Inspection on 30/11/06 for St Martins

This inspection was carried out on 30th November 2006.

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

The inspector 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 17/02/06

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 Key Unannounced Inspection 11:00 30th November to 21st December 2006 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 DS0000025926.V322285.R01.S.doc Version 5.2 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. DS0000025926.V322285.R01.S.doc Version 5.2 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 DS0000025926.V322285.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th February 2006 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. Mr Patrick Bell and Mrs Bridget Bell privately own and run the service, with Mrs Bell as the registered manager. 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. There are five lounging areas in the home four on the ground floor and one on the first floor to the rear aspect of the building. Service users have access to, two dining areas one of which is smaller and cosier. A small sitting area is integrated with the latter, for individuals wishing to sit quietly. Service users are able to take their own furniture into the home, provided that it meets fire safety standards. There are a number of toilets and bathrooms on both floors that are accessible to service users. Up to sixteen bedrooms have en-suite toilets and there is also a shower room in St Martins Rest Home. 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. An emergency call alarm system is available for the benefit of service users requiring the assistance of staff. Fees are charged at £450.00 per week and service hairdressing at £15.00 per session and private chiropody charge at £22.00 per session. Service users also pay for personal effects, the prices of which are variable. The home’s statement of purpose is made available to service users on request and a copy is kept in the staff office. Each service user is offered a copy of the home’s service user guide, once admitted to the home. DS0000025926.V322285.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and a key inspection of the service for the inspection year 2006/2007. This meant that all key standards were covered as well as any other standard for which a requirement was made at the last inspection. It was carried out over two days beginning on the 30/11/06 at 11.00 a.m. and finished on the 21/12/06. The inspection was timed to meet as many relatives and staff as possible in order to gain their views on the quality of care provided by the home. At the time of the inspection there were twenty-eight service users in the home. Most were out in the communal areas; sitting quietly, reading, watching TV or listening to music. They were generally relaxed, comfortable and, engaged with staff throughout the course of the inspection. Given that the inspection was unannounced, it was positive that service users were engaged in some way shape or form and not left without stimulation. The inspection involved interviews and discussions with up to five staff, as well as the registered manager, detailed discussions with service users, an assessment of meals and activities in the home, a tour of the building, an assessment of staff recruitment/service user/and financial records maintained by the home. Interviews and discussions were also held with three of the service users’ relatives. The inspection considered written feedback from questionnaires returned by staff and service users about their experiences in the home. Most of the feedback received was positive. Service users were receiving care and support that is of a good standard at St. Martins. Further improvements are required to enhance the standard of services provided to individuals and, they are outlined in the body of this report. At the time of the visit the registered persons did make an application to provide care and support for service users with a diagnosis of Dementia. This application has now been withdrawn. What the service does well: The registered persons pride themselves on their ability to provide good longterm care that offers stability to service users. In doing this, positive links are maintained with key professionals such as the GP, district nurses, social workers and continence advisors. Positive links are also maintained with relatives and service users’ friends, where possible. All service users are given an opportunity to pursue their religious aspirations – which is very important to those taking up the offer. DS0000025926.V322285.R01.S.doc Version 5.2 Page 6 The manager leads a dedicated staff team and maintains a presence at St Martins to ensure that the service is delivered in accordance philosophy of the home. Staff continued to work within the ethos and philosophy of the home and most service users feel that they are treated with dignity and respect. It must be stated that service users view such experiences, as invaluable. Service users enjoy living in a home that they feel is safe, and most lead long and fulfilled lives at St Martins. What has improved since the last inspection? What they could do better: Updated information in the statement of purpose and service user guide must be made available to service users at all times and in suitable formats. A copy of the service user guide must be offered to each individual living in the home. Staff must ensure that the specialist needs, e.g. chiropody, of service users are identified and acted upon at all times. Service users involvement and the range of activities provided could be improved through more choice and by advertising them. Meals provided must be more reflective of the choices made by service users. Strategies need to be in place to enable service users to make such choices. Action should be taken to ensure that service users feel confident, and assured that they could make complaints about the services provided at St Martins. Service users would enjoy better protection from abuse, once the local authority’s adult protection protocols are followed and all staff are provided with adult protection training. In order to improve safety in the home, an occupational therapist assessment of the premises needs to be carried out and, food storage must be in line with DS0000025926.V322285.R01.S.doc Version 5.2 Page 7 food safety standards. Safety would also be enhanced, by arranging a fire safety inspection of the home. The recruitment practices need to be more robust and this includes checking prospective employees’ right to work in the United Kingdom. The registered manager needs to undertake training as required by regulation to achieve the appropriate qualification in management and care, or its equivalent. The quality of the service provision needs to improve by carrying out an internal audit of the service and having an annual development plan in place for the home. Policies and procedures should be reviewed regularly, as part of quality monitoring at St Martins. 