Random inspection report
Care homes for older people
Name: Address: St Martins Care Home 42 St Martins Road Bilborough Nottingham NG8 3AR one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Linda Hirst Date: 1 2 0 7 2 0 1 0 Information about the care home
Name of care home: Address: St Martins Care Home 42 St Martins Road Bilborough Nottingham NG8 3AR 01159297325 Telephone number: Fax number: Email address: Provider web address: janet1960@msn.com Name of registered provider(s): Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Barbara Elsie Nunn care home 21 Number of places (if applicable): Under 65 Over 65 21 21 dementia old age, not falling within any other category Conditions of registration: 0 0 Dementia - over 65 years of age (DE(E) (21) Old age, not falling within any other categort (OP) (21) Date of last inspection Brief description of the care home St Martins Care Home provides 21 places for older people requiring residential care who also have a diagnosis of dementia. The registered company is Broadoak Group of Care Homes. The Registered Provider is Mrs. B. Nunn. It is situated in a quiet part of Strelley, some three miles north west of the centre of Nottingham. Care Homes for Older People Page 2 of 13 Brief description of the care home There are bathrooms and toilets to both floors. There is an assisted bath on the ground floor to support people using the service in bathing. Suitable aids and adaptations are obtained through the district nursing service. The home has ample communal space and a pleasant enclosed garden. The current weekly fees range from £329.83 to £338, an additional fee of £10 is also added should a person have dementia care needs. These fees do not include hairdressing or chiropody. Relevant information in regard to the fees and the facilities and services are available on the point of enquiry. Care Homes for Older People Page 3 of 13 What we found:
We did this visit as part of the work we have to do under the Care Standards Act 2000 before we use the new Law, the Health and Social Care Act 2008 which will mean we work with services in different ways. This service was given a 1* adequate rating in May 2009. We have received information about the service through safeguarding and from the Local Authority which leads us to believe that the information the service gave us in their self assessment questionnaire might not be right. We therefore decided to visit. There are also a number of issues which we asked the service to address when we visited the last time. We looked at these areas during this visit to make sure people are getting the help they need to meet their needs and keep them safe. We looked at whether the plans of care give good guidance to staff, whether they understand these and put them into practice to make sure peoples needs are met. We looked at whether peoples health care needs are fully recorded in care plans, whether staff understand peoples health needs and take action to make sure they have the treatment they need to keep them well and healthy. We looked at how people who use the service are helped to make decisions about their lives and care to check they can do this where they are able. We looked at the arrangements in place to safeguard people from abuse and to make sure that they are protected properly by staff and managers. We looked at whether the service is clean and well maintained to make sure people live in a safe and comfortable environment that meets their needs. We looked at whether staff are recruited safely and whether they have all of the information and documentation required by Law to make sure they are safe to work with vulnerable people. We looked at whether they get the training they need to do their jobs properly. We looked at the management arrangements as there is an acting manager in post who has not applied to become registered with us. Finally we looked at whether the owners visit the service, and whether they do quality audits to make sure the service is being run and managed effectively and in the best interests of the people living there. We have not made a requirement for a manager to be appointed who is fit to run the service and who will apply to become registered as this will be dealt with legally as part of the application to transition registration to the Health and Social Care Act. What the care home does well:
We spoke to a visitor who told us they are very happy with the service. The person told
Care Homes for Older People Page 4 of 13 us, I like it here because it is more family orientated. The staff keep them clean, the food looks good. I had an issue with the hairdresser but thats resolved now. I feel (the person) is safe, the staff seem to know what they are doing and they have a lot of patience. We found that all of the staff files we looked at had evidence that the information and documents required by Law to make sure that staff are safe to work with vulnerable people had been received. Staff we spoke with confirm that this is the case, I had to provide three references, I could not work at the service until my Criminal records Bureau check came in, even though I had one before. We also found the staff have done a lot of training including safeguarding, Basic Food Hygiene, Medication, Inductions, Coroner Training, Non Abusive Physical and Psychological Interventions. What they could do better:
We found that the plans of care still do not reflect the individual needs of people and although plans are reviewed they are not updated as required which may be confusing for staff. For example, we found one review said that a person was being less aggressive but we found lots of incidents have happened, some of them very serious. When we spoke with the staff about these they told us there are no triggers for the persons behaviour, but we could clearly identify patterns and triggers from the records. When we spoke with the acting manager she told us that providing personal care is a known trigger, if staff do not know the triggers they may, inadvertently put themselves in dangerous situations. We looked at how the care plans help staff understand the needs of people who have Diabetes. We found these to be inadequate. The normal range of readings for the person is not identified, although the acting manager knows what this is. The plan gives conflicting information, in one place stating that her blood sugar monitoring needs to be done daily but then in another stating, it should be done regularly. When we spoke with the acting manager to clarify what regularly may mean, she told us the testing is done once a month, although she acknowledges that this is not what is written in the plan. When we spoke with a senior carer, responsible for doing the tests she told us, I do the readings with her, we do this weekly or if she is agitated we judge whether we need to do it. The plan states the person has the kind of Diabetes which is controlled by diet and tablets. The staff we spoke with know that they need to control the persons sugar intake through diet but they did not know the person also takes tablets for this. (One of the staff we spoke with is responsible for giving out these tablets, I have done training about what medication is for and the side effects.) We found the plan does not contain the signs of hyper and hypo-glycaemia to guide staff so they can keep the person safe and call for medical attention when needed. When we spoke with staff we found they know and can describe the signs of hyperglycaemia, but not the more dangerous hypo-glycaemia, one told us, Ive never seen it. I cant remember I would call for a senior if this happened. The senior we spoke with told us, I have not been on when she has been hypoglycaemic, I dont know what to do if she was. Care Homes for Older People Page 5 of 13 We looked at how people are enabled to make decisions and whether staff assess peoples