Inspection on 24/09/09 for St Martins

This inspection was carried out on 24th September 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Martins 21/10/09

St Martins 23/08/07

St Martins 06/06/06

St Martins 22/02/06

St Martins 09/11/05

St Martins 09/12/04

St Martins 13/07/04

St Martins 18/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2009.

Key inspection report Care homes for older people Name: Address: St Martins Oakhill Park Liverpool Merseyside L13 4BP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Claire Lee     Date: 2 5 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 32 Information about the care home Name of care home: Address: St Martins Oakhill Park Liverpool Merseyside L13 4BP 01512280983 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: stmartins@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Care Management Limited care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 42 Date of last inspection Brief description of the care home St Martins is a care home that provides personal and nursing care for forty two older people. The home is situated in the Broadgreen area of Liverpool and is within easy access to bus routes, churches, shops and local amenities. The home is owned by Southern Cross and is managed by Ms Jackie Achilles. St Martins is a purpose built single storey building. There is a car park to the front of the home and residents have the use of an enclosed garden at the rear and also an inner courtyard with seating. All bedrooms provide single accommodation and have twenty en-suites facilities. Communal space within the home consists of three lounges and a large dining room. One of the lounges is a designated smoking area. Residents are provided with Care Homes for Older People Page 4 of 32 0 Over 65 42 Brief description of the care home equipment and aids to assist their mobility and an alarm system with a call bell is operational throughout the building. The fee rate ranges from three hundred and thirty pounds to seven hundred and nineteen pounds a week. Care Homes for Older People Page 5 of 32 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: two star good 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: An unannounced visit took place as part of the inspection and this was carried out over two days for a duration of fifteen hours. Forty one people were accommodated at this time. The term resident is used in this report as this is what the people staying there like to be called. During the time spent at the home different areas were looked at and a number of care, staff and health and safety records were checked to see what care the residents living there received. Discussion took place with a visiting health care professional, five residents, two relatives, two visitors, five staff and the manager. During the inspection four residents were case tracked (their files were looked at and they were asked for their views of the home). Other residents also took part in the inspection and all the key and other standards were assessed during the visit. Reference is made to them in the report. To find out more about the care provided at Care Homes for Older People Page 6 of 32 the home survey forms called Have your Say About..... were distributed to a number of staff, relatives and residents prior to the inspection. Twenty were returned from the staff and seven from the residents. A number of comments from them and from interviews conducted with residents, staff and relatives have been included in this report. An AQAA (annual quality assurance assessment) was completed for the inspection. The AQAA comprises of two self-questionnaires that focus on the outcomes for people. The self-assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service, including staff numbers and training. The manager completed this to a satisfactory standard. The last key inspection was conducted on 23rd August 2007. Care Homes for Older People Page 7 of 32 What the care home does well: There is a good system in place to introduce people into the home. This includes plenty of information regarding St Martins and also the completion of resident assessments to help ensure staff can meet their needs. The home had a friendly atmosphere and staff were seen to greet visitors warmly. Residents had a plan of care which was person centred. Staff therefore knew what the residents needed help with in a way in which they preferred. Care plans seen also recorded details regarding spiritual and cultural wishes so that staff understood and respected this element of their care. Regular care reviews had taken place with the resident and their family member so that they were fully aware of the care being given and changes made to keep them well. Residents were happy with the care they were receiving and the following comments were made, I have lots of help and The girls do everything they can to help. Staff interviewed were able to talk about the care and support they provided and the different ways in which they encouraged residents with their independence. There was plenty of equipment, such as, wheelchairs, moving and handling equipment, hand rails and special beds and mattresses to assist with this. Staff were seen to be polite in their approach and to spend time with residents in an unhurried manner. Residents were addressed by their chosen name and title and staff knocked on bedroom doors before entering as a mark of respect. Good systems were in place for staff, residents and visitors to report any concerns or complaints they may have. The manager also holds weekly surgeries to enable people to come and see her for a chat on an informal basis. Records seen showed that concerns or complaints received had been investigated promptly by the manager. Residents interviewed said they knew the manager would sort out any issues. Residents interviewed were pleased with the standard of the food served and the menus seen showed that residents were offered a good choice of hot and cold meals. Light refreshments were also served during the day. Southern Company monitor the standards of the meals so that residents have a well balanced diet. Residents interviewed said they enjoyed the food. The following comment was made, You