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Inspection on 10/07/07 for St Martins Care Home

Also see our care home review for St Martins Care Home for more information

This inspection was carried out on 10th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The trained staff are good at recognising when residents need help from other Health care professionals to improve their health and well being. Good unhurried support is given to residents` who need assistance when taking their medicines. There are enough staff to meet the needs of the residents at the home. All of the staff have achieved their National Vocational Qualification to make sure they are trained to meet the needs of residents who need care. Proper checks are done on all staff who come to work at the home to make sure they are suitable to work with vulnerable people.

What has improved since the last inspection?

A record of what activities residents are involved in is now made to show how people spend their day. Staff have completed training to bring them up to date with the courses they must do in order to work safely with the residents.

What the care home could do better:

The initial assessments should include more personal and social history with information about the cultural and religious needs of the residents to help the staff understand and support people better The care plans should be more detailed about the care needs the person has and what action staff must take in order to support them to ensure residents are cared for safely and their needs are met. The care plans should be more detailed about the personal, social, cultural and religious needs of the residents to ensure that staff give people the care they need. Residents or their relatives should be involved in planning the care they receive so that they give their views on how they want to be helped. It would also be better if care staff read the care plans rather than relying on verbal information which might not be accurate Care plans should include details of residents` medical conditions and, where appropriate, relevant information about their treatment to ensure staff have as much information as possible to support people.Staff administering medicines need further training in the uses and side effects of medicines to help them understand how medication may affect residents. The medication trolley must be kept secure at all times during administration to ensure residents are not placed at risk. The medicines fridge should be available and a record demonstrating that the temperature is maintained within the required range. This ensures that medicines are stored appropriately. Medicines with a shortened expiry date should be dated when opened so that it is evident when they must be discarded. This is to ensure that medicines are not given when they have lost potency or become contaminated, The service could develop the range of activities provided which are appropriate to the needs of less able residents in order to meet their social needs. The residents` preferences with regard to their routines should be documented in their care plans so the staff can uphold their choices. The daily menu could be better displayed in the home so that residents know what is available and can make informed choices at meal times. Staff could have better access to policies and procedures and information on what to do should they suspect abuse in the home. To maintain the safety of the residents at all times. The building could be decorated to incorporate modern good practice recommendation for environments for people with dementia to support the residents in a more appropriate way. Improvements could be made to bedroom furniture to minimise the risk of a person hurting him or herself. The pathways in the garden should be better maintained to ensure residents have free and safe access to fresh air. Staff could receive more in depth training on dementia to improve their understanding on how to provide the best possible care for residents. The acting manager should be registered as soon as possible and the provider must notify the Commission that the previous manager has left.St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 8The owner could write a list of the actions he will take to address the issues relatives raise in their questionnaires to make sure the home is being run in the best interests of the people living there.

CARE HOMES FOR OLDER PEOPLE St Martins Care Home 42 St Martins Road Bilborough Nottingham NG8 3AR Lead Inspector Susan Lewis Unannounced Inspection 10th July 2007 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 Care Home DS0000002217.V340935.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. St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Martins Care Home Address 42 St Martins Road Bilborough Nottingham NG8 3AR 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) 0115 929 7325 Broadoak Group of Care Homes Mrs Barbara Elsie Nunn Vacant Care Home 21 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (21) of places St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Old age, not falling within any other categort (OP) (21) Dementia - over 65 years of age (DE(E) (21) Date of last inspection 6th February 2007 Brief Description of the Service: The fees are social services rates which are for 2007/08 £307. The most recent inspection report is stored in the office. It was discussed with the acting manager how to make the report more accessible. St Martin’s Care Home provides 21 places for older people requiring residential care who also have a diagnosis of dementia. It is situated in a quiet part of Strelley, some three miles north west of the centre of Nottingham. There are bathrooms and toilets to both floors. There is an assisted bath on the ground floor to support residents in bathing. Suitable aids and adaptatations are obtained through the district nursing service. The home has ample communal space and a pleasant enclosed garden. The home was initially registered in 1995 and subsequently in 2002 with the Commission for Social Care Inspection. The registered company is Broadoak Group of Care Homes. The Registered Provider is Mrs. B. Nunn. St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This inspection involved one inspector and a pharmacist inspector; it was unannounced and took place over 7 hours, including lunchtime. The main method of inspection used was called ‘case tracking’ which involved selecting four residents