CARE HOMES FOR OLDER PEOPLE
St Martins Queen Street Gillingham Dorset SP8 4DZ Lead Inspector
Mike Dixon Unannounced Inspection 5th October 2005 09:30 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.V256410.R01.S.doc Version 5.0 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.V256410.R01.S.doc Version 5.0 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.V256410.R01.S.doc Version 5.0 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). 9th February 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.V256410.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by the Commission as part of its regulatory duty to inspect all care homes twice a year. The purpose was to assess the home’s compliance with some of the key national minimum standards for older persons and to review the requirements and recommendation from the previous inspection report. The inspection was conducted by M Dixon and took 5.5 hours, during which time the he spoke with five service users, three staff members and the manager. He visited all communal areas and a sample of bedrooms. He looked at a variety of records and documentation relating to the running of the home. On the day of the inspection there were thirty-two service users living at the home, including one older person who was admitted during the course of the afternoon. What the service does well: What has improved since the last inspection?
St Martins DS0000026873.V256410.R01.S.doc Version 5.0 Page 6 The home has implemented in full two of the four requirements from the previous report and has mainly implemented the remaining two. The one recommendation, which is beyond the control of the home’s manager, has not been addressed. Topical creams that are kept in bedrooms are now safely stored to minimise the risk to other service users. In some cases care records now include the date of commencement of the application of non-prescribed topical creams and give the reason for the treatment. The date of commencement of the application of the creams is now written on the label of the relevant container to assist with the audit trail of medication. The management has made progress with the development of a comprehensive quality assurance system. All potentially harmful cleaning products are now securely stored, in accordance with the provisions of COSHH. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Martins DS0000026873.V256410.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Martins DS0000026873.V256410.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No standards were considered in this section. EVIDENCE: St Martins DS0000026873.V256410.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8 and 10 The home liaises effectively with the primary health care team and ensures that service users’ health care needs are met. The home has the necessary resources and facilities to enable staff to meet the care needs of the service users. Staff treat service users with respect and dignity, promoting service users’ feelings of worth as valued members of the home and community. EVIDENCE: The home enjoys a good level of support from the primary health care team. Service users receive a visit from their doctor when they are unwell and community nurses visit to carry out nursing tasks, to offer guidance to the staff and to conduct a basic annual health check on service users. Community psychiatric nurses visit to provide support and assistance to service users suffering from dementia and/or mental health problems. Doctors review service users’ medication at least once a year. Service users have access to all the necessary health care resources in the community, including hearing and sight tests and chiropody. St Martins DS0000026873.V256410.R01.S.doc Version 5.0 Page 10 Care staff monitor the health care needs of the service users and report any concerns or changes to senior staff; referrals are then made to the doctor or community nurse, as necessary. Staff monitor service users’ weight and take action where there has been any significant gain or loss. Service users have some opportunity for mental stimulation and physical exercise through the activities programme. The home has the necessary equipment and resources to promote tissue viability and to ensure the comfort and well-being of the small number of service users who spend a lot of time in bed. Staff take steps to safeguard the dignity of service users through the promotion of continence. Where feasible, service users look after themselves with a minimum of assistance from staff. In discussion with the inspector, service users confirmed that they received the help from staff that they needed and that they had access to health care provision that they required. Staff were observed to approach service users in a helpful manner and to use the appropriate transferring equipment to assist those with poor mobility. Staff encouraged service users to be as independent as possible when assisting them. Most service users have their own bedroom; they are able to lock their door if they choose. Service users are able to make and receive telephone calls in private and they receive their mail unopened. Service users’ clothes are maintained in good condition. Service users are able to make choices about how and where they spend their day and their rooms are “personalised” in accordance with their wishes. St Martins DS0000026873.V256410.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 and 15 The home provides a varied programme of activities but it is in need of some development in order to meet the expectations of all service users. The home encourages service users to keep in contact with their friends and relatives and thereby helps to maintain links with the local community. The catering provision ensures that service users are offered nutritious meals at regular intervals during the course of the day. EVIDENCE: An activities coordinator, working ten hours per week, has recently commenced work at the home. He is in the process of ascertaining with service users what changes or developments they might like to the existing programme. The home has been without a coordinator for an extended period but has continued with regular activities which include board games, quizzes, discussions, cake making, manicure/nail care sessions, exercise and the “pata-dog” scheme and Tuesday club night. Many of the service users participate in and enjoy the activities but there is a view amongst a few service users that the programme does not meet their expectations. The activities coordinator is looking to address this shortfall, where feasible. The amount of stimulation that can be offered is also dependent on the time that is available to care staff as they go about their duties.