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. The summary of this inspection report can be made available in other formats on request. DS0000025926.V322285.R01.S.doc Version 5.2 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 DS0000025926.V322285.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): (1,2,3,6) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their relatives would benefit from having updated information about the home. However, they (SU) are assured that their needs would be thoroughly assessed and, terms and conditions regarding their stay would be made available to them, or their relatives. EVIDENCE: A statement of purpose and service user guide in developed for the benefit of service users. They contain information about the service provided at St Martins and what one could expect if they chose to live there. It is therefore essential that they are kept updated and reflective of the service. The statement of purpose was dated 2002 and needed; details of the Commission in relation to complaints and when service users could contact, the arrangements for smoking in the home, and an accurate description of the facilities in bedrooms e.g. hand-wash basin only, toilet only or full en-suite with toilet and bathing/hand washing facilities. DS0000025926.V322285.R01.S.doc Version 5.2 Page 10 From talking to three of the most recently admitted service users, they informed that they had not seen a copy of the service user’s guide. During an interview with one staff member they were not aware of this document, which is an important document. The registered manager informed that most service users did not want to keep a copy, so it is usually put on their file. There was some evidence of this. None of the service users were aware of the charges for their care and indicated that their relatives looked after this. This was substantiated from speaking with relatives, who confirmed that they were kept in the loop about charges and/or changes, particularly following reviews. It was also the case from the written feedback provided by service users, that they had adequate information about the home, prior to living at St. Martins. The registered persons must, however, ensure that the information in both documents remain updated and in formats suitable to the service user group. Staff working in the home should be aware of the documents provided to service users. Service users spoken to did not have a copy of their terms and conditions. However, copies were found on their personal files. In one case, this document was incomplete and the registered manager explained the circumstances that led to this. Plans were in place to correct this. The documents seen detailed the rights and obligations of the service users and the registered persons, and in some cases they were signed off by a relative acting on behalf of the service user. Service users were aware and satisfied with their individual arrangements. From a random sample of the files for the most recently admitted service users, there was evidence that a full needs assessment was carried out on each individual, prior to their admission. Management and staff were therefore able not only identify the various needs of the individual, but they also detailed a plan of action for how they were met. Where possible relatives were involved in this process and a summary of the care management assessment is obtained as part of the home’s admission process. Service users therefore have some assurance that their needs could be met by the home. It was noted that this was an improvement from the last inspection visit. Intermediate care is not provided at St Martins and as such standard 6 was not assessed at this inspection. DS0000025926.V322285.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): (7,8,9,10) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users generally benefit from having a service user plan detailing their needs and this includes their personal, social and health care needs. They are supported to maintain a healthy lifestyle and this includes support with medication. The physical needs of service users could be better monitored to ensure more adequate provision pf healthcare. Service users enjoy their privacy and are satisfied with the levels of respect that exhibited by the staff. EVIDENCE: Five service users plans were examined, including three of the most recently admitted that were part of case tracking. A satisfactory system of service user planning is in place at the home, in that they generally detailed the health, personal and social care needs of service users. The assessments cover areas such as physical health, religion, dietary preferences, oral health, mobility, speech and language and leisure pursuits. Where possible service users and their relatives are involved in the planning and they were reviewed at regular periods. It is important to note that significant changes in most cases are recorded and acted upon so as not to compromise the quality of care given to service users. The manager and senior DS0000025926.V322285.R01.S.doc Version 5.2 Page 12 staff have the responsibility for reviewing and updating the service user plans. Risk assessments for individuals were also in place. Two of the service users spoken to informed that they had not seen their care plan (service user plan), although they remembered that they had a review. They knew however what the home had to provide for them. There was evidence that several interventions were made on service users behalf with regard to promoting their health care. One service user stated; ‘I have an optician’s appointment in January for my cataracts – the manager arranged it for me’. Another spoke of having an eye test coming up and