CARE HOMES FOR OLDER PEOPLE
St Margaret`s 25-27 Queens Road Harrogate North Yorkshire HG2 0HA Lead Inspector
Kate Shackleton Key Unannounced Inspection 23rd November 2006 08:30 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 DS0000007791.V321150.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 DS0000007791.V321150.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Margaret`s Address 25-27 Queens Road Harrogate North Yorkshire HG2 0HA 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) 01423 529544 01423 875151 info@stmargarets.biz Mr John Kneller Mrs Wendy Margarita Kneller Mrs Ann Elizabeth Hayton Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25) of places St Margaret`s DS0000007791.V321150.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service Users to include up to 25 (OP) and up to 25 (DE (E)) up to a maximum of 25 Service Users. 18th July 2006 Date of last inspection Brief Description of the Service: St. Margarets provides a care service to 25 people with dementia who are over 65 years of age .The home is situated in a residential area of Harrogate with good access to the towns services and amenities. At the time of this visit the weekly charge ranges from £340 to £430.Not included in this charge is hairdressing, chiropody, papers and taxis. The Service Users Guide tells service users /representatives about the service and the Commission for Social Care inspection report is displayed on the notice board in the home. St Margaret`s DS0000007791.V321150.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The accumulated evidence used in this report has included: • A review of the information held on the home’s file. • Information submitted by the registered provider in the Pre Inspection Questionnaire. • Feedback from six service users surveys. • An unannounced visit to the home which lasted eight hours and included a tour of the premises, talking to service users, care staff and management. Examining some records and observing staff working with service users. Requirements made at the last inspection were checked What the service does well:
Service users live in a clean, comfortable home. Staff are kind and helpful and make an effort to provide the service in the manner that service users want. Routines are flexible and emphasis is placed on treating people who use the service with respect and enabling them opportunities to exercise choice in key areas of their lives. Examples given included rising and retiring times, clothes, food and activities. Comments heard from service users included “ It is very comfortable and staff are very kind.” and “helpers are very good and very patient.” Service users are able to access the primary health care team and other health professionals ensuring that their health care needs are met. A good choice of food and drinks are available. This provides service users with a varied nutritious diet, which promotes good health. Visitors are encouraged and made welcome. This helps service users maintain contact with family and friends. Regular service user and relatives meetings take place. This enables any interested parties the opportunity to be involved in the running of the home. There is a variety of activities designed to interest service users and encourage participation to overcome boredom and isolation. People who use the service are supported to follow their religious beliefs. There is a clear and user-friendly complaints procedure and complaints are taken seriously. This promotes openness and transparency, which helps St Margaret`s DS0000007791.V321150.R01.S.doc Version 5.2 Page 6 relatives and others on behalf of service users to say if they are not happy with any aspect of the service. The staff are provided with comprehensive training to improve their knowledge and skills. This makes sure that service users receive care from a wellinformed staff team whose practice is up to date. What has improved since the last inspection?
There has been significant improvements since the last inspection and all but one of the requirements made at that time have been complied with. A revised “Residents Guide “ has been produced providing service users and relatives with clear useful information about the service they can expect to receive at St Margaret’s. Service users are properly assessed to identify what their diverse care needs. A plan of care is produced giving staff clear guidance about the service that they have to provide to meet peoples needs. The manager and staff have undertaken more training this ensures that service users receive a service from a better-informed staff team whose practice is up to date. The activities programme now incorporates the type of activities that service users have expressed an interest in. The Complaints policy and procedure has been revised to make it easier to understand and more accessible to service users/relatives. Some work has been completed on the environment to make it a pleasanter living space. Work is underway to improve the number and nature of the bathing facilities, which will afford service users more choice. A number of safety issues have been addressed making the home a safer place to live. Improvements to the recruitment process minimises the risk of unsuitable staff being employed and therefore promotes the safety of service users. A system for ensuring that standards are maintained and improved is being implemented. The views of service users and their relatives are sought as part of this quality assurance process. A new set of Health and Safety procedures have been introduced to guide staffs practice. This minimises the risk of harm or injury making the home a safer place for service users to live. St Margaret`s DS0000007791.V321150.R01.S.doc Version 5.2 Page 7 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 DS0000007791.V321150.R01.S.doc Version 5.2 Page 8 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 DS0000007791.V321150.R01.S.doc Version 5.2 Page 9 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 and 3. Standard 6 does not apply to this service. Quality in this outcome area is good This judgement has been made using available evidence including a visit to the service. Prospective service users have their needs assessed prior to admission to make sure that the service can deliver the care needed. EVIDENCE: Case tracking confirmed good practice. All service users have recently been reassessed and potential service users are properly assessed prior to an admission date being arranged. The manager visits potential service users/relatives to discuss their needs and answer any questions they may have about living at St Margaret’s. Service users/representative are offered the opportunity to visit for a look around. Service users spoken to were unable to recall any of the circumstances surrounding their admission to the home. Feedback from surveys confirmed that people were given enough information about the home. Four of the six
St Margaret`s DS0000007791.V321150.R01.S.doc Version 5.2 Page 10 surveys returned confirmed that enough information was provided about the home before an admission date was confirmed. The remaining two did not provide information relating to St Margaret’s, but stated that their choice of home was limited due to hospital discharge arrangements and St Margaret’s was the only home available. All of the surveys confirmed that contracts had been received. Files examine confirmed this. The contract is clear about what the service users can expect for the fee that they pay. Staff spoken to said that they were informed about all new admissions and were able to read the assessment as well as discussing how the care service will be delivered in order to meet the persons needs. People who use the service or their relatives are provided with a “Resident Guide” this gives the details of the service and facilities provided as well as the terms and conditions of residence. St Margaret`s DS0000007791.V321150.R01.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users health and personal care needs are met. EVIDENCE: Files examined included comprehensive care plans detailing the type of service that staff has to deliver to meet the personal, health and social needs of the service user. Plans include a range of risk assessment’s that guides staffs practice. Information provided enables staff to manage risky areas of people’s lives in a safe and competent manner. Relatives are consulted and sign the care plans on behalf of the service users. Regular reviews are conducted to ensure up to date information is available. Plans are changed as and when changes to care needs dictate. Staff act as key workers for named service users. Staff spoken to were aware of the care planning process and discussions had taken place in a recent staff meeting about them being more involved in developing the plan with the service user. Staff were observed providing support in a kind and helpful manner and service users looked clean and well cared for.
