Inspection on 14/12/07 for St Margaret`s Care Home, Grimsby

This inspection was carried out on 14th December 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 Care Home, Grimsby 17/12/08

St Margaret`s Care Home, Grimsby 18/01/07

St Margaret`s Care Home, Grimsby 09/02/06

St Margaret`s Care Home, Grimsby 25/01/05

St Margaret`s Care Home, Grimsby 04/08/04

St Margaret`s Care Home, Grimsby 05/03/04

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

CARE HOMES FOR OLDER PEOPLE St Margaret`s Care Home, Grimsby Littlecoates Road Grimsby North East Lincs DN34 4NQ Lead Inspector Mrs Kate Emmerson Unannounced Inspection 14th December 2007 09:30 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 Care Home, Grimsby DS0000002802.V356568.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 Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Margaret`s Care Home, Grimsby Address Littlecoates Road Grimsby North East Lincs DN34 4NQ 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) 01472 241780 01472 250243 enquiries@sunhealthcare.org Sun Healthcare Limited Position Vacant Care Home 56 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (47), of places Physical disability (9) St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th January 2007 Brief Description of the Service: St Margaret’s is a purpose built residential and nursing home. The accommodation is provided over one level. Nursing care is provided in the home, and there are two specialist areas within the home that provides care for EMI and Huntingdon’s Chorea service users. The home is close to local services, shops and public houses. It is also on a bus route in to the town centre of Grimsby. Fees for the service range from £329 - £661 per week. Additional charges apply for Hairdressing - costs vary, chiropody - £8.00, toiletries - costs vary, top up for double rooms used as single and rooms with ensuite - £10. St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one and a half days in December 2007. To find out how the home was run and if the people who lived there were pleased with the care they received t the inspector spent time watching how the care was given. The inspector spoke to the manager, some of the staff working in the home at the time of the inspection and people who lived in the home. Surveys were sent to the home and completed surveys were received from four staff, nine service users and five relatives/visitors. Paper work kept in the home was also seen, this included records to make sure that the staff were safe to work in the home and that they had been trained to their job. Records of the care provided were also examined. Whilst the report shows there are still some areas requiring work there had been significant efforts to improve the service. The changes in manager in 2007 had resulted in incomplete/inconsistent application of some processes. However the staff and people living in the home felt that there was overall improvement. What the service does well: The home was very clean and tidy, had a very friendly feeling and had lots of space in the communal rooms where could people sit and relax or eat their meals. The staff were very friendly and knew about the care the service users needed. Most of the care people needed was written down and was checked often by the staff to make sure that there had been no changes. The records that the staff write every day about the people who live there clearly show how the person has been and the care that was given. The home cared for some very ill people and some were cared for in bed all the time. The staff made sure that they were kept comfortable in bed and used lots of pillows and special mattresses to help them. People living in the home were generally very positive about the care they received and the staff who worked there. They stated that they enjoyed the meals provided and said that if they didn’t like what was on the menu they could something else. St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 6 The home was working towards the targets for half the staff to be qualified carers. The home had people who have very different types of illnesses and some of the staff had received some training in Dementia and Huntingdon’s Chorea to make sure they understand how this affects people and how care must be given. The home had regularly assessed the quality of the care it provided and involved the service users and professionals who visited the home in this process although the new manager will require instruction in this area to ensure this continues. The activities are organised by an activities coordinator. The activities are varied and provided in groups and individually for people even those who were bed dependant. What has improved since the last inspection? What they could do better: The registered person must ensure that a contract has been provided to all people living in the home so they have all the information they need about the home. They must improve consistency in record keeping in care files and ensure that care identified in care plans is followed to ensure that peoples health and personal care needs are met and people are not put at unnecessary risk. They must make sure that staff on duty are able to know when the call bell is activated so that people can get the care need without waiting too long. They St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 7 must ensure that there are enough suitable bathing facilities for the people who live in the home. They must make sure that there is enough staff on duty to provide care and supervision and those records accurately show who is on duty at any one time. They must provide evidence that staff are adequately trained and that staff are supervised on a regular basis. They must ensure that medication records are clearly and accurately maintained. Where people have particular needs around the medication this must be written in the care plan and agreed. They must make sure that the home is kept safe for people by ensuring cleaning fluids are locked away and fire doors are not propped open 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 Care Home, Grimsby DS0000002802.V356568.