Inspection on 03/09/08 for St Martins Care Home

This inspection was carried out on 3rd September 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 20/01/09

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 13/11/2008.

CARE HOMES FOR OLDER PEOPLE St Martins Care Home 42 St Martins Road Bilborough Nottingham NG8 3AR Lead Inspector Karmon Hawley & David Litchfield Unannounced Inspection 3rd September 2008 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.V371360.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.V371360.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 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.V371360.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 4th March 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.V371360.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 0 star this means that people who use the service experience poor quality outcomes. 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. The area manager, acting manager and four members of staff were spoken with during the visit. Four people using the service and one visitor 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. The service provided us with an Annual Quality Assurance Assessment that gives us information about the service and what they feel they have achieved over the previous year. Information from this assessment is included in this report. What the service does well: St Martins Care Home DS0000002217.V371360.R01.S.doc Version 5.2 Page 6 People using the service spoke positively about the care that they received and the staff that support them. They told us that staff are kind and caring and look after them well. Plans of care are mainly in depth and highlight people’s needs so that staff have the necessary information needed to support people using the service. There are no restriction on visitors and visitors may be received in private should they wish. One visitor told us that they are always made very welcome when they go to the home and they are offered a cup of tea. People using the service and the visitor said that staff are always kind and respectful to them. Staff spoken with are able to discuss the needs of people using the service and how they support them to meet these. The menu has been changed following discussions with people using the service so that they are offered particular food that they enjoy. Positive comments were received about the quality of the food. What has improved since the last inspection? What they could do better: Make sure that a copy of the preadmission assessment and written confirmation that staff can meet the person’s needs is available to people using the service. This is to ensure that people know that staff can meet their needs St Martins Care Home DS0000002217.V371360.R01.S.doc Version 5.2 Page 7 before they make a decision to move into the care home they are assured that their care is planned according to their needs prior to and following admission to the care home. Plans of care must be in place for all identified needs to make sure that peoples needs are fully met. Risk assessments must be in place for all highlighted risks to ensure that people using the service are fully protected. Medication policies and procedures must be improved upon to make sure that people using the service are protected and they receive their medication as prescribed. The range of activities and resources available must be improved upon to ensure that people using the service live a full and quality life of their choosing. People’s diverse needs must be considered when planning and delivering care to ensure that care is delivered in their preferred way. The complaints procedure must be presented in a way that people using the service are able to understand to ensure that they are able to use this if needed. All complaints received must be documented and fully investigated to ensure that peoples concerns are acted upon. Safeguarding allegations must be referred to the Local Authority to ensure that these are investigated appropriately and people using the service are protected. The management culture and the procedures in place for alerting safeguarding allegations must be addressed to ensure that these are referred at all times and people using the service are protected. Maintenance issues must be addressed to ensure that people using the service live in a safe and comfortable environment. Sufficient staff must be available at all times to ensure that people’s needs are met and they remain safe. All the necessary documentation required by law must be obtained for all new staff before they commence employment to ensure that people using the service are protected from unsuitable people being employed. Further staff training and monitoring of staff practices following this must take place to ensure that well trained and competent staff supports people using the service. St Martins Care Home DS0000002217.V371360.R01.S.doc Version 5.2 Page 8 The acting manager must submit an application to us to become the registered manager to ensure that people using the service live in a home that is managed by a person who is fit to be in charge. The quality assurance systems must be improved upon to ensure that people using the service have more of an opportunity to have their say in the running of the care home. Consultation with the fire authority must take place in regard to staff practices in propping open fire doors to ensure that people using the service remain safe. All significant issues must be reported to us to ensure that we can monitor the service and outcomes for people living there. