Inspection on 07/06/05 for St. Margarets

This inspection was carried out on 7th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St. Margarets 06/06/06

St. Margarets 13/12/05

St. Margarets 19/01/05

St. Margarets 05/07/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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 Care Home 99 Carlisle Road Eastbourne, East Sussex BN20 7TD Lead Inspector Lucy Green Unannounced 7 June 2005 10:15 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 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 H59-H10 S46888 St Margarets V218581 070605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service St Margarets Address St Margarets Care Home 99 Carlisle Road Eastbourne East Sussex BN20 7TD 01323 639211 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Total Support Solutions Ltd Miss Teresa Howell Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (OP) 22 of places St Margarets H59-H10 S46888 St Margarets V218581 070605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users to be accommodated is twenty-two (22). 2. 2. Service users must be older people only aged sixty-five years and over on admission. Date of last inspection 19 January 2005 Brief Description of the Service: St Margaret’s is registered to provide residential care to twenty-two older people. At the time of the inspection, fifteen people were accommodated. The home is a large, detached, three-storey, Grade 2 listed building situated in the Meads area of Eastbourne. The home is located within walking distance of local amenities and the main seaside town is a few minutes drive away. Service user accommodation consists of sixteen single rooms and three shared rooms. Many of the bedrooms have ensuite facilities. Communal areas currently comprise of a lounge, reception and landing seating areas and a large dining room.The external grounds offer an attractive and well maintained garden to the rear of the property. Parking facilities are available at the front of the home. The home has a series of chair lifts which enable service users to access all three floors of the home. St Margarets H59-H10 S46888 St Margarets V218581 070605 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6.25 hours on 7 June 2005. This is the first statutory inspection of this year. The purpose of this inspection was to assess compliance with the requirements of the last inspection and to generally monitor care practices A tour of the premises took place, rotas and care records were inspected. Seven of the fifteen residents, and three staff were spoken with. The Inspector observed the preparation and serving of the lunchtime meal. What the service does well: What has improved since the last inspection? Since the last inspection, the home has updated the policies and procedures in line with latest legislation and good practice guidance. Staff have received training in food hygiene, in line with a requirement at the last inspection. The Deputy Manager has arranged to attend training in the protection of vulnerable adults which will then be cascaded to all staff. Medication systems have been reviewed and recording sheets were found to have been properly completed at this inspection. St Margarets H59-H10 S46888 St Margarets V218581 070605 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Margarets H59-H10 S46888 St Margarets V218581 070605 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection St Margarets H59-H10 S46888 St Margarets V218581 070605 Stage 4.doc Version 1.20 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 standard(s) 3 & 5 Residents benefit from an admission process which allows their needs to be appropriately assessed and their questions answered. EVIDENCE: One resident has recently moved into St Margaret’s for a trial period. There was documentary evidence that a full assessment had been carried out prior to admission. The resident confirmed that the Manager of the home had visited her at her previous placement to assess whether St Margaret’s could meet her needs. For a variety of reasons it was not possible for the resident to visit prior to moving in, but a friend visited on her behalf to assess the quality and suitability of the home. The Deputy Manager reported that prospective residents are encouraged and supported to visit the home and where appropriate have a meal or drink with the other residents. St Margarets H59-H10 S46888 St Margarets V218581 070605 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 Residents benefit from the provision of appropriate and respectful support with their health and personal care needs. Residents would be further protected from the regular undertaking and review of risk assessments. EVIDENCE: Three care plans were examined and discussed with the Deputy Manager. There was evidence that each resident has a plan of care which provides detailed information about their strengths and needs. The care plans were well maintained and easy to use. It was however noted, that some of the information had not been reviewed since implementation. In particular, risk assessments had not been re-visited following a change of need identified in the main body of the plan. Some entries had not been signed and dated and it is important that this be rectified. Care plans contain a record of the input received from other healthcare professionals and copies of letters requesting referrals. On the day of inspection several residents received external medical attention and advice and staff were observed updating the records accordingly. St Margarets H59-H10 S46888 St Margarets V218581 070605 Stage 4.doc Version 1.20 Page 10 Seven residents were spoken with and all confirmed that staff provided their care with dignity and respect. Three residents spoke of recent illnesses where the home had arranged appropriate medical attention rapidly. The storage and recording of medication was inspected and found to be satisfactorily maintained. The Deputy Manager confirmed that only staff who had received relevant training handled medication an there were certificates in place to reflect this. Various policies for managing medicines were included at the front of recording sheets, so staff could refer to them easily. Risk assessments are in place to assess