St Martins DS0000026873.V256410.R01.S.doc Version 5.0 Page 12 Service users can have visitors whenever they wish; the home’s policy on visiting arrangements is explained in the Service User Guide. Service users say that their friends and relatives are made welcome at the home. The management encourages participation from relatives in activities at the home and invite them to social gatherings such as a bbq which was held earlier in the summer. Contact with the local community is also maintained through the visits from local schoolchildren during the Christmas period. Visiting clergy call at the home on a regular monthly basis. Service users enjoy their meals at St Martins and get enough to eat. There is a choice of items and dishes at each mealtime and the content of the menu is reviewed and adapted periodically. Dietary needs and preferences of service users are taken note of following admission and any changes in service users’ circumstances are communicated to the catering team. Meals are spread reasonably evenly over the course of the day; between teatime at 5 pm and breakfast the following morning service users have the offer of a light snack at 8 pm. Hot and cold drinks are served at regular intervals during the day and evening. Service users are encouraged to take their meals in the dining room but their wishes are respected if they have a particular desire to remain in their bedroom to eat. The home has been without a permanent main chef for an extended period and has therefore had to make use of agency staff. This situation does not appear to have had a major impact on the quality of the provision at the home. St Martins DS0000026873.V256410.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The home has a comprehensive complaints procedure which enables service users and/or their representatives to address any concerns they might have. The policies and practices of the home ensure that service users are safeguarded from abuse or harm. EVIDENCE: The home has a complaints procedure which complies with regulations and meets National Minimum Standards. The procedure is contained in the Service User Guide and terms and conditions of residence; it is also displayed in the front hall. The manager reported that no complaints had been received. From discussions with service users during the course of the visit it was evident to the inspector that they would feel confident about raising any concerns with the manager or senior staff. The home has adult protection and “whistleblowing” policies/procedures and a copy of the Dorset County Council “No Secrets” guidance. Staff receive training and guidance on the subject. From discussion with the inspector during the visit staff demonstrated awareness of relevant issues. There are also policies/procedures that relate to the management and protection of service users’ finances. In previous inspection reports the inspector has recommended that the policy which precludes staff from assisting in the making of or benefiting from service users’ wills be placed in a more prominent place; the manager has addressed the matter with Care South management and it remains under review.