and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. One person in the home speak languages other than English and was “case tracked” to check that staff understood and provided for their cultural, religious and communication needs. Some of the people who live at this home have a limited ability to understand and communicate. Therefore some judgements in this report are from observation of staff and resident interactions Two members of staff and one set of relatives were spoken to as part of this inspection. In addition the views of two other residents who were not part of the “case tracking” were sought to form an opinion about the quality of the service. Documents were read as part of this visit and medication was inspected to form an opinion about the health and safety of residents at the home. A partial tour of the building was undertaken, all communal areas were seen and a sample of bedrooms to make sure that the environment is safe and homely. A review of all the information we have received about the home since the last inspection was considered in planning this visit and this helped decide what areas were looked at. What the service does well: The trained staff are good at recognising when residents need help from other Health care professionals to improve their health and well being. St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 6 Good unhurried support is given to residents’ who need assistance when taking their medicines. There are enough staff to meet the needs of the residents at the home. All of the staff have achieved their National Vocational Qualification to make sure they are trained to meet the needs of residents who need care. Proper checks are done on all staff who come to work at the home to make sure they are suitable to work with vulnerable people. What has improved since the last inspection? What they could do better: The initial assessments should include more personal and social history with information about the cultural and religious needs of the residents to help the staff understand and support people better The care plans should be more detailed about the care needs the person has and what action staff must take in order to support them to ensure residents are cared for safely and their needs are met. The care plans should be more detailed about the personal, social, cultural and religious needs of the residents to ensure that staff give people the care they need. Residents or their relatives should be involved in planning the care they receive so that they give their views on how they want to be helped. It would also be better if care staff read the care plans rather than relying on verbal information which might not be accurate Care plans should include details of residents’ medical conditions and, where appropriate, relevant information about their treatment to ensure staff have as much information as possible to support people. St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 7 Staff administering medicines need further training in the uses and side effects of medicines to help them understand how medication may affect residents. The medication trolley must be kept secure at all times during administration to ensure residents are not placed at risk. The medicines fridge should be available and a record demonstrating that the temperature is maintained within the required range. This ensures that medicines are stored appropriately. Medicines with a shortened expiry date should be dated when opened so that it is evident when they must be discarded. This is to ensure that medicines are not given when they have lost potency or become contaminated, The service could develop the range of activities provided which are appropriate to the needs of less able residents in order to meet their social needs. The residents’ preferences with regard to their routines should be documented in their care plans so the staff can uphold their choices. The daily menu could be better displayed in the home so that residents know what is available and can make informed choices at meal times. Staff could have better access to policies and procedures and information on what to do should they suspect abuse in the home. To maintain the safety of the residents at all times. The building could be decorated to incorporate modern good practice recommendation for environments for people with dementia to support the residents in a more appropriate way. Improvements could be made to bedroom furniture to minimise the risk of a person hurting him or herself. The pathways in the garden should be better maintained to ensure residents have free and safe access to fresh air. Staff could receive more in depth training on dementia to improve their understanding on how to provide the best possible care for residents. The acting manager should be registered as soon as possible and the provider must notify the Commission that the previous manager has left. St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 8 The owner could write a list of the actions he will take to address the issues relatives raise in their questionnaires to make sure the home is being run in the best interests of the people living there. 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. St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 9 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 Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 10 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): 3 and 6 Quality in this outcome area poor. People are assessed when they are admitted to the home but the assessment is not holistic enough and does not always highlight the person’s needs. People are at potential risk of not having their needs met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From the four plans that were viewed there was no evidence that residents were assessed by staff from the home prior to moving to the service. This means that staff at the home are unprepared to meet the needs of the person when they move. Although each plan did have a copy of the care management teams social services assessment, which was obtained in some cases prior to the person moving, providing staff with some information about the person’s care needs. St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 11 Staff spoken with said that they had nothing to do with assessments and that was left to the manager. There were made aware of people who were moving to the home at handover and made people as welcome as they could