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Inspection on 12/08/08 for St Martins Residential Home

Also see our care home review for St Martins Residential Home for more information

This inspection was carried out on 12th August 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents are supported to remain healthy and staff are supporting the residents to attend health appointments on a regular basis. Various positive comments from staff were included in the comment cards submitted to the Commission such as, "The information I need to care for the residents is given to me regularly". "Service provides a safe, secure and happy environment for the residents, with staff who are interested in their needs and do their best in their job roles." "The service we offer is to meet the residents needs to the best of our ability." One community nurse passed information via a comment cards and felt that, "Home always seeks advice and acts upon it. Health care needs of clients are always met. Privacy and dignity of individuals is always respected. Medication is always given correctly. Most of the comment cards we received from residents said, "I know who to talk to if not happy. " Staff showed good knowledge and understanding of the needs of the residents. During this visit they were observed talking to residents in a polite manner and showing a good rapport with all of the residents.

What has improved since the last inspection?

Residents` care plans have been reviewed and updated so that staff have all the information they need to support residents to live at St Matins. A training plan has been produced for the staff to help to ensure that they have the skills to meet people`s support needs and that they are up to date with current good practice. The home has exceeded the national standard for care homes with regard to Staff qualifications. This states that at least 50% of the team should hold a care qualification (NVQ). The following comments, were made by staff during our visit, "The manager is brilliant". "The manager is understanding and approachable.". "The manager is very good.".

