Inspection on 17/02/06 for St Martins

This inspection was carried out on 17th February 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 Martins 30/11/06

St Martins 03/11/05

St Martins 30/03/05

St Martins 18/01/05

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE St Martins 80 Aldersbrook Road Manor Park London E12 5DH Lead Inspector Stanley Phipps Unannounced Inspection 17th February 2006 02:00 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 Martins DS0000025926.V283403.R01.S.doc Version 5.1 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 Martins DS0000025926.V283403.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Martins Address 80 Aldersbrook Road Manor Park London E12 5DH 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) 020 8530 5972 020 8530 8051 Mr Patrick Bell Mrs Bridget Bell Mrs Bridget Bell Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places St Martins DS0000025926.V283403.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd November 2005 Brief Description of the Service: St Martins Rest Home is a care establishment accommodating elderly service users. It is registered to accommodate up to thirty-six (36) The home is located in local facilities and is easily accessed by local transport. It is privately owned by Mr Patrick Bell and Mrs Bridget Bell. Mrs Bell is also the registered manager for the home. The home is set on large grounds and itself is spread over two floors, almost in the shape of an ‘H’. There is a large garden located between the front and the rear buildings., Staff are on hand twenty-four hours to provide care and support to all service users to ensure that they enjoy life to its fullest potential. St Martins DS0000025926.V283403.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place in just over four hours. It was timed to observe the afternoon activities, supper and to monitor the overall progress of the home. An assessment was undertaken of: the health and safety records, staffing recruitment and training records, the environment, the complaints record, a random sample of service user plans, and policies and procedures. Detailed discussions were held with the manager, the deputy manager and one of the senior staff members on duty. Informal discussions were also held with other staff on duty and a brief interview was held with the relative of a service user. Fourteen service users were also spoken to. This was followed by a tour of the environment. The inspection found that St Martins continued to provide a good service to individuals and that there have been improvements to the service. However further improvements were required to comply fully with all standards set out in the National Minimum Standards for Older People. This would ensure that the service users receive an even higher standard of service. What the service does well: What has improved since the last inspection? St Martins DS0000025926.V283403.R01.S.doc Version 5.1 Page 6 The registered manager took positive action to promote the safety and welfare of service users. As such arrangements were made to ensure that CRB checks were in place for each staff member as well as action had been taken to ensure that records held on staff were maintained in line with regulation (Schedule 2 of the Care Homes Regulations 2001). Positive action was also taken by carrying risk assessments on key, safeworking practices in the home and thus, service users are now in a safer environment. 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 Martins DS0000025926.V283403.R01.S.doc Version 5.1 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 Martins DS0000025926.V283403.R01.S.doc Version 5.1 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): (3) At St. Martins service users benefit generally from having their needs thoroughly assessed, upon which a decision to admit is taken. This practice must be carried out at all times to ensure that all identified needs are met. EVIDENCE: It is usual practice for the home to admit service users by carrying out a detailed assessment prior to admitting individuals to the home. As part of the inspection the most recent admission details were looked at. The service user was admitted just two days prior to the inspection visit. The most recent assessment information provided by the placing authority lacked detail as this service user had a condition, which was treated by medication, required specialist diets and blood sugar monitoring. He was admitted with poor quality information and the home’s assessment process did not fill the relevant gaps, potentially compromising the health and welfare of the service user. More importantly a risk assessment was not in place for the individual – neither from the placement authority nor one undertaken by the home. In interviewing the service user he indicated that his blood sugars were previously taken daily, but since in the home they had not been done. There was no record of that his bloods were monitored, neither was there a plan for them to be monitored. This must improve. St Martins DS0000025926.V283403.R01.S.doc Version 5.1 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 the following standard(s): (9) Service users receive good support with their medication, which has a positive impact on their health and welfare. EVIDENCE: At the time of the visit none of the service users were able to self medicate. This meant that they relied upon the staff to support them with this aspect of their healthcare. All service users were on some form of medication and a satisfactory medication policy was in place to guide staff safely through this process. Staff responsible for administering medication, have all received appropriate training. Medication charts were appropriately signed and medication storage was satisfactory. St Martins DS0000025926.V283403.R01.S.doc Version 5.1 Page 10 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): (12,14) At St. Martins service users are given opportunities to participate in a range of activities that are consistent with their preferences. They also enjoy choices that enable them to take control of their lives as far as possible. EVIDENCE: During the inspection the activities offered to service users were looked at and they were quite varied. The combination of activities, were reflective of the social, cultural, religious and recreational interests of the service user group. Levels of participation varied from individual to individual, depending on ability and interest. Whatever the case there was something in place for each service user, even though it may be of a low-key nature. Some of the activities included sing-a-long, keep fit movements, bingo, soft ball games and general knowledge question and answer group. In addition to this, there were several board games to include scrabble, cards and monopoly. Service users were also observed reading either the newspapers or magazines. The newspapers of choice were the sun and the daily mirror. Magazines included hello, take –abreak and country life. A key strength of the home was supporting service users to pursue their interests. In so doing the home is visited by various religious bodies for example for Catholic followers – every Wednesday, Pentecostal-every Thursday monthly, Christ Nisi – Saturdays monthly and the London City Mission – Friday monthly. In speaking with a relative of a service user he was of the view that St Martins DS0000025926.V283403.R01.S.doc Version 5.1 Page 11 her religious needs were unmet and indicated that she was a Seven-day Adventist. However in checking her file, her religion was noted as Church of England. Her husband provided the information and he is down as the next of kin. He made it clear in writing that he did not wish for information to be released to any third party without his expressed permission. It was clear that there was family conflict, however the home provided evidence that it was carrying out the wishes of the service user and her husband. Concern was also raised by the relative, about the home not providing culturally appropriate diets and engaging the service user in a culturally appropriate day centre. The home provided evidence of cooking – rice, peas and chicken and the service user refused, preferring English dishes. The home also provided evidence that the husband visits regularly and brings in dishes that are sometimes consumed by the service user. It was difficult to conclude that the home was not adequately meeting the needs of all service users including those from a minority ethnic grouping. Attempts to contact the service user’s husband to obtain feedback on the care provided by the home – failed. There was evidence that service users are supported to make positive choices in their lives and this was mainly in areas such as meals, activities and events in the home, personal grooming e.g. when they would like their hair done and the pursuit of their spirituality. They choose the times they go to bed and most recently were involved in choosing the carpets for the hallway. Service users spoken to all indicated that given choice in the home. St Martins DS0000025926.V283403.R01.S.doc Version 5.1 Page 12 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): (16,17) There are adequate systems in place for the promotion and the protection of service users rights. This also includes, their right to complain. EVIDENCE: A satisfactory complaints procedure is available to all staff, service users and their relatives. The home keeps a record of complaints and compliments and on assessing this record there were more compliments than complaints. The manager explained that concerns are addressed spontaneously to ensure that service users and their relatives are not only listened to but, addressed appropriately. All service users spoken to knew who they could complain to. Staff showed a good understanding of their role in supporting a service user to voice their concerns. One relative interviewed, confirmed his awareness of the complaints procedure. Twelve responses from relatives were randomly assessed and they all rated the service provided by St Martins as excellent. At the time of the visit none of the service users were engaged with legal services, however it was clear that if they wished to, then the registered manager would guide in the direction that was in their best interests. This is so because many of the service users have their relatives acting on their behalf and in some cases a representative from the local authority would be involved. Service users are also supported to exercise their civil rights at both the local and general elections. Opportunities are provided for them to take part either through postal-voting or using the local polling stations. It is true to say that some service users take part while others do not and this is clearly a matter of choice. St Martins DS0000025926.V283403.R01.S.doc Version 5.1 Page 13 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): (22) The registered persons keep the needs of service users under review and this includes ensuring the provision of specialist equipment to safely meet their needs. However, more attention is required to ensure all equipment used promotes the safety of service users. EVIDENCE: There was evidence that service users were assisted to maintain their independence. This is promoted by keeping the needs of service users under review and ensuring that staff are adequately trained in moving and handling procedures. At the time of the visit most of the service users were mobilising with little support from staff. As such the home is did not require specialist equipment in a major way. There were grab rails appropriately fitted to the home and the manager was aware that if and where necessary, an occupational therapist assessment would be required to determine the specialist requirements of individual service users. Two service users were over one hundred years old and a wheelchair was used to assist them in mainly transfers. It was observed that one service user was transferred without the use of footplates – which were not attached to the wheelchair at the time. Staff indicated that at times the service user refuses to use them. They were St Martins DS0000025926.V283403.R01.S.doc Version 5.1 Page 14 advised that this must be pertinently recorded and that the footplates must be used so as not to compromise the safety of service users. St Martins DS0000025926.V283403.R01.S.doc Version 5.1 Page 15 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): (27,29,30) Service users are given caring and sensitive support through a dedicated staff team that are skilled, appropriately trained and in adequate numbers to meet their needs. The staffing combination on each shift needs to be documented on the staffing rota, as evidence that they are on duty providing care and support to service users. Improvements in the recruitment practices provide greater protection for all service users. EVIDENCE: A dedicated staff team was in place at St Martins and this was observed from the low levels of staff sickness and staff turnover, as well as how, the staff deported themselves on the day of the visit. The staffing rota was examined and it bore evidence that on average the morning shift is covered on average by seven staff members comprising of the either the manager or deputy, or both and the evenings were covered with similar numbers. Two waking night staff and a sleep-in (not represented on the rota) covered night duty. The numbers and skill mix were satisfactory, except that it is a regulatory requirement for all shifts to be recorded on the staffing rota. In this case the sleeping shift was not. There was evidence and times when the numbers were greater than what was described above and this decision was made in meeting the needs of service users. Staff training records, were examined and it was accepted that staff were provided with training that was specific to the needs of the service user group i.e. the