and learning about their needs as they cared for them. Intermediate care is not provided in this service. St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 12 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 and 10 Quality in this outcome area is poor. Residents’ health and personal care needs are not addressed in a way, which is consistent and safe, this places them at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The four plans viewed did not identify how any needs were to be met and no improvements had been made as required at the last inspection there was no evidence that any work had taken place on them other than a review that the new acting manager had carried out recently. There was some evidence that families had been involved in these reviews. Staff spoken with said that they didn’t use the plans as they didn’t find them useful and were not involved in their creation. St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 13 Residents spoken with said they were not involved in creating their care plans and didn’t know the home had any information about them. A relative spoken with said that the acting manager had recently discussed the plan when making changes. Care plans did provide some evidence that health care needs were being addressed such as people were being weighed regularly and changes monitored. Chiropodists were visiting and a resident spoken with confirmed that they saw a doctor when they needed to. Visiting district nurses were spoken with and they confirmed that the home provided very good support to people with pressure care needs and those whom she visited did not develop sores in the home but usually following a hospital admission. The nurse spoken with confirmed that any equipment ordered was used properly and staff were diligent in their care of residents. However care plans where risk assessments had been carried out that identified the person as being at risk or even very high risk of developing a pressure sore had no plan of care to show how this risk was to be minimised. This was noted at the last inspection and a requirement set. From the evidence seen the requirement has not been met despite the improvement plan from the provider stating it had. Care plans contain insufficient information about residents’ medical conditions and the medicines being used to treat them. The Medication Administration Records (MARs) show no gaps in signatures however, when variable doses are prescribed, there is not always a record of how many have actually been given. Handwritten MARs are clear and comprehensive but are not signed and countersigned. Medicines are administered with careful reference to the MAR and residents are provided with support and encouragement when necessary. However, the trolley was not kept secure at all times and on one occasion medicines were taken to a resident in the member of staff’s hand. All senior care staff administer medicines and have been trained ‘in house’. The senior carer spoken with had little understanding of the uses and side effects of medicines. Medicines are stored securely and appropriately. There is a medicines fridge with a daily temperature log; however, action has not been taken to ensure that the temperature remains within the required range. St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 14 There are 2 bottles of eye drops in use in the fridge, which were not dated when opened. From observation it was clear that staff treated residents with respect, residents were smartly dressed however it did look like not one resident in the home had had their hair brushed that day. This was brought to the acting manager’s attention. Staff spoken with understood about treating residents with dignity and how to ensure that when providing personal care their dignity was maintained Residents spoken with confirmed that staff spoke to them kindly, knock. St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 15 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 and 15 Quality in this outcome area is adequate. Some lifestyle choices recorded and respected, however cultural needs are not assessed to ensure that they are met. Meals are nutritious and appetising. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was some limited information on care plans that residents’ religious needs were identified but there was no understanding of peoples cultural or evidence that other diversity needs being addressed. There was some evidence on plans that people were able to see a visiting minister and able to take part in leisure and social activities. There was programme of activities on display but in discussion with residents and visitors they felt that wasn’t very much on offer to entertain residents overall. The acting manager had introduced a record of activities that residents were involved in during the week and this showed that residents were involved in a St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 16 variety of different activities including sing-alongs, visiting entertainers, exercise groups, dominoes as well as having visitors and the hairdresser. This had been a recommendation at the last inspection. Staff were observed throughout the day spending time with residents both chatting and encouraging them to take part in activities. Meaningful activities were discussed with the acting manager. Assessments did identify some hobbies and interests for residents such as gardening but there was no evidence that this information was being used to develop activities that would be of benefit to them. Residents spoken with said that they kept hold of their money or their family helped them with it, this ensures that residents remain as independent as possible. Lunch was observed to check that residents receive an appropriate and nutritious diet. The meal looked and smelled appetising and some residents had a specially blended diet, however blended meals were mixed together and did not follow current good practice on blended diets. This was discussed with the manager to ensure good practice guidance is followed. Appropriate aids were given to residents to assist them to maintain their independence in eating their meals. Staff were seen to be respectful whilst showing affection to residents throughout the meal. Residents spoken with said that they were happy with the meals and that they received plenty of it. Residents spoken with did not know what they were having for the meal and the chalkboard that displayed the menu was illegible. Staff spoken with said the cook went round every resident in the morning to ask what they wanted to eat. It would be helpful if the menu could be displayed in a better manner. Drinks were seen being served throughout the day and staff spoken with said that residents were able to have a drink or snack whenever they wanted one. Residents spoken with said they thought that they could have a drink when they wanted and said they never went hungry. St Martins Care Home DS0000002217.V340935.