Inspection on 12/05/09 for St Martins Care Home

This inspection was carried out on 12th May 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Martins Care Home 12/07/10

St Martins Care Home 20/01/09

St Martins Care Home 03/09/08

St Martins Care Home 04/03/08

St Martins Care Home 10/07/07

St Martins Care Home 06/02/07

St Martins Care Home 11/07/06

St Martins Care Home 20/12/05

St Martins Care Home 03/06/05

St Martins Care Home 07/09/04

St Martins Care Home 28/05/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE St Martins Care Home 42 St Martins Road Bilborough Nottingham NG8 3AR Lead Inspector Karmon Hawley Key Unannounced Inspection 12th May 2009 09:30 DS0000002217.V375444.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought 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. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address St Martins Care Home DS0000002217.V375444.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 janet1960@msn.com Broadoak Group of Care Homes Mrs Barbara Elsie Nunn Manager post 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.V375444.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Old age, not falling within any other category (OP) (21) Dementia - over 65 years of age (DE(E) (21) Date of last inspection 20th January 2009 Brief Description of the Service: St Martin’s 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. 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. St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who live at the home 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. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service. We was not due back before the inspection, therefore we did not use it as part of our planning for this inspection. We also reviewed all of the information we have received about the home since we last visited and we considered this in planning the visit and deciding what areas to look at. As four statutory requirement notices were sent to the provider following the previous inspection in respect of plans of care, reviews and safeguarding issues we planned to look at the compliance in regard to these during this inspection. The main method of inspection we use is called ‘case tracking’ which involves us choosing three people who live at the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We spoke with staff and people using the service to form an opinion about the quality of the service being provided to people living at the home. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. What the service does well: People may visit the care home and spend some time there so that they can get a feel for what it would be like to live at the care home before they make a decision to move in. St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 6 People using the service told us that the staff are kind and caring and that they feel well looked after. People using the service are supported to access specialist services such as the district nurse, optician and doctor as required. People using the service told us that the staff are very kind and caring at all times. We saw staff support people in a professional manner to ensure that their privacy is respected. People using the service told us that the routine of the care home is flexible and that they can spend their time as they wish. So that people can maintain contacts with people that are important to them, there are no restrictions on visiting and visitors may be received in private should they wish. A varied and appealing menu is on offer and choices are available at each mealtime, specialist diets, such as diabetic diets, are also catered for. What has improved since the last inspection? Preadmission assessments are now available so that people using the service are assured that their needs will be assessed and that staff can meet these before they make a decision to move into the care home. Development has taken place in regard to the care planning process, working towards ensuring that these are in place for all identified needs and are more person centred. Although the Mental Capacity Act has not yet been utilised within the care planning process people’s rights and choices are considered. Staff now look at the way in which they talk to people using the service to make sure that they are respectful at all times. More activities are now available for people using the service, increasing their satisfaction with the lifestyle that they experience. Staff have undertaken further training in relevant areas to make sure that people using the service are protected from harm or abuse. The disused items have now been removed from the garden so that this is a more safe and pleasant environment for people using the service. Doors are now locked and keys are not left in doors where substances hazardous to health are stored. St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 7 Time is now allowed for staff to have official handover periods to ensure comprehensive transfer of necessary information about people using the service between shifts. A slight improvement has been made in regard to the supervision of staff to monitor their training and development. Some improvement has been made in regard to the induction process to make sure that all new staff are aware of their roles and responsibilities. Staff have undertaken further training since the previous inspection, working towards completing all compulsory training. Some improvement has been made in regard to the quality assurance systems, working towards ensuring the people using the service are able to have more of a say in how the service is run and managed. Special door guards have been purchased to ensure that fire doors are not propped open with unsuitable wedges so people using the service are protected from the risk of fire. What they could do better: Plans of care and risk assessments need further development to ensure that these are must in place for all highlighted needs such as diabetes mellitus and managing behaviour. The use of the Mental Capacity Act needs to be further utilised to ensure that people’s rights are fully considered and maintained. Further maintenance is required to make sure that people live in a safe, well maintained and comfortable environment. Staff must not work at the service without undergoing the necessary checks as required. Further staff training in compulsory areas is needed to make sure that all staff members have the required knowledge and skills to meet people’s needs. Further developments in regard to the quality assurance systems are needed so that everyone using the service can express their views as able and the results of this inform the business planning for the year. Further work is needed in regard to staff supervisions to make sure that all staff are supported and their development is monitored. St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 8 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. St Martins Care Home DS0000002217.V375444.