St Margaret`s DS0000007791.V321150.R01.S.doc Version 5.2 Page 12 Service users spoken to made comments like “ It is very comfortable and staff are very kind.” And “helpers are very good and very patient.” Feedback from surveys confirmed that service users always receive the care and support that they need. One survey said that the care is “exceptional” There remains an outstanding issue from the last inspection relating to the respect for the privacy and dignity of service users when it comes to discreetly managing incontinence. Previously seat covers were placed on the chairs of service users who suffered from incontinence thus highlighting their particular situation to anyone visiting the home. The remedy for this has been to place seat covers on everybody’s chair following a survey of relatives to get their views. This action further compounds the breach of people’s dignity and is therefore poor practice. The responsibility for this course of action lies with the homeowner who wants to protect the furniture. The use of appropriate incontinence wear and other measures should make it unnecessary to use these types of seat covers. Service users are registered with a General Practitioner and are able to access the primary health care team and other health care professionals. Surveys confirmed that service users always receive the medical support that they need. Discussions take place to decide who is to be responsible for looking after service users medicines and it is usually the case that the service takes responsibility for them. Medications managed and administered by staff are undertaken in a safe manner and appropriate records kept. The medicine trolley is stored in the corridor outside the dining room. Best practice dictates that it should be stored in an area that has hand washing facilities and sufficient work surfaces with appropriate security measures. St Margaret`s DS0000007791.V321150.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. Flexible routines promotes the type of lifestyle that meets the differing needs of service users. EVIDENCE: From observations made on the day, routines appear flexible. Service users were observed moving freely around the home, some were listening to music others watching the television. During the afternoon a member of staff organised a Quiz game. Staff spoken to were able to give numerous examples of how they support service users to make their own decisions in key aspects of their lives. Examples given included: rising and retiring times, clothes to wear and food. Staff were observed delivering the service in a manner that offered choices to service users and respected their right to remain in control. There is a comprehensive activities programme and the staff arrange an activity most afternoons. Service user plans include details about the type of activities that service users enjoy. A record of group activities is kept.
St Margaret`s DS0000007791.V321150.R01.S.doc Version 5.2 Page 14 Feedback from surveys confirmed that activities that service users can take part in are arranged. The home will make arrangements for service users to either attend church or have clergy visit. There is an open visiting policy with no restrictions. Visitors are made welcome. At the time of this visit visitors were seen in the home. Service users can see their visitors in private either in their bedrooms or a “visitors room”. Menus examined show a choice of food at every mealtime. Staff were observed offering people choice and providing appropriate support to service users who needed help with feeding. Service users who don’t want to eat in the dining room can sit at a dining table in one of the lounges. Some service users were seen taking advantage of these arrangements. Service users food preferences are known and special diets are catered for. Surveys returned were limited in the information provided, three suggested that service users always liked the meals and three suggested that they usually did. One commented, “ I could not recommend the food at St Margaret’s more highly”. Dining room tables were set with appropriate cutlery. Mealtimes were relaxed and unhurried allowing service users as much time as they needed to complete their meal. Service users confirmed that they liked the food. St Margaret`s DS0000007791.V321150.R01.S.doc Version 5.2 Page 15 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. An easily accessible complaints procedure and an informed staff team promotes good service delivery. EVIDENCE: There is a revised easy to understand complaints procedure that is included in the Service users Guide. The guide is given to every service user or their representative. Discussions with staff confirmed that they understand the complaints procedure and that if they suspected or witnessed any abuse of service users they would report it to the manager. Staff receive training in this aspect of their work. Surveys received confirm that relatives /representatives know who to complain to. The complaints record examined shows that the one complaint received since the home was last inspected was responded to in a timely manner St Margaret`s DS0000007791.V321150.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. To empower and enable service users a more dementia friendly environment needs to be created. EVIDENCE: The home has a friendly atmosphere and is fresh and clean. The two lounges are spacious and overlook well-kept front gardens with seating areas. The premises are arranged over three floors with few considerations given to environmental issues that help people who have cognitive impairment or dementia care needs to be more independent. Most bedrooms have basic furnishings and service users are invited to bring in their own items. Three bedrooms have ensuite facilities. All of the shared bedrooms have screening to provide privacy. Currently work is underway to improve the bathing facilities. One bathroom has a hoist. When the work is completed the home will have two assisted baths with hoists and a shower/wet