St Martins DS0000026873.V256410.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The design and layout of the home is suited to the needs of older persons in most respects, offering a comfortable environment for service users. The home meets the requirements of the fire safety officer thereby ensuring the welfare of service users. The home has a cleaning routine which provides a pleasant and odour free environment EVIDENCE: An upgrading programme of the premises/facilities continues in place. Recent work includes the redecoration of a few bedrooms, some bathrooms/WCs and replacement of curtains in the corridors and stairway. Although there are some limitations on the provision of services arising out of the design/layout (mainly the relatively small size of a few of the bedrooms) the home is generally suited for the intended purpose. Service users are able to access all areas of the home and the garden by use of the passenger lift and ramps. St Martins DS0000026873.V256410.R01.S.doc Version 5.0 Page 15 The home meets the requirements of Dorset Fire and Rescue Service by the implementation of fire safety measures which include the regular servicing of the fire precaution and emergency lighting systems, the carrying out of staff training and drills. New and clearer fire safety notices are displayed in prominent places around the home. The manager has a fire risk assessment which is kept under review. The premises were found to be clean and free from unpleasant odours. Service users with whom the inspector spoke confirmed that their bedroom was cleaned regularly. Bed linen and towels were observed to be in a good condition and the laundry room was tidy and well-organised. Cleaning materials, equipment and protective clothing are all provided to enable staff to maintain good hygiene standards. St Martins DS0000026873.V256410.R01.S.doc Version 5.0 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): 27 and 30 Staffing arrangements are sufficiently robust to ensure that all duties at the home are carried out efficiently. Staff receive the training which they need to meet service users’ care needs. EVIDENCE: The staff team comprises the manager, deputy, care team managers, care assistants, activities coordinator, domestics, chefs and kitchen assistants. The majority of staff posts at the home are filled; the manager is currently looking to recruit a day time and night time care assistant and a chef. There are some additional shifts that need filling as a result of sickness and maternity leave. The staff group is able to address the shortfalls through individuals working additional shifts, with the exception of the catering team where agency workers are employed. The home is able to meet the care needs of the service users who are currently accommodated at the home through the existing staffing arrangements. Staff can provide the necessary personal care and monitor the health care needs of service users and follow up issues that arise. Service users who spoke to the inspector were confident about the staff group’s ability to look after them. The staff training programme includes induction and foundation training for recently appointed staff members and covers health and safety topics, including manual handling, first aid and infection control. Care-related topics
St Martins DS0000026873.V256410.R01.S.doc Version 5.0 Page 17 are covered as the need arises. Staff members with whom the inspector spoke expressed their confidence in the training programme which offers them the opportunity to develop their skills. Some staff members have received training in dementia awareness. The manager is looking to develop the provision for dementia care in recognition of the fact that the home accommodates a significant minority of service users who suffer from short term memory loss. St Martins DS0000026873.V256410.R01.S.doc Version 5.0 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): 33 and 38 The management has implemented a comprehensive quality assurance system which has provided a lot of useful information about how well the home is run. The health and safety measures that the home takes ensure that service users are protected from harm. EVIDENCE: A survey of the home has been completed by an independent consultant which is based on in-depth questionnaires which were given to a wide range of people who have an association with the home, including service users, relatives, staff and external professionals. The results have been analysed and indicate a high level of contentment with the quality of the provision at the home. The management now needs to develop an action plan, perhaps linked to an overall annual development plan, in order to demonstrate how it is addressing the few areas that were identified for attention.
St Martins DS0000026873.V256410.R01.S.doc Version 5.0 Page 19 The home takes a proactive approach towards the promotion of the health and safety of service users by a number of means: the carrying out of risk assessments, by being vigilant about potential hazards, arranging training for staff, the provision of manual handling equipment and the regular servicing of the facilities and equipment. There is also monitoring of incidents and accidents and evidence of action taken to minimise risks to service users. St Martins DS0000026873.V256410.R01.S.doc Version 5.0 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 x x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x x x x 3 St Martins DS0000026873.V256410.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 12(1) Requirement Care records must include the date of commencement of the application of non-prescribed topical creams and the reason for the treatment. This requirement from the earlier report has been mainly addressed; previous timescale of 3/3/05 not met. Timescale for action 31/10/05 St Martins DS0000026873.V256410.R01.S.doc Version 5.0 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 OP18 Good Practice Recommendations The management should put the policy which precludes staff from assisting in the making of or benefiting from service users’ wills in a more prominent place, e.g. with the policies relating to service users’ finances and/or in the staff’s terms and conditions of employment. This recommendation is made for the third time. The management should produce an action plan to demonstrate how it will implement the recommendations from the survey, which might be linked to an annual development plan, reflecting aims and outcomes for service users. 2 OP33 St Martins DS0000026873.V256410.R01.S.doc Version 5.0 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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