CARE HOME ADULTS 18-65 St Martins Residential Home 63 Martins Lane Wallasey Wirral CH44 1BG Lead Inspector Diane Sharrock Unannounced Inspection 12 August 2008 09:30 th St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 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 Residential Home DS0000018941.V363535.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 Adults 18-65. 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 Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Martins Residential Home Address 63 Martins Lane Wallasey Wirral CH44 1BG 0151 639 9877 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) No email Assistwide Limited Manager post vacant Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only – Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia – Code MD The maximum number of service users who can be accommodated is: 16 Date of last inspection 17th December 2007 Brief Description of the Service: St Martins Residential Home is situated in a residential area of Wallasey, close to Liscard Village. It is a substantial detached property with three floors and a number of internal changes of level. The home would not be suitable for an independent wheelchair user or anyone with a physical disability. The building does not have a lift in situ. St Martins is not externally identified as a care home and blends in with the surrounding buildings. There are twelve single bedrooms and two that can be shared if residents so wish. The home has a dining room one lounge, and a conservatory which overlooks the large garden and also serves as the smoking room. Shops, a post office, pubs, restaurants, other community facilities and bus routes are available in Liscard, only a short walk from St Martins. The Registered Person Mr Carter owns another similar home nearby. The temporary manager is Debbie Partridge who has advised the commission she will apply for registration to be the registered manager as a matter of priority. The weekly fees to the home are £340 per week. St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We carried out an unannounced visit to the home on the 12th August 2008 Inspections involve measuring a number of standards considered as important by the Commission. The Commission considers 22 standards for Care Homes for Adults (18–65) as key Standards, which have to be inspected during a key inspection. All key standards for this type of service are highlighted in bold in the relevant sections of this report. We gathered information for this inspection in a number of different ways. ‘Case tracking’ was used as part of the visit to the home. This involves looking at the support a person gets from the home including their care plans, medication, money and environment, time is also spent meeting residents and staff. Two of the people living in the home were case tracked as part of this inspection. We met the majority of residents and spoke with a number of staff on duty. Before our visit we sent out survey forms to the home. Residents and members of staff completed these and their replies helped us with planning our visit and in writing this report. We have received ten comment cards from residents living at the home and staff have indicated were they have supported people in filling the forms in. Four staff have also submitted comment cards to us with their opinions about the home. The manager completed a questionnaire we sent before our visit. Information from this was again used by us to plan this inspection and in writing this report. A selection of Comment cards were also left in the home to offer people further opportunity to give their opinions. Any information the Commission for Social Care Inspection (CSCI) has received since the last big inspection is also taken into account in writing this report. St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Residents’ care plans have been reviewed and updated so that staff have all the information they need to support residents to live at St Matins. A training plan has been produced for the staff to help to ensure that they have the skills to meet people’s support needs and that they are up to date with current good practice. The home has exceeded the national standard for care homes with regard to Staff qualifications. This states that at least 50 of the team should hold a care qualification (NVQ). The following comments, were made by staff during our visit, “The manager is brilliant”. “The manager is understanding and approachable.”. “The manager is very good.”. St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 7 What they could do better: Some areas were noted to need action taken and further evidence to be in place to meet other standards and regulations. Staffing levels must be kept under review in order to make sure that staffing levels are appropriate to the needs of the residents. These reviews should include with staff and residents and their opinions should be included in the reviews. Staffing levels should also be reviewed regarding the necessary resources and hours for domestic work and cooking and managerial hours at the home. The responsible person must make sure that all regulation 26 visits are carried out monthly and reports produced to show there are regular company checks on the standard of living offered in the home. Complaints procedures should be developed and be openly accessible to everyone and put into a format that the people who use the service can understand. Financial care plans are needed for the management of the finances of the people who use the service in order to ensure they are safeguarded from any potential risk of financial abuse. Care plans need to be developed to include all aspects of each persons social needs and requests so that staff and residents have enough information to show how their needs will be met. Evidence of consultation with the people who use the service and their relatives around important issues affecting the home, such as plans for access to suitable activities and trips and review of menus and quality of food should be developed and put in place. An updated development plan should be produced and shared with residents; staff and relatives to show what plans are taking place regarding their home including the decoration and maintenance of the home. Continued improvements are needed to the home environment in order to ensure that the people who use the service live in a well-maintained, comfortable environment. Risk assessments must be in place for all possible hazards in the home’s environment to ensure the safety of the people who use the service including all doors seen wedged open, and all ruffled flooring that may create a trip hazard. The statement of purpose must be updated so that everyone has enough information to make decisions about the home and are kept up to date with all St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 8 aspects about the home including the management of the home, the complaints procedure and the current fees. 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 Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service Adequate information is provided prior to residents moving into the home which helps to make sure that prospective residents needs are assessed so that they can be sure of meeting the person’s needs. EVIDENCE: An information brochure about the service is available to tell people about the services and support they can expect. This helps everyone to decide if St Martins is the right place for the person to live in and if their needs and choices can be met there. This brochure is called a statement of purpose and was found to be in need of being updated which was also pointed out at the last key visit to the home. Eg, There was no information on the current fees to the home, details of the management of the home was not accurate and did not mention the current manager. The brochure said, “……..there would be an opportunity to participate in various social and other activities and organised outings,”, but there had been no recent organised outings, this was not found to be accurate at this visit. St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 11 We received a good response from the people who live at the home from comment cards sent to us and out of 10 received, two people felt they did not get enough information before they moved in, everyone else was satisfied with the information provided at the time. We looked at one recent assessment of somebody who had moved into the home and staff had given a lot of information to help the resident settle into the home and to provide staff with enough information to help support this person. We also received four staff comment cards who all felt they received enough information about the people at the home to help them support each person. St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6.7.9. People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service The