St Margaret`s DS0000007791.V321150.R01.S.doc Version 5.2 Page 17 room. The work on the shower/wet room has started. Toilets are strategically placed around the house. Notices continue to be pinned up around the home instructing staff about their duties. This institutional practice is a poor management strategy for the proper support and guidance of staff. It is also not conducive with promoting a relaxed comfortable environment for service users. This issue was raised at the last inspection. One service user said she felt cold so an additional fan heater was brought into the lounge and the seating was rearranged to move the chairs away from a large bay window. A number of radiators around the house were not working. An unguarded freestanding radiator was in the dining room to provide additional heating. This is a safety hazard. Action was taken to get the radiators working. St Margaret`s DS0000007791.V321150.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a properly vetted and appropriately trained staff group EVIDENCE: Staff were observed responding appropriately to service users and spent time talking to them in order to understand their wishes. The rota showed that there is enough care staff on each shift taking into account times of peak activity. Staff spoken to say that they generally had enough time to deliver the service. Feedback from surveys show that in their opinion there is usually sufficient numbers of staff on duty. One relative commented “Staff are fully hands on and always within sight of the service users”. Staff files examined showed a robust recruitment process ensuring that only suitable people are employed. St Margaret`s DS0000007791.V321150.R01.S.doc Version 5.2 Page 19 There is an induction programme that ensures new staff members are given the right information to be able to do their jobs. Staff spoken to said that the on going training programme provides them with the skills and knowledge to meet service users needs. The training programme includes the mandatory training needed to meet service users basic needs such as First Aid, moving and handling and Health and Safety. Specialist training provided includes dementia care, abuse awareness and infection control. 66 of the care staff has achieved National Vocational Qualification level 2. St Margaret`s DS0000007791.V321150.R01.S.doc Version 5.2 Page 20 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 and 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 managed in a manner that seeks to ensure that service users and their representatives are comfortable and content with the service provided. EVIDENCE: The manager has achieved a recognisable qualification for managing a care home. She has undertaken additional training relating to managing a care service for people with dementia care needs. Staff and service users say the manager is easy to talk to and approachable. Feedback from surveys also confirm this to be the case. Comments included “ A very well run friendly clean care home, where care for the service users is the main concern of all levels of staff” St Margaret`s DS0000007791.V321150.R01.S.doc Version 5.2 Page 21 The service actively encourages the involvement of service users, family, friends and advocates. Six monthly meetings are held where ideas for improvements can be put forward. Management are working on a Quality Assurance scheme that will ensure that standards are maintained and improved. Surveys of all service users or their representatives to seek their views has already been done. Regular staff meetings and individual staff supervision encourages an open and transparent management style that concentrates on the needs of service users and the proper support of staff. The management operates a system that protects service users from financial abuse in circumstances where service users money is held for safekeeping. The home works to a clear health and safety policy and regular safety checks are carried out. Some randomly selected records and safety certificates were looked at and were up to date Requirements made following the last fire and environmental health officer’s visits have been actioned. The necessary work has been completed. St Margaret`s DS0000007791.V321150.R01.S.doc Version 5.2 Page 22 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 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 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 St Margaret`s DS0000007791.V321150.R01.S.doc Version 5.2 Page 23 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 OP10 Regulation 12(4) Requirement The registered person must make suitable arrangements to ensure that the home is conducted in a manner, which respects the privacy and dignity of service users. Incontinence pads must be removed from the lounge chairs. Timescale of the 31/07/06 not met. The management of incontinence must be so discreet so as not to 08/12/06 compromise services users privacy and dignity. Arrangements must be made to ensure that any unguarded 08/12/06 additional heaters do not place service users at risk of injury. Timescale for action 2 OP19 13(4) St Margaret`s DS0000007791.V321150.R01.S.doc Version 5.2 Page 24 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. 2 3 Refer to Standard OP7 OP9 OP19 Good Practice Recommendations Staff should be involved with working with the service user to develop the care plan. The medicine trolley should be moved from the corridor and stored in a more suitable place. All the radiators should be working. If additional heating is needed, this should be risk assessed and properly guarded. Someone should be responsible for checking on a regular basis that the radiators are working efficiently. Staff notices should not be displayed around the home. Consideration should be given to making the home more user friendly for people with dementia care needs. St Margaret`s DS0000007791.V321150.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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
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