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 Care Home, Grimsby DS0000002802.V356568.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): 2, 3 and 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs were assessed prior to admission to the home and plans of care were developed from the information gathered. A written contract/statement of terms and conditions was provided on admission to the home although there was some evidence that this may not have been consistently applied. The home does not provide intermediate care. EVIDENCE: The home had a policy and procedure in place to support practise in the assessment and admission of service users. St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 10 The files observed provided evidence that assessments were completed prior to admission to the home by on of the nurses. Assessments of care needs included the assessment of service users personal care, diet, sight, hearing, medication, continence, risks, mobility, history of falls, and mental state needs. The individual case files also evidenced if the nursing needs were met by the nurses in the home, or through the District Nursing team dependent on the terms of the individuals placement in the home, and whether they were residential, or nursing service users. The Royal College of Nursing assessment tool was used to determine the nursing requirements of people admitted for nursing care. There was evidence that assessments and care plans completed by Social Services were also obtained and held on file. Care plans for all the service users had been developed from the information gathered at assessment. The staff confirmed that they had been provided with the information required to provide care prior to people being admitted. There was evidence that people were provided with a contract/statement of terms and conditions that include a statement of fees to be paid and detailed who was responsible for payment of the fees. However the manager was advised to check that everyone had received a contract as five of the eleven people who responded to surveys stated that they had not received a contract/statement of terms and conditions. St Margaret`s Care Home, Grimsby DS0000002802.V356568.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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There was continued improvement in care planning but there was a lack of consistency in detail and people were put at risk when the care instructions were not followed. The management had continued to monitor the quality of care planning and was actively trying to improve this area. Medication records were not clearly maintained in all cases, which could increase the risk of errors. There was improved practise in relation to ensuring peoples privacy and dignity and care plans supported practise in this area. EVIDENCE: Seven care files were examined during the inspection. St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 12 Across both units there was evidence of very good practise in care plans which were generally very detailed re general care/nursing needs and reflected the needs identified at assessment. Overall there was improvement in the standard of care planning. The care plans supported people’s independence and identified particular risk areas such as risk of choking. However the instructions were not always followed. For example where one person was at risk of choking the care plan gave clear instructions about positioning the person both in the chair and in bed and stated that the person should not be laid on their back. In turn charts it was clearly recorded on at least two occasions that the person had been turned to lie on their back. This would be a risk to their health and safety. Records of wound care were very detailed and identified the progression of healing of a wound and the dressings used. There were detailed records where specialist health professionals had had input in the service users care. Daily diary sheets had improved in terms of the detail in the records and consistency of application. There was some improvement in the detail of evaluations of the care plans and some very good practise seen in this area. However in some files, evaluations were still not detailed and consisted of a date and signature with little or no information as to the health and welfare of the individual. There was little evidence that some of the evaluations took into consideration weight charts and other monitoring charts. There was some evidence that the manager was continuing to try to improve the quality of the care plans and educate staff but she had not always recorded her actions. There was evidence in most of the care plans viewed that the service users had agreed their care plan. Care plans were kept in service users own rooms so they have access to them. The nursing staff administered all the medication. Medication records were viewed. Records for the receipt, disposal and administration of controlled medication were maintained but some of the recording was untidy and unclear and errors in recording were noted although the manager had addressed these. Records for the administration, receipt and disposal of other medication were completed and recording had improved since the last inspection. Where there had been changes to the prescription mid cycle, the records of the changes had not always been dated and signed by the person altering the record. Most of the prescription instructions were printed on the medication administration records but hand transcribed instructions for administration of medication had not been signed or witnessed. This is recommended to ensure St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 13 correct and clear instructions have been recorded. In one case where a person sometimes refused to take medication this was given in their drinks. The person had been in hospital and a care plan for this practise had