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 and 18 Quality in this outcome area is adequate. Staff respond to residents’ concerns and complaints promptly but there is no written evidence to support this. Staff understand their responsibilities to protect residents but are not given the information they need to fully promote this. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A recommendation was made to create a book to capture all issues or concerns no matter how minor this still has not been done and discussion with residents and relatives it is clear that they have brought issues to the staff’s attention such as missing laundry or slippers. Not having such a book could mean trends are missed and more serious issues arise as a result. This was discussed with the acting manager, who created a record during the inspection visit. The Commission has not received any concerns regarding this service since the last inspection. In discussion with residents and relatives all felt that if they made a complaint it would be dealt with either by carers or the acting manager. Staff spoken St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 18 with understood their responsibilities to support residents to make a complaint and understood what they needed to do. However staff did not understand that all concerns raised even minor ones must be reported. All staff have undergone Adult Abuse Awareness training and those spoken with had a good understanding of their responsibility and what they must do including if they suspect the manager of abuse. This ensures that residents are protected. However staff did not know where policies and procedures were kept. This may place residents at risk if staff need to access information in them quickly. Visitors spoken with said they felt that their loved one was safe and well cared for when they left the building. All residents spoken with said that they felt safe and staff never raised their voice or were unkind to them. St Martins Care Home DS0000002217.V340935.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 and 26 Quality in this outcome area is adequate. There are certain aspects of the home that are not fit for purpose and do not support people with dementia. The service is generally clean but some poor practice places residents at potential risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was no evidence of any further maintenance work since it was re decorated last year. The bedrooms viewed were adequate but in some cases the furniture was very shabby with the edging peeling away which could cause skin tears if a resident were to catch him or herself against it. St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 20 There is no dedicated maintenance person for the home; rather he is shared between other homes within the group, this means that maintenance issues such as the garden may not be responded to promptly. The home is registered for people with dementia and shows no evidence of good practice guidelines being followed in terms of the use of colour or symbols to help orientate residents. The lounge areas are pleasant and well lit with residents spoken with saying that it is comfortable and warm. Residents have access to a pleasant and enclosed garden, with garden furniture, however the pathway was uneven and this was due to weeds growing between the paving slabs this was a possible trip hazard for residents. Residents spoken with said they liked their rooms and were able to access them when they wanted to. The home was clean although there was an area in the lounge that was mal odorous, in discussion with the acting manager she was aware of the issues that were causing the problem and staff were trying to address this. The laundry is situated away from the lounge and dining area and so soiled linen does not need to carried through these areas and so minimise any risk of infection. On the day of the inspection the laundry door remained open throughout with no one in attendance for long periods of time, this potentially places residents, who have dementia or mobility issues at risk if they were to enter this area. St Martins Care Home DS0000002217.V340935.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): 27, 28 29 and 30 Quality in this outcome area is good. Recruitment procedures are robust and protect residents from people who may abuse them. Staff are employed in sufficient numbers to support residents and receive basic training to enable them to carry out their job. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection the service had full occupancy and there were sufficient staff on duty to support the residents and maintain their safety. Staff were not rushed and were able to spend time with residents talking and residents spoken with said they appreciated that fact the staff could sit and talk with them. Staff were able to discuss what tasks they were involved in when supporting residents but also saw that being able to sit and ‘chat’ was important to residents well being. Training records and information from the AQAA showed that 100 of all staff had National Vocational Qualification Level 2 in care. This ensures that staff St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 22 have reached a level of assessed competence in care. This exceeds the recommended minimum of 50 and is good practice. Staff receive regular training including updates of such training as Moving and Handling, First Aid and Infection Control. In discussion with staff they said that training was promoted and that they were supported to attend appropriate training to help them perform their job. A requirement was set at the last inspection regarding Dementia Care training. Staff spoken with said that they had attended an in-house training course but it was very basic and didn’t go into much detail about how to provide good care for people with dementia. Staff said they felt they would benefit from a more in depth training as most of the residents they worked with had some form of dementia. Training records of two staff were viewed and showed that staff had recently attended this training. Recruitment records showed that staff fill out an application form and two references and a Criminal Records Bureau and POVA first check are obtained. However, as the start date for each member of staff was not on their contract or anywhere else it was not possible to verify whether they started after these were obtained or before. This was discussed with the manager who said she would add it to the front sheet that showed whether references and Criminal Records Bureau checks had been received. St Martins Care Home DS0000002217.V340935.