Inspection on 18/09/07 for St Margaret`s

This inspection was carried out on 18th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Margaret`s 10/06/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St Margaret`s Mylord Road Fraddon St Columb Cornwall TR9 6LX Lead Inspector Alan Pitts Unannounced Inspection 18th September 2007 10:00 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.V346019.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.V346019.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) saintmargarets@tiscalli.co.uk 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.V346019.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 building work ongoing to provide 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.V346019.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 18th September 2007 over a period of approximately 5 hours, and was carried out by two inspectors. The inspectors met with the registered manager, staff, and residents, visited all parts of the building, and examined documentation. Overall the inspectors found a home that had a relaxed and comfortable atmosphere, and the residents’ spoken with said that the staff worked hard and they like living at St Margarets. What the service does well: What has improved since the last inspection? What they could do better: Communication with the Commission for Social Care Inspection should be better, and greater commitment should be made to managing the home, as this is where the majority of the requirements and recommendations arise (some carried over from the previous inspection). The home can do more to ensure it can meet the needs of residents prior to admission, and to ensure that residents are protected. The home could do more to demonstrate a commitment to staff training and supervision. St Margaret`s DS0000009258.V346019.R01.S.doc Version 5.2 Page 6 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.V346019.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.V346019.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 adequate. This judgement has been made using available evidence including a visit to this service. The home does not adhere to accepting 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 nursing assessment that was signed and dated on the day of admission to the home. The registered manager stated that this had been done earlier, but the documentation does not support this. The documentation did not show that a care needs assessment had been carried out prior to admission. The home is using the same form for pre and post admission assessments. This was identified as a requirement at the previous inspection in 2006. St Margaret`s DS0000009258.V346019.R01.S.doc Version 5.2 Page 9 Standard 6 is not applicable, as the home does not provide intermediate care. St Margaret`s DS0000009258.V346019.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): 7, 8, 9, 10 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health care needs of residents are identified, planned for in individual care plans that could be improved. Medicines are generally stored and administered safely. Residents said that they are treated with dignity and respect. EVIDENCE: The care plans contain relevant information, and show regular and frequent review by a nurse, but there is little indication of resident involvement in this. In respect of health care the daily entries are informative. The interventions required in order to meet residents’ care needs shown on care plans could be more descriptive, rather than using terms such as “ensure personal hygiene is met”. The entry should direct care and as such say how the carers are to meet care needs. The care documentation includes a comprehensive set of riskassessments (e.g. bed rails), and a ‘pen portrait’ of residents. Care staff maintain the personal and oral hygiene of residents who require assistance with such matters. Residents are assessed regarding the risk of St Margaret`s DS0000009258.V346019.R01.S.doc Version 5.2 Page 11 obtaining pressure sores; with appropriate preventative equipment provided as required. The incidence of any pressure sores are recorded and reviewed. All residents are registered with a GP. The home will refer to the District Nurse/Psychiatric Nurse for support and advice as required through the GP practice. Dental, optical, and chiropody services are provided. Medicines were seen to be appropriately stored and administered. Medicine Administration Records were seen to be in order, though prescriptions are often hand written and this was identified as a recommendation for best practice at the previous inspection in 2006. Staff were seen to move people in wheelchairs without ensuring that foot plates were properly fitted. A collection of foot plates was noted under the desk in the entrance area. The care documentation shows that there is liaison and referral to other healthcare agencies as appropriate. Medical appointments are recorded in the diary. Staff were observed to treat residents with dignity and respect. Reference to the residents’ privacy and dignity is made in all care plans. Those residents spoken with confirmed that they felt that they were treated appropriately and with due deference, and were generally complimentary of the staff and the care provided, though this was balanced by less positive comments. One resident describing the home as “average”, another said that they had “had accidents” waiting for staff to attend. St Margaret`s DS0000009258.V346019.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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. There is a range of social/recreational activities offered. Residents receive visitors at any reasonable time throughout the day, and are helped to exercise choice and control over their lives within the bounds of their individual capabilities. Dietary needs are met. EVIDENCE: There has been a significant improvement in the social/recreational lifestyle of the residents at St Margarets. The activity plan and comments from the residents support this. The daily entries in the care documentation still make sporadic reference to how people spent their day, more usually stating where they spent their day. The entries in the activity book have improved in detail and frequency, but more can be done to better reflect the lifestyle of the residents. 