been developed for the persons stay on the ward. The home had continued to use this care plan and could not provide evidence that they had discussed and agreed this care plan with the persons GP on his return to the home. Direct, and indirect observations during the inspection provide evidence that people were treated with dignity, and respect. Care plans had been developed to support people’s independence and ensure privacy and dignity was maintained. This was particularly evident in the EMI unit care plans. There was access to a public telephone in the entrance area of the home or use of one of the office telephones for private calls. People could have a telephone in their rooms if required. Mail was given to individuals unopened or to families where this had been agreed. Screening was provided in all shared rooms to uphold, and maintain privacy and dignity during care provision. Staff were provided with training in promoting privacy and dignity during induction. St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 14 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Visitors were encouraged to access the home and maintain contact with family and friend’s who lived there. There had been continued improvements in the activities available, these were individualised and incorporated activities for those who were bed dependant. The menus had been improved and people were offered a varied and balanced diet. Significant efforts were being made to improve the dining area. EVIDENCE: St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 15 Direct observations evidenced that visitors were encouraged to access the home, and that the staff were supportive, and welcoming to them. Visitors were positively encouraged to assist in the care provision of their relatives and two relatives were seen assisting with meals. The relatives were clear to point out that this was because they enjoyed still being involved in their carer’s role and not because they felt they had to. There was evidence that continued efforts had been made to improve the activities in the home and make these available to all the people who live in the home. An activities coordinator was employed 30 hours per week. She was an experienced carer and had previously worked in the home. She confirmed that the majority her hours were involved in activities and her other role was to provide an escort on transport for the day care service users. The coordinator stated that she now had a plan for activities and this was displayed in the foyer. This included individual activities, as many of the service users are bed dependant, and group activities. Records and direct observation evidenced that she spends time reading books and papers to service users, also chatting, nail care and playing cards and dominoes. The records also showed that there had been external entertainers such as singers. There had been events to celebrate occasions such Christmas and bonfire night. The coordinator stated she would assist people to meet religious needs where identified and currently sat and read the bible to individuals where this was requested. Whilst the activities plan was now displayed there remained varied comments from staff and people who live in the home regarding the availability and/or frequency of activities. Some felt there were not enough activities in the home and staff stated that they didn’t have time to be involved with the provision of activities. The staff did demonstrate that they had an understanding of people’s likes and dislikes in this area and described how they assisted people. For example they were aware that one person liked to watch the football and made sure that he was informed when this was on and ensured he access to a TV. The management were in the process of decorating and reconfiguring the dining room in the main part of the home. This was going to provide a dedicated area for activities and this should enable the coordinator to further develop and promote her work. Surveys indicated that overall people were happy with the meals provided. The staff also thought the food was good and commented on the variety of choice available and the presentation. St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 16 The chef showed the inspector the menus. These had been improved and provide a single four-week rotating menu. The menu offered choices at each mealtime. Individual’s dietary needs and likes and dislikes were recorded and the chef had a good working knowledge of these. There was evidence that where people required a specific diet, such as a vegetarian diet, these needs were met. Liquidised diets had improved and they were well presented and were freshly prepared from the main menu. The records relating to the safe preparation and storage of food were complete and up to date and records of food served were maintained. The kitchen staff had received training relevant to their role. There was evidence of home baking and the chef stated that they were doing baking on a regular basis. The kitchen was very clean and tidy and the chef stated that they had been provided with new equipment. Staff were seen assisting service users in a sensitive manner. However there was one incident where a person’s meal had been left out uncovered on a bedside table whilst a staff member came to feed the person. The food may also have become cold during the wait and may not be pleasant for the individual who was unable to vocalise if this was the case. The majority of the people were served their meals in their rooms or in the communal lounges. It was very pleasing to see that the dining room on the nursing/residential unit was being improved at the time of the visit. The room was being redecorated and new furniture had been purchased. Comments about the food from people who lived in the home included ‘the food is very good’, ‘meals are very good’, ‘the meals are fine, if I don’t like what’s on the menu I get something else’ and ‘the meals are great’. Staff stated that the food had improved and that the cooks were tying