was nervous about it. She indicated that the registered manager was helping her to come to terms with going ahead with the appointment. There were sound records in place detailing the health care appointments for all service users. This is very important as most of the service users had a condition associated with growing older. In most cases, staff acted appropriately in monitoring, recording and making interventions to ensure that service users lead a comfortable life, regardless of their individual circumstances. However, there was one case in which a service user had some difficulty with her feet, one of which was worse than the other. She had digits that were beneath the sole of her feet with the nails overgrown. This resulted in her experiencing great discomfort when walking as the nails were impacting on the sole of her feet. The problem should have been picked up by staff and appropriately acted upon. The registered manager informed that she was not aware of this and would contact the chiropodist without delay. Staff needed to be more vigilant to ensure that the health care needs of service users are identified and promptly acted upon. All service users have access to a GP, dentist with arrangements made for hearing tests. As part of promoting health care in the home, trained staff administered medication, as most service users were unable to independently carry out this task. A medication policy was in place to guide them and from observation this process was satisfactorily carried out. Drug storage and recording was also satisfactory. Medication monitoring in the home is carried out by the management and in general - effectively met the needs of service users. At the time of the visit controlled drugs were not used in the home. On the day of the visit staffing interaction with service users indicated that service users were respected and their privacy upheld. Staff were observed calling service users by their preferred names, listening carefully to what was said to them and displayed a sense of professionalism in carrying out their duties. Feedback received from interviews held with three relatives confirmed this. One relative stated, ‘the staff are always polite with my sister’. In support of this another service user commented, ‘some staff are good and others could be bullish, however, the staff here are kind and treat us well. We feel respected here’. DS0000025926.V322285.R01.S.doc Version 5.2 Page 13 There is capacity in the home to ensure that service users are seen in private and this is used as and when required. The induction for staff covers respecting service users and staff have a copy of the General Social Care Council’s code of conduct, which guides their practice. From the written feedback received most service users indicated that they felt- ‘listened to’. DS0000025926.V322285.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): (12,13,14,15) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy some level of activities provided by the home, which could be improved. They benefit from maintaining positive relationships with relatives and friends, and are encouraged to maintain control in their lives. Their nutritional needs are generally met, although the registered persons need to actively involve service users in choosing their meals. EVIDENCE: On the day of the visit service users were at various parts of the home, some were reading, others relaxing and later on in the day some were listening to background festive music, while playing board games with staff. It was evident that staff were engaged with service users throughout the inspection. In speaking with service users, some preferred to do very little and this was respected. For others, it was very much varied and this included one individual stating that she liked knitting, but did not have the opportunity to so do. This was a pastime of the service user, which she quite missed. There is a list of activities in the home, which includes general knowledge quizzes, tea parties, sing-a-long, gentle exercises, church services and board games including monopoly. A hairdresser was present on the first day, doing service users’ hair and for those participating- they quite enjoyed the experience. One service user stated ‘I quite look forward to having my hair DS0000025926.V322285.R01.S.doc Version 5.2 Page 15 done’. The activities could be improved through; ensuring that they are more widely advertised, that service users are more involved in choosing them and where possible service users are supported to do what they enjoy, culturally or otherwise. This would ensure greater physical and mental stimulation for all. From speaking with service users and relatives, it was clear that positive relationships are encouraged to ensure that individuals maintain their networks, which are invaluable to them. Some relatives visited more regularly than others and for those without relations, friendships are encouraged within the home. Two service users were hand-in–hand and spoke positively about how they enjoyed each other’s company. There is a feeling of family and cosiness in the home and this is positive. There was no evidence of restrictions placed on visitors against the wishes of service users. It is, however, vitally important to ensure where issues of conflict between relatives appear, unless this adversely impacts on the service user – that all relatives are encouraged to continue feeling valued when visiting the home. Although this is not currently an issue in the home, there was evidence that this could become an issue in the future. Where there are difficulties encountered with visitors – the visitor’s policy should be invoked in the interest of service promoting satisfactory relations in the home. In viewing the private spaces of service users and speaking with them, it was clear that they were encouraged to bring in their personal possessions to the home. One individual brought in his TV and was quite pleased to have done so. He stated; ‘its nice to have your own and this makes me feel at home’. Most service users have support from their relatives in looking after their personal and financial affairs, and this is done in accordance with their individual wishes. Appropriate records were held in the home relating to service users’ finances and access to such records are provided in line with the home’s access to information policy. Service