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Martins Care Home DS0000002217.V371360.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.V371360.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who may wish to use the service are not always assured that their needs will be assessed and that these can be met before they make a decision to use the service. The service does not offer intermediate care. EVIDENCE: The area manager visits prospective people within the community to carry out a preadmission assessment, to see if the staff are able to meet a person’s needs before a decision is made to move into the care home. Within four case files examined this assessment is available and demonstrates that people’s care needs are been assessed before admission, however there was no written confirmation to state that staff are able to meet the person’s needs. The case file of the newest person admitted to the care home did not have this assessment on file, the area manager stated that she had completed this and that it was at the care home where she was based, she stated that she had St Martins Care Home DS0000002217.V371360.R01.S.doc Version 5.2 Page 11 informed staff of this person’s needs before they were admitted to the home. Staff spoken with were able to discuss the needs of this person and the support that they required. To enable people to get a feel for what it would be like to live in the care home they are encouraged to come and visit and spend time at the home should they wish. The service does not offer intermediate care. St Martins Care Home DS0000002217.V371360.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Most plans of care are in-depth and provide staff with enough information to meet people’s needs, however this is compromised when plans of care have not been completed and may result in people’s needs not being fully met. People using the service are not protected by the medication practices that take place. EVIDENCE: To ensure that staff are aware of the needs of people using the service they undergo various assessments in regard to their daily activities and medical conditions. Information gained, is then used to form a plan of care to make sure that staff know the support that is needed to meet people’s needs. Plans of care are in place for all highlighted needs, with the exception of the newest person admitted to the care home and they are mainly personalised and reflected people’s personal needs and choices so that they receive care in their preferred way. St Martins Care Home DS0000002217.V371360.R01.S.doc Version 5.2 Page 13 Risk assessments are in place for most identified risks to ensure that these are minimised and people using the service are kept safe. However within one plan of care a risk assessment was not in place in regard to smoking and the support needed to remain safe. Within the case file of the newest person admitted, there was no plan of care in place or risk assessment despite a risk being observed by us. The acting manager stated that this information is on her personal computer at home and is not yet completed as they are waiting for more information to arrive from the family. We requested that this situation be remedied immediately to ensure that this person is protected from the identified risk; this was actioned whilst we were at the care home. Staff spoken with were had not observed the identified risk, however they were able to discuss the support needs of this person. There was evidence of some reviews taking place and plans of care being updated as needed to ensure continuity of care. Staff spoken with are aware of the needs of people using the service and they are able to discuss the support that they offer them to meet their needs. People using the service told us, ‘I am settled and happy here, the staff look after me,’ and ‘I am happy and relaxed, I have no complaints.’ There is evidence within plans of care examined to show that people using the service have access to specialist services such as the district nurse and doctor as needed. Staff spoken with confirmed that people using the service are able to access these services as required. During the tour of the care home specialist equipment such as a hoist and hospital beds were observed. All staff spoken with apart from one told us that they had had training on how to use the hoist, one member of staff said that they had not had this training, however they were using the hoist with other staff. Medication records observed demonstrate that some medication is being administered and not signed for as given and some medication is not being administered yet signed for as given. This resulted in one person who was on a course of antibiotics not getting this medication as prescribed. There are also concerns in regard to staffs understanding about what each medication administered is for, as one member of staff was unaware of a medication when asked, however they did look this up afterwards so that they knew. They also stated that the medication training course that they had been on had only been twenty minutes long and they would like to do more training. There are also concerns in regard to the amount of medication that people are refusing. Since the beginning of the month approximately seventy tablets have St Martins Care Home DS0000002217.V371360.R01.S.doc Version 5.2 Page 14 been refused by people using the service. This was discussed with the acting manager who agreed to address this issue and consult with the doctor to see if alternative arrangements could be arranged which may suit people more and enable