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Inspection on 20/12/05 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 20th December 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 manager and staff are very committed to providing good standards of care for the residents. Residents feel the staff are sensitive to their needs and choices. The food is well thought of and residents feel respected and enabled to socialise in a manner that is comfortable for them. The home`s care planning process is very detailed and comprehensive. The home provides a domestic and comfortable environment, which is well maintained, in most parts. The gardens are well maintained and provide a comfortable place to relax, away from noise and traffic.

What has improved since the last inspection?

Various parts of the home have been decorated, the gardens in part have been cleared and provide a pleasant area to relax in private. The home continues to present itself as a comfortable, domestic, warm environment. Standards of care delivered by the care staff and manager continue to be high.

What the care home could do better:

Evidence from residents, staff and documentation confirms that the home is frequently understaffed. Despite the home only having occupancy levels of 17 residents, the care needs of those residents are not being met fully by two staff on duty. The care needs are such that often two workers are required for personal care tasks for one resident, leaving other residents, particularly at key times without the assistance or supervision when they require it. This also presents a health and safety hazard to residents and staff. An immediate requirement has been issued to the proprietor, in respect of this. The manager is often working shifts, mainly as the second member of staff. This is reducing dedicated management hours that are required for the safe, effective management of the home. Whilst the care offered by the manager and care staff is highly respected, the manager is required to work supernumery management hours in order to ensure the safe running of the home and to ensure that it is managed in the best interests of the residents. An additional requirement was made for this issue.