elderly. Most recently three staff members successfully completed the qualified first aid course and this would ensure that service user safety is better promoted in the event of emergencies. Staff were good at what they did St Martins DS0000025926.V283403.R01.S.doc Version 5.1 Page 16 i.e. providing good quality care and support to an elderly group of service users. This was evidenced from the low levels of incidents, complaints and adult protection issues in the home. There was an improvement in the recruitment practices of the home in that evidence was provided that a CRB (Criminal Records Bureau) check was applied for, albeit after the staff had started working in the home. No further evidence of this practice was observed at this visit. A potential member of staff was on the premises on the day of the visit to meet with service users and look around the home. This was carried out under supervision and with service users’ consent. A short interview was held with this individual who was able to describe the recruitment process of the home, including the acquisition CRB checks, prior to employment. She also expressed the view that service users were looked after very well and that the home was well managed. St Martins DS0000025926.V283403.R01.S.doc Version 5.1 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 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): (32,34,35,36,37,38) At St Martins service users benefit from having a dedicated manager who leads by example, have support systems in place to guide staff and ensures that service users financial welfare is promoted. Improved record keeping and health and safety practices, ensures that service user safety and general is enhanced. EVIDENCE: The registered manager has the overwhelming support of the service users, their relatives and the staff working in the home. She is successful in maintaining a homely and family type environment at St. Martins – one in which she is able to communicate effectively with all groups. Although she leads the service, it was observed that she is involved in all aspects of care and support. There was evidence that she leaves no stone unturned i.e. personally escorting service users and staying at service users bedside in hospital, in ensuring that they get the care they deserve. One of her strengths is in meeting the religious needs of service users and one of the compliments St Martins DS0000025926.V283403.R01.S.doc Version 5.1 Page 18 viewed, sums up the result of her input which read: ‘ St Martins is a very relaxed comfortable home where residents are respected and well cared for’. Another example of her dedication to service users could be drawn from the fact that she supported a couple to celebrate a fifty–sixth wedding anniversary. The home was generally well maintained and evidence received from the organisation’s private accountant indicated that the business was financially viable. Service users and their relatives could be therefore assured that the home would continue to provide services to them in the future. At the time of the visit all but one service user was independently handling their finances. In almost every other case, the relatives of service users were supporting them with their financial affairs. This meant that there was little involvement by the home’s management in this area. From all indications the financial affairs of service users were appropriately handled. The home has a good system in place for recording and monitoring any funds that are looked after in the home, on service users behalf. There was evidence that staff are supported to carry out their duties at St. Martins. They are provided with formal supervision on a two monthly basis, group supervision during team meetings and informally. The night staff have their supervision by coming into the home during the daytime and this is positive. The deputy manager indicated that appraisals are carried out annually and evidence of this was not examined at this visit, but would be carried out at the next visit. Staff spoken confirmed that they receive supervision that supports them to carry out their duties. There was an improvement in this standard as records held on staff were now in line with Schedule 2 of the Care Home Regulations 2001. The management team was again reassured of the importance of maintaining their records in line with this regulation. The home’s record keeping was generally accurate and any improvement required is identified in Standard 3 of this report. The home also maintained a satisfactory set of policies and procedures that provided good guidance for staff in promoting the welfare of service users. Improvements were also noted with required to health as the registered manager carried out risk assessments on the safe working practice topics i.e. moving and handling, first aid, food hygiene, infection control and fire. All other areas of health and safety were satisfactory and this included the maintenance of key records such as fire, the lift –maintenance, electrical maintenance, gas and records of incidents/accidents. At the time of the visit automatic-fire closing systems were being fitted to doors along the corridors. In discussion with a senior staff on duty, plans were in place to fit them where required – throughout the home. This would promote a safer environment for staff, service users and their relatives. Another major improvement was the process for replacing carpets in the corridors, which were badly worn. This would be an enhancement to the safety and ambience of the home. St Martins DS0000025926.V283403.R01.S.doc Version 5.1 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. 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 2 X X x HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 x X X X 2 X X X x STAFFING Standard No Score 27 2 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 4 X 3 3 3 3 3 St Martins DS0000025926.V283403.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 12,13 Requirement The registered persons are required to ensure that service users are admitted on the basis of having: a detailed assessment conducted on them and this includes a risk assessment. The registered persons are required to ensure that footplates are used when transporting service users. If service users refuse a risk assessment must be in place and a record made of the service user’s decision. The registered persons are required to record on the rotaeach shift covered by staff to include sleep-ins. Timescale for action 15/05/06 2 OP22 13, 23 05/05/06 3 OP27 19 05/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Martins DS0000025926.V283403.R01.S.doc Version 5.1 Page 21 St Martins DS0000025926.V283403.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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. Extracts may not be used or reproduced without the express permission of CSCI St Martins DS0000025926.V283403.R01.S.doc Version 5.1 Page 23 - 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!