them to take their medication. The tablets that have been refused are being stored in a plastic container in the drugs trolley. A book is in use to log medication that has been refused, however this only accounted for forty-seven tablets, which shows us that not all tablets had been documented. There is also a concern about staff’s understanding of the importance of taking certain medication to keep their conditions under control, such as medication for epilepsy. There had been an occasion where a dose of this medication had been missed as the person was sleeping at the normal administration time. Neither this incident, nor the action that staff had taken to ensure that this person remained well had been documented. Handwritten entries are still not being signed by two members of staff to show that these have been checked as correct when recorded. On observing the staff training records for the safe administration of medication, this training had taken place three years ago. Therefore the area manager contacted the pharmacy and began arrangements for updates to take place. Throughout the visit staff were observed to treat people using the service in a kind and respectful manner. People using the service told us, ‘staff are very kind to me, they look after me well, and ‘the staff are good, they are respectful to me.’ Staff spoken with were able to discuss how they maintain a persons privacy and dignity when offering personal care. St Martins Care Home DS0000002217.V371360.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service are not always offered sufficient activity and stimulation to experience a lifestyle that satisfies their needs and promotes their interests. People using the service have little opportunity to exercise their rights and choices due to the ‘routine of the home’ and the lack of staff available to facilitate this. EVIDENCE: There is currently no one specifically employed to deliver activities to people who use the service, therefore staff carry out a few activities such as bingo and playing music and singing when time allows. Also outside entertainers visit the home on occasion such as a person to deliver motivation and exercise and a music man. On the day of the visit several people were seen to enjoy a game of bingo, however staff told us that this was the first time in weeks that this had taken place. On speaking with the staff they stated that there was not enough for people to do to occupy their time, and limited time was available for them to spend time offering social activities for people using the service. Staff told us that ‘we are scared to spend time sitting talking to people in case we get told off for doing St Martins Care Home DS0000002217.V371360.R01.S.doc Version 5.2 Page 16 this,’ ‘ everything here is task focussed, there are not enough staff to spend time with people,’ ‘ people do not get much choice, everything is done by the clock.’ One person using the service who had played bingo stated, ‘we don’t really do that much, we just tend to watch the TV or listen to music.’ Other people using the service were seen to spend their time walking around the home or sitting in their chairs listening to music or watching TV. The activity entries in people’s case files told us that there are limited activities available for people using the service and there is often many weeks between these. Currently no one at the care home attends religious services, however one person had done so previously but now finds it difficult to attend a service due to the lack of someone to take them. Holy communion is available for those who wish to take part, and two people currently using the service do so. There are no restrictions on visitors to ensure that people are able to maintain contacts with those who are important to them. One visitor spoken with said, ‘the staff are very pleasant, they always make me feel welcome and offer me a cup of tea when I come in the afternoons.’ One person using the service spoken with said that their family visit them when they can. People’s personal preferences are documented within plans of care to demonstrate that staff have considered the basic ideas of equality and diversity of people. Staff spoken with are able to discuss the support that people using the service need to ensure that their needs are met in their preferred way. The menu on offer follows a four weekly cycle and choices are offered at each mealtime. There was evidence within the minutes of a residents meeting that the menu had been discussed and changed following this to that people got meals that they particularly liked. The meal presented on the day of the visit looked appetising and was plentiful. One person using the service said, ‘I enjoyed my dinner, the food is nice here.’ St Martins Care Home DS0000002217.V371360.