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

This inspection was carried out on 18th January 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 14/12/07

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 Key Unannounced Inspection 18th January 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.V328669.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.V328669.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 Mrs Olivia McFerran 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.V328669.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th February 2006 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.V328669.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 January 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 on in the home 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 service users. Completed surveys were received from thirteen staff, sixteen service users and eleven relatives/visitors. Paper work kept in the home was also seen, this was to make sure that the staff are safe to work in the home and that they had been trained to their job safely. Records of the care provided were also examined. A random inspection was undertaken in June 2006 following two complaints made to the Commission. The Commission does not make that report available to the public on the Commissions website and interested parties should contact the Commission directly for a copy of the report. The requirements made at that inspection were checked for compliance at this inspection and the management had generally made good efforts and the majority of the requirements were met. 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 manager had checked the care plans regularly to make sure that the staff had brought them up to date. 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. St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 6 The service users were generally very positive about the care they received and the staff. 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 regularly assessed the quality of the care it provided and involved the service users and professional who visited the home in this process. What has improved since the last inspection? What they could do better: St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 7 The care plans must record all the service users needs and these must be checked on regular basis to ensure that the care is adequate to meet the service users needs. They must check and monitor the service users health more closely. They must improve consistency in record keeping in care files. The lounge in one unit and the dining room in another should be made more comfortable and homely. They must complete all the checks to make sure that the staff are safe to work in the home before they start. Records must be dated to show when medication came into the home and records must be completed to show if the medication was taken or not so that medication can be tracked all the time it is kept in the home. They must provide evidence that they provide a nutritious and varied diet by keeping records of all food service in the home including that served for special diets. They must make sure that staff receive training to keep service users safe from abuse, when assisting them to move and in the event of a fire when they start in the home and at regular intervals thereafter. They must make sure that staff receive regular supervision. They must make sure that staff on duty are able to know when the call bell is activated. They must ensure that there are enough suitable bathing facilities for the people who live in the home and that there is hot water to every bedroom. They must make sure that there is enough staff on duty to provide care and supervision and that other service such as day care do not impact on this. 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.V328669.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.V328669.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 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users needs were assessed prior to admission to the home and plans of care were developed from the information gathered. Service users were provided with a written contract/statement of terms and conditions on admission to the home. EVIDENCE: St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 10 The files observed provided evidence that assessments were completed prior to admission to the home. 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 of service users 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 the service users 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. There was evidence that service users 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. Thirteen of the fifteen service users who responded to surveys stated that they had received a contract/statement of terms and conditions and all but one stated that they had received enough information about the home before they were admitted to it. One service user commented that the manager was ‘very helpful’ and another stated that the manager and the deputy manager were ‘extremely helpful and approachable’. Some of the service users or their families had visited the home before deciding on placement. 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.V328669.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 adequate. This judgement has been made using available evidence including a visit to this service. There was some improvement in care planning but not all needs were identified and there was lack of consistency of practise in care provision and completion of records. The management had continued to monitor the quality of care planning and actively improve this area. There was a lack of care planning to support the care of those with challenging behaviour. There were some gaps in medication records so a full audit trail could not be maintained. The management had provided additional training to staff in maintaining users privacy and dignity and there was evidence of improved practise. Attention to detail in care provision such as mouth care will improve this further. St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 12 EVIDENCE: Six service users care files were examined during the inspection. The care plans were generally detailed re general care/nursing needs and reflected the needs identified at assessment and some improvement could be seen in the EMI unit care plans. 