Inspection on 20/01/09 for St Martins Care Home

This inspection was carried out on 20th January 2009.

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 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 12/05/09

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 19/06/2009.

CARE HOMES FOR OLDER PEOPLE St Martins Care Home 42 St Martins Road Bilborough Nottingham NG8 3AR Lead Inspector Karmon Hawley & Susan Lewis Unannounced Inspection 20th January 2009 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Martins Care Home DS0000002217.V374183.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.V374183.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Old age, not falling within any other categort (OP) (21) Dementia - over 65 years of age (DE(E) (21) Date of last inspection 3rd September 2008 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 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. 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.V374183.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people living 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 delivery that needs further development. A review of all the information we have received about the home was considered in planning this visit and this helped decide what areas were looked at. Two regulatory inspectors conducted the unannounced visit over 1 day, including the lunchtime period. The main method of inspection we use is called ‘case tracking’ which involves selecting the care plans of four people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. As some people living in the care home have dementia care needs this has limited the number of their views and opinions that have been included in this report. We therefore used a specialist tool called Short observational framework for inspection (SOFI) this is a methodology we use to understand the quality of the experiences of people who use services who are unable to provide feedback due to their cognitive or communication impairments. SOFI helps us assess and understand whether people who use services are receiving good quality care that meets their individual needs. Two hours were spent observing the care given to a small group of people. All observations were followed up by discussions with staff and examination of records. The area manager, acting manager and five members of staff were spoken with during the visit. Five people using the service were also spoken with during the visit to gain their views and opinions of the service. We also undertook a full tour of the care home, which included looking at the bedrooms of those people who we case tracked and communal areas of the home. St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Medication practices and records have been improved upon to make sure that people using the service receive their medication as prescribed and they are protected. Some people have been consulted about a programme of activities that they may wish to do and further resources have been purchased to facilitate; this working towards ensuring that people’s recreational needs are satisfied. Some bedroom furniture has been replaced or repaired, working towards a better maintained environment. Ongoing redecoration continues to take place, working towards a better maintained environment. St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 7 Some staff training has taken place working towards ensuring that all staff have the necessary knowledge and skills to meet the needs of people using the service. People using the service have been sent a questionnaire so that they can express how they feel about the service that they are receiving. What they could do better: A copy of the preadmission assessment and written confirmation that staff can meet a person’s needs must be available. This will ensure that people are assured that their needs can be met and that care is planned according to their needs prior to and following admission to the care home. Risk assessments and management plans in regard to individuals identified risks must be in place. This will ensure that risks are managed and people using the service are fully protected. Improvements are needed in the care planning process to make sure that plans of care are in place for all identified needs, these are personalised and kept up to date. This will ensure that people’s needs are met in their preferred way and they receive continuity of care. Staff must be aware of the content of plans of care and implement these when supporting people using the service. This will ensure that people are supported appropraitely and their needs are met. Staff must not talk to or treat people using the service in an infantile way, which undermines their dignity. This will ensure that people using the service are treated with respect at all time. People using the service must be consulted further about a programme of structured activities. This will ensure that people’s recreational needs are satisfied. 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 maintained. Management must understand their responsibility to recognise the signs and indications of abuse or neglect and follow their responsibility to report all safeguarding concerns to the Local Authority. This will ensure that people are protected and people who are not directly connected to the service appropriately investigate all concerns. Where bedroom furniture is shabby and broken it must be replaced to ensure that adequate and functioning furniture is available for people who use the service. St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 8 The disused items stored in the garden must be removed. This will ensure that people using the service are protected from risk of harm. Doors must not be left unlocked nor keys left in doors that store substances hazardous to health. This will ensure that people using the service are protected. Sufficient staff must be available in regards to people’s dependencies and needs to ensure that their needs are met. Time must be facilitated for staff to have a handover period where they are updated about people using the service. This will ensure that vital information is not lost in transition and people using the service receive continuity of care. All new staff must undertake an induction to ensure that they are aware of their roles and responsibilities. Records of the induction must be available for inspection. This will ensure that people using the service are protected from untrained staff caring for them. All staff must be trained and able to apply their knowledge in all compulsory areas of their work - as