Inspection on 30/10/08 for St Margarets

This inspection was carried out on 30th October 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Margarets 04/09/07

St Margarets 18/10/06

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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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Margarets St Margarets 10 Rothsay Road Bedford Bedfordshire MK40 3PW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Katrina Derbyshire     Date: 3 0 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: St Margarets 10 Rothsay Road St Margarets Bedford Bedfordshire MK40 3PW 01234345964 01234345964 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Calsan Limited Name of registered manager (if applicable) Mary Theresa Cook Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home St Margarets is a privately owned care home and is able to accommodate 21 people 65 years of age and over. 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 en-suite 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 Care Homes for Older People Page 4 of 27 0 0 0 0 Over 65 21 21 21 21 care home 21 Brief description of the care home parking bay for the disabled is provided. Information about the home is given out on request by phone or when visiting. Inspection reports by the CSCI are displayed on the notice board of the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. This unannounced key inspection was carried out on 30th October 2008. During the visit the communal areas and some of the individual accommodation was seen. The inspector spent time with the people living at the home. Management and staffing records were examined and staff were interviewed. The care of three people was looked at in detail. Evidence used and judgements made within the main body of the report include Care Homes for Older People Page 6 of 27 information from this visit, feedback from people who use the service and the homes documentation. Observation of care practise and communication between the people living at the home and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. The fees range for this service are as follows, this information was supplied by the Registered Manager on 30th October 2008 Lowest 457.06 per week and the highest is 500.00 per week What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 27 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre admission assessments are sufficient to ensure staff have the information they need to make a decision as to whether they have the skills and services to meet the needs of the person. Evidence: The statement of purpose that usually is one document was written using several documents displayed within the home or in the office, alongside other literature on a noticeboard in the front hallway. This gave information as to the services available at the home and the staff. On reading all the different forms and brochures it was noted that all matters listed within this regulation had been met. However there is a need to keep this information together to ensure that people have access in an easy to understand way. People spoken with confirmed that they had seen a brochure, however a copy of the complete service user guide was not given to them. Care Homes for Older People Page 11 of 27 Evidence: Assessment of peoples needs were seen to be in place within the care records examined. These documents described the needs of the people prior to moving into the home. Information contained within these included, needs all personal care and prompts needed as she never washes her hands. Further information was then gathered following their actual admission to build up a complete picture of the person. This provided a personal history on the career of the person, their family and their personal likes and dislikes. Staff when interviewed confirmed that it was the policy of the home that they should read this information to assist them in understanding the needs of the person. People living at the home confirmed that they had been involved in their assessment, that they had been asked their views as to what they believed were their needs. In addition visiting relatives on the day of inspection also confirmed that they had been welcomed to look around the home and staff had sought their input as to the needs of the person. Intermediate care is not offered at this home. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good access to medical support by staff ensures peoples health care needs are met. However inconsistencies in the management of medication place people at risk of not receiving the care that they need. Evidence: Care plans had been changed to attempt to meet the requirement that we made at the previous inspection regarding this standard. However more information is still required to ensure there is sufficient detail to guide all staff. Examples included where a person had been identified as needing assistance with their personal care, this was the only statement made. There was no guidance as to how they liked to get dressed or washed for example in the morning or at night. Staff when questioned were able to describe many of the needs of the people as detailed within their assessment profile but not all. Therefore it is essential that care plans are in place for each assessed need that give specific guidance on how those needs should be met. People living at the home felt that their privacy was maintained. Staff were observed Care Homes for Older People Page 13 of 27 Evidence: assisting people to the toilet in a discreet manner and ensuring all doors were closed. Staff through interviewing spoke of the need for confidentiality concerning the people that lived at the home and demonstrated that they understood that they must never discuss their personal details. Privacy screens where needed were noted to be in place. Medication stocks were examined alongside the records relating to this area. The storage of medication was seen to be secure, there was no