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. However there were some deficiencies, which must be addressed. Care plans had not always been developed where needs were identified. For example, one service user was assessed as having poor mobility and requiring assistance in this area and was also at risk of developing pressure sores but there was no care plan to identify how needs would be met and risks minimised. Another service user was observed to require mouth care on both days of the inspection. The service user was totally dependant yet the care plan did not detail the need for mouth care to be provided. Although staff were aware of this need and it was included on monitoring sheets there was no written evidence care had been provided on either day or previously. There was equipment in the home to enable staff to give mouth care and in the Royal unit the staff had set up individual mouth care trays. In another file the service user was identified as taking only a small diet but a nutritional risk assessment had not been completed and in another case although a risk assessment had been completed this hadn’t been updated following a weight loss, and so the scores and assessment of risk were incorrect. The care plans on the EMI unit did not identify the care required specific to the mental health needs of the service users and still did not detail intervention required to manage challenging behaviour. Daily diary sheets had not always been recorded in chronological order and there was inconsistency in when the records were completed, some had been completed every shift whilst others had been completed once a day. There was some evidence that care plans had been regularly evaluated and updated as required. One care plan showed particularly good practise in this area. In other files, evaluations were not detailed and generally consisted of a date and signature with little or no information as to the h4alth and welfare of St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 13 the service user. There was little evidence that evaluations took into consideration weight charts and other monitoring charts. The evaluations were sometimes written on the care plan and updates to the care plan were occasionally written within the evaluation. Information relating to new care needs and care requirements could be missed with this approach. There was some evidence that the manager was continuing to try to improve the quality of the care plans and educate staff and there was evidence of management audits within the care plans. There was evidence in 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. Medication records were viewed. Records for the receipt, disposal and administration of controlled medication were maintained. Records for the administration, receipt and disposal of other medication were completed. However the records for receipt of medication were not always dated. 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. There were a couple of gaps noted on the administration records where they had not been signed as medication given or a code entered where medication had not been administered. The nursing staff administered all the medication. St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 14 Direct, and indirect observations during the inspection provide evidence that the service users are treated with dignity, and respect most of the time. There was improved practise on the Royal unit generally and staff were observed to interact more openly with the service users during care tasks. Service users were dressed appropriately. The staff stated that a hairdresser was to start to provide services in the unit and this will assist in maintaining appearance for all the service users. Staff reported an improvement in the provision of equipment to enable them to provide care. Service users had access to a public telephone in the entrance area of the home or service users could use one of the office telephones for private calls. Service users could have a telephone in their rooms if required. Service users mail was given to the service users unopened or to families where this had been agreed. Screening was provided in all shared rooms to uphold, and maintain privacy and dignity for the service users. Staff were provided with training in promoting privacy and dignity during induction and further training had been provided to staff in this area following concerns raised at the last inspection. St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 15 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 adequate. 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 service users. There had been improvements in the activities available to the service users, these were now individualised and incorporated activities for those who were bed dependant. Forward planning and provision of information for service users and staff will improve this area further. There had been efforts to improve the menu planning and service uses generally received a wholesome and varied diet. There were some indications that those served a liquidised/soft diet were not offered adequate choice. There had been little effort to improve the dining room in the nursing/residential unit, which remained very unappealing. EVIDENCE: St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 16 St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 17 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 efforts had been made to improve the activities in the home and make these available to all the service users. An activities coordinator was now 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 she didn’t have a set plan for the activities in the home, she stated that she has developed individual activities, as many of the service users are bed dependant. Records evidenced that she spends time reading books and papers to service users, also chatting, nail care and playing cards and dominoes. The records showed that she spends time approximately twice a month with each service user as she works round the home. The records