a minimum this must include managing challenging behaviour and safeguarding vulnerable adults. This will ensure that people are safe and their needs are met. The acting manager must submit an application to us to become the registered manager. This will ensure that people live in a care home that is run and managed by a person who is registered to be in charge. Quality systems must be in place to: monitor and improve the service, to take into consideration the views of people using the service, and to demonstrate that the service is run in the best interest of people who use the service. Staff must be appropraitely 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. The Fire Authority must be consulted with regarding keeping doors open, whilst complying with Fire safety regulations to keep people living at the service safe. All significant issues are required to be made known to the commission to ensure that we can monitor the service and the outcomes for people living there. Please contact the provider for advice of actions taken in response to this St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 9 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 10 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.V374183.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People may not always be 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: The acting manager stated that she visits people in the community prior to admission to carry out a preadmission assessment to see if the staff can meet people’s needs before they make a decision to move in to the care home. We saw that preadmission assessments are available in some of the plans of care that we examined, however are not available in them all. In this instance a social worker assessment has been obtained before admission, which give the staff some information about the person’s needs. There is no evidence however to demonstrate that staff have assessed and confirmed that they are able to meet the person’s needs before admission. St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 12 People may also 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. The care home does not offer intermediate care services. St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The needs of some people using the service are not fully met and they are not supported appropraitely, either due to plans of care and risk assessment not being in place or these not being utilised effectively by staff. Although staff maintain people’s privacy, people are not always treated with respect when staff speak to them in a infantile way. EVIDENCE: People using the service undergo various assessments such as the activities of daily living, pressure area care and manual handling so that staff can assess their needs. Most assessments contain valuable information, which is personalised, however this information is not always used when staff develop plans of care. Within one plan of care, an assessment for pressure area care highlighted that additional support is needed in this area to make sure that the person does not develop sores, however a plan of care to guide staff how to do this was not in place. St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 14 Some people using the service have dementia and behaviour that is challenging, however within the case files we examined specific plans of care are not in place to show how staff are to support people and keep them safe. There is evidence of people experiencing behaviour that is challenging within daily records and an incident had occurred where one person using the service had hit another. Although there are some risk assessments in place for things such as smoking, we saw in the case files examined that risk assessments are not in place for people who exhibit behaviour that is challenging or when a person is at risk of falling. Also where a plan of care and risk assessment is in place in regard to a special diet that a person needs, we saw an incident had occurred where a person had choked as staff had not followed these and had given an inappropriate diet. We saw that some plans of care have not been updated to make sure that people receive continuity of care, despite evidence of their conditions changing. Two requirements were set at the previous inspection to make sure that specific plans of care and risk assessments are in place for all identified needs. As we suspect that a breach has occurred and these requirement have not been complied with we seized further evidence from the service, which will be analysed and discussed with our enforcement team in regard to considering further enforcement action. People using the service told us that the staff are kind and caring and that they feel well looked after, however one person did express concern in regard to the shouting that goes on when people are exhibiting behaviour that is challenging, “there is a lot of shouting here, it is unsettling, I often take myself to my room.” Staff spoken with are able to discuss people’s needs, however their knowledge on supporting people with dementia and behaviour that is challenging varies and not all of them are able to discuss good practice recommendations. People using the service are supported to access specialist services such as the district nurse, optician and doctor as required. Two people using the care home confirmed that they are able to see the doctor when they need to, “I have a cold, I have seen the doctor about it, as I have a bad chest,” and “I can see the doctor when I need to.” Staff spoken with said that they support people to access specialist services when needed and that the district nurses are very supportive. St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 15 During the tour of the building we saw that specialist equipment such as mattresses and cushions are available for people to use. One person using the service told us about their special chair, which they thought was very comfortable. Staff who administer medication have been trained to do so and we saw them following good practice recommendations. People using the service are supported appropraitely by staff in regard to their medication and making sure that they get this on time. The medication records that we examined show us that people using the service are getting their medication as prescribed and that good record keeping is now taking place. Staff record the temperature of the medicine room and the medicine fridge so that medication is stored at the correct temperature, however records show us that the medication fridge is too cold most of the time for medication that is stored there. The acting manager altered the thermometer on the fridge and told us that she would monitor this to make sure the correct temperatures are maintained. One person using the service told us, “the staff give me pain killers when I need them, I often have pain in my back.” We also saw staff reassure a person using the service when they were in pain and offer them support and pain relief. 