CARE HOMES FOR OLDER PEOPLE
St Margarets 22 Aldermans Drive Peterborough PE3 6AR Lead Inspector
Dragan Cvejic Key Unannounced Inspection 2nd August 2006 08:00 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 DS0000015187.V298352.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 DS0000015187.V298352.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Margarets Address 22 Aldermans Drive Peterborough PE3 6AR 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) 01733 567961 F/P 01733 567961 Mr Riaz Mawani Mrs Sayida Mawani Ms Kathleen Gregson Care Home 15 Category(ies) of Learning disability (1), Old age, not falling registration, with number within any other category (14) of places St Margarets DS0000015187.V298352.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 1 client with LD Date of last inspection 31st October 2005 Brief Description of the Service: St Margarets is situated in a predominantly residential area of the city of Peterborough near to Peterborough District Hospital. The home is close to local shops and transport routes. St Margarets is a three story, semi-detached property that has been adapted for use as a residential care home for older people and one service user with learning difficulties. A stair lift serves the three floors. The home has successfully created a homely atmosphere, an objective that is clearly proclaimed in their Statement of Purpose. St Margarets DS0000015187.V298352.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out during the morning hours. All service users were present at the beginning of the inspection. The main methodology used for this inspection was case tracking, whereby two service users and two staff, who predominantly worked with them, were case tracked. The other methods used to obtain the evidence included a talk with the management, talk with two more service users, observation of practice and reading of documents. A partial tour of the home and checking previous inspection requirements with the manager were also used to provide an accurate picture of the home and the service provided. What the service does well: What has improved since the last inspection?
The home responded to requirements and recommendations from the previous inspection. They strived to improve conditions and provisions for service users.
St Margarets DS0000015187.V298352.R01.S.doc Version 5.2 Page 6 The manager stated that the replacement of some older windows was agreed with the owners. The new format used for care plans was welcomed by staff: “This format is much better. We can get all the information we need from care plans.” Staff were well trained and encouraged to continue with personal development that, consequently, impacted on improved services and care for service users. All but two staff had acquired the NVQ qualifications. The manager became a trainer for the Protection of Vulnerable Adults and carried out regular training for staff. She kept good training records and ensured that staff attended refresher courses, so that their knowledge was up to date and effectively used in the care process. The manager reviewed survey questions for service users to obtain a full and clear picture of their opinion of the service and provisions and used the survey monthly. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Margarets DS0000015187.V298352.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 DS0000015187.V298352.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 at least once during a 12 month period. 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 home ensured that service users applying for a place were fully assessed to ensure that their needs would be fully met upon admission. EVIDENCE: The service users’ records were kept in two folders: one containing working documents, care plans, risk assessments, appropriate individually chosen charts and some other documents individually relevant. The other folder contained financial and some other older documents. The contracts in that folder showed the fee payable and indicated the source of payment. Agreement on those partly funded payment by social services was in the folder checked. Folders checked contained details of full initial assessments. Different sources of information were used in the assessment and the home engaged external professionals to support initial assessments. Osteoporosis society contributed to the initial and on-going assessments by carrying out falls risk assessments for all service users.
St Margarets DS0000015187.V298352.R01.S.doc Version 5.2 Page 9 A service user spoken to confirmed that he was properly assessed prior to admission to the home. St Margarets DS0000015187.V298352.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9.10,11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A new format for care plans was much better and allowed easy access to all relevant details, so that staff were fully aware of service users’ needs, goals and planned actions to meet these assessed needs. Service users knew of their care plans, but did not sign them, as well as they did not sign reviews. EVIDENCE: Service users’ care plans were drawn up in a new format and addressed all relevant needs and contained updated risk assessments. Staff stated that care plans were fully informative and presented a good working document. However, although reviews were recorded, they were not signed by users or their representatives despite the forms containing the box for these signatures. A service user explained how her healthcare needs were met: “My blood sugar is coming down. A speech therapist showed me how to take medication with yoghurt so that I can easily swallow.” Another user stated: “Opticians come here. A staff member took me on the bus to a dentist.” Medication procedure was appropriate. A staff member was observed administering medication implementing the correct, written procedure. Medication records for case tracked service users were accurate. By
St Margarets DS0000015187.V298352.R01.S.doc Version 5.2 Page 11 introducing secure storage for some medication downstairs, the manager simplified the administration procedure and minimise potential for a mistake. Privacy and dignity were respected. Although all staff were female at the time of the site visit, service users case tracked did not want a male carer. The home recorded service users wishes in case of death. A service user was in the process of making a will with support from the staff team. The home had procedures for how to deal with terminal illness and death. St Margarets DS0000015187.V298352.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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 home met the service users’ social needs, helped them engage in activities they wanted and organised varied activities in the home, making sure service users were stimulated to participate in the activities they enjoyed. EVIDENCE: Three service users spoken to confirmed that their social needs were met. One user explained that he had more contacts with friends outside the home, at college. Another user stated that she socialised with other users and had a very good relationship with staff. She commented on manager’s attitude: “I have never met anybody so nice as the manager. She is an angel in disguise.” A third user stated, describing the staff actions: “They would do anything for you. We do not have careless carers here.” Daily routine was recorded in individual care plans. A service user was helped to attend a college and work place, although he wondered if there was an opportunity for him to get a free bus pass. He stated that he wanted staff to hold and administer his medication and was happy that the Council (Social Services) held his money and he had access to it whenever he wanted. The other user had her relative acting as a Power of Attorney regarding her finances.