also showed that there had been an occasional external entertainer such as a singer. She stated she would assist service users to meet religious needs where identified and currently sat and read the bible to individuals where this was requested. The low key ad hoc arrangements for the activities seemed to be the cause of the varied comments from service users regarding the availability of activities and staff were vague as to the arrangements. The coordinator was advised to plan ahead and advise service users and staff or display a plan of activities, in advance, of where she was working and the activities available. Surveys indicated that overall the service users were happy with the meals provided only two commented that the quality was variable, one stated that the meals were ‘sometimes very poor but again sometimes they are ok’ another stated ‘some are good some, are rubbish’. The staff also thought the food was good and commented on the variety of choice available and the presentation. Seven of the staff that commented felt that the quality and choice of the liquidised/soft meals could be improved, as they felt it always looked the same. This couldn’t be adequately followed up as there were no records of the food being served for liquidised/soft meals and there was evidence that the set menus were not being adhered to. There was evidence that a lot of thought had gone into providing menus for service users but these were causing some confusion in the kitchen and were not being adhered to. St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 18 In the pre inspection questionnaire information the main menu provided showed a six-week rotating menu. There were separate menus for those requiring a liquidised diet and this was rotated over a 4-week period and there was an additional menu for those requiring vegetarian diets, which was rotated over 3 weeks. The cook on duty thought the main menus were rotated over a 3-week period. There was some evidence from records and observation of preparations in the kitchen that the menus were not being adhered to. Records of food served were maintained for the main menu and the vegetarian menu but were not maintained for liquidised meals provided. At the last inspection there was evidence that home baking was rarely completed due to time constraints, the cook stated that they were now doing baking on a regular basis. The cook on duty had a good understanding of the service users likes and dislikes and individuals needs where there was food intolerance or the need for a fortified diet and records of this information was maintained in the kitchen. Staff were seen assisting service users in a sensitive manner. The majority of the service users were served their meals in their rooms or in the communal lounges. The dining room on the nursing/residential unit although cleaner remained functional and uninviting. The kitchen was clean and tidy and appropriate records relating to the storage and preparation of food were maintained, there were some gaps in the cleaning records. At the last inspection it was noted that the tea trolleys were in a dirty condition, there was significant improvement in this area at this inspection. It was also noted at the last inspection that there was inadequate supplies of crockery, whilst the staff said this situation new crockery had been purchased there were still very few plates in the kitchen. However the manager advised the Commission in writing that following the inspection unopened boxes of crockery had been located in the home. St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 19 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 adequate. 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 manager was not able to adequately evidence that all staff had received training to protect service users from abuse due to gaps in record keeping. The management had acted promptly and appropriately to any allegations of abuse in the home. EVIDENCE: The complaints records showed that there had been 2 complaints since the last inspection neither of which was substantiated. The records showed that complaints were taken seriously and evidence investigation proves and contact with the complaint. The complaints procedure was displayed in the home. St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 20 The Commission had received two complaints in the same period of June 2006; both mostly identified the same areas of concern. An unannounced inspection was completed in June 2006 and the outcomes are as follows. Medication: There had been issues relating to nurses asking staff to administer medication, the manager had been made aware of this and this practice had ceased. Mobility equipment: There was evidence that there may be insufficient moving and handling equipment, inadequate bathing facilities, and use of specialist chairs without assessment. Health and Safety (infection control): The sluice had not been working adequately Room 217: There was evidence that there was insufficient space for safe moving and handling tasks to be undertaken in this room, an environmental risk assessment had not been completed. Incontinence Pads: There was evidence that there had been insufficient monitoring of supplies of continence aids and wipes leading to inadequate stocks to meet the needs of the service users. During the course of the inspection the manager ordered extra supplies to ensure an adequate stock. Social Activities: There was evidence that there were inadequate activities provided in the home due to staff shortages. The manager had taken action to address this by the final visit to the home by employing an activities coordinator for 30 hours per week. Staffing: There was evidence that staffing levels had not been adequately maintained to ensure that service users needs would be met. However there was evidence that the management did make efforts to cover shifts with permanent staff bank staff or agency staff. There was evidence of low staff morale and increased staff turnover; staff sited a variety of reasons for this. A number of requirements were made as a result of the above inspection and these were monitored for compliance at this inspection. Overall the inspector found an improved situation and the majority of