Inspection on 18/07/08 for St Margarets

This inspection was carried out on 18th July 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Margarets 19/07/06

St Margarets 10/01/06

St Margarets 21/06/05

St Margarets 06/12/04

St Margarets 17/06/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE St Margarets 17 Brookvale Road Highfield Southampton Hampshire SO17 1PW Lead Inspector Nick Morrison Unannounced Inspection 18th July 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Margarets DS0000011792.V367711.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 Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Margarets Address 17 Brookvale Road Highfield Southampton Hampshire SO17 1PW 023 8058 4877 023 8055 1089 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) Mr Thorne Mrs Thorne Mrs J Francis Care Home 18 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (18), Mental disorder, excluding learning of places disability or dementia (4), Mental Disorder, excluding learning disability or dementia - over 65 years of age (18), Old age, not falling within any other category (18), Physical disability (4) St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users must be at least 55 years and over. No more than 4 service users between the ages of 55 and 64 years in the categories of DE, MD& PD may be accommodated at any one time. 19th July 2006 Date of last inspection Brief Description of the Service: St Margaret’s is a care home situated in Highfield, Southampton. The home is registered to provide care to eighteen service users within the categories of old age. The home also accommodates service users who have a physical disability, dementia, mental health issues and four service users over the age of 55. This has been agreed part of the conditions of registration. The home is a large detached property and comprises of accommodation in both single and double bedrooms arranged over two floors. The home also has two lounges, a dining room and a smoking room situated on the ground floor. The home has a stair lift, which enables service users to access both floors of the home. To the rear of the property is a car parking area and to the front of the property is a large well-maintained and pleasant garden. The home is situated close to local facilities and is a short journey away from Southampton. Current fees in the home are between £410 and £430 per week St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This report represents a review of all the evidence and information gathered about the service since the previous inspection. This included a site visit that occurred on 18th July 2008 and lasted three hours. During this time we went into each room, looked at service users’ files and met with people living in the home. We also met with the Senior Carer on duty and spoke with two other members of staff. All records and relevant documentation referred to in the report were seen on the day of inspection. The Manager was not working on the day of the inspection, but we did talk to her on the telephone on that day again three days later to confirm some issues and to provide feedback about the inspection. We sent out a number of surveys and received replies from two members of staff and eight service users. We also spoke with a relative on the day of the inspection as well as two people living in the home. We have also referred to the Provider’s Annual Quality Assurance Assessment (AQAA). What the service does well: What has improved since the last inspection? Since the previous inspection the service has addressed a requirement concerning staff having more training relevant to the needs of people living there. They have also addressed three recommendations made at the previous inspection relating to staff interview records, environmental risk assessments and monitoring service users’ weight. Further improvements have been to the security of the home and to staff training. St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from having their needs assessed prior to moving into the home and have the information they need about the service. EVIDENCE: The home requires full assessment for all service users prior to deciding whether or not they can meet the person’s needs in the home. Service users’ files showed that these assessments were in place and had been completed prior to the person moving in. Assessments were comprehensive and contained details of all needs. Clear information about the service was available to all people moving into the home and each person had a copy of the Service User Guide in a folder in their room so that they and their relatives could refer to it at any time. St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from having their needs identified in a care plan and from having their healthcare needs met. They are protected by the home’s medication policies and procedures and are treated with dignity and respect. EVIDENCE: There had been a recommendation from the previous inspection that service users’ weights be recorded on admission to the home to adequately assess needs and risks. Evidence from service users’ files demonstrated that this recommendation has now been addressed. Each service user has a Care Plan in place that relates to their assessed needs. Care Plans were written clearly and had been reviewed on a regular basis. There were kept in a locked cabinet in the kitchen so that they were both secure and readily available to staff. St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 10 The Care Plans were not specific enough about the exact support that each person required. They contained information such as “needs total assistance with personal care” or “needs a bit of assistance on the stairs” rather than being descriptive about exactly what staff needed to do in order to address peoples needs. Risk assessments were also lacking in detail about what action staff needed to take in order to manage the identified risks. This was discussed with the senior member of staff on the day of the inspection visit and also subsequently with the Manager and a requirement has been made for the Care Plans and risk assessments to be improved in this respect. The health needs of people living in the home were monitored well. Records were kept on service users’ files about their current health needs and records also showed that needs were responded to in a timely manner and that people were supported to access the healthcare services they needed. The service liaises with the families of service users to ensure they are kept informed about their relative’s health needs and this was confirmed by relatives. Observation throughout the day of our inspection visit showed that people living in the home were well presented and had support to maintain their own appearance where necessary. During the inspection visit it was noted that people were being shaved in the lounge areas. This was discussed with the senior member