only have to ask and it is cooked for you. The home was pleasantly decorated and residents had personalised their rooms with items from their own home. Areas viewed were warm and also adequately ventilated to ensure comfort. There is plenty of communal space and with three lounges the residents can choose where to spend their day. Staff were receiving regular supervision of their job role to help support them in the work place and to develop their training needs. Staff said the manager was good at arranging meetings and keeping them informed of developments in the home. The staff use a variety of methods to seek the views of the residents. This includes satisfaction questionnaires and regular meetings. It was evident that people had an opportunity to communicate and contribute to the running of the home. Residents interviewed said the manager was approachable and made sure the home ran smoothly. The following comment was made, We see Jackie (the manager) each day and she is always chatty. Care Homes for Older People Page 8 of 32 Staff had access to a a good range of policies and procedures regarding health and safety. A spot check of a number of contracts for equipment and services, for example, gas safety and fire prevention were in date to ensure the ongoing protection of people living in the home. What has improved since the last inspection? What they could do better: Recording systems for administering medicines to the residents was found not to be robust. Staff were signing the medicine charts at the end of the medicine round rather than signing them when administered. Medicines must be signed when given. The existing procedure places people at risk as medicines may not be administered according in accordance with the prescription or staff forget to sign accurately. The medicine policy should record details regarding recording of medicines to help ensure staff are aware of the correct procedures to be followed. A communal minibus owned by the company is available approximately once a month for residents to enjoy social activities outside the home. It is recommended that the company look to making this available more frequently or to purchase a minibus for St Martins. Staff said this would be beneficial and residents have also requested more trips out from the home. The number of hours allocated to the activities organiser to help arrange activities should be increased so that the residents receive more time to enjoy the social programme. Staff have access to policies and procedures for safeguarding people. It would be beneficial however for the staff to have the contact details for reporting an allegation displayed in the staff room for easy access. The manager is undertaking training regarding the Deprivation of Liberty safeguards. These are measures in place to help ensure the staff are aware of their duties and responsibilities under the Mental Capacity Act 2005. They help to safeguard people who may lack capacity to make particular decisions. This should be given to all staff as part of their training programme. Maintenance of the home should include the replacement of the chipped bathroom tiles, as they increase the risk of cross infection and detract from the appearance of the bathrooms. Care Homes for Older People Page 9 of 32 Not all staff had police clearance prior to commencing their employment in the home. These must be received prior to starting work to ensure residents are protected by robust recruitment practices to keep them safe. Staff supervision notes and residents care files should be locked away when not in use to ensure the records are held securely. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 10 of 32 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 11 of 32 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. People thinking of moving into the home received sufficient information to help them to to make a decision. Residents needs were assessed to ensure the staff could provide the right level of support and care they required. Evidence: There was plenty of information available for residents accommodated and prospective residents and their families to look at. This helps them to decide if the home is right for them and whether the staff can provide the care and support they need. A brochure called a Service User Guide and Statement of Purpose gave information regarding the home, for example, terms and conditions of residency, the management structure and how to raise a complaint. Information was available about the Commission, including the last key inspection report from 2007. There were also plenty of leaflets regarding the owners of the home, Southern Cross. People were seen to be made welcome by the staff when they arrived and there was Care Homes for Older People Page 12 of 32 Evidence: comfortable seating in the hall so that the residents and their visitors could read the information on the notice boards at their leisure. The manager completes a care needs assessment for prospective residents. Assessments for three new residents were looked at. This included information regarding past medical history, medicines prescribed and help with various activities, for example, mobility, eating and drinking and personal care. Details of social, family background and preferred interests were also recorded. This information ensures staff are aware of the residents individual care needs with emphasis on the level of support they would need once admitted. The AQAA reported that residents and their families are welcome to visit the home any time and to stay for lunch. Residents benefit from an initial six week period when they can decide if the home is right for them. The AQAA also recorded plans for improvement in relation to the key worker system. This is when a member of staff takes on extra responsibilities for a number of residents. The manager is keen to develop this to help residents settle down more quickly in their new surroundings. A resident said they felt the staff were very supportive when they arrived at the home and that their queries were answered promptly. Intermediate care is not provided at St Martins and therefore this standard was not assessed. Care Homes for Older People Page 13 