whether residents are able to take responsibility for their own medication. It is required that these risk assessments are reviewed at regular intervals and particularly where a residents’ needs have changed. St Margarets H59-H10 S46888 St Margarets V218581 070605 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 Residents are supported and encouraged to lead healthy and fulfilling lives. EVIDENCE: The home does not have a set programme of activities, although a number of events occur on a regular basis. A ‘care dog’ comes into the home each week and residents and staff spoke positively about this activity. Similarly, the Deputy Manager holds an exercise class every Thursday, which by all accounts is a popular and well attended event. Parche, a local church group provide a monthly church service at the home and other residents have their own private arrangements to enable their religious needs to be met. Some residents informed the Inspector that they go out independently and meet up with friends for meals and drinks out. It is recommended that the home try to facilitate more social outings for those residents who need support outside the home. Staff confirmed that St Margaret’s operates an open door policy for relatives and friends to visit. One resident stated that she has regular contact with friends and that staff have contributed to her social needs, by posting her letters when she has been unable to do so. St Margarets H59-H10 S46888 St Margarets V218581 070605 Stage 4.doc Version 1.20 Page 12 Another resident reported that she has regular visitors who are always made to feel welcome and included at the home. Meals at St Margaret’s have provoked a great deal of discussion over recent months. The Cook who had been employed at the home for many years has left and been replaced by a new Chef. The differing styles of cooking and a change in the food budget has generated a variety of opinion being expressed. One resident has complained about the meals she now receives and a variety of actions have been taken to try to rectify the situation. The Inspector spoke with seven residents about the food provided. One resident re-iterated the complaints she had made to the home, another reported that meals were ‘ok’ and five expressed satisfaction with the food they received. On the day of the inspection, a meal of steak and kidney pie, mash potato and three fresh vegetables was served, with a vegetarian option of poached cod, grilled tomatoes, basil, lemon, cauliflower and cabbage. The meal was noted to be well-presented and enjoyed by all. The Chef has begun regular meetings with several of the residents to ascertain their wishes about the food and take note of their ideas. Similarly, regular residents’ meetings are held and the Chef is invited to attend. The Chef informed the Inspector that he is currently in the process of compiling a rotating six-week rota based on the feedback he has received from residents and staff. St Margarets H59-H10 S46888 St Margarets V218581 070605 Stage 4.doc Version 1.20 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Residents benefit from an open culture where they are able to express their views and feel valued. Recruitment procedures protect residents from abuse. EVIDENCE: St Margaret’s has a complaints policy which is on display for residents and visitors to the home. A log of complaints received is maintained and the action taken recorded. It is recommended that where a complaint is made in writing, the home respond in a letter detailing the outcome of the complaint investigation. The seven residents spoken with all confirmed that they knew how to complain, without fear of reprisal. One resident stated “my complaints procedure, is to complain”. The management team at St Margaret’s protects residents from abuse by promoting an open culture in the home, where staff and residents are encouraged to air their views. The Deputy Manager has subscribed to a training course on the Protection of Vulnerable Adults, which she will then cascade to the staff team. Recruitment procedures, do not allow any new member of staff to commence employment at St Margaret’s without the appropriate checks from the Criminal Records Bureau being received. St Margarets H59-H10 S46888 St Margarets V218581 070605 Stage 4.doc Version 1.20 Page 14 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 standard(s) 19, 25 & 26 Residents benefit from an attractive, spacious and clean environment. Residents would be better protected if the identified health and safety matters were addressed. EVIDENCE: The findings below were based on the Inspector touring the building and talking to residents and staff. St Margaret’s is a three-storey, Grade 2 listed building situated in a quiet residential area of Eastbourne. The home is located in close proximity to local amenities and the seafront. Décor is satisfactory throughout the home. Resident accommodation is provided in sixteen single bedrooms and three shared bedrooms. All residents who share have expressed a positive wish to do. Many of the bedrooms provide ensuite facilities. The home offers a range of communal areas, including a large and attractive dining room, a lounge, landing and reception area. A large and wellSt Margarets H59-H10 S46888 St Margarets V218581 070605 Stage 4.doc Version 1.20 Page 15 maintained garden is situated to the rear of the property. Parking is available at the front of the home. The home has a series of stair lifts which provide access to all three floors. The majority of the residents at St Margaret’s use the stair lifts independently. Communal bathrooms and toilets are appropriately situated on each floor. Bathrooms are fitted with electronic bath seats to enable residents to bathe safely with support. The Providers have undertaken a lot of maintenance at the home, since taking it over in July 2003. Residents spoke positively about the upkeep of the home and all spoken with felt the home provided a stunning environment to live in. There has been an outstanding requirement since the home was purchased that a number of health and safety issues are rectified. In particular, all windows above ground floor must be restricted, radiators and pipe-work should be guarded and hot water outlets controlled. Further