Inspection on 18/10/06 for St Margarets

This inspection was carried out on 18th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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 30/10/08

St Margarets 04/09/07

St Margarets 29/06/06

St Margarets 26/09/05

St Margarets 26/05/05

St Margarets 10/08/04

St Margarets 04/05/04

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Claremont House

Oak Ridge

Coopers Mill Ltd

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Ashville House

Bramley Avenue (73)

Paradise Lodge

Bilney Hall

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

CARE HOMES FOR OLDER PEOPLE St Margarets St Margarets 10 Rothsay Road Bedford Bedfordshire MK40 3PW Lead Inspector Carol Mitchell Unannounced Inspection 18th October 2006 09:25 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 DS0000014960.V315992.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 DS0000014960.V315992.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Margarets Address St Margarets 10 Rothsay Road Bedford Bedfordshire MK40 3PW 01234 345964 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) Calsan Limited Mary Theresa Cook Care Home 21 Category(ies) of Dementia - over 65 years of age (21), Learning registration, with number disability over 65 years of age (21), Old age, not of places falling within any other category (21), Physical disability over 65 years of age (21) St Margarets DS0000014960.V315992.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th June 2006 Brief Description of the Service: St Margaret’s is a privately owned care home able to accommodate 21 elderly people. The home is an attractive detached Victorian building situated in a quiet residential area of Bedford just a few minutes walk from the banks of the River Ouse. Bedford town centre is also within walking distance, and the home is well served by public transport. The home has 17 single rooms and two doubles; two of the rooms have ensuite facilities. The home has a lift, and an extension has been added to the kitchen area. The extension also provides a staff room and two additional toilets. There are public parking bays to the front of the home, (pay and display) and a parking bay for the disabled is provided. The following information about fees was obtained from the home on 18th October 2006: Fees are £425.86 weekly, not inclusive of hairdressing (from £5), or chiropody (£10). Information about the home is given out on request by phone or when visiting. St Margarets DS0000014960.V315992.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report considers information received since the date of the last inspection 29th June 2006, and from the unannounced visit on 18th October 2006. The Commission received one complaint, which was investigated by a Protection of Vulnerable Adults panel, and two notifications during this time. Information from the Commission’s pre- inspection questionnaire could not be returned in time for this inspection report because the questionnaires were only distributed the week before the inspection visit. This information will therefore be considered in the next inspection report. The unannounced inspection visit took place over 4 hours on 18th October 2006. During the visit the inspector spoke to residents, checked some records, spoke to staff, the manager, and owner, and looked around some parts of the building. The inspector would like to thank everyone who helped with the inspection visit. What the service does well: This is a clean home with a happy and homely atmosphere and the people living there and their families like it. One resident said, “I am looked after well, I am more independent since I came here. They are lovely, everyone is kind, and the food is lovely.” The manager wants to be told if there is anything wrong. A resident said, “Mary told me, if I have any problems to tell her so that’s what I’d do.” Families like this home. They can visit any time and are made to feel welcome. “It’s very welcoming.” “I couldn’t have chosen better.” The home has good links with people like local doctors and district nurses, so that any care needed is arranged. This home makes sure that its staff are trained. For example staff who give out medicines have been trained before they are allowed to do this. St Margarets DS0000014960.V315992.R01.S.doc Version 5.2 Page 6 People working at the home enjoy their work, and they are a good team. “We always work together.” The staff are well supported by the owner and manager. The owners are good at finding out what needs doing to make the home better, and then take action to improve things. They always make sure that decoration is being done so the home is a nice place to live. What has improved since the last inspection? What they could do better: The manager is doing well but agrees that she needs to think about different ways of working to make sure that she is running the home in the best possible way for the residents, staff, and herself. Some recording of information in the home needs to be improved. For example the way in which care plans are written, and the way assessments of skin and any sores are recorded. Anyone involved in employing staff at the home needs to be clear about how all jobs are to be advertised because this is one way to show that people are employed in a fair way. St Margarets DS0000014960.V315992.R01.S.doc Version 5.2 Page 7 The owner said that a special valve would be fitted to the bath, which has very hot water, so that this is safe for anyone using the bathroom. (This bathroom is not usually used by people living at the home.) 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 DS0000014960.V315992.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 Margarets DS0000014960.V315992.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager makes sure that the home can provide the care needed before residents move in, so people living at the home know that their needs will be met. EVIDENCE: An example of a comprehensive assessment was seen and discussed. The manager emphasised the importance of making sure that full information is obtained from hospital before the admission of a resident is agreed. In the past a resident had agreed with a move from a double to a single room, and this decision had been recorded. St Margarets DS0000014960.V315992.R01.S.doc Version 5.2 Page 10 A resident explained that the manager came to see her before she moved in to check that the home would be the right place for her to live. The most recent report from the Commission, and the complaints procedure were on display in the reception area. St Margarets DS0000014960.V315992.