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Medicine records were not kept accurate and this may place residents at risk. Evidence: Residents had an individual care file with documents relating to the care and support they needed. Care plans were seen for daily activities such as moving safely, washing, dressing, eating and drinking, risks of falls and communication. Good information was recorded for them to provide care and support to the residents based on their assessed needs. The care plans were unique for each individual to help with the provision of person centred care. Residents spoken with said the staff knew about their preferred daily routine and how to help them. There was evidence of resident and relative involvement with the plan of care as part of the review process. This helps to ensure they are aware of the care they are receiving. Staff had reviewed the care each month and the review provided a summary of the care given over a set time to evidence any changes. Supporting care documents included risk assessments to help keep people safe, visits by doctors and also daily records for the care given. Residents who needed medical Care Homes for Older People Page 14 of 32 Evidence: treatment or who had specific care needs were seen to have good input from a range of external professionals. A visiting health professional was complimentary regarding the staff and the good communication that existed. She said the staff took on her recommendations and worked well with her. Staff were seen to attend to the residents regularly to ensure they were well looked after. Those residents who had to remain in bed looked rested and records had been completed which showed they were receiving regular drinks and help to move in bed to ensure their comfort and well being. The manager had completed checks of the care documents to ensure they were filled in accurately, as part of monitoring the standard of care given. The staff care for residents with high dependencies, however those who are more able were being encouraged to maintain their independence. The care records gave staff plenty of information as to what the residents could do for themselves and how much support they needed. For example, the level of support needed with walking or dressing. Residents interviewed said they were pleased with the care and support they received. The following comments were made, I get enough help and I am more than happy with everything. The majority of medicines were being administered via a dosage system called a blister pack and residents had a medicine chart with a record of their prescribed medicines. Recording systems for administering medicines were not accurate. Staff were signing the medicine charts at the end of the medicine round rather than signing them when administered. This may place people at risk, as medicines may not be administered in accordance with the prescription or staff forget to sign accurately. This was found to be the case. Although a check of some medicines showed they had been given there were staff signatures missing for the morning medicine round. The manager said that she would review the recording practices for the medicine administered and we were notified following the inspection that measures were being put in place to help rectify this. Staff give out a large number of medicines in the morning and this medicine round was seen to take a long time. It would be beneficial to look at the times medicine are administered as part of the review process to assist the staff. Staff had received medicine training, however the medicine policy should record details regarding recording of medicines to help ensure staff are aware of the correct procedures to be followed. Staff had completed risk assessments for residents who wished to administer their own medicines. Staff were supporting them with this practice so that they were able to do this in a safe manner. Care Homes for Older People Page 15 of 32 Evidence: Records of medicines disposed of were clear, accurate and complete, which made accounting for medicines simple and easy to follow. A check was completed for a number of controlled medicines (medicines that are liable to misuse) and these were found to be kept securely stored and records had been completed accurately. Staff were seen to be attentive and helpful towards the residents. Care and support was given in a respectful manner. For example, this was observed when staff were helping residents with different aspects of personal care, choosing clothes, help with walking, transferring safely and assistance with meals. Staff did not hurry the residents and took time to explain the help they were going to give. Staff were seen to knock on private doors before entering and to address residents with their chosen title and name. To ensure privacy during bathing, an occupied sign had been placed on the bathroom door when it was in use. Two staff members are enrolled on a dignity champion course, which looks at how to promote good standards of respect when caring for residents on a day to day basis. It was evident that the staff are forward thinking in promoting this area. A resident said, The girls are always polite. Care Homes for Older People Page 16 of 32 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. Social activities and meals are both well managed and provide daily variation and interests for the residents living at the home. Evidence: There was a pleasant, relaxed and friendly atmosphere in the home. Visitors arrived at the home at various times of the day and a relative said, You are always made welcome and the staff have time for a chat. Holy Communion is offered to the residents so that they can continue with their chosen faith and residents have access to a hairdresser each week. Residents spoken with were happy with the routine and gave examples of how staff accommodated their individual wishes. For example, a number of residents were seen to have a late breakfast as they like to get up later during the day. Another resident commented on the fact that they she can choose how to spend her day and what social events should would like to take part in. Residents liked the fact that the home was spacious and that there were a number