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People using the service are not assured that their complaints will be listened to and acted upon. People using the service are not protected from abuse. EVIDENCE: The complaint policy has now been updated and circulated to people using the service, however this is in small text and not in an easy to read format that people with dementia care needs may understand. The annual quality assurance assessment told us that the service has not received a complaint since the last inspection, however when speaking with staff they told us that a complaint had been received in regard to an allegation of abuse. This was discussed with the area manager who told us that neither the safeguarding adults team (a specialist Local Authority team that investigates all concerns) or us had been notified of this as is required and she had investigated the complaint which was unfounded, no documentary evidence was supplied to support this. Staff spoken with are able to discuss the action that they would take should they receive a complaint to ensure this was reported to the appropriate person. People using the service spoken with did not express any complaints or concerns about the care received at the care home. St Martins Care Home DS0000002217.V371360.R01.S.doc Version 5.2 Page 18 On speaking with staff we were made aware of four other safeguarding concerns in relation to verbal and physical abuse and neglect. The concerns made were discussed with the acting manager and the area manager, the area manager was aware of one of the concerns and stated that she had investigated this and it was unfounded, she told us that this had not been notified to the Local Authority nor us as required. They were unaware of the remaining three concerns; therefore the appropriate action in regard to making safeguarding alerts was reinforced so that immediate action could be taken. One person using the service was distressed at one point during our visit and spoke with us in regard to another person living in the care home stating that they had caused several bruises to her forearm following a disagreement. One staff member spoken with confirmed that this had occurred. This had not been recognised as a safeguarding incident and consequently had not referred to the safeguarding adults team or us. During our visit a person using the service was seen to be involved in a disagreement with another person, which was aggressive in nature. This took place outside the staff room and it was unobserved by staff for 5 minutes until someone came to defuse the situation, which they did successfully. On speaking with staff they are aware of their responsibilities in regard to preventing abuse and reporting it, however concerns were expressed as to how incidents are then dealt with once reported to the management. St Martins Care Home DS0000002217.V371360.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although some improvements have been made to the environment people using the service remain at risk of injury from the items that require repair and replacement. EVIDENCE: The annual quality assurance assessment information stated that some of the furniture had been replaced in the home as a lot of this was either damaged or broken. During the tour of the home, it was observed that some of the furniture had been replace to provide a safer environment for some people using the service. Nevertheless during the tour we observed areas of concerns in 16 out of 18 people’s room such as a rotten window frame with no window restrictor, a damaged door and broken furniture to exposed screws, which could cause harm to people. There were also two loose handrails in one area of the care home, one of which was coming away from the wall. An immediate requirement was set to address the main issues of concern and two St Martins Care Home DS0000002217.V371360.R01.S.doc Version 5.2 Page 20 maintenance people came to the home on the day of the visit to deal with these. One person using the service told us that although there was broken items of furniture in their room it did not really bother them, as they did not use the items in question. The area manager stated that some more new furniture had been arranged and the provider was waiting for the delivery to be completed before bringing this to the care home. However one complete set of new furniture was brought to the care home on the day of the visit and arrangements were made for more to be delivered this week. The care home was clean and tidy in all areas observed, however there were several areas where an unpleasant odour was noted. These were discussed with the acting manager who stated that she would address these issues. During the visit new carpets were being laid in people’s rooms. In one room where the carpet had been lifted, the floor was in a poor state and stained with urine. This was discussed with the acting manager due to the concern of laying a new carpet on this, she agreed with out concerns, however the new carpet was still laid without any attention being given to the state of the floor. St Martins Care Home DS0000002217.V371360.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are insufficient numbers of well trained staff available to meet the needs of people using the service and to keep them safe at all times. People using the service are not protected by the recruitment procedures in place. EVIDENCE: The duty rota examined showed us that the care home is typically understaffed despite the manager telling us that three staff members are required on shift during the day. Staff spoken with stated that this was a regular occurrence, however they are aware that the acting manager is trying to make changes to bring the numbers up to three at all times. One person using the service said, ‘the staff are normally about if I need someone, but I do have to wait sometimes.’ On our visit we saw people wandering about the care home unattended and unsupervised, asking us for help and asking for staff, when we intervened we had some difficulty finding a member of staff, but we did locate a cleaner who dealt with the person’s request. On examining plans of care, within two people’s case tracked it stated that they required constant supervision and support, however no one using the service was observed to have this attention. St Martins Care Home DS0000002217.V371360.R01.S.doc Version 5.2 Page 22 Although on our visit there were three members of staff on shift, they were observed to be constantly busy attending to people’s needs. Due to the staffing numbers and the layout of the building there are periods of time when people are left unattended. It was during one of these periods of time when a disagreement between two people using the service broke out as mentioned in standard 18. The annual quality assurance assessment told us that all staff have attained the National Vocational Qualification (a nationally recognised work and theory based qualification) level 2 and some staff are working towards level 3, this training ensures that staff gain a variety of knowledge and skill in caring for the people using the service. Three members of staff spoken with all confirmed that they had achieved this training and two stated that they are working towards level 3. The Annual Quality Assurance Assessment told us that all new staff undertake an induction to ensure that they are aware of their roles and responsibilities on commencing employment. Staff files examined showed us that some staff have undertaken an induction. Staff spoken with confirmed that an induction takes place, however one person felt that this could have been better. Four staff files were examined, three of which contained all the required documentation by law to ensure that people using the service are protected from unsuitable people being employed, however the fourth file for a new member of staff only contained one reference. On speaking with staff, two confirmed that they had undertaken a robust recruitment process and that satisfactory criminal record bureau checks (a police check to see if an individual has a police caution or criminal record) had been received before they started work. Staff training records showed that there is a deficit in compulsory training such as fire safety, manual handling, infection control and health and safety, despite a requirement being set at the previous inspection. There was evidence to show that some training had been arranged since the previous inspection, and that the management are finding it difficult to get all staff to attend. Staff spoken with confirmed that they had not attend much training since the pervious visit and did not express the need for further training with the exception of a more in depth medication course. During our visit we saw that a number of fire doors, including the door to the smoke room had been propped open. On discussing this practice with staff they stated that this always happened and that it was normal practice. St Martins Care Home DS0000002217.V371360.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People using the service are not given a real opportunity to have a say in how the home is run and managed. People using the service are not fully protected from risks due to the working practices in place. EVIDENCE: The acting manager has been in post for one week, and has yet to apply to us to become the registered manager. She has previous experience in caring for people in the community in a management position. She outlined her induction and stated that the area manager is supporting her with this. Staff spoken with stated that they had not really had much of a chance to get to know the acting manager yet, however they did not have any concerns. The visitor spoken with did not know that there was a new manager in place and said that they had not yet met them. St Martins Care Home DS0000002217.V371360.R01.S.doc Version 5.2 Page 24 There was evidence within three case files examined that some quality assurance questionnaires had been given to people who use the service, however the information had not been collated to give an overview of the results. The comments seen within those plans were of a positive nature and said that they were generally satisfied with the care received. There are also meetings held for people living at the care home to give them the opportunity to have their say, however the last one held was in April of this year. There was no evidence of any other quality assurance monitoring taking place to demonstrate that the service is acting in the best interest of people using the service. Four people’s personal accounts were examined; these corresponded with the accounting sheets. There was evidence that these are being checked on a regular basis to ensure that these are correct. Receipts for past expenditure is not readily available, however recent receipts are and the acting manager stated that she will ensure that this continues. The acting manager is the only person who has access to this money; therefore one person only signs all transactions. Should a person require any money when the acting manger is not at the care home there is money available in the petty cash that may be used. The information in the Annual Quality Assurance Assessment outlined the maintenance and servicing checks that have taken place. To confirm this we examined the lift, hoist and fire certificates, all of which were satisfactory. Throughout the visit, several fire doors were seen to be propped open with various objects; one of these doors was the door leading into the smoking lounge, the chair, which was used to prop this door open, was immediately removed. On speaking with staff they stated that is was a regular occurrence that doors were propped open. Some members of staff showed a lack of awareness to the importance of stopping this practice. Staff have not received training in health and safety, on discussing the hot water that is accessible to people using the service outside the staff room, staff said that it can get very hot, however this has not been assessed and a risk assessment in regard to this is not in place. St Martins Care Home DS0000002217.V371360.