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.V375444.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured that their needs will be assessed and that staff can meet these before they make a decision to move into the care home. The service does not offer intermediate care. EVIDENCE: Prior to admission the acting manager goes out and visits people in the community to do an assessment to make sure that staff are able to meet people’s needs. There is evidence of preadmission assessments taking place within case files examined. People may also visit and spend time at the care home before they make a decision to move in so that they can get a feel for what it would be like to live at the care home. St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 11 Staff spoken with said that they get enough information about people when they move in so that they can support them appropriately. The service does not offer intermediate care. St Martins Care Home DS0000002217.V375444.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Plans of care have improved, ensuring that more information is now available for staff to support people using the service; however the areas that still require attention may mean that people are not always supported effectively and they are not fully protected from risks. People using the service are treated with respect and their dignity is maintained. EVIDENCE: A new format is in use in regard to care planning, this is more fluid and organised. Whilst this has improved the care planning process the acting manager feels that further modifications are needed and he has prepared a report outlining this to the provider. Care plans now contain more information in regard to people’s needs, however due to the format in use some of the wording in each person’s care plan is the same and not personalised to each individual. St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 13 There is also only brief information in regard to the support that people need to ensure that their needs are met. Also when issues have been highlighted within assessments such as people’s behaviour that may be seen as embarrassing to others, care plans are not in place to ensure that the person’s dignity is maintained. Risk assessments are in place, however again these follow the format and have not been expanded where needed to ensure that all individual needs such as wandering and behaviour that may be seen as challenging are included and thus managed. The assessment on general health mentions diabetes mellitus when appropriate, however it does not provide information that is specific to the condition and the support that people may need such as annual health checks to make sure their health and wellbeing is monitored. People’s weights are now shown in a graph format which allows staff to monitor people’s weight more easily and take action if there are significant changes. The Mental Capacity Act has not been utilised within plans of care, however we can see that people’s rights and choices are fully considered and maintained in the care planning process. There is evidence of reviews and evaluations taking place to ensure that people using the service receive continuity of care by ensuring that staff are aware of their current needs. Staff spoken with are able to discuss people’s needs and the support that they offer them, they feel that the new care plans are much better. People using the service feel that their needs are met. Information within plans of care show us that people are supported to access specialist services such as the doctor, district nurse, optician and dentist as needed. We saw that specialist equipment such as mattresses, cushions and beds are in place for those people who need them. People using the service tell us that they can access specialist services; “I have got a cold, I do not need to see the doctor, but I could if I wanted to,” I got some new glasses a few weeks ago.” St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 14 Staff who administer medication have been trained to do so and on observing the lunch time medication round we saw that staff maintain good practice recommendations. Medication records examined show us that people receive their medication as prescribed and that all the necessary checks take place as needed. During the inspection we saw that staff recognised that a person using the service was in pain and they offered them a pain killer for this. Throughout the inspection we saw staff treat people with respect and maintain their dignity at all times. We discussed the fact that it was felt that some staff spoke to people in an infantile manner at the previous inspection. Staff tell us that they do not feel that they are doing this, they are simply using terms of endearment and people using the service use them as well. If people feel uncomfortable with this staff feel that people would say something. Staff went on to discuss how they feel that it is important to be aware of how they present themselves, their body language and they way that they talk to people, as people may interpret it differently to which it is intended. They discussed how they ensure that they maintain people’s privacy and dignity; “we knock on doors and cover people up when supporting them with personal care.” People using the service tell us that staff are kind and caring and respectful at all times. St Martins Care Home DS0000002217.V375444.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. As activities have improved people now experience a more satisfying lifestyle and they enjoy the activities on offer. People are supported and enabled to maintain contact with people that are important to them. EVIDENCE: Staff now have more time to support people using the service with various activities such as reminiscence, handicrafts, musical instruments, sing songs, cards and dominoes. Records that have been kept show us that activities are taking place on a regular basis. A monthly news letter is now sent to people using the service and is on display for visitors to read should they wish. This covers the celebrations that are taking place and the activities that are planned for the month. On the day of the visit we saw people join in a musical instrument activity, this brought about a positive atmosphere where both staff and people using the service were laughing and singing. St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 16 Staff spoken with offer the following