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. During a period when activities were taking place we did see that staff infantilise people using the service on occasion, by speaking to them in a ‘baby like’ way and using expressions such as ‘oh, you did ever so well.’ Staff spoken with told us that they make sure that they knock on people’s doors and cover them over when they are supporting them with personal care to make sure that they respect their privacy. St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although some people using the service feel that their expectations are now met, others still feel that further could be done to make their lives more enjoyable. Staff are aware that people using the service are entitled to their rights and choices, however these may still be compromised due to the lack of staff understanding and use of the Mental Capacity Act 2005. EVIDENCE: Staff currently support people using the service with activities when they have the time and further resources have been purchased to support them in this. Therefore activities such as bingo, ball games, quizzes, board games, bowling, arts and crafts and music therapy are available to people using the service. An outside entertainer who offers exercise to music also visits the care home on a monthly basis. The acting manager has spoken briefly to people using the service about the different types of activities that they want to do, however has not had the opportunity to do this in depth as yet. St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 17 Staff spoken with said that they feel there is sufficient for people to do, however some people do need encouragement to join in. People using the service told us, “there are some activities but not that many, it depends upon the space and the weather, I would like more to do,” “there are not many activities but I do not want to join in them anyway,” “there are not that many activities but I am not that bothered, I don’t really want to do that much,” and “it is not as good as I thought it would be, there are no activities, I used to enjoy them before.” During the specialist observation we observed staff assisting and supporting people as needed and that staff were friendly with people using the service. An activity also took place in this time frame and staff asked people if they wanted to join in. For those who chose not to, their wishes were respected. Those people who chose to join in appeared to be enjoying the activity and several were laughing and making jokes with the staff. The activity was throwing beanbags onto a disk on the floor. Where people had movement difficulties the carer altered the distance the disk was placed on the floor to accommodate the need. Following the activity people mainly spent their time watching the television or slept. We observed though that the television is in the corner of the lounge and it was evident that not all the chairs in the room could see the television clearly. During the observation people using the service were mainly in a positive or passive state of wellbeing, which was enhanced during the time that activities were taking place. 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, “I have a nice room upstairs, which I can go to when I want,” “I can do what I want and go to bed when I want,” and “I can go out when I like, there are no restrictions, I can do what I like to do.” Staff spoken with confirmed that the routine is flexible, stating that, “this is their home, they should feel relaxed and settled, people can do what they want to do,” and “we should make sure that people are not frightened and they are relaxed in their own homes, so that they feel safe and secure and that they can approach staff for anything that they need.” 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. People using the service told us, “my visitors are always made welcome,” and “I don’t tend to get many visitors but when I do they are made welcome and I can take them to my bedroom if I want.” St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 18 Staff spoken with are aware that people using the service should be supported in making their own decisions and stated, “I have done a course in equality and diversity, we should not stereotype people, we should consider their culture and preferences, we should support them in the choices that they make.” People who do not smoke may chose to sit in the smoking area, we saw that this has been discussed with people using the service and relatives where necessary. A disclaimer to state they are aware of the risks has been signed by relevant parties. However many people using the service have dementia care needs and the Mental Capacity Act has not been considered in this assessment to make sure that a person has the capacity to consent to this. 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. Although staff said that biscuits are available with drinks in the mornings and afternoons, we did not see these being offered to people using the service during these times. People using the service told us that the food is good and that they are given choices in what they eat. We saw staff encourage people to go through to the dining room for lunch but where people wanted to eat in the lounge they accommodated this. St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although people using the service are assured that their complaints will be listened to and acted upon they are not fully protected from abuse. EVIDENCE: So that people can make a complaint if they feel the need to, the complaints policy is on display in the main entrance hall. A new complaints procedure has been introduced to make sure that any complaint received is investigated and resolved appropriately. 