CARE HOMES FOR OLDER PEOPLE St Martins Care Home 42 St Martins Road Bilborough Nottingham NG8 3AR Lead Inspector Andrew Sales Unannounced Inspection 20th December 2005 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.V272728.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Martins Care Home DS0000002217.V272728.R01.S.doc Version 5.0 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 Mrs Gail Kirkby Care Home 21 Category(ies) of Dementia (21), Old age, not falling within any registration, with number other category (21) of places St Martins Care Home DS0000002217.V272728.R01.S.doc Version 5.0 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 3rd June 2005 Brief Description of the Service: St Martins Care Home provides 21 places for older people requiring residential care. 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. The home has ample communal space and extensive gardens. 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.V272728.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted by A.J.Sales on 20 December 2005. The focus of inspections undertaken Inspection (CSCI) is upon outcomes for provided. This process considers the requirements, minimum standards of by the Commission for Social Care residents and their views of the service home’s capacity to meet regulatory practice; and focuses on aspects of service provisions that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting residents and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. The inspector also spent time talking to other residents in the home and three members of staff. Overall the feedback was very good. Residents were happy to express their views about the home, they were positive in terms of the skills and attitude of the staff and of the overall standards of care, food, social recreation and the atmosphere. What the service does well: What has improved since the last inspection? What they could do better: St Martins Care Home DS0000002217.V272728.R01.S.doc Version 5.0 Page 6 Evidence from residents, staff and documentation confirms that the home is frequently understaffed. Despite the home only having occupancy levels of 17 residents, the care needs of those residents are not being met fully by two staff on duty. The care needs are such that often two workers are required for personal care tasks for one resident, leaving other residents, particularly at key times without the assistance or supervision when they require it. This also presents a health and safety hazard to residents and staff. An immediate requirement has been issued to the proprietor, in respect of this. The manager is often working shifts, mainly as the second member of staff. This is reducing dedicated management hours that are required for the safe, effective management of the home. Whilst the care offered by the manager and care staff is highly respected, the manager is required to work supernumery management hours in order to ensure the safe running of the home and to ensure that it is managed in the best interests of the residents. An additional requirement was made for this issue. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Martins Care Home DS0000002217.V272728.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Martins Care Home DS0000002217.V272728.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4,6. Resident’s receive an assessment prior to admission. Assessment plans are well documented. The staff team are familiar with the individual needs of the resident’s. The manager supports staff to access training in the needs of older people. Intermediate Care is not provided at the home. EVIDENCE: Two care plans were checked by the inspector. These are the standard Broadoak company assessments. They are very detailed and contained all the needs assessments required in this standard. They are well laid out and contain daily records and evidence of support from other healthcare professionals. Local authority assessments were present. Staff spoken with said they had received induction training and supervision and training in mandatory health and safety topics as well as subjects relating to the healthcare of older people. Staff files evidenced training certificates to support this. Resident’s felt that the staff are competent, attentive and professional. St Martins Care Home DS0000002217.V272728.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Residents receive a comprehensive assessment. Assessments are updated following a review. The home is able to meet the healthcare needs of it’s residents. Medication issues are managed appropriately. Residents are treated appropriately. EVIDENCE: Two care plans observed, were well set out and detail each area of need and an action plan is drawn up to meet this need. Risk assessments were well documented in each of the resident’s plans that were inspected. Particular attention is placed in the need to prevent pressure sores, falls and safe working practices. Daily records are well maintained by care staff and professional input from district nurses and GP’s is well documented. Evidence gained from speaking to residents and staff suggested the care planning process was accurate and outcomes satisfactory. St Martins Care Home DS0000002217.V272728.R01.S.doc Version 5.0 Page 10 Resident’s plans contain details of each individual’s health care needs, including tissue viability and continence risk assessments. There is evidence that people have been appropriately referred to health care professionals. Care plans viewed contained records of visits by district nurses, General Practitioners and other professionals. Healthcare professionals were observed visiting on the day. The inspector was informed that the residents can register with a GP of their choice. Staff training records evidenced that medication training was provided for staff responsible for the administration of medication. The homes medication administration systems have been well maintained. There is a policy and procedures for receiving, recording, storing, handling, administering and disposing of medicines. The home is registered with the local pharmacist and support and advice obtained as and when needed. Staff were observed during the visit interacting positively with individuals, four resident’s spoken with, reported staff provide a good standard of care and areas of concern would be discussed with the registered manager. All of the residents who spoke with the Inspector commented very positively on the conduct and attitude of the staff. St Martins Care Home DS0000002217.V272728.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Residents are supported to access daily activities and access the local community. Residents feel they retain much of their independence after moving into the home Resident’s maintain contact with family and friends. Food provided at the home is considered to be very good by the residents. EVIDENCE: Residents spoken with, felt they were happy with the level of activities within the home and outside. Residents commented that the philosophy of the home and the attitude of the staff enabled them to make choices and felt they were generally well respected. The staff reported that they encourage residents to participate in events and outings. Visitors are welcomed and come in regularly. There is a calendar of events that informs people of activities available. Residents also spoke well of social arrangements in the home. Although there is no formal activities program, the manager arranges for local artists to visit the home, who provide mainly musical entertainment. These are particularly popular with those with cognitive impairments. St Martins Care Home DS0000002217.V272728.R01.S.doc Version 5.0 Page 12 Residents spoken with commented positively on the standards and quality of food. Resident’s stated they are able to request drinks at anytime of day and night. Special diets can be catered for as described by the cook and care plans evidenced that the home refers people to the dietician for advice on nutrition. The cook stated she had worked at the home for eight years and was able to get to know the residents preferences quickly. Three full meals are offered daily and snacks available at suppertime. All resident’s spoken with confirmed that they liked the food and could have a choice if requested. Staff spoken with, were well aware of residents individual preferences. St Martins Care Home DS0000002217.V272728.