St Margarets DS0000015187.V298352.R01.S.doc Version 5.2 Page 13 Service users stated that food was good and they had a choice. A service user explained how her diabetes was effectively controlled by an appropriate diet. She explained that staff ensured that she could get some chicken, her favourite, but only white meat, that did not affect her blood sugar level and cholesterol and added: “I can’t have egg and bacon as this is too greasy.” All service users stated that they liked fish and chips and they had it ones a week as they wanted. There were no special cultural dietary requirements. St Margarets DS0000015187.V298352.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users knew how to complain if they wanted to and were confident that the manager, in particular would take all their concerns and complaints seriously. They were protected by the home’s policies and procedures and by the staff awareness and knowledge of the protection issues. EVIDENCE: The home did not receive any complaints since the last inspection. There was an investigation in progress about a conflict between two users, not witnessed but reported, and with the involvement of social services. This process demonstrated the home’s determination to offer full protection to service users. The home had a whistle blowing policy and staff were fully aware of the procedure if they wanted to use it. Service users stated that they felt protected and the home provided a consent form for some areas, such as money and medication, demonstrating full consultation with service users or their relatives. St Margarets DS0000015187.V298352.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 at least once during a 12 month period. 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 home was suitable for service users and appropriately equipped and maintained to ensure user’s needs were met. EVIDENCE: Despite the home being smaller in size regarding the number of bedrooms, it created and offered a very homely environment. The manager explained the maintenance programme and stated that one of the identified needs was a replacement of two windows with double glazed ones. The lights in the entrance were replaced and improved lighting. During the site visit a fire safety engineer carried out his inspection. He reported identified elements for improvements to the manager. The manager reacted straight away to address all mentioned issues. The home was recently inspected by an Environmental health officer and there were no specific requirements set from this authority.
St Margarets DS0000015187.V298352.R01.S.doc Version 5.2 Page 16 The home did not have cleaning staff employed, but the cleanliness was good. Staff were fully aware of cleaning procedures and infection control measures. St Margarets DS0000015187.V298352.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff employed in the home were fully committed to their duties and ensured that service users accepted them as supportive, helpful, honest and trustworthy. EVIDENCE: It appeared that the home had enough staff employed to meet the users’ needs. However, the staff spoken to and the manager stated that the cover for all shifts resulted from staff commitment to the home and to the service users, rather than contracted hours. The home did not use agency staff and the cover was provided by permanent staff working overtime. All staff were employed on a part time basis and were responsible for all tasks within the home: for care and support to service users, for cooking, for cleaning and even for small maintenance jobs. Staff rota showed that the manager too was covering all duties, although she tried to allocate management hours within her shifts. The home exceeded the requirement to have a minimum of 50 NVQ trained staff. All staff, but two, who were on this training, held NVQ qualifications. Staff were keen to learn, appreciated training and applied new skills and knowledge at work. They, however stated that they attended training on their days off and had not been paid for training days. Recruitment policy was designed to protect service users. The manager exceeded the standards when she insisted on a renewed CRB disclosure when the first came inaccurate. She ensured the staff member worked supervised, despite an extended CRB check-time.
St Margarets DS0000015187.V298352.R01.S.doc Version 5.2 Page 18 The home accommodated students from college on a work placement scheme and ensured they worked constantly supervised and did not perform any personal care duties. Service users spoke proudly of “their staff”, they stated that “their staff were the best”. St Margarets DS0000015187.V298352.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home operated safely and ensured that all safety procedures were followed to protect service users and staff. Service users felt safe and confident that they and their interests would be protected. EVIDENCE: The manager had completed her Registered Manager’s Award training since the last inspection. She skilfully ran the home, guiding users and staff in an open and transparent atmosphere. She invested her personal time into the life of the home by working at home on her computer to ensure all policies and documents including care plans and risk assessments were accurate, up to date and clear. She managed to keep the staff morale high in conditions where they were expected to undertake any task. The staff felt supported and appreciated and stated that the level of formal supervision, once in three
St Margarets DS0000015187.V298352.R01.S.doc Version 5.2 Page 20 months was sufficient, as commented: “we could talk to the manager at any time and we also have staff meetings regularly.” The manager reviewed survey questions to ensure that all aspects of provisions were assessed by all participants: service users, staff, visitors and external professionals. The home’s quality assurance was very effective. However, the manager did not operate the budget, but stated that the owners agreed to all her requirements regarding the expenditure and the needs of the home. The home had an insurance policy. Service users’ money held in the home was accurately recorded and kept safe. A service user stated that it was his choice and wish that staff hold his personal allowances. Another user also had some small amount of money held in the home and he was happy with Social services controlling his money. Written transactions were kept for all service users expenditures. Safe working practices were in place through the policies, procedures and training that ensured that all staff were trained in all mandatory subjects. The manager ensured that other relevant safety authorities regularly inspected the home. The most recent visits were by environmental health and by the fire and alarm maintenance man. The manager ensured that records of all incidents/accidents were accurate and contributed to ensuring users’ safety. St Margarets DS0000015187.V298352.R01.S.doc Version 5.2 Page 21 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 2 3 3 3 3 St Margarets DS0000015187.V298352.R01.S.doc Version 5.2 Page 22 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. 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. Refer to Standard OP7 OP30 OP33 Good Practice Recommendations The home should offer to service users to sign their care plans and reviews. The proprietor should provide paid time for staff’s mandatory training. The proprietor should provide communication facilities for the manager and staff, i.e. computer and fax, so that staff can access information, keep records in typed form and communicate effectively with the regulatory authorities and POVA department. The proprietor should provide the manager with the planned budget allowing her better control on home’s expenditure and ensuring full provisions for staff and service users and maintenance aspects are planned for the period ahead. 4. OP33 St Margarets DS0000015187.V298352.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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