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 resolved. People using the service did not express any concerns during our visit and one person said, “ I would talk with the staff if I felt unhappy about anything.” There has been one safeguarding alert made since the previous inspection, which covers numerous issues such as neglect and physical abuse, the Local Authority is still investigating this. In the meantime the provider has ordered a new standaid hoist to address some of the issues of concern and a referral has been made to specialist services to support staff in obtaining essential equipment needed by one person using the service. St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 20 Seven members of staff have undertaken training in safeguarding adults and staff spoken with are able to discuss what they feel constitutes abuse and their roles and responsibilities in making sure that people are safe. However during our inspection we found that an incident where one person using the service had hit another person following an altercation not been reported. On speaking with staff not all of them are aware that incidents like this need alerting to the Local Authority so that these can be investigated appropraitely and so that people using the service are protected. A requirement had been set at the previous inspection in regard to ensuring that management understands their responsibility to recognise the signs and indications of abuse or neglect and follow their responsibilities in reporting incidents to the Local Authority. As we suspect that a breach has occurred and this requirement has not been complied with we seized further evidence from the service, which will be analysed and discussed with our enforcement team in regard to considering further enforcement action. St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although people using the service live in a comfortable environment, leaving the smoke room door propped open and the current storage of disused items in the garden may affect this. Improvements to the environment continue to take place, however there are still areas such as some bedroom furniture that detracts from this. EVIDENCE: There is evidence of ongoing maintenance taking place and decorators are currently redecorating areas of the care home. One person using the service told us, “I have a nice room here, it has been a bit inconvenient with the decorators being here, but it’s alright.” Although some items of furniture still require attention to make sure that these are well maintained, some new furniture has been purchased and other furniture has been repaired. St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 22 There are several items of disused furniture and an old cooker stored in the garden where people using the service have access. There is a smoking room available for people who may wish to use this facility. When we entered the care home one of the smoke room doors had been propped open, however staff did remove this when asked to do so. One person using the service told us, “I have to ask for my cigarettes as the staff have them, but it is good that I can smoke here, I have to smoke in the smoke room.” During the tour of the building we saw that the upstairs bathroom is not in use, the acting manager stated that there are plans to change this into a shower room and that people currently use the other facilities in the care home. During the tour we also saw that a cleaning cupboard on the ground floor where chemicals are stored was left unlocked and the keys were in the door. People using the service have access to this area and consequently this cupboard. This issue was brought to the attention of the acting manager who locked the door and removed the keys immediately. St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. As staff do not have an official handover period of time allocated, important information could be lost in transition of shifts. Although some progress has been made in regard to staff training, some staff do not have all the necessary knowledge and skills needed to fully support people using the service. EVIDENCE: The staff duty rotas show us that three members of staff are on duty throughout the day and two members of staff throughout the night. In addition to this there are domestic and kitchen staff and the acting manager is now supernumerary. People using the service told us, “there are enough people here to help me, I sometimes have to wait but it is ok,” “the staff are alright, they look after me well, there are enough staff here to look after me,” and “I don’t take much notice of the staff, they are ok, they help me when I need a hand.” Staff told us that there are usually enough staff and that staffing levels have been increased a little since the acting manager has taken charge. However two members of staff said, “it is difficult at times when some people need a lot of support and attention due to their needs,” and “it is difficult at some meal times as a lot of people need help and there is not always enough staff available to support them.” St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 24 During our inspection it became apparent that a safeguarding incident had not been referred to the Local Authority, on speaking with staff, concerns were discussed about the handover period and that this information may have been lost in transition to senior staff. Staff are not paid for an official handover period and it is assumed normal practice that staff come in ten minutes before their shifts starts so that they can have a verbal handover from other staff. It was stated that on occasion that this time is very limited and only a quick handover takes place. Three members of staff have completed the National Vocational Qualification (a nationally recognised work and theory based qualification) level 2 and one has completed level 3. This training is designed to enhance people’s skills in caring for people. One member of staff confirmed that they had undertaken this training and stated that it had helped in their development. On examining staff personnel files we saw that some staff have undertaken an induction when they first started working at the care home, to make sure that they are aware of their roles and responsibilities. However there is no written evidence to show that new members of staff have undertaken this training. On speaking with new members of staff they stated that they had undertaken an induction with senior members of staff and that this had been helpful. The acting manager also confirmed that new staff had undertaken an induction, however she was unaware where the paperwork to evidence this had gone. To make sure that people are protected from unsuitable people being employed we examined staff files to see if they contain all the required documentation such as references and a criminal record bureau check (a police check to see if an individual has a police caution or criminal record). We saw that staff files contain evidence of criminal record bureau checks, however not