CARE HOMES FOR OLDER PEOPLE
St Margaret`s 25-27 Queens Road Harrogate North Yorkshire HG2 0HA Lead Inspector
Jean Dobbin Unannounced Inspection 6th December 2005 10:10 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.V270207.R01.S.doc Version 5.0 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.V270207.R01.S.doc Version 5.0 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 507503 01423 875151 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.V270207.R01.S.doc Version 5.0 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. 17th May 2005 Date of last inspection Brief Description of the Service: St Margaret’s is a large old detached house in a quiet residential street near to the centre of the town, and local amenities. It has three floors, with lawned gardens, with benches, to both the front and rear of the property. There are parking facilities behind the house. St Margaret’s provides personal and social care for twenty-five residents with dementia, over the age of 65. The manager and carers have good links with the community nursing and psychiatric team, as nursing care is not provided by the service. There are service users’ bedrooms on all three levels with two staircases and a passenger lift to aid access. There are five shared bedrooms and three rooms with private toilet. The rooms are different shapes and sizes in keeping with the age of the building. Service users can personalise their rooms if they wish. St Margaret`s DS0000007791.V270207.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This summary relates to an unannounced inspection on Tuesday 6th December 2005,lasting six hours including preparation work. The registered manager was present throughout the visit, and the registered provider for part of the time. The visit included a tour of the residents’ areas, both communal and private as well as looking at some care records and documentation about how new staff are recruited. There was the opportunity to talk with seven residents, three members of staff, and a visiting district nurse, whose comments are contained within the main report What the service does well: What has improved since the last inspection?
There has been some progress with assessing what kind of support residents will need whilst living at St Margaret’s, which enables residents to be treated as individuals. The staff are able to attend training sessions enabling them to give more appropriate care to particular residents. Staff members continue to work towards their NVQ Level 2 award. There is planned and ongoing refurbishment and redecoration of the bedrooms and corridors, so that the residents can live in more attractive surroundings. St Margaret`s DS0000007791.V270207.R01.S.doc Version 5.0 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. St Margaret`s DS0000007791.V270207.R01.S.doc Version 5.0 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 DS0000007791.V270207.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The residents’ needs are assessed prior to moving to the home, but a more comprehensive assessment would enable more individualised care to be planned. EVIDENCE: The care records of three service users were examined. One of these had moved to St Margaret’s since the last inspection. All the notes showed that there had been an assessment of the service user, by the manager, prior to admission. All showed that there had been discussion with the service users’ relatives. The assessment documentation has been changed for the most recent resident, however there is still insufficient detail to provide a total picture of the service users’ needs. There needs to be more detail about the person’s mental, physical and spiritual needs, as well as a social history, highlighting family relationships and important life events. This would enable the carers to communicate and care for the service user in a more individualised manner. St Margaret`s DS0000007791.V270207.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 The personal, social and health care needs of the service users are well addressed, but they are not underpinned with sufficiently detailed plans of care. EVIDENCE: The case notes of three service users were examined during the inspection. These specific notes were chosen as two of the three residents had more complex needs. All the notes had care plans in place, although they were not very easy to follow. They were reviewed monthly, however like the preadmission assessment they lacked detail and made assumptions about carer’s knowledge. For example a diabetic resident required a “suitable diet”, and another resident “needs help” with dressing. This lack of detail may affect a resident’s care, when provided by an inexperienced or unfamiliar carer. There are regular ‘handover meetings’, where changes in care needs are discussed by staff, and residents therefore receive consistent care. Risk assessments need an urgent review for all residents. This will ensure that the care provided to service users is as safe as possible. For example one resident has had several falls over the last three months, some requiring hospital attention. The risk assessment needs to be in much greater detail. Gaining advice and