information about these health and safety matters can be found in the Management and Administration section of the report. Due to the layout of the home, there is not a separate laundry for the cleaning of residents’ clothes. Washing machines and tumble driers are located in a conservatory area, situated off the main lounge. Sluicing facilities are not currently available in the home and it is recommended that this is a consideration for the future. St Margarets H59-H10 S46888 St Margarets V218581 070605 Stage 4.doc Version 1.20 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Staffing levels are arranged flexibly to reflect the changing needs of the residents. EVIDENCE: On the day of inspection, fifteen residents were living at St Margaret’s. There were three carers on duty, including one senior carer and additional domestic and kitchen staff. The rota indicated that these staffing levels were typical. During the inspection, it was noted that the increased needs of one resident, was placing a strain on staff time, however, this resident has now moved to an alternative placement. The senior carer on duty confirmed that staffing levels would be adequate to meet care needs, once the above resident had moved on. Staffing levels had recently been temporarily increased at night to support two residents through illness. One resident commented that she was impressed that additional staff had been brought in to assist while she was unwell and that they were “wonderful” and treated her with “dignity and respect”. The home has recently conducted a survey of residents’ view and the six returned comment cards were shared with the Inspector. Three comment cards stated that the home would be further improved with extra activities, including the opportunity for trips out. It is recommended that staffing levels are reviewed to ensure residents have opportunities to have their social expectations met. St Margarets H59-H10 S46888 St Margarets V218581 070605 Stage 4.doc Version 1.20 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 & 38 Residents would be better protected if the home had a uniform system for the managing of residents’ finances. Safety in the home must be improved for the protection of all residents. EVIDENCE: The home has now completed an inventory of belongings for residents living at St Margaret’s. The majority of residents manage their own personal finances or are supported by representatives. The home does however, hold a small amount of money for a few residents. The Inspector viewed the storage and record keeping and it is required that this area is improved. Residents’ money should be kept separate from one another and a record of all incomings and outgoings maintained, backed up with receipts. The Deputy Manager showed a form had been devised to maintain a running total of monies, but not all staff are working to this system. St Margarets H59-H10 S46888 St Margarets V218581 070605 Stage 4.doc Version 1.20 Page 18 There has been an outstanding requirement since the home was purchased that a number of health and safety issues are rectified. In particular, all windows above ground floor must be restricted, radiators and pipe-work should be guarded and hot water outlets controlled. The Inspector acknowledges that a rolling programme has been in place to address these issues, but this has not been completed within the timescales agreed. Since the inspection, the Inspector has written to the Responsible Individual requiring an action plan which demonstrates that the environment is safe for the people living at St Margaret’s, is submitted. It was also noted throughout the inspection, that a number of fire doors were propped open and as discussed at previous inspections, this practice cannot be allowed to continue and another immediate requirement was issued. St Margarets H59-H10 S46888 St Margarets V218581 070605 Stage 4.doc Version 1.20 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x x 2 2 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x x x 2 x x 2 St Margarets H59-H10 S46888 St Margarets V218581 070605 Stage 4.doc Version 1.20 Page 20 YES Are there any outstanding requirements from the last inspection? 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 7 Regulation 15 Requirement Care plans should be regularly reviewed and updated to reflect changing needs. All entries to be signed and dated . Risk assessments to be carried out in respect of all areas of residents lives. Risk assessments should be regularly reviewed and updated, particularly as change in needs are identified. A record should be maintained of the residents weights including any action taken where a change in weight has occurred. An accurate log of monies held on behalf of residents is maintained. All outgoings should be supported with receipts. All windows that are above ground level to be restricted. (Previous timescales of 01 January 2004, 01 November 2004 and 01 April 2004 not met). Pre-set valves are fitted to control all hot water taps to which residents have access. (Previous timescales of 01 December 2004 and 01 April 2005 not met). Timescale for action 01 August 2005 01 August 2005 2. 7 13(4) 3. 8 4. 35 17(1)(a) & Schedule 3(3)(m) 17(2) & Schedule 4(9) 13(4)(a) 01 August 2005 10 July 2005 07 June 2005 5. 38 6. 38 13(4)(a) 07 June 2005 St Margarets H59-H10 S46888 St Margarets V218581 070605 Stage 4.doc Version 1.20 Page 21 7. 38 23(4) The home review its practice of propping open fire doors and consult with the Fire Brigade for guidance. (Previous timescale of 19 January 2005 not met). 07 June 2005 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 12 & 27 16 22 26 Good Practice Recommendations Staffing levels to be reviewed to ensure they are adequate to meet the social expectations of the residents. The home respond to complaints received in writing, by preparing a written reply outlining the outcome of any investigation and actions taken. The layout of the is home assessed by a suitably qualified person. The home consider the need for future sluicing facilities. St Margarets H59-H10 S46888 St Margarets V218581 070605 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 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. 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