of lounges to sit in. The manager confirmed that the activities offered to the residents has improved since the last key inspection. An activities organiser is employed for eighteen hours a week, Care Homes for Older People Page 17 of 32 Evidence: however residents interviewed said they would on occasions like more organised events. An increase in the hours allocated for activities would therefore be beneficial. A staff member said that the home, Could do with a full time activities co ordinator. Planned events included, bingo, play your cards right, parties, quizzes, musical entertainment, knitting club, table top tennis and hand massages. The AQAA also stated that there is now a gardening club and newsletter regarding events in the home. The activities were displayed on notice boards and the activities organiser was seen to meet with the residents to ask them what they would like to take part in. Card games were taking place during the inspection and a number of residents said how much they enjoyed the knitting club and the parties. Halloween is being celebrated and a show case cabaret is planned for November 2009. Residents made the following comments, We have lots of parties and There are things going on that we really enjoy. The Commission sent out staff surveys prior to the inspection and staff reported that the home would benefit from their own minibus. A communal minibus owned by the company is available approximately once a month for the residents at the home. It is recommended that the company look to making this available more frequently or to purchase a minibus for St Martins. Staff interviewed confirmed that a number of residents would benefit from more trips out from the home to help them maintain their independence and join in with community based events. The AQAA and surveys from residents and relatives received in house by the manager also make reference to providing this. Feedback from the residents and their relatives regarding the menus was good. Their comments included, Very good food (resident), We can choose what we want (resident), I have no complaints (resident), We get plenty of home cooking (resident), Lovely food (resident) and The food seems nicely prepared and cooked. (relative). The nutritional content of the food is monitored by the company so that residents are served meals that are well balanced to help keep them healthy. The kitchen was found to be very well stocked and this included plenty of fresh fruit and vegetables. A new kitchen floor was being laid at the time of the inspection and the kitchen staff dealt with the disruption in a professional manner. Meals were still served on time and the residents had been informed of a change of menu to accommodate the work that was being undertaken. Environmental health records were up to date to ensure good standard of hygiene in the kitchen and for the food served. The dining room tables were attractively laid for lunch and each table had a flower Care Homes for Older People Page 18 of 32 Evidence: arrangement, linen tablecloth and napkins. The majority of residents attend the dining room, however they may have their meals in their own room if preferred or with their family members. Staff served the lunch in an unhurried manner thus providing residents with plenty of time to enjoy their food. Care Homes for Older People Page 19 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents complaints were listened to and residents were protected by the homes policies and procedures to keep them safe. Evidence: Residents, visitors and staff had access to a complaint policy and procedure. Details of which were displayed in the Service User Guide, on the notice board and also within the homes policy folder. There was plenty of information easily available for people to see should they wish to raise a concern. The AQAA recorded five complaints received and the complaint log detailed the subsequent investigations and action taken. One complaint was upheld and this has been resolved to the satisfaction of all parties. The Commission received a concern regarding poor staffing levels. This was not upheld following an investigation. The AQAA reported that the manager holds evening surgeries for residents and relatives to attend so that they can meet to discuss any queries or concerns they may have. A notice was displayed in the home to advertise this. There were safeguarding procedures in place to keep the residents safe and staff had received training to ensure they know how to report an alleged incident. The AQAA confirmed that there had been no referrals to the safeguarding team for investigation. Two were received by the Commission and investigated by the relevant agencies. Staff were able to describe abuse and how it should be reported to keep people safe. It is Care Homes for Older People Page 20 of 32 Evidence: recommended that contact details for reporting an alleged incident be displayed in the staff room so that staff can easily access this information. The manager is undertaking training regarding the Deprivation of Liberty safeguards. This is to ensure the staff are aware of their duties and responsibilities under the Mental Capacity Act 2005. This helps to safeguard people who may lack capacity to make particular decisions. This should be given to all staff as part of their training programme. The manager confirmed that no deprivation of liberty referrals had been made at this time. Care Homes for Older People Page 21 of 32 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. Residents live in comfortable, clean, pleasant and suitably adapted surroundings. Evidence: St Martins is a purpose built home and it was found to be clean and comfortable. Areas seen were pleasantly decorated and records showed that the accommodation was being maintained to a good standard. Day to day jobs had been completed promptly and rooms decorated as needed. Colour schemes were pleasing to the eye and residents said they liked the numerous fresh flower arrangements which were displayed in the home. Their comments included, The home is kept very nicely and Although it is not home, the girls do everything to make it feel nice. Likewise staff said the home was kept clean and well