St Margaret`s DS0000007791.V270207.R01.S.doc Version 5.0 Page 10 support from other professionals may bring about suggestions that will reduce the occurrence of these falls. In addition, these falls and other ‘untoward incidents’ affecting service users must be reported to The Commission. (See Standard 38) There was the opportunity to talk with a visiting community nurse, who described the care given to her ‘client’ as “absolutely amazing”. She felt that whenever she visits she can always find a member of staff and the staff seem to know what’s going on. She feels her client has received high quality and appropriate care. She also commented that there seemed to be a very stable workforce at St Margaret’s, which is beneficial for the residents. St Margaret`s DS0000007791.V270207.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None EVIDENCE: St Margaret`s DS0000007791.V270207.R01.S.doc Version 5.0 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None EVIDENCE: St Margaret`s DS0000007791.V270207.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The residents live in a secure, pleasant environment, where refurbishment is ongoing and needs to be sustained, in order to maintain the standard of the décor. EVIDENCE: A tour of the house was carried out at the start of the inspection. The general appearance and feeling is that St Margaret’s is a happy, clean and comfortable place in which to live. The communal rooms are bright with large picture windows overlooking the garden. Service users appeared very contented and those asked said that they liked living there. There is a planned refurbishment programme and there was evidence, on the day of inspection, of redecorating taking place and new furniture being installed. However some of the upstairs rooms still require some cosmetic work, including the two bathrooms, which were mentioned in the last report. Rooms 16 and 12 need re-decorating and a recent water leak means that two bedroom ceilings need repainting. Rusting grab rails in the toilet in Room 1
St Margaret`s DS0000007791.V270207.R01.S.doc Version 5.0 Page 14 need removing or replacing. This work needs to be completed in order to improve the surroundings for the residents. One room smells of urine, which the manager is aware of, and this requires attention. The external doors are secure and there is a call bell system in place in all the bedrooms. Many of the service users do not use the system however because of their mental impairment. The staff rely on regular and frequent checks to ensure their residents’ safety. Appropriate assessments of those residents unable to use the call bell system are needed to identify those most at risk. There is a small smoking area within St Margaret’s however it has no venting to the outside, its only ventilation being into the corridor, with the resident’s dining room very close by. St Margaret`s DS0000007791.V270207.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 Whilst the home ensure that new staff are supported, in order to fully protect residents, they must not deploy new staff without CRB or POVAfirst being in place. EVIDENCE: There was the opportunity to look at the recruitment file belonging to a staff member, who had recently started work at St Margaret’s. There was evidence of two references and the carer was being supervised by a named, experienced carer, pending the return of statutory CRB checks. There was however no evidence of a POVAfirst check, before deployment, which is required to ensure service users are in safe hands. St Margaret`s DS0000007791.V270207.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 Hot water temperature records are not in sufficient detail and do not demonstrate that residents are being protected from harm. EVIDENCE: The records of hot water temperatures were examined. The monitoring is not carried out often enough; the actual temperatures are not recorded; and there is no written identification of individual rooms. This checking needs to be carried out more often, to ensure that residents and staff are not put at risk, and the details properly recorded to evidence this. It became evident during the inspection that untoward incidents affecting residents are not always being reported appropriately to the Commission, as required by regulation (See Standard7). St Margaret`s DS0000007791.V270207.R01.S.doc Version 5.0 Page 17 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 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X X X 2 STAFFING Standard No Score 27 X 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 1 St Margaret`s DS0000007791.V270207.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13.4 Requirement Timescale for action 06/03/06 2 OP29 19.1.b 3 OP38 13.4 4 OP38 37 Where care plans demonstrate areas of risk to residents, there must be a detailed risk assessment in place to address this From the time of the next 06/12/05 employment, and thereafter, all staff must have a POVAfirst check prior to starting work, if the manager is unable to wait for the CRB certificate. Actual hot water temperatures 06/01/06 must be recorded and documented regularly on a room-by-room basis All accidents and incidents 06/12/05 affecting the service user must be recorded and reported to the Commission, as required by Regulation 37 of the Care Standards Act 2000 St Margaret`s DS0000007791.V270207.R01.S.doc Version 5.0 Page 19 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 Refer to Standard 3,7 19,26 Good Practice Recommendations There should be more detail recorded in the initial assessment. This should enable more individualised care plans to be constructed. The following areas need addressing to improve the environment for the residents:2 upstairs bathrooms Rooms 12 and 16 need re-decorating Bedrooms affected by recent water leak need ceilings painting Rusting grab rails in the toilet, within Room 1, need removing or replacing Cigarette smoke from the smoking room needs to be vented to the outside, rather than into the building. St Margaret`s DS0000007791.V270207.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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