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The home has policies and procedures in place for dealing with complaints and adult protection. Training in adult protection is now in place. EVIDENCE: A complaints procedure is in place. Complaints records were not inspected on this occasion. The inspector is not aware of any complaints against the service in the last year. The home has the Nottinghamshire County Council’s guidance on the Protection Of Vulnerable Adults. The home also has company policies on adult protection and whistle blowing. Staff spoken with demonstrated an understanding of Adult Protection issues. Training certificates in respect of Adult Protection were observed on staff files, this is also covered during the induction process. St Martins Care Home DS0000002217.V272728.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25,26. The location and layout of the home is suitable for its intended purpose. It is safe and well maintained. EVIDENCE: The home has been maintained to a very good standard. The manager stated that as far as she is aware there are no requirements outstanding from the Fire Officers or the Environmental Health Officers last inspection of the home. Rooms were individually and naturally ventilated with windows conforming to recognised standards. Central heating could be controlled in each room. Emergency lighting was fitted throughout with records of appropriate testing taking place. Room lighting was domestic with bedside lights available. Two water outlets were tested and found to be satisfactory. The home is generally clean and procedures are in place to promote hygiene. The gardens were observed to have been well maintained and residents say they find the gardens in summer, a fine place to relax in peace. St Martins Care Home DS0000002217.V272728.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. The home is not currently deploying sufficient numbers of staff on each shift. There is an appropriate recruitment and selection procedure. The range of skills amongst the staff group are relevant to the needs of the resident’s. Staff training is provided. EVIDENCE: A staff rota was observed which showed which staff are on duty at any time during the day and night and in what capacity. This was discussed with staff members and the manager. Currently there are only 17 resident’s residing at the home. The inspector asked what the care needs of all the residents were and was informed that there are 2 residents assessed with Dementia, three with onset of Dementia, five residents who required two care workers for full personal care and four residents who required assistance to eat at mealtimes. In addition to these support needs, one member of staff would be responsible for administering medication. The inspector identified that regularly, only two members of staff would be on duty between 11am and 7am or 7.30am the following day. When the inspector consulted with five residents, three of the resident’s commented that sometimes they had to wait for help and found that staff were reluctantly too busy to assist them at that particular time they required. Given the needs of the residents this is inadequate and leaves residents at risk and waiting for key services. St Martins Care Home DS0000002217.V272728.R01.S.doc Version 5.0 Page 16 The manager informed the inspector that all staff are now enrolled on NVQ training. Three members of staff who the inspector spoke with, confirmed that they were receiving training in a number of mandatory and care specific subjects. The files of 2 staff were examined and demonstrated that appropriate procedures were undertaken for recruiting staff that ensured the protection of resident’s. Police disclosure was obtained, appropriate employment history and references accessed. All staff receive terms and conditions of employment. St Martins Care Home DS0000002217.V272728.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,36,38. The home is generally well managed with residents interests put first. The operational management and development of the home is not facilaited by the current working schedules of the manager. The formal supervision of staff within the home is not possible with the current working patterns of the manager. Health and safety management is partially documented, some areas require improving. EVIDENCE: Residents and staff felt the manager was committed and approachable and was dedicated to providing quality standards of care for the residents, but spent a majority of her time providing care support. As stated in national minimum standard 27 the inspector discussed the manager’s working commitments for the average week. The manager should not be used for filling in staff shortages. The home is not benefiting from dedicated management hours that should be used to focus on promoting health and safety management, St Martins Care Home DS0000002217.V272728.R01.S.doc Version 5.0 Page 18 developing the staff induction and training program and the framework for staff supervision. The inspector observed some of the home’s records, which are held securely and most are maintained in good order. The manager stated that portable appliances are tested each year, fire equipment, escape routes, fire doors are checked weekly by staff and the fire alarm, door releases and emergency are tested at required intervals. The direct link to the fire service was last tested on 1/10/04. A gas service inspection was conducted on 6/09/04. The manager stated that passenger lift and hoists are regularly serviced. The inspector has asked the manager to provide up to date records of all system and appliance servicing following the inspection. At the time of the report this has not been provided. Accident records were observed and are appropriately maintained. Staff files contained evidence of first aid and moving and handling training. Safety procedures are posted. Resident’s commented that they feel their safety and well being is promoted well in the home. St Martins Care Home DS0000002217.V272728.R01.S.doc Version 5.0 Page 19 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 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 X X X X X 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 X X X 2 x 2 St Martins Care Home DS0000002217.V272728.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard 27 32 Regulation 121a 134c 181a 101 121ab. 18 2 134a-c 2345 Sch4 Timescale for action Ensure adequate numbers of 20/12/05 staff are on duty 24 hours per day. Ensure sufficient super numery 20/12/05 management hours are available to ensure effective management of the home. Ensure staff are appropriately 30/01/06 supervised Ensure Health and Safety 30/01/06 records are supplied to the Commission relating to maintenance of appliances and equipment. Requirement 3 4 36 38 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Martins Care Home DS0000002217.V272728.R01.S.doc Version 5.0 Page 21 St Martins Care Home DS0000002217.V272728.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 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.V272728.R01.S.doc Version 5.0 Page 23 - 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. 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