the requirements were met. Although staff confirmed that they had been provided with training in the signs and symptoms of adult abuse and referral procedures at the last inspection, the staff training records at this inspection showed that only 16 of the 62 care staff and nurses (includes 21 bank staff) in the home had received training in relation to adult protection. The manager was able to show that ongoing training was being provided but names of attendees at training had not always been recorded. Those staff spoken to and in the majority of surveys showed St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 21 that staff had a good understanding of the terms protection of vulnerable adults and whistle blowing. The home had clear policies and procedures for the Protection of Vulnerable Adults and this also relates to the reporting systems of the Local Authority. The home also has an appropriate whistle blowing policy. The home had referred two incidents of possible abuse to the Local Authorities Protection of Vulnerable Adults team, one case of unexplained bruising and one of physical abuse from one service user to another, a further incident had been referred by the home of one service user physically assaulting another just prior to writing the report. This last incident was also received into the Commission as a complaint. The investigations by the Local Authority were ongoing at the time of writing this report and the Commission have requested an action plan from the home in respect of protecting the service users as all the incidents had occurred in the Royal unit. St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provided a clean, tidy and well-maintained environment for the service users. Some of the communal areas would benefit from being made more domestic in character. All staff could not hear the call bell due to the system in place; while this did not appear to affect the care in the home at the time of the inspection this may increase risks to service users and staff health and safety. The home has sufficient bathrooms and toilet facilities but a review of the facilities is required to ensure the home can continue to meet the higher dependency levels of the service users accommodated. The management had made good efforts and sought professional assistance to provide appropriate seating for service users. St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 23 EVIDENCE: The home is built on one level and is accessible to service users in wheelchairs. Generally the home was clean tidy and well maintained and there was evidence that the redecoration programme was continuing. There was a variety of communal space available to the service users. The communal space was generally homely and domestic in character. At the last inspection it was noted that the lounge and quiet room in the Royal unit and the dining room in main building were very utilitarian. The small sitting room in the Royal unit and main lounge had been cleaned and tidied and was a little more pleasant for the service users. The main dining room was still uninviting. 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. Staff also stated that although the home had two shower trolleys one was unsuitable and did not fit in the shower room in the Royal unit. At this inspection the manager reported that a new shower trolley had been ordered but there were no plans to make any alterations to the bathroom or replace the hoist. One of the directors 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. He was advised to review provision for bathing to ensure that there were sufficient facilities to meet the needs of those accommodated. During a tour of the building it was noted that there were some service users being nursed in bed, these service users had been well positioned through the use of pillows and looked very comfortable. The manager was able to evidence that, since the last inspection, professional assessments had been completed for the use of specialist seating where this was required. At the last inspection the staff reported that the sluice on the Wybers unit was not working adequately for its purpose. At this inspection the manager and staff stated that the sluice had been replaced. The Royal unit was odorous at the last inspection, due to the levels of incontinence four of the bedrooms carpets had been replaced by non-slip hard flooring to try and alleviate the odour problem. There had been some improvements in the décor in the Royal unit and the unit was generally cleaner and odour free. The temperature of the hot water in the bedrooms was variable in the Royal unit, some taps were running cold for some time before coming hot and in one bedroom the staff reported that the water was always cold. There was St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 24 evidence that the home had been actively trying to resolve this problem and work was ongoing with plumbing companies. It was noted that on testing the call alarm from a service users bedroom that staff took in excess of five minutes to attend plus some of the staff were just wondering past giving out teas and seemingly ignoring the call bell. On investigation it was found that the call bell activates individual units carried by staff but only 3 of the 10 staff had a unit and the staff in Royal unit do 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. That said, however, there was only one complaint from a service user who commented on a survey that staff ‘staff have a tendency to turn a deaf ear to the call system’. St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 25 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 adequate. This judgement has been made using available evidence including a visit to this service. There had been significant improvements in the way the home was staffed. Staffing levels had been provided consistently and there had been a gradual reduction in use of agency staff following good efforts to recruit and retain staff. Service users felt their needs were met. However the service users may not be adequately supervised during periods of the day when the home accept day care users in the Royal unit due to reduced staff/service user ratios. Generally recruitment practise was adequate but two