comments about the activities on offer for people using the service; “we do activities such as music, bean bags, and talking, as some people like to talk about the past,” “there could be more but we are still in the process of finding out about people’s abilities and understanding what they want, it is a learning process. They enjoy a sing song and a dance, staff tend to do the dancing, but the residents enjoy this,” “the activities have improved, we have more things and I am happy with what we have got now.” So that people’s religious and cultural needs are catered for, in house church services and the delivery of Holy Communion are held for those that wish to attend. As the people currently living in the care home are not of an ethnic minority these services are aimed towards people’s current needs, however the deputy manager stated that other services would be sought if required. People using the service offer the following comments about the activities and their experiences of living in the care home; “it is nice here, I have been to see the hairdresser today, she is very good,” “it is very nice here, I am very happy,” “there are activities, maybe not everyday but there are enough and I am satisfied with what we have. I enjoyed the music session this morning and the bean bag game, it is very good” and “I am very happy here, I enjoy the activities, I like anything to do with music, I played the xylophone today, I am very good at it, we played basket ball the other day which was fun.” So that people using the service can maintain contacts with people that are important to them there are not restrictions on visiting and visitors may be received in private. Throughout the inspection several visitors came into the care home and were made welcome by the staff. One person using the service says that their family are made welcome when they visit, “my brother and children come to visit me, they are made welcome and I can take them to my room if I want.” Staff spoken with tell us that people can make their own decisions about how they spend their time and what they do throughout the day. People using the service confirm this and we saw people spend their time as they wished. Staff spoken with show a good understanding in regard to people’s personal needs and preferences, they are able to discuss diversity of needs and how they support people in meeting these; “ I have previous experience in regard to the Mental Capacity Act, people can make their own choices and decisions and it is important that we still give people choices who may forget, we need to prompt them to remind them that they do have choices, for example that they have money that they can spend if they need anything,” “I did a course St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 17 on equality and diversity, its about meeting people’s individual and diverse needs, for example if they wish to have a male or female carer due to their religion. It has helped me to make sure that people’s rights and choices upheld such as meals, clothes and everyday thing. It is important for people to feel safe and secure and that they trust us.” A wholesome and nutritious menu is on offer to people using the service with choices and specialist diets available at each meal time. There are plans a foot to get people using the service more involved in deciding the menu and food on offer and this will take place at ‘residents’ meetings. Both staff members spoken with say “the food is very good there are choices available.” People using the service tell us, “the food is good, there are choices and enough to eat” and “the food is beautiful.” St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are assured that their complaints will be listened to and acted upon and that they are protected from abuse. EVIDENCE: So that people using the service know how to make a complaint if they need to the complaints procedure is on display in the main entrance and within the information pack located in each person’s room. So that people using the service have the opportunity to express any concerns a ‘surgery’ in now being held where people can ‘pop’ in to see the acting manager if they wish to alongside ‘resident’s’ and relatives meetings. The service has not received any complaints since the previous inspection. Staff spoken with are able to discuss how they would deal with a complaint should one be received so that this is dealt with and resolved. One person using the service says, “I could speak to someone if I was unhappy but I have nothing to complain about.” Most staff have now undertaken training in safeguarding vulnerable people and when spoken with they are able to discuss their roles and responsibilities in St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 19 regard to protecting people, they now have a good understanding about the types of abuse that may occur and what to do about it if it does. Staff have also attended a course on managing challenging behaviour and when spoken with they tell us, “the challenging behaviour course was good, it talked a lot about restraint, this is not used at our home, however it showed us how to break free if someone got hold of us. If challenging behaviour occurs it’s about thinking why, what has upset them, the training has helped me in care delivery. I have learnt about relating loss to people’s behaviour and understanding why they may behave as they do.” One member of staff discussed an episode where they have dealt with behaviour that may be challenging and how they used the methods that they have been taught, which resulted in them dealing with this successfully. Staff feel that since they have attended this course people using the service are now more settled due to increased understanding and the new practices that staff use. One member of staff spoke about the use of body language when communicating with people to make sure that people do not feel challenged or intimidated, they feel that people have the right to say what care they want and that they should be offered choices, not doing this is abuse. They feel confident that abuse is not taking place within the care home and if they thought it was they would report it. Another member of staff says, “the most important thing is to make sure people feel safe and secure and happy in their environment, not frightened and being sure that they can stand up and express their views.” One person using the service says, “the staff are wonderful and are there when needed there are enough staff and I feel safe.” St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment in which people live has improved to provide a more comfortable and homely environment, however the outstanding maintenance issues detract from this. EVIDENCE: New bedroom furniture and furnishings have been put in place since the last inspection making people’s rooms look more homely. We saw that specialist equipment such as assisted baths, hoists and beds are in place for those people who need them. Whilst the environment is comfortable and homely there are a number of maintenance issues such as the broken stair gate and unguarded radiators that St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 21 need attention. The acting manager has made a list of these and has forwarded them to the provider for their attention. We saw that the garden has now been cleared of rubbish and people may now use this area safely. We saw that some of the windows are flaking and rotting on both the inside and outside, this could affect the security of the care home due to the window locks that are secured on this wood. During the tour of the care home we saw that all the doors that must be locked to maintain people’s safety are. The upstairs bathroom remains unused and the bath very stained as previous, despite assurances that this would be dealt with to provide a more clean and comfortable environment for people using the service. People using the service tell us, “I like it here, I have my own space, my own furniture and things; I can do my own thing but also have company if I want to” and “I have my own room and have new furniture it is very nice.” St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported by sufficient numbers of staff to meet their needs, however due to the remaining deficits in compulsory training not all staff have the necessary knowledge and skills to fully meet people’s needs. EVIDENCE: An in depth assessment is currently being carried out by the acting manager in regard to the staffing levels to make sure that sufficient staff are available to meet the needs of people using the service, once this has been completed this will be forwarded to the provider to consider any action to be taken. Staff spoken with tell us, “the team all work well together, it is now a lot more relaxed, morale is good and has been boosted as more time is now spent with residents. If 3 members of staff are on duty there are enough staff but it can still be demanding, we now have more time to supervise both lounges, I am not sure how this will work when the home is full” “there are enough staff, however I am unsure how this will stand when we are full.” Staff tell us that they now have official handovers between shifts so that information exchange is more comprehensive. People using the service do not express any concerns about the staffing levels. St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 23 A number of staff have attained or are working towards achieving the National Vocational Qualification level 2 or 3 (a nationally recognised work and theory based qualification designed to develop people’s knowledge and skills in caring for people). Staff spoken with tell us that they have undertaken this training and that it helps them in supporting people using the service. So that staff are aware of their roles and responsibilities when they first start working at the care home, they all now undertake an induction, however at present this is very basic. The acting manager stated that he has plans to update the induction package so that it follows best practice recommendations. Staff spoken with confirm that all new staff undertake an induction and that they work with senior members of staff to make sure they know all that they need to so they are able to carry out their job role effectively. Staff files examined show us that whilst a through recruitment process is normally undertaken a misunderstanding in regard to the acting manager and the application for a Criminal Record Bureau check (a police to see if an individual has a police caution or criminal record) meant that he had not undertaken a POVA 1st check (a check to see if a person has been placed on a register of people that are known to have abused vulnerable people in the past) before he started working at the care home. The provider and acting manager believed that this was not needed as part of the registration process with the Care Quality Commission is for these checks to be carried out. We set an immediate requirement to make sure that a POVA 1st was gained to ensure that people using the service are protected from unsuitable people being employed. The acting manager made a decision not to work at the care home until the necessary checks have been made. The provider sent us evidence following the inspection to show us that this requirement has been complied with. All other staff files examined contain the necessary documentation required by law such as references and proof of identification, to make sure that people using the service are protected. Staff spoken with confirm that they have undertaken a Criminal Record Bureau check before they commenced working at the care home. The staff training matrix examined shows us that there are still some areas where further training is needed, however since the previous inspection staff have undertaken a number of training courses such as challenging behaviour and manual handling. The acting manager stated that he is aware of the deficits and that he is in the process of devising a new matrix and arranging additional training to make sure that all staff have completed compulsory training. St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 24 One person using the service feels that the staff are well trained to carry out their job role, “the staff are well trained to do their jobs and they know how to look after me.” Another feels that the staff are very good, kind, caring and helpful. Both staff members tell us that they feel supported in their training and development and say that they have undertaken all compulsory training as required. They spoke of how this has improved and developed their practice and the way that they support people using the service. St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the service is improving to make sure that it is well run and managed and people are protected. Some people are enabled to have more of a say in how the care home is run, however others may not be able to utilise the methods currently in use due to their needs. EVIDENCE: The acting manager has been in post for three weeks and is currently in the process of applying to become the registered manager. There are issues in regard to the necessary checks needed prior to employment that have been discussed in standard 29. St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 26 He has previous experience in managing a care home and has extensive qualifications in regard to his job role. Although the