maintained. The layout of the building allows residents to socialise in different communal areas. There are three lounges and an area within one lounge accommodates people who wish to smoke. This has been risk assessed as being safe. The lounges had comfortable armchairs and coffee tables and a number of these were placed in different areas of the room to provide designated small areas. This enables residents to meet their visitors in private and enjoy a quiet time. Residents have the use of a computer and juke box and all lounges have televisions and music systems. The main lounge is spacious and this enables the staff to use as variety of aids to help residents move safely and in comfort. Care Homes for Older People Page 22 of 32 Evidence: The majority of residents attended the dining room for lunch and this was a social occasion for the residents to get together and enjoy meeting other people. Bathrooms seen had equipment to assist residents to bathe safely and in comfort. Residents can use a bath or walk in shower according to preference and the hot water was being tested to the baths to ensure it was delivered to a safe temperature. Records seen evidenced this. Residents interviewed said there was plenty of hot water at different times of the day. Two bathrooms were found to have chipped tiles and the replacement of these should be included in the general maintenance plan for the building. The chipped tiles may cause an increased risk of cross infection and the appearance of them detracts from the standard of the bathrooms. The manager, following consultation with the residents, is in the process of making changes to the bathrooms to make them more homely in appearance. There was plenty of equipment in the home to ensure residents could maintain their own independence and to help those who were frail. For example, hand rails and moving and handling equipment. Special nursing beds with mattresses were provided in a number of rooms to ensure maxim comfort for residents who were frail in health. Residents have the use of a hairdressing salon. This room is also used for general storage, however it is cleared when the hairdresser is visiting. The garden has individual patio areas with garden furniture and BBQs were held during the summer months, including a celebration of Independence Day on 4th July. The AQAA reported that improvements have been made to the garden and a resident said how much she enjoyed sitting out on the patio during the summer. Bedrooms were decorated to a good standard and residents had brought in items from home to make their rooms feel special and more like their own home. This included pieces of furniture, small fridges and personal bed linen. A resident said, I am more than happy with my room and I have made it feel cosy. Lockable drawer space was available for the safe keeping of personal items and the AQAA reported that individual bedroom keys were available on request. A resident confirmed that their bed was comfortable and that the bed linen was changed regularly. A call bell with an alarm was fitted in each room for residents to use. The laundry room was clean and staff had access to plenty of gloves, aprons, liquid soap and hand towels through out the home. This helps to ensure a good standard of hygiene. Care Homes for Older People Page 23 of 32 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. The procedures for the recruitment of staff need to be more robust to ensure the protection of the residents at the home. Evidence: The staffing rota was looked at and this showed the numbers of staff on duty to provide care and support to the residents. The manager was on duty with a registered nurse, a senior carer and six care staff. A registered nurse is on twenty fours a day. In the afternoon there were four care staff on duty and three at night. The registered nurse supports the senior carer with the management of the residents who have personal care needs. Other staff on duty included two cooks and kitchen, domestic and laundry staff. Residents said the the staff were always busy, however they were pleased with the standard of care given to them. They said that the staff were helpful, attentive and answered calls for assistance as soon as they could. Comments included, Very nice staff, The home is kept very clean and domestic staff are very good and They are lovely to us. Likewise a relative reported, I find everyone very kind which is reassuring. Staff interviewed said they worked well together and this was seen at the time of the inspection. Staff comments included, The staff work as a team to promote individual care needs to give a high standard of care to the clients. Staff were observed to spend time with the residents, chatting to them on an individual basis or within a group. Good communication was evident and they Care Homes for Older People Page 24 of 32 Evidence: attended to their needs in a professional manner. Residents who needed to be nursed in bed due to their frail health were attended to regularly to ensure their comfort and well being. The AQAA gave details of the National Vocational Qualifications for the staff. This provides formal learning in care at Level 2 and Level 3. At present there are nineteen permanent staff and twelve have achieved an NVQ in care at Level 2 and three at Level 3. Five staff files were looked at with regards to recruitment practices within the home. The files included references and police checks, CRB (Criminal record bureau) disclosures. One member of staff had commenced employment prior to the CRB being received. This places people at risk. Staff can only commence employment once police clearance has been received along with all the other necessary checks required. This helps to protect people who use the service. The manager gave assurances that all staff now have police clearance. New staff had received an induction in accordance with the Skills for Care Induction Standards. This provides a formal introduction into care. There was evidence of an ongoing training programme for the staff to ensure they worked safely. For example, moving and handling, food hygiene, health and safety, first aid and infection control. Other courses arranged included continence management and