adequate written references had not been obtained in all cases. A programme of varied staff training was provided including mandatory and training to meet the needs of those service users accommodated and NVQ training. Some staff were slow to complete the induction training and there were some gaps in the provision of mandatory training, which may put service users health and safety at risk. EVIDENCE: At the last inspection staffing levels were inadequate to meet the service users needs. The home had service users who were highly dependant, the majority St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 26 of which needed two carers to assist them with personal care and provide assistance with toileting and pressure relief. A high proportion of service users required assistance with feeding. Service users needs could not be adequately met on day shifts with less than three care staff on duty in each unit plus two trained nurses. The home had been struggling to provide these levels ion a consistent basis with staff sickness and staff turnover also having an impact. At this inspection the staff reported a significant improvement. New staff had been employed and rotas were now being met on a consistent basis. The service users stated on surveys that the staff were always or usually available when they needed them and they received the care and support they needed. Comments from the service users included ‘staff try their best, sometimes overstretched to cope with the residents’, ‘staff are very helpful, ‘all staff ok’, ‘always pleasant and helpful’ and ‘staff are often busy due to low numbers’. The agency had been using a high number of agency staff to cover shifts to ensure staffing levels were maintained the manager reported that this had gradually reduced as new staff had been recruited and over the last couple of weeks prior to the inspection they had not had to use any agency staff. Staff confirmed that this was the case. The main area of concern was in the Royal unit when there were day care service users present. The staff reported that although a staff member was provided to assist with transport on Friday afternoons this did not happen on other days leaving care staff to escort service users on the bus and leaving the floor short. The manager stated that the arrangement was for one of the nurses to cover the floor in these instances. The other concern has been recent incidents of alleged abuse by service users to other service users and this may indicate a lack of supervision on this unit during the time day service users are present. This must be reviewed and the manager must ensure that day care provision is not impacting on the care of other service users accommodated. Staffing levels must be maintained through out the shift and increased staffing where necessary must be provided to care for the day care users. The manager maintained records of staff training completed this showed that mandatory training and training specific to the needs of the service users had been provided. Staff confirmed in surveys that they received a variety of training. However records showed that here were gaps in the provision of training, nineteen staff required fire safety training and eight required moving and handling training and there was insufficient evidence to show all staff had received training in the protection of vulnerable adults. Some of the gaps were attributable to staff being new starters but this training should be part of induction. Induction training was provided to Skills for Care standards. The manager was able to evidence in one case that a staff had started to complete their St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 27 workbooks and staff in surveys and discussions confirmed that they had received skills for care induction. There was some evidence that staff were not completing the induction within twelve weeks and the management must be more proactive ion this area. The home had started a mentor system to help to support new starters and improve retention of staff; records showed regular supervision of new starters and the new staff stated that they felt supported. The home was committed to provision of NVQ training, three staff had completed NVQ 2, three had completed the training an were waiting for verification, four were working towards NVQ 2 and four had enrolled for training in November 2006. Staff were encouraged to continue with training and one was waiting for verification for NVQ level 3, one was working towards Level 3 and two had registered for level 3 The home had also provided a small group of staff with training in Huntingdon’s disease via the specialist nurse in this area. Four staff files were checked, these were new starters since the last inspection. Of these all contained checks required for employment although one had commenced employment before references had been received and another contained two references but one had not been obtained from the staff member’s previous employer even though previous employment had been in a care home. 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.V328669.R01.S.doc Version 5.2 Page 28 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an experienced manager in charge of the home. The home has a system of monitoring quality in the home. Service users financial interests were safeguarded. The staff have received improved supervision programmes and the management have worked hard to improve staff morale and communication in the home. Frequency of supervision must be increased to ensure six sessions of supervision per year are provided. The health and safety of staff and service users were generally protected but some gaps in training, which may put service users at risk. St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 29 EVIDENCE: The manager Olivia McFerran is a trained nurse who has also completed her Registered Managers award. Mrs McFerran has many years experience of the care industry and working in St Margaret’s. An experienced deputy manager supports her in her role. The records of transactions where service users 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. Service users rooms have lockable facilities for them to safely store their money, and valuables. Service users are