of staff on the day of the inspection visit and also subsequently with the Manager and they have undertaken to ensure that all personal care will take place in private in future. Medication in the home was well managed. They use a monitored dosage system and keep good records of all medication coming into and going out of the home as well as good, clear records of all medication administered to people living in the home. Staff involved in medication administration have received training and clear procedures were in place to support good practice. All medication was stored securely. There were some gaps on the medication records, although it was clear that people had received their medication when cross-referenced with the amount of medication left. However, we have advised the manager to ensure that medication records are closely monitored and that staff record accurately all of the time. St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from being able to exercise choice and control and have stimulating activities. They also benefit from good support in maintaining contact with friends and families and a good, balanced diet. EVIDENCE: The home provides a wide range of activities to ensure that people living there receive stimulation and are able to interact with others. Entertainers are brought into the home and there are also bingo and music therapy sessions. There were also activities such as art classes, poetry reading and memory games. The home also recognised the need to provide some activities that would encourage people living in the home to exercise their limbs as much as possible. In addition, staff spend a lot of time interacting with service users and promoting socialisation among all the people living in the home. St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 12 The interaction staff had with service users throughout the day of the inspection visit was very good. They spent a lot of time with people and ensured that people were included in conversation and stimulated. The way staff spoke with service users was very positive and demonstrated a high degree of respect and understanding. The home had introduced new activities to try to ensure that things did not get boring for people living in the home. One member of staff at the home is about to go on a training course for activity co-ordinators. Although there were a wide range of interesting activities in the home there were no activity plans or records. We discussed with the Senior Carer the fact that plans and records would help service users to know what activities were due to take place and would provided evidence of how much involvement each person living in the home had with the various activities. The Manager has undertaken to ensure a system is put in place for this. People living in the home were supported to maintain contact with their families and friends. Records showed there were regular visits and that staff kept in touch with families to ensure they were kept up-to-date with what was happening with their relative. The visiting policy encouraged visitors to visit the home at any time that was convenient to them and the person they were visiting. The only stipulation was that visitors contact staff if they were going to visit after eight O’clock at night, in order that security of the building could be maintained. The food in the home was of good quality. The food storage area showed that only good quality food was purchased for the home and menus showed that a range of nutritious meals were available. People living in the home told us the food was good and that they received sufficient portions. Individual dietary requirements were catered for and the home had also done some positive work in introducing people to a wider range of food, particularly where this had been a health issue for people. The kitchen area was well managed and kept very clean. St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from a clear and effective complaints procedure and are protected by the home’s adult protection procedures and practices. They would be further protected by staff receiving more training in protecting vulnerable adults. EVIDENCE: The home has a Complaints Policy in place and this has been made available to all service users and their families. A copy of the policy was also kept in the Service User Guide in each service user’s room. People told us they were aware of how to complain if they thought they needed to. In the entrance there was a comments box that could be used by service users and their relatives to highlight positive aspects of the service and to raise any concerns they might have. Most of the comments were very positive and this reflected the feedback we received from service users and relatives. Concerns were responded to and addressed as quickly as possible. There was a system in place to ensure that all complaints were recorded and responded to in line with the Complaints Policy. The home had received no complaints in the previous twelve months. St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 14 Policies and procedures were in place regarding adult protection and whistleblowing. Staff had signed to say they had read and understood these. Staff told us they had not received any formal training in protecting vulnerable adults, although they did have some awareness of reporting procedures. A requirement has been made in respect of this so that staff receive training in understanding and identifying potential abuse and are able to respond to instances appropriately. No such issues had been identified in the home and all the feedback we got from people suggested that they felt that people living there were safe. St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from living in clean, safe, well-maintained environment. EVIDENCE: The home was well maintained and ongoing plans were in place for maintaining the standard of the decoration and furnishing of the home. The laundry, kitchen and toilet facilities had all been improved and updated since the previous inspection. All service user rooms were redecorated and re-carpeted prior to each new person moving in and all the rooms seen on the day of the inspection visit were very well presented. Curtains and armchairs throughout the home had also been replaced since the previous inspection. The Manager informed us that the Providers were very St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 16 good at ensuring the home was very well maintained and were very positive towards requests for funding for improvements. The home now has a designated smoking room in response to new smoking regulations. The room is solely for people living in the home; staff do not smoke in the home. There are currently four people living in the home who smoke and the smoking room is situated and ventilated so that the smoke does not impinge on the rest of the home. Infection control procedures were in place and