dementia care. These courses help the staff to care for the residents and their associated conditions. Staff interviewed said they receive regular training and the AQAA reported that the manager is looking to implement the Southern Cross diploma in house training programme. This provides good evidence of the managers commitment to staff development and learning. Care Homes for Older People Page 25 of 32 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. St Martins was found to be well run in the best interests of people who live there and their welfare was being promoted and protected. Evidence: The manager of the service is Ms Jackie Achilles. She has many years experience in caring for older people and is a registered nurse. Ms Achilles is in the process of applying to the Commission to become the registered manager for the home. This application should continue, as the home has been without a registered manager for a long period of time. Ms Achilles has attended training in safe working practices and has signed on with a training provider to undertaken the necessary NVQ managerial course as part of her professional development. Discussion with the manager showed that she was committed to monitoring and improving standards in the home for the benefit of the people who live there. The AQAA reported that the manager has an open door policy and this was found to be the case. Feedback from surveys received and from interviews conducted with Care Homes for Older People Page 26 of 32 Evidence: staff, residents and visitors was complimentary. They felt the manager was supportive and daily contact with her enabled them to contribute to the development of the home. Staff use a variety of methods to seek the views of the residents. This includes meetings, satisfaction surveys and daily communication as the staff go about their work. Residents and relatives had the opportunity to give their views or opinion of the service. The manager ensures staff receive training and supervision of their job role, so that the residents receive good care and support to enable them to live their daily lives in a way they prefer. Staff interviewed said they received regular supervision and the hand overs at each shift gave them the information they needed to care for the residents safely. Comments included, We have regular meetings in which we can express concerns and discuss ways to improve and We have very good training and we are all have to attend. The quality of the service was always being checked in a number of areas. For example reviews had taken place of the resident care documents, health and safety of the building, equipment in use, complaints and accident reporting. These checks had taken place regularly and the manager had taken action if needed help improve the service offered to people. Monthly visits to the home were also being conducted by senior management and reports compiled of their findings. This is to ensure good standards are maintained within the company. An administrator oversees the residents financial records to protect their financial interests. Records seen were up to date, simple and easy to follow. The need for accurate medicine records to be maintained is stated under Standard 9 of this report and for CRB disclosures to be obtained for all staff prior to employment under Standard 29 of this report. Other records viewed in relation to the care were found to be up to date and accurate to help ensure the residents received the care and support they needed. Formal records had been kept of accidents that affected the residents welfare and the daily care records had been updated with the incident and action taken by the staff following the event. It was found that residents care files and staff supervision notes were kept in the offices and the door not alway locked when staff were not in attendance. These records should be securely stored, as they contain confidential information. Staff had access to a number of polices and procedures to help them work safely and in accordance with current legislation. A spot check was undertaken of certificates and testing of a number of services and equipment, for example, fire prevention, gas and Care Homes for Older People Page 27 of 32 Evidence: electric certificate. These were found to be in date to ensure they were operating safely. Staff also receive regular fire prevention training. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 29 of 32 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 9 17 Records of medicine kept and administered must be accurate. This is so that all medicines in the home are fully accounted for. 20/10/2009 2 29 18 Staff must not commence 25/11/2009 employment prior to a police check being received. This is to ensure the protection of the residents 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 9 The medicine policy should record details regarding recording of medicines to help ensure staff are aware of the correct procedures to be followed. A communal minibus owned by the company is available approximately once a month. It is recommended that the company look to making this available more frequently or to purchase a minibus for St Martins. The residents would Page 30 of 32 2 12 Care Homes for Older People 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 benefit from more trips out from the home. 3 12 The number of hours allocated for conducting activities should be increased to ensure the residents receive more time to enjoy the social programme. Contact details for reporting an allegation should be displayed in the staff room for staff to easily access. Deprivation of Liberty training should be given to all staff to ensure they are aware of the safeguards for people who lack capacity to take particular decisions. Replacement of the chipped bathroom tiles should be included in the maintenance plan for the building, as they increase the risk of cross infection and detract from the appearance of the bathrooms. Staff supervision notes and resident care files should be locked away when not in use to ensure the records are held securely. 4 5 18 18 6 19 7 37 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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