one prescribed for controlled drugs at the time of this inspection so this specific area was not looked into. The majority of medication was given using a monitored dosage system, all cards seen were noted to be correct and matched all details on the relevant medication record. However some medication administered from boxed medication had inaccurate balances remaining when audited within the current 28 day period. One person for their Zopiclone 7.5mg should have had a balance of 20 tablets, however there were 19. Another person for their omeprazole 20mg had an incorrect balance of 8 tablets. Effective auditing is required and a requirement has been made. Documents viewed within the care records showed that people had attended a variety of health care appointments at the local hospital. In addition District Nurse notes of treatments provided by them at the home were also kept on site. On speaking to people that lived at the home and staff they confirmed that medical attention was sought in a timely manner if a person became unwell. One example of this was a person had become unwell just five days before this inspection, entries showed that staff had contacted the Doctor straight away to ask for a home visit. The Doctor came on the same day and treatment was given. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to continue personal relationships with opportunities to see relatives inside and outside of the home, so benefit from the emotional and social support from this. Evidence: On the day of this inspection the cook had contacted the home to state they were unwell and could not work. The manager was then seen to prepare and cook the main lunchtime meal herself. A white board was noted to display the meal that was available, there was one option written on this board. When people were asked what they would do if they did not like this option, they advised that they would be offered something else like an omelettes. Peoples views on the standard of food at the home were mixed they included, its alright most of the time and I always enjoy my food, this is lovely. There are two areas that provide dining table and chairs and these were seen to be fully utilised at lunchtime, other people had their meals using a small table in front of them. On speaking to people who lived at the home, they confirmed that their relatives and friends visited them. None of the people spoken with were aware of any restrictions on Care Homes for Older People Page 15 of 27 Evidence: visiting and all confirmed that they could meet with their friends and family in private. Daily records also contained entries by staff to indicate when people had received visitors. Information was also available so staff would know whom to contact if a person had a change in circumstance. One relative spoken to said, staff have have always been friendly and welcoming when we visit, the issues that we raised at first they sorted them out and everything is fine now. Observation throughout the inspection noted that interaction between staff and people living at the home was continuous and supportive. One person frequently called out, various staff members instantly went to the person and provided them with reassurance. Staff and people living at the home advised that there were opportunities to go out, this was either to visit relatives or by staff taking them for a walk down to the embankment. In addition board games and other indoor activities were provided. One person was seen to be writing letters, another was watching television whilst another person was reading their book. This demonstrated that people are able to pursue their individual interests during the day. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes policies and training of staff in abuse is not sufficient to ensure all allegations or suspicions of abuse would be referred to and benefit from the protection of a multi agency approach in this area. Evidence: The complaints procedure policy of the home on examination showed that it was clear in its guidance to management and staff and included timescales that the complainant should be responded to if they raised a concern. A complaint had recently been raised and the Commission for Social Care Inspection had been made aware of the issues involved. The response made by the owner to these concerns were seen at this visit. This had been carried out within the timescale required to meet the regulation, however due to insufficient postage the complainant had incurred a cost. This was reimbursed later. Other people spoken to stated that they did feel comfortable raising any concerns that they had, they did not feel that they would be treated any differently if they did. Records showed that staff had undertaken training in abuse, this was supported by staff who were interviewed at this visit. The copy of the local protocols in safeguarding adults was out of date, there had been several revisions of the policy since and the home did not have any of these. In addition the homes own policy in safeguarding was examined. Its guidance to staff in what should happen if there was a suspicion of Care Homes for Older People Page 17 of 27 Evidence: abuse was inaccurate. It indicated that the owner would decide on its investigation, this does not meet with the multi agency protocols in this area. All alleged incidences of abuse must be referred to the local safeguarding team, it is then decided how and who should undertake the investigation. Staff were not aware of the need to refer all matters either, when questioned they felt that management would investigate first to ascertain if the allegation was true or not. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of decoration and furnishings are sufficient to provide a homely environment for people to live in. Evidence: The communal areas in the home were noted to contain furnishings that were in a good state of repair. The decoration in these areas were also of a sufficient standard, and the use of pictures and plants helped in creating a homely environment. Individual rooms contained personal items of the person including photographs and ornaments. The small outside area was well maintained. One person commented however that the side gate may present a risk to someone who has dementia ,as they could leave the premises without anyone noticing as there was no security measure on the gate. Everyone spoken with stated that they felt the home was very clean. All the communal areas and a random selection of individual rooms seen at this visit showed that this was the case. There were no odours detected at this inspection. Staff were seen to follow hygiene standards when carrying out varying tasks. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel that the staff have sufficient knowledge to meet their individual needs and preferences. Evidence: The homes recruitment policy and procedures as previously assessed are clear. Three files were examined at this inspection of those staff most recently employed by the home. All three files contained an application and references. In addition a POVA First check had been undertaken prior to their commencement at the home, evidence of a criminal records bureau check was also in place. Communication and interaction between people living at the home and staff was seen to be supportive and frequent. The interaction suggested that good relationships had been built up over time. Comments from people that live at the home included, I think they are all just lovely, the staff are very good here and they have always been very nice to me. Training records were examined, these showed that training had been undertaken by some staff in the following areas, moving and handling, food hygiene and health and safety. On questioning staff they confirmed that they had access to training and felt that they had sufficient support to enable them to undertake their role in the home. Care Homes for Older People Page 20 of 27 Evidence: People living at the home who were spoken with felt that the staff had a satisfactory level of knowledge and felt confident in their abilities to meet their needs. Staff when questioned on the needs of people were able to give a sufficient explanation as to the individual and their needs and preferences. The home employ catering and housekeeping staff alongside varying levels of care and support workers. Again people felt that there were sufficient staff on duty to meet their individual needs. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and safety systems are sufficient to reduce the risk of accidents and incidents in this area for the people living at the home. Evidence: There was a Registered Manager in post at the time of this inspection. Staff spoke highly of the support that she offered them in carrying out their roles and responsibilities in the home. They found her approachable and clear in her guidance to them, describing her as valuing their contribution to the running of the home. In addition comments from people living at the home were also favourable, one person said, I think she is a wonderful woman. The manager demonstrated that she and the staff had worked on the requirements made at the previous inspection to improve standards, although further improvements are still needed in care planning. The views of people that have been involved in the home had been sought through the sending out of questionnaires. The manager advised that any comments that were Care Homes for Older People Page 22 of 27 Evidence: received would be acted upon. The relatives of one person spoken with stated that when their relative had moved into the home, there are had been several things that they had raised to the staff and management. They reported that their views were accepted and their request for changes had been acted upon. Health and safety records were examined. These showed that safety checks including fire, water temperature and electrical appliance had been carried out. Staff training records showed that staff had also received training in the varying areas of health and safety. Risk assessments had also been carried out, these showed where there was a possible risk and gave guidance on what staff should do to reduce this risk. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 3 4, 14 The manager must ensure 30/10/2007 that all new people being admitted to the home have a needs led assessment carried out to meet the needs of the people living in the home. The manager must ensure 30/10/2007 that all the people living in the home have care plans to meet the needs of the people using the service. The manager must ensure that all the people living in the home have risk assessments carried out as stated in the regulation to keep them safe Review the risk assessments of the people living in the home to ensure the information is updated with changing needs 30/10/2007 2 7 14, 15 3 8 13 4 38 13 Undertake a risk assessment 30/11/2007 for some of the activities undertaken in the main lounge. Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 A care plan containing sufficient information must be in place for each assessed need for every person. This is to ensure that their needs are met in full. 31/12/2008 2 9 13 Medication systems must be changed to allow for improved auditing of medication. This will identify stock shortage, invalid entries and to check people have actually received their medication. 31/12/2008 3 18 13 The safeguarding policies of the home must be up to date and contain guidance that meets with the local multi agency protocols. This is to ensure that all suspicions and allegations of abuse area managed through a multi agency 31/12/2008 Care Homes for Older People Page 25 of 27 approach to safeguard the people living at the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The information for the statement of purpose should be kept together to provide an easy to read document or file for the people living at the home. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!