different meals. St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 17 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service users had access to a complaints procedure and complaints were treated seriously. The homes policies and procedures, recruitment processes and staff training protected the people in the home. EVIDENCE: The complaints records showed that there had been four complaints since the last inspection two of which had been referred to the safeguarding adults team for investigation these were not substantiated. The records showed that complaints were taken seriously and evidence the investigation process and contact with the complainant. The complaints procedure was displayed in the home and made available in each bedroom and in information provided by the home. There was evidence that the majority of staff had received training in safeguarding adult’s procedures and signs and symptoms of abuse. Of the forty-three care/nursing staff all but five had received training. Those staff spoken to showed that staff had a good understanding of the terms protection St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 18 of safeguarding adults and whistle blowing. Staff also found the manager to be approachable. The home had clear policies and procedures for safeguarding people in their care and this also relates to the reporting systems of the Local Authority. The home has an appropriate whistle blowing policy. All checks had been completed to ensure that staff were safe to work with vulnerable people prior to employment. St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 19 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, 20, 21, 22, 25 and 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provided a clean, tidy and well-maintained environment and there had been continuous work to improve the environment. There were some issues that may put people’s health and safety at risk. EVIDENCE: The home was built on one level and was accessible to people in wheelchairs. Generally the home was clean, tidy, odour free and well maintained and there was evidence that the redecoration programme was continuing. There was a variety of communal space available. The communal space was generally homely and domestic in character. There was work in process to St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 20 improve the dining room in the main part of the home and lounge in the Royal unit. This was a requirement that had been outstanding for some time and it was very pleasing to see the significant efforts to improve these areas. At the last inspection it was identified by the staff, that the bath on the Wybers unit was unable to be used due to the bath seat being very slippery when immersed in water. The staff also stated that the service users were unable to use the type of bath hoist provided in this bathroom. There has been no work completed to address this and the manager reported there were no plans to make any alterations to the bathroom or replace the hoist. One of the directors at the last inspection stated they felt the bathroom and hoist were serviceable but there were no service users accommodated that could use the type of hoist in this bathroom. The manager was advised to continuously review provision for bathing to ensure that there were sufficient facilities to meet the needs of those accommodated. The pressure on the bathing facilities in the home had been resolved in part with the provision of a new shower trolley and by issues with the water temperatures on Royal unit having being addressed. During a tour of the building it was noted that there were some people being nursed in bed, they had been well positioned through the use of pillows and looked very comfortable. The new manager was looking at options that would enable more people to be safely sat out of bed. The problems with the variable temperatures of the hot water in the bedrooms and bathroom in the Royal unit had been addressed. It was noted that on testing the call alarm from a persons bedroom on the nursing/residential unit that staff took in excess of five minutes to attend plus some of the staff were just wondering past. When questioned the staff were not aware of the call bell having been activated because they were not carrying an individual unit which alerts staff. Individual units were not provided to all staff and only 3 units were available in the home. The staff in Royal unit did not carry a unit at all so would be unaware if a staff member was dealing with an emergency in a bedroom and needed assistance unless the staff member was able to call out. Two people complained during the inspection about staff taking an excessive amount of time to answer the call bells. Neither had complained to the management as they felt that the reason was due to low staffing levels. The call bell system provides a print out which shows when the call bell was activated, a small random sample showed that the call bell was usually answered quickly. The manager was advised to complete further reviews on the system to ensure people’s needs are being met in a timely manner and to ensure all staff have a unit so they can be alerted when a bell is activated. St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 21 Two members of staff had attended a train the trainer course in infection control to enable the home to provide training in house and this subject was also incorporated into other training such as catheter care. There were some issues with regard to fire doors and uncontrolled access to cleaning fluids, which may put service users at risk but these have been detailed under standard 38. St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 22 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 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Adequate staffing levels had not been provided on a consistent basis due to staff turnover and sickness rates. However this was an improving situation since the new manager had implemented a number of short and long term measures