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, 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager really wants to make any improvements she can. She also works closely with, and makes sure that residents get to see people like family doctors and district nurses whenever they need to. The staff are also very kind and well meaning. This means that people living at the home feel that they are well looked after. EVIDENCE: Residents said they are well looked after, and relatives writing in October 2006 questionnaires say that their family members receive very good care. A visiting social worker spoke about the home in glowing terms, saying she is very pleased because individual care is given. St Margarets DS0000014960.V315992.R01.S.doc Version 5.2 Page 12 Two residents were being cared for in bed at the time of the inspection visit. They looked comfortable, and well cared for. Food charts were being maintained, and district nurses had approved the care being given. Staff have received training in areas such as dementia and diabetes. Infection control issues are given attention, and on the day of the inspection visit, additional soap dispensers and hand towel dispensers were being installed. Residents have care plans, which are agreed by relatives and reviewed. Risks are also assessed. However, sometimes care plans are not the meaningful, working documents they should be, because information is written elsewhere, or not recorded at all, or not written down in sufficient detail. The manager and staff are able to describe the actions and care they undertake in detail, but this is not necessarily then reflected in the care plan. Examples of this were discussed with the manager during the inspection visit. Sometimes statements in care plans are too broad or ambiguous when not explained in detail. For example “skin condition good” can mean different things to different people, and there is a need to describe accurately all body checks and outcomes more fully. The home has close links and good relationship with local family doctors and district nurses. There is also good support also from a community psychiatric nurse who visits regularly. Arrangements are in place for dental and optician services. The senior care assistants who administer medicines have received training for this. A resident confirmed that tablets are administered correctly. The manager confirmed that she would support any resident who wishes and is able to look after their own medicines. During the inspection visit, staff were careful to deal with residents attentively, and in private. There was one occasion where more thorough care could have been taken to protect privacy, and a staff member concerned realised this straight away. Although this was an isolated incident, it led to a discussion about the manager needing to make sure she is not always counted in the care staff numbers to give herself the best chance of fulfilling important roles, such as objectively monitoring all aspects of care within the home. A resident confirmed that she chooses which clothes to wear, and she said that her clothes are nicely laundered. Members of staff and the manager dealt with residents courteously and with kindness during the inspection visit. St Margarets DS0000014960.V315992.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager and staff try hard to make sure that they know residents well, and they are very warm and friendly. This means that people can feel sure that their expectations about living at the home will be met. EVIDENCE: Staff at the home have received training in dementia care, and potted histories have been written following research into people’s lives. These could be used to help improve care plans and the care given to residents, especially those suffering with dementia. There is a programme of events at the home, and at the time of inspection visit a bingo game was being played by several residents. Bingo took place in the lounge where the atmosphere was homely, very relaxed and happy, with banter between staff and residents. People spoken to said that they love living at the home, and in questionnaires relatives said that they were very pleased they had chosen this home for their family member. St Margarets DS0000014960.V315992.R01.S.doc Version 5.2 Page 14 The staff and manager demonstrated individual strategies for distracting and calming people with dementia. This information could be specifically written in the care plans, to make them more meaningful and useful. In questionnaires, relatives reported that the home is very welcoming at all times to visitors, and that the staff are very friendly. At least one resident is currently supported by an advocate, and the home is able to obtain this service when it is needed. All of the residents spoken to said that they really like the meals, they have plenty of food to eat, and they do not get hungry. Dining tables were attractively presented. The cook explained that she is able to order whatever she needs, and that extra snacks are available when desired. Special diets are catered for, and meals are mashed or liquidised if necessary. Food charts are maintained when a need is identified, for example, these were in place for the two ladies confined to bed. St Margarets DS0000014960.V315992.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager makes sure that the proper checks are done before people are allowed to join the staff team, and the owner and manager take any complaint very seriously, and try very hard to make sure that they are doing everything right. Therefore people living at the home can feel sure that they will be kept safe and protected from harm. EVIDENCE: The staff and manager were gentle, kind, polite, and patient with residents during the inspection visit. Residents said that staff speak to them politely at all times, and staff questioned explained that they would tell the manager if they heard anyone addressing a resident in an impolite way. Appraisals for staff include a self-assessment question about communication with residents. Staff have received training concerning the protection of vulnerable adults. All staff have also recently received training on the management of aggression in the work place. St Margarets DS0000014960.V315992.R01.S.doc Version 5.2 Page 16 There is a complaints procedure which is on display in the foyer, and a resident recounted being informed by the manager to tell her straight away if there is something at the home with which she is not happy. During investigations into one complaint received, the manager and owner, described full cooperation, a desire to do right by the residents, and to take any actions deemed necessary to ensure the safety of residents. The manager was able to discuss her role in complaints