no infection control issues were highlighted during the inspection visit. The home maintains a good balance between being relaxed and comfortable and being clean and safe. St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service Service users benefit from being supported by adequate numbers of sufficiently trained staff and are protected by the home’s recruitment policies and practices. EVIDENCE: There had been a requirement from the previous inspection that staff must undertake training in service specific issues to enable them to understand the needs of the service user category. Evidence from staff training records and from discussion with staff showed that this requirement has now been met. Since the previous inspection staff had received training in dementia, palliative care and mental health. There had been a recommendation from the previous inspection that the manager maintain records of staff interviews. This recommendation has been addressed. The manager confirmed that records were now being kept of staff interviews. St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 18 The home employs three carers each morning and two or three each afternoon. At night there is one member of night staff and one person sleeping-in/on-call. In addition to this there is a cook and cleaner. Training records showed that all training was up-to-date and that staff received training opportunities on a regular basis. This was confirmed in discussion with staff and in the written feedback we received. All the staff in the home have, or are working towards, a National Vocational Qualification (NVQ) at level two and four staff are working towards an NVQ at level three. A relative spoken with confirmed that she thought the staff in the home were very well trained and skilled in supporting the people living in the home. Staff confirmed they had induction training and this was demonstrated by the induction records in their files. Staff records also showed that the home ensured all staff were recruited in a professional manner and that all the necessary pre-employment checks were undertaken prior to staff beginning work in the home. St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users are protected by the home’s financial procedures and by the management of health and safety issues. EVIDENCE: There had been a recommendation from the previous inspection an environmental risk assessment be undertaken and reviewed annually. This recommendation has now been addressed and clear records are kept of annual environmental risk assessments. The Manager of the home is registered and has demonstrated that she has the skills, knowledge and experience to manage the home. St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 20 Feedback from staff, service users and relatives was very positive about the Manager and the way she manages the home. People said she was very approachable, focused on the needs of people living in the home and very supportive. We spoke with the Manager four days after the inspection visit and she informed us that she had addressed all the issues highlighted in this report. We looked at the system the home uses for managing the small amounts of money they look after for people who live in the home. All money was kept in a locked cash-box inside a locked cabinet in the kitchen. Inside the cash-box were moneybags for each person with their individual money. Records of expenditure were kept in a book, which was also kept in the cashbox. The records did not match up with the amount of money in each person’s moneybag. We were informed that this is sometimes due to a lack of the right change and that the amount of money each person had was correct in the records even if it was not in the moneybag. We discussed with the Senior Carer and the Manager the need to implement a different system for managing this money so that individual records are kept and that, at all times, the amount of money people have in their moneybag corresponds with the amount of money they should have. The home has a positive approach to quality assurance and is focussed on ensuring that the service responds to the needs of people living there. The comments box is available and people are encouraged to use it either for positive comments or for suggestions about improvements. Questionnaires are available throughout the year and feedback is sought and recorded from a wide range of sources including staff, service users, relatives and visiting professionals such as doctors and community nurses. The only part of the quality assurance process missing is the process of analysing feedback and producing an annual development plan for the service based on the views expressed. The home does tend to respond to individual comments on an immediate basis and manages to do this well. In producing an annual development plan the home will be able to implement a planned response to the views expressed, will have something concrete to share with stakeholders and will be able to clearly demonstrate how well the service is improving in response to the views of stakeholders. We have discussed this with the Manager and she has undertaken to improve this over the next six months. We also discussed with the Manager the fact that the Care Standards Act 2000 requires services to notify the Commission of deaths, illnesses and other events. There was evidence from the day of the inspection visit that we are not being informed of all these incidents at present. Discussion with the Senior Carer showed there was some confusion in the service about which incidents St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 21 needed to be reported. We have discussed the issue with the Manager and referred her to the relevant part of the Regulations. She has undertaken to ensure that the Commission is notified of all necessary incidents in future. Health and safety was well managed in the home and good records were kept. No health and safety issues were identified during the course of this inspection. Fire records are also well maintained and the home has recently contracted with an external company to undertake their fire risk assessments and training. Although there are some areas of this section of the report that require some attention from the Manager, the rating given reflects the fact that the outcomes for people living in the home are generally very good. St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 3 St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Care plans and risk assessments must contain sufficient detail for staff to be clear about exactly what support they need to provide All staff must receive training in the protection of vulnerable adults Timescale for action 31/08/08 2 OP18 18 (c) (i) 31/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Margarets DS0000011792.V367711.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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