to try and improve the situation. A programme of varied staff training was provided including mandatory and specific training to meet the needs of those people accommodated and NVQ training. However there was insufficient evidence to show that all staff had completed adequate training. Recruitment procedures had improved and people were now protected. EVIDENCE: People who lived in the home were highly dependant, the majority of which needed two carers to assist them with personal care and provide assistance with toileting and pressure relief. A high proportion of people required assistance with feeding. Needs could not be adequately met on day shifts with less than nine care staff on duty plus two trained nurses. The home had been St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 23 struggling to provide these levels on a consistent basis with staff sickness and staff turnover having an impact. The staff rotas did not clearly or accurately show who was on duty at any one time and showed that there may not have been sufficient staff on duty on some shifts. The staff spoken with stated that there had been some issues with staffing levels but this had improved with the new manager and agency staff had been provided to cover shortages recently. The new manager had also stopped the staff coming on duty at staggered to ensure that sufficient staff were on duty at the start/end of a shift. The manager had identified that there were insufficient staff employed to provide the numbers required on shift on a consistent basis particularly at times of sickness and she was in the process of recruiting new staff at the time of the inspection. The manager was requested to provide staff rotas to the Commission on a weekly basis. The people who lived in the home all had positive comments about the carers. However they had noticed that the home was short staffed at times To some extent they accepted this and had not complained even where this affected the care they were receiving, such as call bells not being answered very quickly. One person said ‘the staff are good’ another said the staff at night are good’ and a visitor said that they ‘are good carers’. Another relative stated ‘sometimes more carers are needed’. There was some evidence that induction training was provided to Skills for Care standards although records were not available for all staff. There was evidence that new staff were given a basic introduction to the home and the procedures on their first day. There was a training matrix, which showed that staff had received mandatory training including fire safety and moving and handling. However the staff training files, which should have contained all the certificates, contained very little evidence to support the information on the staffing matrix and certificates could not be found on the day of the inspection. Staff confirmed that they had received a variety of training. The manager was able to provide evidence of courses booked which were wide ranging and included training specific to the needs of the people living in the home. There was no specific training plan for the nurses who worked in the home. The home was committed to provision of NVQ training, of twenty two care staff seven staff had completed NVQ 2 and nine were working towards NVQ 2. Staff were also encouraged to work to wards further NVQ qualifications. The home had also provided a small group of staff with training in Huntingdon’s disease via the specialist nurse in this area. St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 24 Three care staff and one nurse’s recruitment files were checked, these were new starters since the last inspection. Of these all contained checks required for employment. All the staff had been employed on receipt of a POVA first check and prior to a full CRB check being obtained, whilst this is acceptable in exceptional circumstances it should not be normal custom and practise. St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There had been a period of change in the management position, which had resulted in some systems such as quality monitoring, supervision and health and safety checks not being fully and/or consistently maintained since April 2007. There is now an experienced manager in charge of the home and some improvements were evident. People’s financial interests were safeguarded. St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 26 EVIDENCE: There had been an unsettled period in terms of management of the home since the last inspection. The manager in post at the last inspection had left in April 2007; the post had been filled but had become vacant again at the beginning of December 2007. The manager Annette Bristow had been in position for two weeks prior to the inspection. She is a trained nurse who has worked at the home for 2 years and she has been deputy manager since May 2007. She had also worked in a deputy manager’s position in her previous employment. There was little evidence that the new manager had received any induction into her role or that she had received instruction in processes such as quality monitoring. She will need to apply to the Commission to become the Registered Manager. People who lived in the home were involved in the running of the home through meetings and questionnaires. There was evidence that quarterly audits of processes in the home including care plans had been completed and surveys had been used. However there was no evidence that results of these had been formulated into action plans. The new manager stated that she had not had an induction into the quality monitoring systems in the home. There was some indication from people who lived in the home, staff and visitors that the care received was good and that the home was improving. Whilst there was some evidence that some care staff had received some supervision sessions this was not at sufficiently regular intervals to meet the standard of six times per year and some staff had received no supervision. However all staff spoken with reported much improved staff