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 St Margaret`s DS0000009258.V346019.R01.S.doc Version 5.2 Page 13 views and/or concerns, and they felt that choice was available to them. The cook was seen going round the home asking for people’s lunch selection (ham or smoked fish). The inspectors used an observational tool to ascertain the level of activity amongst residents and the quality of staff interactions with residents. A selection of residents was observed over a 1½ hour period. Residents were seen to be in a positive state of well being (happy, contented, comfortable, relaxed), approximately 50 of the time, and engaged with their environment (actively watching/following, listening (music), or doing something to occupy time) for about 61 of the time. Approximately 33 of staff interactions with residents were judged to be good (Interactions that enhance personhood. They show warmth, are respectful and enabling, and providing residents with a feeling of safety. Are sensitive and assist individual to be in control of their actions and lives), the remainder being neutral (these interactions neither undermine nor enhance people. They are part of everyday care, often short requests or suggestions. They are simply an exchange of information). Lunch was observed to be a sociable occasion with the majority of residents eating in the communal areas. The menus indicate that residents receive a varied and appealing diet. Specialist diets are catered for. Food is prepared in a kitchen separate from the main building and situated in the car park. Heated trolleys are used to transport food to the dining room. Residents were generally complimentary about the food, though two residents commented that food is sometimes cold. The registered manager undertook to look into this, one option being to place the plates in the hot trolley as well. St Margaret`s DS0000009258.V346019.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Comments from service users were positive, but the home can do more to empower residents and staff. Residents are protected by an appropriate adult protection policy. EVIDENCE: A complaints procedure is in place, and the residents spoken with confirmed that they would feel able to express any concerns that they may have. The complaints procedure does not have the correct contact details for the Commission for Social Care Inspection, or the contact details for the local Department of Adult Social Care. This was identified as being needed at the previous inspection. The home’s Protection Of Vulnerable Adults procedure was in the policies and procedures manual. The protection of vulnerable adults procedure, refers to Cornwall Adult Services procedures, ‘whistle blowing’ and the ‘No Secrets’ guidance, and includes relevant contact details. There is insufficient evidence in the staff training records to ascertain the level of training provided in relation to adult protection. St Margaret`s DS0000009258.V346019.R01.S.doc Version 5.2 Page 15 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 adequate. This judgement has been made using available evidence including a visit to this service. The location and layout of the home is generally suitable for it’s stated purpose and provides a safe environment. The home was clean, and free from offensive odours. Bedrooms were comfortable and contained the personal possessions of the occupant. EVIDENCE: The home offers accommodation for 28 service users. There are 13 en-suite rooms with their own lavatory facilities. 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. Residents’ rooms were seen to be clean, comfortably furnished and personalised to varying degrees. A sudden change in weather had lowered the outside temperature considerably on the day of the inspection. This combined with a large number of doors being open (both external and internal), and building work to the front of the property led to a number of comments from St Margaret`s DS0000009258.V346019.R01.S.doc Version 5.2 Page 16 residents and staff that they were cold. The home should be able to respond to changes in temperature to ensure the well being of the residents. The building works at the front of the building have altered access for staff and residents alike, and the registered provider did not advise the Commission for Social Care Inspection of any such works. There are two sluice facilities. Recommendations have previously been made to provide proper rack storage in the sluice rooms, and this recommendation continues. The sluice rooms do not have a hand washing facility. The registered manager has previously been advised to audit the premises to ensure that there is sufficient and suitable hand washing facilities throughout the home. Bottles of alcohol solution were seen in corridors. The laundry is generally suitable and capable of meeting the demands of the home, a new washing machine has been provided with a sluice facility, and dissolving sacks are used in conjunction with this. The kitchen was seen to be orderly and clean, though a number of practical issues were discussed with the kitchen staff and the registered manager: • There is no telephone communication between the main building and the kitchen, which could put staff at risk in the event of injury or accident. • There is a need to manoeuvre the hot trolley over a door lip, down a ramp at an angle to the door, across the car park and over another door lip. There is no specified route so this may be blocked by parked vehicles. • There is no risk-assessment or manual handling assessment relating to kitchen duties. • The inspector was advised that the single domestic sink unit is insufficient for the commercial demand on it, and the kitchen would be better served by a large double sink unit, with a smaller wash hand basin in the corner. • The inspector was advised that the kitchen floor can be slippery. St Margaret`s DS0000009258.V346019.