users therefore have some control over their lives at St Martins. All service users are offered at least three meals per day, with drinks and snacks available in between main meals. Menus were in place for vegetarians, diabetics along with non-specialist diets. Lunch on the first day of the inspection was; ham or chicken, mashed potatoes, green peas and carrots. One service user was having a liquidised diet, but could not say what it was. A number of service users felt they were not given choices in the menus. The system currently used, involves staff preparing meals from pre-planned menus, which are then offered to service users. All service users spoken to informed that if they refused, alternatives are offered. While the meals seen were varied, nutritionally balanced, and well-presented, service users need to be actively involved in determining their menus. Two service users indicated that they ate lunch because they were hungry. Another indicated that the meals are sometimes good and sometimes okay. Evidence taken from the diet plan of a service user, indicated that his diabetes was DS0000025926.V322285.R01.S.doc Version 5.2 Page 16 under control with the meals provided by the home and he was grateful for that. Staff supporting service users with their meals did so in a sensitive manner. There were issues around the storage of food in the home, but this is covered under health and safety (Standard 38) – in this report. DS0000025926.V322285.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): (16,18) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints procedure is in place and available to service users at St Martins. Adequate arrangements are also in place to promote the safety of service users. However, more needs to be done to encourage service users to air any unhappiness they feel. Service users would also receive better protection, if all staff receive training in adult abuse. EVIDENCE: A satisfactory complaints procedure is in place for the benefit of service users. It must be stated that it required re-formatting and relocating during the course of the inspection to improve accessibility to service users. There was evidence of a complaint raised by relatives who were unhappy with the way their relation was treated. They were also able to refer their concern to the local authority, being dissatisfied with the home’s handling of the matter. This is positive. While most of the service users were aware of their right to complain, most people spoken to were actually afraid to raise concerns in the home. It was clear that the culture exhibited by some service users was that if they expressed their concerns then they would be seen as ‘naughty, trouble – makers or at risk at being kicked out of the home’. During an interview with one service user, she became distressed talking about her experiences, mainly because she did not wish for them to related to the manager. It was clear that the registered manager was held in high esteem, but this could work against service users’ best interests, if they feel unable to raise concerns. It is strongly recommended that the registered manager develop a strategy to change this. DS0000025926.V322285.R01.S.doc Version 5.2 Page 18 Staff interviewed were aware of the service users’ right to complain. However, they too needed to take an active part in encouraging service users to raise concerns if the were unhappy with any aspect of the service. The complaints record indicated that there were low levels of complaints, but this may not be due to service users being happy with their experiences in the home. Service users need to feel reassured when they raise concerns that it is okay to so do. An adult protection procedure is in place at the home and most staff were aware of it. There was evidence that some staff had been on training in respect of adult abuse, while others were yet to have this training. Two of the staff were interviewed and they demonstrated an understanding of dealing with allegations and suspicions of abuse. It is of prime importance that all staff receive adult protection/abuse training, as a matter of priority – particularly in light of the fact that service users are very wary of raising concerns. There was on adult protection matter in the home since the last inspection and while a case for abuse was not made, it brought up several key issues. One of the main issue was once the concern was raised, the home decided to investigate without notifying the Adult Protection coordinator. It took the relatives to raise the concern with the social worker for the issue to looked at in within the agreed protocols of the local authority. The registered persons must follow adult protection protocols in the future and if in doubt, it is better to report matters and then take direction accordingly. One positive aspect to come out this was that a policy on same gender care has been introduced. DS0000025926.V322285.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): (19,22,24,26) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users generally live in a home that is structurally sound and designed with their needs in mind. While the accommodation both private and communal is generally safe, action needs to be taken to maximise the safety of service users, particularly with regard to the communal areas. EVIDENCE: On the day of the inspection, the home was clean and tidy and service user appeared comfortable. There were renewal works taking place in the front lounge, where the floor covering was replaced and this was carried out with minimum disruption. The work was completed to a high standard. All service users spoken to were happy with the décor and layout of the home. The proprietor takes an active part in maintaining the building and, renewals and replacements are carried out on a rolling basis. The grounds were generally clean, although there was quite a bit of debris (leaves) on the external grounds. Plans were in place to have this cleared. DS0000025926.V322285.R01.S.doc Version 5.2 Page 20 Records were presented to indicate that the home met with environmental health standards. The last fire department check was carried out in 2002 and the registered persons should obtain an inspection to ensure that the home is still compliant with current fire regulations. Safety cameras are used in the home, and are cited at exits and entrances to the home, as