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 1 X X X X X X 2 STAFFING Standard No Score 27 1 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 2 X X 1 St Martins Care Home DS0000002217.V371360.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 (1) schedule 3 Requirement You must have available a copy of the preadmission assessment and written confirmation that staff can meet the 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. You must have plans of care in place for people’s identified needs to ensure that these are met. Risk assessments and management plans in regard to all identified risks must be in place to ensure that people using the service are fully protected. You must put systems into place to ensure that the recording, administration and storage of medication is accurate, safe and secure. This will ensure that people using the service are protected by the medication practices and received their medication as prescribed. When medication is refused or DS0000002217.V371360.R01.S.doc Timescale for action 10/10/08 2 OP7 15(1) 10/11/08 3 OP7 13(4,c) 10/11/08 4 OP9 13(2) 01/10/08 5 OP9 13(2) 01/10/08 Page 27 St Martins Care Home Version 5.2 6 OP12 16(2,n) 7 OP12 16(2,n) 8 OP16 22(2) 9 OP16 22(3) 10 OP18 13(6) 11 OP18 13(6) 12 OP18 13(6) omitted you must ensure that the person is monitored for any ill effects and suitable after care provided. If there is repeated omission you must consult an appropriate medical professional to ensure that people using the service remain well. You must consult people using the service about a programme of structured activities. This will ensure that people’s recreational needs are satisfied. You must provide the resources necessary so that people people’s recreational needs are met on a daily basis. You must ensure that the complaints procedure is in a format that people using the service would understand. This will make sure that can express any concerns that they may have. You must ensure that any complaint made is fully investigated. This will ensure that people’s concerns are acted upon. You must alert the Local Authority of the five safeguarding concerns established on the day of the inspection. This will ensure that people using the service are protected. You must 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. You must 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 DS0000002217.V371360.R01.S.doc 10/12/08 10/12/08 10/12/08 01/10/08 01/10/08 01/10/08 01/10/08 St Martins Care Home Version 5.2 Page 28 13 OP19 13(4,c) 14 OP19 16(c) 15 OP27 18(1,a) 16 OP29 19(1,b) 17 OP30 18(1,c,i) 18 OP31 8(1) and people who are not directly connected to the service appropriately investigate all concerns. You must repair or make safe: • The splinted doorframe in room 1. • The exposed screws in room 11 and15. • The loose handrails outside room 8. This will ensure that people using the service live in a safe environment. 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 was initially set at a previous inspection and has only been part met. Further action is needed to ensure full compliance. You must provide sufficient staff to be able to follow people’s planned care and meet their needs. You must ensure that the required documentation has been obtained for all staff prior to commencing employment to ensure that people using the service are protected from unsuitable people being employed. You must ensure all staff are trained and able to apply their knowledge in all compulsory areas of their work – as a minimum this must include infection control, moving and handling, fire training and health and safety. This will ensure that people are safe and their needs are met. The acting manager must submit DS0000002217.V371360.R01.S.doc 04/09/08 10/11/08 10/11/08 01/10/08 10/01/09 10/11/08 Page 29 St Martins Care Home Version 5.2 19 OP33 24(1) (a)(b) 20 OP38 23(4,a) 21 OP38 37(1) 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 10/12/08 to monitor and improve the service and take into consideration the views of people using the service 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. Consult with the Fire authority 01/10/08 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. All significant issues are required 01/10/08 to be made known to the commission to ensure that we can monitor the service and the outcomes for people living there. 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 OP7 OP19 Good Practice Recommendations Consider the Mental Capacity Act when gaining consent from those people who sit in the smoke room to ensure that they have made an informed decision. Good practice guidelines on environments for people with dementia care could be followed to improve the DS0000002217.V371360.R01.S.doc Version 5.2 Page 30 St Martins Care Home 3 4 OP26 OP35 environment for the people who live there. Consider uplifting the laid carpet in the identified room to treat/replace the soiled flooring to ensure that cross infection is minimised. Two members of staff sign for all money transactions to ensure that these are protected. St Martins Care Home DS0000002217.V371360.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Regional Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AP 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.V371360.R01.S.doc Version 5.2 Page 32 - 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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