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 - Quality in this outcome area is poor. 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. It is not possible to reliably judge the skill mix of staff, or their training. Residents are not protected by the home’s recruitment procedure. EVIDENCE: At the time of the inspection there were 27 people living at the home. The registered manager, one nurse, four carers, one cook and a kitchen assistant, two cleaners and a laundry person were on duty. Comments from residents were generally positive about the staff and the care they provided. There is a current and accurate staff rota. It is not possible to ascertain the level of NVQ qualification in the home, as the personnel files are incomplete and did not contain the relevant certificates. The registered manager stated that all but one carer had achieved NVQ Level 2, but another member of staff also confirmed that they had not undertaken this training. The staff personnel files inspected showed that the home is not protecting residents by adhering to a robust employment procedure. Applicants are not providing, and the employer is not asking for sufficient detail in the job application form. References provided did not correlate with the referees given, and did not include the most recent employer. St Margaret`s DS0000009258.V346019.R01.S.doc Version 5.2 Page 18 Although the registered manager stated that the home has the relevant paperwork for a National Training Organisation compliant induction programme, this was not in use at the home. St Margaret`s DS0000009258.V346019.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is run by an experienced manager, though the requirements and recommendations identified in this report suggest that they may not be discharging their responsibilities fully. 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 generally positive about staff, and the registered manager was specifically mentioned as being “very nice”. The inspectors observed staff attending to residents’ needs in an appropriate and respectful manner. The residents confirmed that they are able to make meaningful choices in respect of their lives at St Margarets. The nature of the St Margaret`s DS0000009258.V346019.R01.S.doc Version 5.2 Page 20 requirements and recommendations identified in this report, some of which have been carried over from previous reports, are predominantly of a managerial nature and therefore cause for concern. The home has undertaken quality assurance questionnaires to residents, family and other relevant agencies. The registered manager undertook to ‘publish’ a summary of the findings. The inspector discussed the financial accounting procedures within the home with the registered manager. Records are supported by receipts, and the home is appointee for one resident only. There is documentary evidence of staff supervision having occurred and this is supported with staff initials, but this is infrequent and irregular. The home is generally well maintained with relevant safety certification and maintenance receipts available. More could be done to assess and minimise the impact of changes to the building on the residents and staff. St Margaret`s DS0000009258.V346019.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 St Margaret`s DS0000009258.V346019.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES 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 OP3 Regulation 14 Requirement The registered manager must ensure that new service users are only admitted on the basis of a full care needs assessment. The registered manager must inform the Commission for Social Care Inspection of any alterations or extensions to the home. The registered manager must ensure the safety of staff, residents, and visitors by completing relevant riskassessments and providing the appropriate facilities necessary for the function of an area or the staff working in it. The registered manager must ensure that staff receive the training relevant to the role they perform, including a National Training Organisation compliant induction programme. The registered manager must ensure that residents are protected. The registered manager must ensure that staff are DS0000009258.V346019.R01.S.doc Timescale for action 01/10/07 2. OP19 13, 39 01/10/07 3. OP28 OP30 18 01/04/08 4. 5. OP29 OP36 19 18 01/10/07 01/12/07 St Margaret`s Version 5.2 Page 23 appropriately supervised. 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 The registered manager should do more to ensure the involvement of the resident, or their representative, in reviewing care plans. Care plans should give clear direction as to the intervention needed in order to meet care needs. 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. Where the instructions are hand written by the supplying pharmacist, the home should discuss this matter with the pharmacist to acquire their signature on entries. The registered manager should do more to ensure that the range of social/recreational activities available is recorded in individual residents care notes. The registered manager should update the complaints procedure to show the correct contact details for the local Adult Social Care office and the Commission for Social Care Inspection. The registered manager should monitor and record the temperature in the communal areas to ensure a consistently comfortable temperature for residents. 2. OP9 3. 4. OP12 OP16 5. OP19 St Margaret`s DS0000009258.V346019.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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.V346019.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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