been checked as correct. The staff were observed to knock on resident’s doors prior to entering. There is a record of preferred names and these were seen to be used. Residents were complimentary of the care and kindness of the staff, and also confirmed that they would feel able to express any concerns. St Margaret`s DS0000009258.V364069.R01.S.doc Version 5.2 Page 11 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, 15 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents largely determine their own lifestyle, though there is a programme of entertainment, and routines are individualised and flexible so that residents can live a lifestyle according to their wishes and needs. Visiting arrangements are flexible. Arrangements to assist residents with their finances are satisfactory. Meals are provided to a high standard, so residents are provided with a choice of wholesome and nutritious food. EVIDENCE: Residents said that they felt that they had enough to occupy themselves. They said they could get up and go to bed when they wished, and staff were observed assisting residents to get up throughout the morning. Some residents choose to spend the majority of their time in one of the lounges, while others prefer their time in their bedrooms. Residents said they could receive visitors when they wished. One resident said “There is always something happening”. The visitor’s book indicated that family and friends visit frequently, and residents confirmed this. Residents also confirmed that they go out with family and friends. Residents confirmed that they would feel able to express their views and/or concerns, and they felt that choice was available to them. St Margaret`s DS0000009258.V364069.R01.S.doc Version 5.2 Page 12 There is a monthly newsletter, which is distributed around the home to keep residents informed of events at the home. The home’s administrator is appointee for one resident, otherwise the home only handles small amounts of residents’ money and appropriate, accurate records are kept. There is a record of food provided and a 4-week rolling menu that also demonstrates choice being available at meals. One resident said “The food is always good”. Specialist diets are catered for. Food is prepared in a kitchen separate from the main building and situated in the car park. Meals are brought from the kitchen into the home via a hot-trolley. St Margaret`s DS0000009258.V364069.R01.S.doc Version 5.2 Page 13 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, 18 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comments from service users were positive, and the home operates an effective complaints procedure. Residents are protected by an appropriate adult protection policy. EVIDENCE: There is a current complaints procedure, and residents said that they would feel able to express any concerns. No complaints have been received by the home or the Commission for Social Care Inspection since the last inspection, though information was provided prior to the inspection in respect of: • No footrests on wheelchairs • Lack of response to calls for assistance • Poor staff attitude towards residents Wheelchairs were observed to be used appropriately and with footrests in place. Staff were observed to respond promptly to the nurse call system, and were also seen to interact with residents in a friendly, respectful manner. The observations are also supported by comments from residents and staff. One residents said “The home is well run with very helpful staff”. There is an adult protection procedure, which refers to Cornwall Adult Services procedures, ‘whistle blowing’ and the ‘No Secrets’ guidance, and includes relevant contact details. Adult protection is included in the staff training programme. Although a number of staff have attended the local authority safeguarding training, more should attend. St Margaret`s DS0000009258.V364069.R01.S.doc Version 5.2 Page 14 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, 26 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. St Margarets provides a pleasant, homely, clean and well-maintained environment for residents to live and feel at home in. EVIDENCE: The home offers accommodation for 28 residents. Internal alterations to the building have completed, providing a new reception area, additional bathing facilities, a new lounge on the first floor and revised office accommodation. Building regulations approval was seen at the time of the inspection. There are sufficient communal lavatory and bathing facilities throughout the home. There is a range of care/nursing aids provided at the home. Access between floors is aided by a passenger lift, and access around the first floor has been improved by the internal alterations. Residents’ rooms were seen to be clean, comfortably furnished and personalised to varying degrees. Communal rooms are pleasant and provide sufficient seating for relatives and visitors. The home was seen to be clean throughout, with no undue odours. St Margaret`s DS0000009258.V364069.R01.S.doc Version 5.2 Page 15 The laundry is generally suitable and capable of meeting the demands of the home, a washing machine with a sluice facility is provided, and dissolving sacks are used in conjunction with this. The kitchen was not inspected on this occasion. St Margaret`s DS0000009258.V364069.R01.S.doc Version 5.2 Page 16 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, 30 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were sufficient staff on duty at the time of the inspection. There is a staff training programme, though improvements can be made in this respect. The home protects residents by adhering to a robust recruitment procedure. EVIDENCE: At the time of the inspection there was the registered manager, a nurse, and 6 care staff on duty (2 were involved in escort duties with residents attending appointments), as well as a cook, kitchen porter, administrator, handyman, and 2 cleaners. Staff were observed to respond promptly to requests for assistance. Staff shifts are usually: Early = 7am-2pm Late = 2pm-8pm Night = 8pm-7am There are 23 staff in total, with 11 having achieved NVQ Level 2 or above, and a further 3 undertaking this training. There is a staff training matrix, though at the time of the inspection this was not fully up to date. There is a variety of training available and provided, but there are a number of staff yet to undertake relevant training or are in need of an update (e.g. infection control, St Margaret`s DS0000009258.V364069.R01.S.doc Version 5.2 Page 17 1st Aid, safeguarding). There are insufficient 1st Aid qualified staff. And the home’s Annual Quality Assurance Assessment identifies that there is not a 1st Aid Policy in operation. The home’s self-assessment (Annual Quality Assurance Assessment) recognises that more could be done in respect of staff training, and a visiting health professional also identified this as an area where the home could improve. A sample staff personnel file was inspected and this demonstrated adherence to a robust employment procedure, including the taking up of references and Criminal Records Bureau checks. A National Training Organisation compliant induction programme is in use and a completed sample was seen at the time of the inspection. St Margaret`s DS0000009258.V364069.R01.S.doc Version 5.2 Page 18 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, 38 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run by an experienced manager, who is suitably qualified. The home undertakes quality assurance questionnaires. Residents’ finances are safeguarded. Staff have been appropriately supervised. The health, safety and welfare of residents is protected. EVIDENCE: Residents comments about staff were positive. The inspectors observed staff attending to residents’ needs in an appropriate and respectful manner. The registered manager is experienced and qualified to NVQ Level 4. There are clear lines of accountability. St Margaret`s DS0000009258.V364069.R01.S.doc Version 5.2 Page 19 The home has undertaken quality assurance questionnaires to residents, family and other relevant agencies. The registered manager has collated the results and undertook to ‘publish’ a summary of the findings. The inspector discussed the financial accounting procedures within the home with the administrator and inspected the records. Records are supported by receipts, and the home is appointee for one resident only. Only small amounts of money are held. There is documentary evidence of staff supervision having occurred and this is supported with staff initials. The home is generally well maintained with relevant safety certification and maintenance receipts available. The home’s policies and procedures are comprehensive in their scope and were last reviewed in May 2007. St Margaret`s DS0000009258.V364069.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 St Margaret`s DS0000009258.V364069.R01.S.doc Version 5.2 Page 21 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 OP30 Regulation 18 Requirement The registered manager must promote staff training, and make arrangements for this to be available to staff. Timescale for action 01/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Where instructions are hand written on Medicine Administration Records the registered manager should ensure that there are two staff initials confirming that the instructions have been checked as correct. The registered manager should encourage attendance on local authority safeguarding training. The registered manager should provide grab rails in the toilet adjacent to the new first floor lounge. 2. 3. OP18 OP19 St Margaret`s DS0000009258.V364069.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Margaret`s DS0000009258.V364069.R01.S.doc Version 5.2 Page 23 - 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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