CARE HOMES FOR OLDER PEOPLE
St Martins Queen Street Gillingham Dorset SP8 4DZ Lead Inspector
Mike Dixon Unannounced Inspection 26th January 2006 10:00 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 DS0000026873.V279680.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 DS0000026873.V279680.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service St Martins Address Queen Street Gillingham Dorset SP8 4DZ 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) 01747 823221 01747 826224 Care South Mrs Sandra Anne Lemon Care Home 32 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (6), Old age, not falling within any other category (32) St Martins DS0000026873.V279680.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 32 in the category OP (Old Age) including up to 6 in the categories DE(E) and/or MD(E). 5th October 2005 Date of last inspection Brief Description of the Service: St Martins is located near to the centre of Gillingham. The home is operated and managed by Care South, which is a ‘not for profit’ organisation operating a number of homes and care services across Dorset. Registration of the home is for accommodation of up to 32 older people over the age of 65 years, and up to six places can be used to provide a specialist service to older people with dementia or other mental health needs. Although the building is relatively old, it is well maintained and provides a range of comfortable accommodation for service users. There are five shared bedrooms and prospective residents are made aware if the vacancy on offer is a shared place. There is level access throughout the home and a passenger lift provides access to the first floor. St Martins DS0000026873.V279680.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted as part of the Commission’s regulatory duty to inspect all care homes twice a year. The purpose was to review the home’s progress in implementing the requirements and recommendations from the previous inspection report. The purpose was also to assess the home’s compliance with the remaining key national minimum standards for older persons that had not been considered during the previous inspection visit. In order to obtain a fuller picture of the home the reader should refer to the earlier inspection report dated 5/10/05. During the visit which lasted six and a half hours the inspector spoke with ten service users, the manager and four staff members. He joined service users for lunch, looked round the accommodation, observed practice, looked at medication supplies and inspected records relating to service users’ care, staffing and medication and other documentation relating to the running of the home. Prior to the inspection, comment cards were sent to the home for distribution to a variety of people who have an association with the home. The Commission received a total of forty-one responses, as follows: twenty-five from service users, nine from relatives/friends, five from health care professionals, including GPs and two from social care professionals. The inspector also spoke with one GP and social care professional prior to the visit. What the service does well:
The home ensures that it only admits service users whose care needs it can meet by carrying out a comprehensive pre-admission assessment. Staff help new service users to settle in and give them the opportunity to decide on whether they wish to make St Martins their home. One relative said in a comment card: “It was particularly helpful when my relative first went to St Martins when even the smallest query was answered.” Care plans are generally comprehensive and informative. Service users and/or their representative are consulted about the care provided and for the most part a record is made in the care plan or review to evidence this occurrence. Most service users say that they are well looked after and several very positive views were expressed by relatives in comment cards about the kindness and competence of the staff. The home enjoys good support from the primary health care team and the general practitioners (GPs) are very complimentary about the standard of care which the home provides. One commented: “excellent home, staff are kind, easy to work with and treat clients with
St Martins DS0000026873.V279680.R01.S.doc Version 5.1 Page 6 dignity”. In most respects, the arrangements for the storage, administration and recording of medication are good and comply with professional guidance. The staff encourage service users to retain control over their lives, where feasible, and to enable service users to participate in decision-making. Service users are encouraged to make choices about how they spend their time and they can “personalise” their bedroom in accordance with their wishes. The management encourage staff to attain nationally recognised qualifications and staff say that they receive the training and guidance that they need in order to do their work. Most aspects of staff recruitment are to a good standard. The manager is experienced and runs the home in the best interests of the service users. Staff members feel that they are well supported by the management and that they are able to raise issues and discuss problems that may arise. There are opportunities for service users and staff to participate in making decisions about the home. The home has suitable arrangements in place to safeguard service users’ finances. What has improved since the last inspection? What they could do better:
There are two requirements and three recommendations arising from this inspection. Care plans must be updated to reflect the current circumstances of service users to ensure that staff are conversant with specific risks that may be present. The recommended improvements to the recording of medication and the monitoring of the fridge temperature should be introduced. With regard to staff recruitment, the home should obtain a reference from a prospective staff member’s most recent employer. The home must retain a copy of each staff member’s proof of identity.