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 and 38 Quality in this outcome area is adequate. Recruitment procedures are robust and protect residents from people who may abuse them. It is not clear that the home is run in the best interests of the residents. Staff receive health and safety training to enable them to carry out their job. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The current acting manager has been in post three weeks. The provider did not formally notify the Commission that the registered manager had left. A St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 24 warning letter has been sent to the Registered Provider Mrs Barbara Nunn regarding this matter. In discussion with residents they said that they didn’t have residents meetings and they were not consulted about what happened in the home. A requirement was made at the last inspection to show how the quality questionnaire information was being used to inform the improvement plan for the home, there is no evidence that this has been done. A recommendation was set at the last inspection to record all staff supervision and evidence was seen on staff files that this is now being done. The arrangements in respect of residents’ finances were checked to ensure their interests are being protected and residents said that either their relatives or they looked after their money. The manager confirmed this and said she did not act as appointee for anyone. All appropriate health and safety checks are carried out. The staff have all completed their statutory training courses and they confirmed that their health and safety is promoted and protected by the provision of training and equipment. St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 25 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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 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 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 3 St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 26 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 OP3 Regulation 15(1) Requirement Information from assessments that is pertinent to the care of the resident must appear on residents care plans. (This is an outstanding requirement 31/03/07) Care plans must show how residents’ needs are to be met by care staff to ensure that they receive the care they need. (This is an outstanding requirement 31/03/07) Residents and or their representative must be involved in creating and reviewing care plans where possible to ensure that they meet the needs of the individual. To ensure that residents get maximum benefit from their medicines, there must be a record of how many are actually given, when medicines are prescribed with a variable dose. To ensure that medicines are administered safely, staff training must include the homes’ DS0000002217.V340935.R01.S.doc Timescale for action 01/08/07 2. OP7 15(1) 01/08/07 3 OP7 15(2)(b) 01/09/07 4 OP9 13(2) 21/08/07 5 OP9 13(2) 30/09/07 St Martins Care Home Version 5.2 Page 27 6 OP9 13(2) 7 OP9 13(2) 8 OP19 13(4) 9 OP19 13(4) 10. OP33 24(1) (a)(b) policy on medicines handling and recording, basic knowledge of how medicines are used and how to recognise and deal with side effects To ensure that medicines are stored appropriately, there must be a medicines fridge available and a record demonstrating that the temperature is maintained within the required range. To ensure that medicines are not given when they have lost potency or become contaminated, medicines with a shortened expiry date must be dated when opened so that it is evident when they must be discarded. Where bedroom furniture is shabby is must be repaired or replaced to minimise the risk it places residents at. The pathway in the garden must be made safe so as to ensure that residents have safe access to the garden. The registered person must ensure that the quality system established is used to monitor the quality and used to improve the service. (This is an outstanding requirement 01/04/07) 21/08/07 21/08/07 01/09/07 01/08/07 01/08/07 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 OP7 Good Practice Recommendations Care staff should read the assessments and care plans to DS0000002217.V340935.R01.S.doc Version 5.2 Page 28 St Martins Care Home 2. OP8 ensure that they are clear about how they should respond to residents and meet their needs. Where residents are identified as having or are at risk of developing pressure sores care plans must be created to show how this need is to be met. Handwritten Medication Administration Records should be signed, checked and countersigned to reduce the risk of errors. Activities could be develop that more readily reflect the interests and abilities of residents. Residents preferences for times to get up and go to bed could be documented in care plans The Registered Person should enable residents to access advocate services. The daily menu could be better displayed in the home so that residents know what is available and can make informed choices at meal times. Staff could have better access to policies and procedures on what to do should they suspect abuse of a residents so they know what to do quickly. Good practice guidelines on environments for people with dementia care could be followed to improve the environment for the people who live there. More in depth training on dementia care could be provided to staff to help them understand the differing needs and how to provide effective care to people with dementia. 3 4 5 6. 7 8. 9 10 OP9 OP12 OP12 OP14 OP15 OP16 OP19 OP30 St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX 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 St Martins Care Home DS0000002217.V340935.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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