a security feature. There was no intrusion on the privacy of service users. There were grab rails throughout the home strategically placed to promote the safety and independence of service users. Some service users were mobilised in wheelchairs, while others used walking aids. Most service users were observed getting by fairly safely. However, in view of the ageing population of the service user group, it is essential that an occupational therapist assessment is carried on the home, to ensure that the environment is best suited to meet their specialist needs. A random tour of service users bedrooms was undertaken, with their permission. They were in good decorative order and were very personalised wit pictures, and personal effects that were valuable to them. All service users spoken to were satisfied with their personal spaces. Relatives spoken to were also quite pleased with the private space. All rooms were adequately lit, had good ventilation with heating facilities that were comfortable to the service users concerned. They all had lockable areas and at the time of the visit, one service user preferred her door left open as she found it difficult to open at times. The registered manager was looking into this. Bedrooms were maintained to at a high standard. The laundry facilities were adequate for meeting the needs of service users, including the appropriate laundering and return of their items of personal clothing. The home has a sluice facility and the washing equipment has the ability to clean soiled linen. Policies and procedures for infection control were in place and facilities for washing hands were cited appropriately throughout the home. It was however observed in one of the bathrooms on the ground floor (opposite bedroom 13) that the right side rail around the toilet had lost its coating and the metal was exposed. This is both unhygienic and a hazard to service users having to use this rail. It needs to be replaced. DS0000025926.V322285.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive support from a dedicated staff team that are adequate in numbers. It is also to their benefit that staff have basic qualifications with arrangements in to additionally provide them with further training. Staffing recruitment needs to be more robust to ensure the safety of service users. EVIDENCE: A roster was in place detailing all staff on duty on a daily basis. The registered manager is in addition to the daily quota of staff with five on in the morning and five on in the afternoon. There are two waking nights with one sleep-in person. The staffing numbers given the needs of the twenty-six service users were adequate. It was positive to note that the staffing numbers on weekends were unchanged. During the peak activities staff were observed supporting service users appropriately. All service users indicated that staff were easily available to them, whenever they required support. Relatives and professionals spoken to also indicated that staff were always available to service users. Apart from the care staff, ancillary staff are employed in the home. As such cleaning, ironing, washing and catering was adequately provided for. The emphasis for care staff was therefore one of providing for the support needs of individuals. The registered persons has in her employ, fifty-five per cent of her staff with an NVQ level 2 and another fifteen percent currently doing their NVQ level 3 in Care. Plans are in place for the other staff to pursue the NVQ level 2 in Care, qualification. This means that staff have a basic understanding of care and this DS0000025926.V322285.R01.S.doc Version 5.2 Page 22 is a positive outcome for service users. Staff interviewed demonstrated a good understanding of care and of the philosophy of care in the home. They were able to describe the work they do and their responsibilities in meeting the care and support needs of service users. The recruitment records of the most recently employed staff was assessed and failed to meet the standard set out in regulation. The staff concerned was from outside the UK and there was no evidence that the individual had the right to work in this country. The individual was issued with a permanent contract, without employment dates and the records indicated she was a full-time student. From the roster she was working for over thirty-five hours per week. Other aspects of her recruitment were satisfactory, however the registered persons must ensure that adequate checks are made on all staff prior to their recruitment. Checking their right to work in the United Kingdom is a significant part of this. There was evidence of training that was provided for staff, which included infection control, food hygiene, first aid the safe handling of medicines, NVQ level 2 and Dementia training. Further training was planned for new staff in the areas identified above. There was evidence that the most recently recruited staff had an induction in line with in the recommended guidelines. From observation and interviews with staff it was concluded that they were capable of supporting elderly service users, and this includes recognising when to involve external professionals. Although staff receive the required minimum of, three paid days training per year, the registered persons could formalise a training and development profile for staff in the home. DS0000025926.V322285.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): (31,33,35,38) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has over twenty years experience in managing the service, and has been able to ensure that it is relatively stable. Most of the service users have expressed their happiness with living at St Martins. They knew the manager and were aware of her role, as she is always present in and around them. Relatives and most of the external professionals spoken to expressed their satisfaction with regard to how the home is managed. In discussion with the manager she demonstrated an understanding of conditions associated with the ageing process. However, there was no evidence of how she kept updated with improving her skills and competence. This is exacerbated by the fact that she has not completed the NVQ level 4 in Management and Care or undertaken training of DS0000025926.V322285.R01.S.doc Version 5.2 Page 24 its equivalent. It is therefore a required that she enrols onto the relevant course or provides