St Martins DS0000026873.V279680.R01.S.doc Version 5.1 Page 7 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 DS0000026873.V279680.R01.S.doc Version 5.1 Page 8 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 DS0000026873.V279680.R01.S.doc Version 5.1 Page 9 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 The home ensures that it only admits service users whose care needs it can meet by carrying out a comprehensive pre-admission assessment. The home ensures that prospective service users and/or their representative are provided with the necessary information to make a decision about moving to St Martins. EVIDENCE: The manager or deputy manager visit prospective service users and carry out a comprehensive pre-admission assessment. They consult service users’ relatives and other social care or health professionals, as necessary. A record is made of the outcome of the assessment and a letter is sent to the prospective service user or his/her representative, confirming that the home is able to meet his/her needs. Service users are offered the opportunity to visit the home before making a decision to move in. Service users and/or their representative are provided with written information about the home to help them in making a decision. Service users stay at St Martins on a trial basis for six weeks, following which a
St Martins DS0000026873.V279680.R01.S.doc Version 5.1 Page 10 review takes place to which relatives and other interested parties are invited. The inspector spoke with a service user who had recently moved to the home and she confirmed that she had been assisted to settle in by staff and other service users. St Martins DS0000026873.V279680.R01.S.doc Version 5.1 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 and 9 Care plans are comprehensive but are not consistently updated to reflect the current circumstances of the service user in question. Service users receive the assistance that they require and have their care needs met. The home liaises effectively with the primary health care team and ensures that residents’ health care needs are met. In most respects the arrangements in place for the storage, administration and recording of medication are in accordance with professional guidance; minor adjustments are needed in order to fully safeguard service users. EVIDENCE: Each service user has a care plan which is based on the pre-admission assessment. Care plans are for the most part updated regularly and more indepth reviews are conducted periodically. Service users and other interested parties participate in the review. In most of the sample of records looked at by the inspector, care plans reflected the current circumstances of the service user in question. One example was noted where the care plan did not reflect the fact that the service user had been experiencing falls recently. Most care plans provide evidence that the service user and/or their representative have
St Martins DS0000026873.V279680.R01.S.doc Version 5.1 Page 12 been consulted regarding the content of the care plan. Risk assessments cover a range of topics relating to the safety and welfare of service users. Service users receive the personal care which they need in order to sustain a good quality of life. Several service users with whom the inspector spoke said that they were well looked after. One service user said “I feel the staff are doing a good job”. Comment cards received from service users confirmed this positive impression of the home. Views expressed by relatives of service users through comment cards include the following: “all staff are very kind to residents” and “I feel she is safe and cared for very well”. Service users were dressed in well-laundered clothing and were well presented. Regular visits to the home by a hairdresser help service users to maintain their appearance. Two service users thought that the home was sometimes a little short of staff as they had to wait to receive attention on occasions. Two service users commented adversely on the lack of privacy and other inconveniences of having to share a bedroom, although they were aware of the situation prior to moving into the home. Service users receive the health care provision that they require. There is good liaison and support from the primary health care team. Doctors and community nurses visit regularly and monitor the health of the service users. Health care and social care professionals for the most part have a very high opinion of the care which the home provides to service users. One professional commented: “excellent home, staff are kind, easy to work with and treat clients with dignity”. The home continues to run an activities programme during the afternoons, although there is no longer an activities coordinator in post. The activities provide service users with some opportunity for mental stimulation and the programme helps to give some focus and interest to the daily routine. The home has a well organised system of storing and administering medication. The management conduct regular audits of the system to ensure that it is working efficiently. Medication is stored in accordance with recommended practice. The written policy/procedure for medication is accessible to the staff; all who administer medication have received training in the safe handling of medication. Service users’ medication is kept under review by their general practitioner. A risk assessment is recorded for those service users who choose to look after their own medication. Minor matters were noted by the inspector with regard to aspects of the recording of medication and the monitoring of the temperature of the fridge where certain medication is stored. St Martins DS0000026873.V279680.R01.S.doc Version 5.1 Page 13 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): 14 The home encourages service users to retain control over their own lives and to participate in decision-making, where feasible. EVIDENCE: With one exception all service users have a relative or other representative who remains in contact. The inspector suggested that the option of obtaining an advocate for the person in question might be explored. The manager has information about accessing advocacy services. Service users have the opportunity to participate in residents’ meetings which take place at approximately four monthly intervals. Friends and relatives of service users are invited to attend these meetings. Service users may choose how and where they spend their time and this was confirmed with the inspector during the course of the visit. Service users may bring in items of interest to “personalise” their bedroom such as pictures, photos, ornaments or furniture. Service users may access their personal records and information on this topic is included in the service user guide. St Martins DS0000026873.V279680.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were considered during the inspection. EVIDENCE: St Martins DS0000026873.V279680.