all files contain two references. These files are for long term members of staff and the area manager stated that character references will be completed. Staff spoken with confirmed that they had undertaken a criminal record bureau check when they first started working at the care home. On examining staff personnel files we saw that more training in infection control and health and safety has taken place. The area manager also showed us copies of invoices, which state that some members of staff have competed training in first aid and manual handling. One member of staff said they feel that they attended all the arranged training and that they had done enough training to keep them up to date. St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 25 As we were concerned that only four members of staff had completed training in fire safety and we had seen that staff prop open fire doors, the area manager contacted a training supplier and arranged fire training for staff. Nine members of staff have attended training in dementia care however none have attended training in managing challenging behaviour. On speaking with staff, whilst some said that they felt pretty confident in supporting people with dementia and challenging behaviour, others are a bit unsure and uneasy with some people. In this instance they stated that they would rely on senior members of staff to deal with situations where people using the service may be aggressive with each other. Staff spoken with stated that they felt that training in this area would be beneficial to them in supporting people more appropraitely. Responses given in regard to dealing with challenging behaviour also differed and not all staff are able to discuss good practice recommendations in how they would successfully support people during these times to make sure that people using the service are protected. Within new staff members files we saw that one member of staff had not attended any training since their employment began and two others had only attended one or two courses. On speaking with new members of staff they stated that they felt supported, however did feel that further training would assist them in their job role. St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although people using the service are now beginning to have a say in how the care home is run, there remains concerns about the way that the care home is managed in regard to ensuring that people’s needs are met and they are protected from risks. EVIDENCE: The acting manager has worked at the care home in a senior position for a number of years. She has previous experience in management and feels supported by the area manager and provider in managing the care home. She has yet to apply to the Commission for Social Care Inspection to become the registered manager. She is aware that many improvements are needed and has begun to work on and develop plans of care, however there remain concerns in regard to the general management of the care home and St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 27 supervision of staff in regards to ensuring that people are protected from abuse. Staff spoken with told us that that acting manager is very approachable and is making changes, which are for the better. They feel that the acting manager is very supportive. One person using the service told us, “it is a very nice place, and the people who run it are very nice, if you want anything, you only have to ask.” The acting manager has begun the process of sending out questionnaires to people using the service and their families to gain feedback of their opinions about the service provided. We saw that a number of these had been returned and that positive comments such as; “I never feel rushed, I can ask for a snack at anytime of the day or night and receive one,” “the staff are very helpful, especially when I am tired,” and “ I am not keen on baths or showers, the staff are sympathetic of my fears,” have been received. This is the only way that people using the service are enabled to have a say in how the care home is run and managed, however, the acting manager is in the process of arranging meetings for people using the service and their relatives to attend in the near future. People using the service can have their money kept in the care home safe if they wish. We checked four people’s personal allowances, which show us that receipts are kept for each transaction and that the money matches the accounting sheet. Only the acting manager has access to this money, so if people need this when she is not there staff usually make plans so that this is available. There are records available to evidence that the staff at the care home are not responsible for anyone’s money, and if power of attorney is in place this is recorded. There is no evidence to show us that staff have undertaken regular supervisions to demonstrate that they are supported in their training and development and that their working practice is monitored. Staff spoken with confirm that they have either not had a supervision for a long time, or they have not had one at all during their employment. On arriving at the care home we saw that a number of fire doors had been propped open. This had been a concern at the previous inspection and a requirement had been set about contacting the local fire authority to discuss these issues of concern. St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 28 The acting manager stated that doors are propped open to assist people in moving around the care home and that the fire authority had sanctioned this, also decorators are painting woodwork and some of these doors had been propped open whilst the paint dried. The acting manager did informed staff to remove the props as able. One member of staff did express concern about the laundry room, stating that there is not enough room when working in there, we pointed out that there was no member of staff in this room at the time when we noted the door was propped open. As there was no record that the fire authority had sanctioned the propping open of fire doors, the area manager contacted them on the day of the visit and asked them to get back in touch with the care home to discuss these concerns. On examining staff training we saw that only four members of staff have undertaken fire training and no fire drills have been carried out to make sure that people using the service are fully protected from fire. The area manager contacted a training source and training was booked for two days following the visit to make sure that this is addressed. Staff spoken with told us that they are