involved in the running of the home through service users meetings and questionnaires. The manager regularly audits processes in the home including care plans and there was evidence that in-depth audits had been completed in December 2006. The manager had also recently sought health professional’s opinions on the quality of care in the home. There was no evidence that results of surveys had been published and made available to service users by the time of the inspection although this was planned. The management had provided an action plan to the Commission following the last inspection and the majority of the requirements had been met and the manager was able to describe some of the action taken in response to recent surveys. Staff supervision was being untaken and there was improved practise to support new staff. Whilst other care staff had received some supervision sessions this was not at sufficiently regular intervals to meet the standard of six times per year. However all staff spoken with reported much improved staff morale in the home and they stated they felt more supported and felt communication had vastly improved across all levels of management. The manager provided evidence that equipment used in the home was regularly serviced including gas boilers and appliances and moving and handling equipment. Records showed that fire equipment, emergency lighting and fire alarm systems were regularly checked and fire drill logs were maintained. There were some staff that had not received training in fire safety and moving and handling, whilst some of these were new starters this training should be part of the induction programme and this must be addressed. Accidents were recorded but there was no system to formally audit accidents in the home. Between 2 November 2006 to the date of the inspection 18 January St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 30 2007, 88 accidents involving service users were recorded in the home. Whilst risk assessments for falls were completed and staff were aware of the issues involving individual service users further analysis may identify additional risk factors. St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 31 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 2 2 2 X X 2 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 32 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 OP7 Regulation 15 Requirement Timescale for action 01/04/07 2. OP8 12(1) 3 OP9 17(1)(a) 4 OP9 17(1) The registered person must ensure that care plans reflect all the care needs of the service users. For example needs relating to mental health, challenging behaviour and mouth care. (Previous time scale 31 August 2006 not met) The registered person must 01/04/07 ensure that the health needs of the service users are monitored. For example needs relating to nutrition and pressure area care. (Previous time scale 31 August 2006 not met) The registered person must 18/01/07 ensure that records of medication are complete so that a full audit trail can be maintained. Records of receipt of medication into the home must be dated and administration records must be signed or a code used where medication has not been administered. The registered person must 18/01/07 ensure that when changes are DS0000002802.V328669.R01.S.doc Version 5.2 St Margaret`s Care Home, Grimsby Page 33 5 OP15 17(2) 6 OP18 13(6) 7 OP22 12(1)(a) 8 OP20 23(2) 9 OP25 23(2) 10 OP27 18(1)(a) 11 OP29 19 12 OP30 18(1) made to the prescription these are dated and signed by the person making the changes. The registered person must ensure that records of all food provided for service users are maintained. The registered person must ensure that all staff receive training in protection of vulnerable adults and associated policies and procedures. Evidence that all staff have received this training must be provided to the Commission. The registered person must ensure that all staff on duty knows when the call bell/emergency alarm system has been activated. 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 and 31 August 2006 not met) The registered person must ensure that hot water to bedrooms in the Royal unit is available at all times and maintained close to 43°C. A progress report must be provided to the Commission The registered person must ensure that there are adequate numbers of staff to provide care and supervision at all times in the Royal unit. The registered person must ensure that two written references are obtained prior to employment of staff. The registered person must ensure that staff complete their induction within a twelve week period and that mandatory training such as moving and handling, fire safety and DS0000002802.V328669.R01.S.doc 28/02/07 14/03/07 14/03/07 01/04/07 21/02/07 18/01/07 18/01/07 14/03/07 St Margaret`s Care Home, Grimsby Version 5.2 Page 34 13 OP36 18(2) protection of vulnerable adults training is provided as part of induction and thereafter at regular intervals. Evidence that all staff have received up to date moving and handling and fire safety training must be provided to the Commission. The registered person must ensure that staff receive formal supervision at least six times per year. 01/04/07 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 3 4 5 6 Refer to Standard OP7 OP8 OP15 OP20 OP22 OP38 Good Practice Recommendations The registered person should ensure consistency in the recording of daily diary records. The registered person should ensure that evaluations of care are detailed and link to monitoring charts such as weight charts. The registered person should ensure service users and staff are made aware of the activities plan and display the activities programme in the home. The registered person should make the dining room in the main area more domestic in character. 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 accidents in the home are audited on a regular basis to try and identify any patterns or risk factors. St Margaret`s Care Home, Grimsby DS0000002802.V328669.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Hessle Area Office First Floor 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.V328669.R01.S.doc Version 5.2 Page 36 - 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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