capacity when this is in doubt. We found that the acting manager has been trying to start assessing peoples capacity, but this is not in relation to any particular decision, where in other cases (such as resuscitation wishes) there is no assessment of capacity to decide what they want to happen. The two stage capacity test is not being done and the records are not being completed in line with legal requirements. We spoke with the staff who told us, we do have people who cant make their own decisions, they have people who come in, social workers etc. Families make decisions about end of life care. There has been a safeguarding allegation made by a former employee about financial irregularities so we looked at the arrangements for finances. We checked four peoples finances, selected at random and found they were all out of date, the last entries had been made in June 2010. We checked the receipts and found these were not up to date, we found that the amounts held did not tally with the records for any of the people we checked. We found differences of £100, £49, £20 and £15, we asked the acting manager for an explanation and she told us she wasnt up to date with her accounting. The acting manager showed us a bundle of receipts in a carrier bag and told us that they were for a person living at the service. She also told us that she had paid the hairdresser £180 (receipt seen) out of her personal funds. She stated that she was weeks out of reconciling the accounts. We could not verify if the bundles of receipts we were shown belonged to the people living at the service or whether these were her personal receipts. The staff we spoke with told us that they have nothing to do with peoples finances, (the acting manager) manages the financial side, we give second signatures where necessary or we will issue a receipt for money coming in and lock it away. A visitor told us, they tell me if (a named person) is in arrears. They dont give me receipts for the money I give them. We have made a safeguarding referral about the arrangements for peoples money to make sure they are properly protected financially. We did a partial tour of the home, including a sample of bedrooms and all working and communal areas to check the home is clean and well maintained. We found several areas were unclean and unhygienic, we found blood stains on the handle of a boiler cupboard downstairs. These were brought to the attention of the Senior Carer, but when we asked the manager to check that these had been cleaned approximately an hour later, we found they had not been cleaned away. We found that several rooms had body fluids clearly staining the carpet. When we asked staff to explain why we were told that the domestic worker had been away on annual leave. Her replacement was unable to attend as she was sick, therefore there had been no domestic cover for one week. We also found several commodes which were difficult to decontaminate. They were observed to be rusty, cracked or torn. Cleaning did not appear to be taking place on the underneath of the seat cover. All commodes seat lifted had staining on them that was difficult to identify as the commode seats were black in colour. One seat lid had a large amount of clearly identifiable dried matter on the seat. Staff we spoke with seemed unclear of the agreed cleaning protocols in terms of commodes. We saw sticky marks and residues on furniture, unclean sinks, there was a prevalent odour in the service and the dining room floor was sticky when walked upon. As can be seen from this report, there are several areas which need improvement to make sure the service is being run in the best interests of people living there. The acting manager has not applied to become registered with us, and in such cases we would expect the providers to be more careful in checking that the service is being run properly.
Care Homes for Older People Page 6 of 13 We looked at the last reports on the providers monthly visits which do not indicate any problems. They must focus on and address the issues of concern we have highlighted to make sure they are demonstrating their fitness to be registered. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 13(4,c) Risk assessment must be in 02/07/2009 place for all highlighted risks such as managing peoples behaviour. This will ensure that people using the service are fully protected. This requirement has been outstanding for three inspections. We are considering further enforcement action. We will not extend the timescale any further. 2 7 15(1) Plans of care must be in place for all highlighted needs such as diabetes mellitus and managing behaviour. This will ensure that peoples needs are met and they are protected. This has been outstanding for three inspections. Enforcement action is being considered. We will not extend this timescale any further. 02/07/2009 3 14 12 The Mental Capacity Act 02/07/2009 2005 must be fully utilised in
Page 8 of 13 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action assessments where people using the service are making decisions and choices that may affect their health and welfare. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. This will ensure that they are fully protected and their rights are maintained. This requirement has been outstanding for two inspections. We are considering further enforcement action. We will not extend the timescale any further. 4 36 18 You must ensure that staff 30/07/2009 are appropriately supervised. This will ensure that they are supported in their work and development and people using the service receive care that follows good practice recommendation. This requirement has been outstanding for two inspections. We are considering further enforcement action. We will not extend the timescale any further. Care Homes for Older People Page 9 of 13 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action 1 26 18 Going forward there must be 02/08/2010 arrangements in place to ensure appropriate domestic cover To keep the home clean and maintain hygiene at all times. 2 26 13 Stained bedroom carpets must be deep cleaned or replaced. To prevent cross infection 02/08/2010 3 26 13 Cracked and rusted 02/08/2010 commodes must be disposed of and replaced. They present an infection control risk Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 13 Challenging behaviour must 31/08/2010 be properly monitored and triggers (where these are known) must be clearly identified and communicated to staff To make sure that people are being supported appropriately and people are not being put at risk. Care Homes for Older People Page 10 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 2 7 14 Care plans must be kept under review and updated when needs change. There must be systems in place to make sure staff understand peoples changing needs To make sure that staff understand the current needs of people and how to assist them. 31/08/2010 3 18 17 The amounts held at the 31/08/2010 service for each individual must tally with their recorded balance and receipts. To safeguard people financially. 4 18 17 There must be records of all money received into the service from relatives, of every expenditure and receipts must be held on individuals records to show how their money has been spent. To safeguard people financially and to ensure their money is being spent appropriately. 31/08/2010 5 33 10 The providers must take 27/08/2010 action to make sure that the service is running effectively To ensure that it runs in the best interests of the people living there. Care Homes for Older People Page 11 of 13 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 26 An industrial carpet cleaner should be available for staff to manage odour control effectively. Care Homes for Older People Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 13 of 13 - 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!