aware that fire doors should not be propped open, however at times this was done to make it easier for people to move through the building. They also said, the maintenance people are currently working in the care home and some of the doorframes are wet. We saw that regular servicing and maintenance of equipment is taking place, by way of the gas and lift certificate examined. St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 29 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 1 X 2 St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 (1) schedule 3 Requirement Timescale for action 10/04/09 2 OP7 13(4,c) 3 OP7 15(1) You must have available a copy of the preadmission assessment and written confirmation that staff can meet a person’s needs. This is to ensure that people are assured that their needs can be met and that care is planned according to their needs prior to and following admission to the care home. This requirement was initially set at the previous inspection and must be complied with. Risk assessments and 30/04/09 management plans in regard to individuals identified risks must be in place. This will ensure that risks are managed and people using the service are fully protected. This requirement is now outstanding and further enforcement action is now being considered. You must have plans of care in 10/04/09 place for people’s identified needs to ensure that these are met. This requirement is now outstanding and further enforcement action is now being considered. DS0000002217.V374183.R01.S.doc Version 5.2 St Martins Care Home Page 31 4 OP7 12 5 OP7 15 6 OP7 12 7 OP10 12 8 OP12 16(2,n) 9 OP14 12 10 OP18 13(6) Staff must be aware of the content of plans of care and implement these when supporting people using the service. This will ensure that people are supported appropraitely and their needs are met. Plans of care must be reviewed on a regular basis and kept up to date to ensure that continuity of care is received and people’s needs are fully met. Plans of care must be personalised so that staff are aware of people’s individual preferences so that they receive care and support in their preferred way. Staff must not talk to or treat people using the service in an infantile way, which undermines their dignity. This will ensure that people using the service are treated with respect at all time. You must consult people using the service about a programme of structured activities. This will ensure that people’s recreational needs are satisfied. This requirement has been part met, however further development is required to achieve compliance. 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 maintained. You must ensure that you make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or DS0000002217.V374183.R01.S.doc 30/04/09 10/04/09 30/04/09 30/04/09 30/04/09 30/04/09 30/04/09 St Martins Care Home Version 5.2 Page 32 11 OP19 16(c) 12 OP19 13(4,c) 13 OP26 13(4,c) 14 OP27 18(1,a) 15 OP27 12 16 OP28 18 abuse. This will ensure that people using the service are protected from abuse. Where bedroom furniture is shabby and broken it must be replaced to ensure that adequate and functioning furniture is available for people who use the service. This requirement has only been part met. Further action is needed to ensure full compliance. You must remove the disused items stored in the garden. This will ensure that people using the service are protected from risk of harm. You must ensure that doors are not left unlocked and keys are not left in doors where substances hazardous to health are stored. This will ensure that people using the service are protected. You must provide assess the dependencies of people using the service and the level of support that they require to ensure that sufficient staff are available to meet their needs. You must ensure that time is facilitated for staff to have a handover period where they are updated about people using the service. This will ensure that vital information is not lost in transition and people using the service receive continuity of care. You must ensure that all new staff undertake an induction to ensure that they are aware of their roles and responsibilities. Records of the induction must be available for inspection. This will ensure that people using the service are protected from untrained staff caring for them. DS0000002217.V374183.R01.S.doc 30/04/09 30/04/09 30/04/09 30/04/09 30/04/09 30/04/09 St Martins Care Home Version 5.2 Page 33 17 OP30 18(1,c,i) 18 OP33 24(1) (a)(b) You must ensure all staff have 30/04/09 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. Quality systems must be in place 30/04/09 to: • monitor and improve the service, • to take into consideration the views of people using the service, and • to demonstrate that the service is run in the best interest of people who use the service. This is an outstanding requirement and has only been part met. Further development is required to ensure full compliance. You must ensure that staff are appropraitely 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. Consult with the Fire authority regarding keeping doors open, whilst complying with Fire safety regulations to keep people living at the service safe. Implement practice recommended by the Fire authority without delay and inform us of the outcome. All significant issues are required to be made known to the commission to ensure that we can monitor the service and the outcomes for people living there. DS0000002217.V374183.R01.S.doc 19 OP36 18 30/04/09 20 OP38 23(4,a) 30/04/09 21 OP38 37(1) 30/04/09 St Martins Care Home Version 5.2 Page 34 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 2 Refer to Standard OP9 OP18 Good Practice Recommendations Monitor the medication fridge temperature and adjust accordingly so that this remains in the correct temperature zone at all times. You ensure that the management understand and follow their responsibility to report all safeguarding concerns to the Local Authority. This will ensure that people are protected and people who are not directly connected to the service appropriately investigate all concerns. You ensure that the management understand their responsibility to recognise the signs and indications of abuse or neglect. This will ensure that will people are protected. Complete character references for long-term members of staff who have insufficient references in place. 3 OP18 4 OP29 St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Martins Care Home DS0000002217.V374183.R01.S.doc Version 5.2 Page 36 - 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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