management. A sample of staff files was checked, and a newly employed care assistant was spoken to. The correct checks had been done. The content of questionnaire feedback indicates that people at the home are aware of their legal rights such as the right to vote. St Margarets DS0000014960.V315992.R01.S.doc Version 5.2 Page 17 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, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The owner makes sure that t he home is well decorated, and that any jobs are done when necessary. This means that people who live there can be sure that the home is comfortable and well maintained. EVIDENCE: A maintenance man and housekeeping staff are employed at the home. On the day of the inspection visit new soap dispensers and hand towel holders were being installed. All parts of the home seen were clean, and there were no unpleasant odours. The lounge is a particularly homely place with a fish tank and caged bird. The lounge carpet has been replaced, new dining room chairs have been purchased, and decoration is ongoing. Whenever a bedroom is vacated, a St Margarets DS0000014960.V315992.R01.S.doc Version 5.2 Page 18 thorough refurbishment is undertaken including new carpet, decoration, new furniture, and new curtains with matching bedding. During the inspection visit a resident and staff member went outside into the garden to enjoy the sunshine. A few bedrooms were seen during the visit, and each was clean, comfortable, and homely. In conversation residents were happy with their rooms, and they confirmed they are welcome to bring in personal possessions. St Margarets DS0000014960.V315992.R01.S.doc Version 5.2 Page 19 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, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The owner and manager make sure that everyone working at the home is trained and supported to do their job properly, so people living there can be sure that they are in safe hands. EVIDENCE: Care assistants and the manager confirmed that they are happy with the number of staff working at the home, and are pleased about the emphasis on training. A care assistant who had just started work at the home had been teamed with a colleague, and was undergoing an induction programme of training. New staff fill in application forms and are interviewed, and the proper checks are made prior to employment. Discussions about the employment of a staff member revealed that the procedure for advertising jobs needs to be more clearly understood by the manager. This can then be followed for all future positions in a consistent way. St Margarets DS0000014960.V315992.R01.S.doc Version 5.2 Page 20 Staff spoken to were able to describe the care needs of individual residents in detail, and had received mandatory and other training. All staff have done National Vocational Qualification training, and new starters have been signed up for this using the established links, which have been developed, by the home. Formal supervision is in place for staff, and appraisals are done. A staff meeting was being held on the day of the inspection visit, and handovers take place when the new shift comes on duty. St Margarets DS0000014960.V315992.R01.S.doc Version 5.2 Page 21 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, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager needs to improve some aspects of the running of the home such as the recording of care needs, and she is keen to do this. The owner, manager and staff really care about people living at the home. Therefore residents can be sure that the home is run with their best interests at heart. EVIDENCE: Staff spoken to feel well supported by the owners and manager, and they receive formal supervision every 2 months. St Margarets DS0000014960.V315992.R01.S.doc Version 5.2 Page 22 The manager has completed suitable training for the position and is well supported by the owners. Residents spoke warmly about the manager, and know her by name. Most of the manager’s shifts are counted among the care staff numbers. In many ways this is a strength because she is always close to the care needs of residents and works closely with staff. However, a review of the way in which the manager works may now be indicated to make sure she can approach managerial responsibilities calmly and in a structured way. (Issues may include developing a “helicopter” view regarding the management of the home, addressing shortfalls within documentation; especially care planning, and sharing such developments with staff.) It is also suggested that the manager would be helped by developing a relationship with a professional mentor as another means of gaining advice and support. The owner arrived for an unannounced monitoring visit during the inspection visit, and spoke with residents in a calm and gentle way. A quality assurance file has been developed and within this were questionnaires returned from residents, family members, and staff. The feedback from questionnaires had been reviewed, and changes made accordingly. For example, relatives were not sure about the role of a “key worker”, and the action taken to address this was detailed. Staff mentioned the need for improved communication, and handovers were improved as a consequence. The most recent inspection report from the Commission was on display in the reception area. A first floor bathroom had a sign warning of hot water. After running for a while the water here was very hot indeed. This bathroom is not currently used by residents, some of whom are frail and have dementia. The owner spoke to the maintenance man about the fitting of a pre-set mixer valve during the inspection visit, and the manager confirmed that she would make sure this bathroom cannot be accidentally entered by residents until the valve is fitted. St Margarets DS0000014960.V315992.R01.S.doc Version 5.2 Page 23 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 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 2 St Margarets DS0000014960.V315992.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP7 OP8 OP38 OP29 Good Practice Recommendations A full review of care plans should be undertaken to ensure that they are individual, meaningful and working documents. The documentation of skin and sore assessments should be improved. CSCI Bedford office should be notified in writing once the pre-set mixer valve has been fitted. The procedure for advertising jobs should be clear so that this can be followed consistently. St Margarets DS0000014960.V315992.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 DS0000014960.V315992.R01.S.doc Version 5.2 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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