evidence that she has acquired the qualification in management and care. It was noted that her deputy works closely with her in managing the service and has achieved an NVQ level 3 in Care, which has a positive impact on the overall service delivery. It was noted that an annual development plan was not in place for the home, although a service user survey had been carried out. In discussion with the registered manager she advised that she was in the process of completing this. Feedback from external professionals is obtained from service users’ reviews and this forum is also used to measure service users’ individual progress. The home also maintains compliment’s log and there were some glowing tributes paid by relatives about the quality of care in the home. There is still a need however for an annual audit to be carried out on the service and to ensure that policies and procedures are reviewed regularly. There was evidence that the relatives of service users play an integral part in their financial affairs. Records were in place for the management of personal allowances in the home and they were found to be in order. A random sample of service users’ finances was checked to evidence this. Funds held in the home are secure and protocols for handling finance were in place. Service users could therefore feel assured that their finances are safely managed in the home. There are generally sound arrangements in the home for promoting health and safety in the home. The health and safety file was updated and there was evidence that the lift, fire alarms, gas and environmental checks were satisfactory. An accident/incident file was in place and appropriately detailed occurrences in the home. Risk assessments on safe working practice topics e.g. fire, food hygiene, and, infection control were in place. Fire drills were regularly carried out with records kept. It was noted that the fitting of automatic fire closing systems to doors along the corridors had not been completed. The registered manager explained that they were having some problems with the company, but would pursue this. One of the areas requiring improvement was for staff to ensure that food storage and handling is safe. There was dry food storage in the kitchen that was uncovered and expired food stored in the fridge. It was reported that most belonged to the staff. This is unacceptable and should cease. Packets of biscuits were found in the basement and they were past their use by dates. The registered manager indicated that they were recently purchased from a reputable supplier. It is important for staff to be vigilant and adopt safe practices in storing food in the home. Finally it was noted that the last fire officer’s inspection was carried out in 2002. The registered persons are advised to arrange an inspection of the home to ensure that it continues to meet current fire regulations. DS0000025926.V322285.R01.S.doc Version 5.2 Page 25 DS0000025926.V322285.R01.S.doc Version 5.2 Page 26 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 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X 2 X 4 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 DS0000025926.V322285.R01.S.doc Version 5.2 Page 27 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 OP1 Regulation 4,5 Requirement Timescale for action 07/03/07 2. OP8 12,13 3. OP12 15(m)(n) 4. OP15 16(i) The registered persons are required to update the statement of purpose and service user guide in formats that are appropriate to the service user group. The service user guide must also be offered to all service users. (Also see standard 1 of this report). The registered persons are 07/03/07 required to ensure that staff take appropriate action to meet the specialist needs of service users e.g. chiropody- at all times. The registered persons are 07/03/07 required to improve the range of activities for service users by; 1) Involving service users in setting them up and this includes taking into consideration individual preferences and needs and, 2) Widely advertising activities in the home for the benefit of service users. The registered persons are 07/03/07 required to make suitable arrangements for enabling service users to make an active choice in relation their nutritional requirements. DS0000025926.V322285.R01.S.doc Version 5.2 Page 28 5. OP18 12, 13 6. OP22 13,23 7. OP26 13, 23 8. OP29 19(4)(a) 9. OP31 10(3) 10. OP33 24(1) 11. OP38 13 The registered persons are required to; 1) ensure that the local authority protocols regarding abuse are followed at all times and 2) ensure that all staff are provided with adult protection training. The registered persons are required to have an occupational therapist assessment carried out on the home. The registered persons are required to replace the defective handrail on the ground floor bathroom (opposite bedroom 13). The registered persons are required to ensure that adequate checks are made to ensure that staff are fit to work in the care home. In so doing checks must be made to ensure their right to work in the UK. The registered manager is required undertake the NVQ level 4 in Management and Care or its equivalent. The registered persons are required to carry out an annual audit of the service and to complete an annual development plan for the home. The registered persons are required to ensure that food is appropriately stored in the home at all times. A system for monitoring the safe storage of food should be in place. 18/03/07 31/03/07 05/03/07 05/03/07 31/03/07 31/03/07 14/03/07 DS0000025926.V322285.R01.S.doc Version 5.2 Page 29 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 OP16 Good Practice Recommendations The registered persons should employ strategies that promote service users confidence in making complaints, e.g. include it as a rolling item on the agenda for the service users meetings and/or reassuring service users informally or otherwise to inform staff if they are unhappy with anything in the home. The registered persons should develop a training and development profile for individual staff. The registered persons should arrange with the local fire authority to carry out a fire safety inspection of the home. (See Standard 38 of this report). 2. 3. OP30 OP38 DS0000025926.V322285.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000025926.V322285.R01.S.doc Version 5.2 Page 31 - 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!