acting manager has not yet seen the action plan that the provider prepared following the last inspection, he is aware of the improvements that are needed within the service. He has prepared a number of action plans to address these issues which he showed to us. Staff spoken with said that they feel supported by the management systems in place, “I haven’t really had a chance to get to know the new manager at the moment, however the deputy manager is brilliant, she has lifted the home up, she is easy to talk to and I get on well with her. The atmosphere is a lot better, we have more time to spend with the residents.” One person using the service feels that the service is well run, “the management is very good, the home is well run.” People using the service now have a say in how the care home is run and managed by way of questionnaires and meetings, however due to the needs of some people using the service this method would not enable them to fully express their views. Questionnaires are not currently sent to staff and we did not see any that had been completed by relatives. The acting manager is unsure if the results from these questionnaires and meeting inform the business planning for the year. The latest ‘residents’ meeting minutes show us that people are happy with the service that they receive, however they would like a wider range of activities. During this time each person was given a copy of the questionnaire and supported by staff to complete this and make sure they understood the questions. Staff meetings have begun to take place on a more regular basis and the minutes of the last meeting show us that issues such as care planning, upholding people’s choices and rights and training have been discussed. Another meeting is planned for the near future, the agenda including a discussion about making sure that staff speak to people using the service in a respectful way at all times. People using the service may keep money in the care home safe if they wish and they can access this at any time. On checking four people’s personal allowances we can see that receipts are available for all transactions and these are signed by two members of staff. One member of staff spoken with feels that it is important to remind people that they have money and that they can have things if they want them as they may not remember this. St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 27 A little progress has taken place in regard to the supervision of staff, the deputy manager has started to do these, however has not had the opportunity to do many. Staff spoken with said they are aware of supervisions and that these will be commencing soon. To ensure that we are informed of all notifiable incidents the necessary documentation is now in place and both the acting manager and deputy manager are aware of when these should be sent to us so that we can monitor the service. The fire log book examined show us that staff are undertaking regular fire drills and systems are tested as required to make sure people using the service are protected from a fire should it occur. The accident records show us that there have not been any untoward incidents and when accidents have happened staff have taken the appropriate action. Maintenance records show us that regular servicing of equipment such as the lift and hoist are taking place as required to make sure that these are safe to use. St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 3 3 St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15(1) Timescale for action Plans of care must be in place for 02/07/09 all highlighted needs such as diabetes mellitus and managing behaviour. This will ensure that people’s needs are met and they are protected. Some progress has been made, however further development is required to ensure that full compliance is achieved. Risk assessment must be in place for all highlighted risks such as managing people’s behaviour. This will ensure that people using the service are fully protected. Some progress has been made, however further development is required to ensure that full compliance is achieved. The Mental Capacity Act 2005 must be fully utilised in assessments where people using the service are making decisions and choices that may affect their health and welfare. This will ensure that they are fully protected and their rights are DS0000002217.V375444.R01.S.doc Requirement 2 OP7 13(4,c) 02/07/09 3 OP14 12 02/07/09 St Martins Care Home Version 5.2 Page 30 maintained. Some progress has been made, however further development is required to ensure that full compliance is achieved. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. Maintenance issues must be addressed to ensure that people using the service live in a safe and well maintained environment. Staff must not work at the service without undergoing the necessary checks as required. This will ensure that people using the service are protected from unsuitable people being employed. You must ensure all staff have appropriate experience and competence and receive training appropriate to meet the homes’ stated purpose and assessed needs of the people who live there. This will ensure that people are safe and their needs are met. Some progress has been made, however further development is required to ensure that full compliance is achieved. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. Quality systems must be in place 30/07/09 to: monitor and improve the service, to take into consideration the DS0000002217.V375444.R01.S.doc Version 5.2 Page 31 4 OP19 23 02/08/09 5 OP29 19 12/05/09 6. OP30 18(1,c,i) 02/08/09 7. OP33 24(1) (a)(b) St Martins Care Home views of people using the service, and to demonstrate that the service is run in the best interest of people who use the service. Some progress has been made, however further development is required to ensure that full compliance is achieved. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. You must ensure that staff 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. Some progress has been made, however further development is required to ensure that full compliance is achieved. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. 8 OP36 18 30/07/09 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 Continue to personalise plans of care to ensure that DS0000002217.V375444.R01.S.doc Version 5.2 Page 32 St Martins Care Home 2 OP28 people’s personal needs and preferences are fully met. Implement an induction that meets the best practice recommendations to make sure all staff are trained to the same standard. St Martins Care Home DS0000002217.V375444.R01.S.doc Version 5.2 Page 33 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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