morale in the home over the past two weeks and they stated they felt more supported. The records of transactions where people were assisted with their finances were clearly maintained and balanced with cash held. Receipts where appropriate were included with the records of individual service users transactions. Records balanced with cash held. People’s rooms had lockable facilities for them to safely store their money, and valuables. The manager provided evidence that equipment used in the home was regularly serviced including gas boilers and appliances and moving and handling equipment. The manager will need to familiarise herself with the servicing programme to ensure that all checks are completed as required. Records showed that fire equipment, emergency lighting and fire alarm systems were regularly checked and fire drill logs were maintained. However there had been a period where systems hadn’t been adequately checked during August/September when the post of handyman was vacant. St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 27 There was a lack of evidence to show that all staff had received training in fire safety and moving and handling and other mandatory courses. There were some environmental issues which needed to be addressed: laundry cupboard doors were unlocked and fire doors in bedrooms were noted to be propped open with waste bins, walking aids and other items, this does not protect people from the spread of fire. Doors to cleaning cupboards and the sluice in the Royal unit had not been kept locked putting people at risk from chemicals hazardous to health. Accidents were recorded but there was now a system to formally audit accidents in the home and records identified actions taken where risks were identified. St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 28 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 2 2 3 2 X X 3 3 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 29 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 OP2 Regulation 5(2) Requirement The registered person must ensure that a contract has been provided to all people living in the home. The registered person must ensure that care identified in care plans is followed to ensure that peoples health and personal care needs are met and people are not put at unnecessary risk. The registered person must ensure that medication records are clearly and accurately maintained. Hand transcribed administration instructions must be signed and witnessed to ensure accuracy and minimise the risk of errors. The registered person must ensure that where medication is required to be administered covertly that this has been discussed and agreed by all parties involved in the persons care particularly their GP. The care plan must clearly identify the actions to be taken and be regularly reviewed. Timescale for action 01/04/08 2 OP7 12(1) 14/12/07 3 OP9 13(2) 17(1) 14/12/07 4 OP9 17(1)(a) 13(2) 12 01/03/08 St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 30 5. OP9 17(1) 6 OP22 12(1)(a) 7. OP20 23(2) 8 OP27 17(2) 9 OP27 18(1)(a) 10 OP30 18(1) 11. OP30 18(1) The registered person must ensure that when changes are made to the prescription these are dated and signed by the person making the changes. (The previous timescale of 18/01/07 was not met) The registered person must ensure that all staff on duty knows when the call bell/emergency alarm system has been activated. (Previous timescale of 14 March 2007 was not met.) The registered person must review the lounge in the royal unit and make this room more domestic in character. (Previous time scale 1 June 2006, 31 August 2006 and 1 April 2007 was not met) (It was reported that work on this area was to start in the near future) The registered person must ensure that the staff rotas accurately show who is on duty at any one time to evidence that adequate staffing levels is being provided at all times. The registered person must ensure that there are adequate numbers of staff to provide care and supervision at all times. Copies of staff rotas are to be provided to the Commission on a weekly basis until further notice. The registered person must ensure that records of the training provided to staff are maintained in sufficient detail to evidence that staff have received adequate instruction to provide care safely and competently. The registered person must ensure that records for induction of new staff are available for inspection. DS0000002802.V356568.R01.S.doc 01/03/08 01/03/08 01/04/08 14/12/07 14/12/07 01/03/08 01/03/08 St Margaret`s Care Home, Grimsby Version 5.2 Page 31 12 OP33 24 13 OP36 18(2) 14 OP38 13(4) 15 OP38 24 The registered person must ensure that the new manager receives instruction into the quality monitoring systems in the home so that the home can continue to develop and improve. The registered person must ensure that staff receive formal supervision at least six times per year. (The previous timescale of 1 April 2007 had not been met) The registered person must ensure that cleaning fluids are kept securely so that people are not put at risk. The registered person must ensure that fire doors can be activated in the event of a fire and laundry cupboard doors are kept locked to minimise the risk and spread of fire. 01/03/08 01/03/08 14/12/07 14/12/07 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 OP8 OP22 Good Practice Recommendations The registered person should ensure that evaluations of care are detailed and link to monitoring charts such as weight charts. The registered person should review the provision and use of bathing facilities in the home to ensure that these continue to meet the needs of the service users. The registered person should ensure that a training plan specific to the further development of the nursing staff is developed and implemented. 3 OP30 St Margaret`s Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Care Home, Grimsby DS0000002802.V356568.R01.S.doc Version 5.2 Page 33 - 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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