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were considered during the inspection. EVIDENCE: St Martins DS0000026873.V279680.R01.S.doc Version 5.1 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 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): 28 and 29 The home promotes the achievement of nationally recognised care qualifications and is building a staff team that enjoys the confidence of service users. The home’s recruitment procedure is mainly robust but is in need of minor adjustment in order to provide better protection for service users. EVIDENCE: The policy of Care South is to register care staff for inclusion on the NVQ 2 programme once they have successfully completed a five month probationary period. In this way the Company promotes the attainment of nationally recognised qualifications by staff. At present approximately one-quarter of the care staff members have achieved either NVQ level 2 or 3 and five more people are currently preparing for NVQ level 2. Unfortunately, several staff members who had achieved NVQ 2 have ceased to work at the home. In discussion with the inspector, care staff confirmed that they received the necessary training and guidance in order to provide care for the service users currently living in the home. Staff were observed to approach and assist service users in a considerate and professional manner during the course of the inspection. The home has a suitable procedure in most respects for the recruitment of new staff which includes the completion of an application form, the taking up of two references, the carrying out of a police/POVA check via the Criminal Records
St Martins DS0000026873.V279680.R01.S.doc Version 5.1 Page 17 Bureau and conducting an interview. In one example of a recently recruited staff member the home had not asked for a reference from the most recent employer which would be recommended practice. The manager undertook to do this immediately. The home has not retained a copy of each staff member’s proof of identity owing to a misunderstanding of expected practice; in all cases the identity of each prospective staff member has been checked prior to their appointment. Staff receive a letter confirming their appointment and a contract of employment. St Martins DS0000026873.V279680.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32 and 35 The registered manager is experienced, has some relevant qualifications and manages the home efficiently in the best interests of the service users. There is an open style of management at the home which enables service users and staff members alike to feel confident about raising issues. The home has the necessary arrangements in place to safeguard service users’ financial interests. EVIDENCE: Sandra Lemon, registered manager, has many years experience of managing care homes and has a social work qualification. She will not be undertaking preparation to attain NVQ level 4 in management of care at this stage of her career. In order to meet this standard in full the registered manager has to attain this qualification. The manager keeps abreast of current practice by
St Martins DS0000026873.V279680.R01.S.doc Version 5.1 Page 19 undertaking training periodically in topics that are related to health and safety and to the care of older persons. She is shortly to attend a training course in risk assessment. The deputy manager will be undertaking the registered manager’s award at NVQ level 4. There are clear lines of responsibility with regard to the management of the home. Regular monitoring visits are made to the home by representatives of the Care South management team in compliance with regulations and copies of reports made are sent to the Commission. One such visit was undertaken during the course of this inspection. Staff and residents’ meetings take place and the outcome is recorded. From discussions with staff members during the course of the inspection it was evident that people had the opportunity to exchange views and to raise issues at staff meetings, supervision sessions and informally on other occasions. The management team is considered to be “approachable” and the staff expressed their confidence in the competence of the manager and deputy. Similarly, service users with whom the inspector spoke expressed the view that they would feel happy to talk with a member of the management team if they wished to discuss a problem or make a suggestion about the running of the home. The home has polices and procedures that relate to the management of service users’ finances. The home acts as the agent for one service user with regard to collecting his pension, but otherwise does not act in any formal capacity on behalf of service users who look after their own affairs or have a representative to assist them. Small amounts of cash are held in a secure place for some service users. Records are kept of all transactions and receipts are retained, where appropriate. Lockable facilities are provided to service users in their own room at their request. Incidents of alleged missing money have occurred in recent months; the matter is under investigation by the police in cooperation with the management. St Martins DS0000026873.V279680.R01.S.doc Version 5.1 Page 20 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 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x x x STAFFING Standard No Score 27 x 28 2 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 x x 3 x x x St Martins DS0000026873.V279680.R01.S.doc Version 5.1 Page 21 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 OP7 Regulation 15 Requirement Care plans must be updated to reflect the current circumstances of service users to ensure that staff are conversant with specific risks that may be present. The home must retain a copy of each staff member’s proof of identity, e.g. birth certificate, passport or driving licence. Timescale for action 28/02/06 2. OP29 17(2) sched 2 31/03/06 St Martins DS0000026873.V279680.R01.S.doc Version 5.1 Page 22 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. Refer to Standard OP9 Good Practice Recommendations When medication is prescribed to be given as PRN the circumstances under which the medication is to be given should be clearly recorded in the care plan. A second person should sign the MAR chart when a hand written entry is added to the list of medication to evidence that the correct details, including dosage, have been entered. The maximum and minimum temperature of the fridge where medication is stored rather than the actual temperature should be recorded on a daily basis. The home should obtain a reference from a prospective staff member’s most recent employer. If the previous post involved working with children or vulnerable adults this measure would be a statutory requirement. 2. 3. OP9 OP29 St Martins DS0000026873.V279680.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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