individual needs of the people living at St Martins are identified so staff can support them to meet those needs. EVIDENCE: We looked at two care plans in detail. Following our last visit the staff have worked hard to develop and update all of the residents care plans. The plans were well presented and covered all aspects of the person’s personal and healthcare needs and were able to demonstrate they can meet the diverse needs of residents at the home including, information on, eg, “bathing/healthcare/-medication/communication/ hearing/ night care plan/ falls/ dental care/ with evidence of support with appointments to dentist to get new dentures as old ones don’t fit,/ mobility/eyesight/ dietary/ foot care. St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 13 There is however limited information about how the service identifies and meets people’s social care and support. This needs to be addressed to ensure that staff and residents have the information they need to fully support the people using the service to have a fulfilled and active social life with appropriate support to help with choices. We met the residents present at the home one person was able to talk about what they had done that day and was looking forward to their tea. One person was looking forward to eventually living in the community independently. Another person said they got on with most people but there was one person they didn’t like or get on with. In looking at their care plans, staff had not included these people’s views and could not show how they were being supported in their personal requests to move out or their opinions of not getting on with other residents. Risk assessments were part of each person’s plan of care. These provided staff with clear guidance and where appropriate instructions as to the support and supervision residents require in a range of environments and situations. Records showed that residents risk assessments have been regularly reviewed and updated. St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.15.16.17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff provide adequate support to residents to try to meet their social needs. EVIDENCE: Residents and staff have regular ‘meetings’ to discuss the management of the home. Minutes of these meetings were seen and showed discussions on most aspects and rules at the home keeping everyone informed. We watched staff supporting residents in the afternoon getting ready for their lunch. They provided assistance and encouragement in a respectful and flexible way. Some residents commented on the quality of the food and said it was “ok” sometimes but they didn’t like the cheaper brands especially the bread. There was no evidence to show they resident’s opinions had been sought about the quality of food and whether they were satisfied with the food on offer. St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 15 The kitchen was equipped with domestic style appliances and staff helped provide meals that residents personally chose during our visit. The cook did not come on duty until one pm and support staff were responsible for preparing and serving meals. The dining room offered a domestic style area with plenty of seating. The tables were marked and would benefit from covers to enhance the décor and the wear and tear to this environment. It was noted that some residents had not being going out as much as they would like. Some residents said they would like to go out on trips but they don’t get that in this home. A lot of the residents said they were bored in the day time and were sat watching the television most days. There was no organised activities during our visit and no planned in house activity programme. The care plans we looked at showed limited information about how the service identifies and meets people’s social care. There was no information to show how they would support people to choose and aspire to have an active social life both in and outside the home. Staff felt they had no time to provide activities on a regular basis as they had no additional activities staff and only occasionally they went shopping with residents if time allowed. Some staff gave suggestions that they would like to see more getting done for the residents and be able to go out more. Staff comment cards included, “An activity co-ordinator would be good to encourage and motivate”. Discussion took place around the national minimum standards were its advised as good practice that the company should provide at least one holiday each year for all residents. At present there is no organised holiday and there are no social activities organised by the homes staff despite the brochure for the home saying it did try to offer opportunities to participate in various social and other activities and organised outings. Most activities are provided by those residents who have family or friends who provide social support and some people attend a day centre. Some residents do have the ability to go out independently however not all residents can do this and rely on any support offered. The managers explained they are in the process of advertising for an activities organiser for 20 hours a week which they feel will help to offer a variety of social activities and will help to develop and support the residents with their social needs and requests. St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18.19.20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are treated well and their personal and healthcare needs are monitored and supported to ensure they stay well. EVIDENCE: Staff who support people with their medication have received training in dealing with medication. We looked at samples of the medication held and records relating to it and found them to be accurate. The systems in place for dealing with medication, along with staff training, help to reduce the risk of mistakes occurring that could impact on people’s health. These were found to be appropriate and safely managed. The use of occasional administration of medications was discussed with the manager as one record was unclear as to how many times it had been given over months and it did not have a care plan. The use of this medication needs to be included in a care plan so that staff and the resident have clear and accurate advice as to when this type of medication should be given and how to safely record it. St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 17 Records and care plans showed that the home provides a good level of support to residents in accessing healthcare. This includes regular healthcare and visits to the doctor and district nurses and more specialist appointments. Staff comments included, “The information I need to care for the residents is given to me regularly”. “Service provides a safe, secure and happy environment for the residents, with staff who are interested in their needs and do their best in their job roles.” “The service we offer is to meet the residents needs to the best of our ability.” One community nurse passed information via a comment cards and felt that, “Home always seeks advice and acts upon it. Health care needs of clients are always met. Privacy and dignity of individuals is always respected. Medication is always given correctly. Individuals usually live the life they choose. Specific needs are always met. If raised concerns been dealt with appropriately. Décor could be improved.” Although there are regular residents meetings the minutes show a lot of information given to people about the management of the home but there seems to bit little evidence of how they express their opinions. Staff felt that because they see resident’s daily they felt that residents can get their views across to them on a regular basis. There is no quality review currently carried out by the company to check the opinions of staff and residents regarding all aspects of the home. This was an outstanding issues identified at the last inspection. St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22.23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate systems are in place within the home for dealing with any concerns or complaints that arise which aim to protect residents. EVIDENCE: Staff said in their comment cards and in discussions with us that they are aware of the action they need to take if anyone raises concerns regarding the service. They receive training in recognising and dealing with safeguarding adults and staff that we met were clear about the actions they would take to make sure residents are safe. Most of the comment cards we received from residents said, “I know who to talk to if not happy. “ However some of the residents during our visit said they don’t really get to spend a lot of time with the staff but felt the staff were ok and mostly listened to what they had to say. The manager has started a login book for all complaints this year so all concerns can be reviewed and acted on appropriately. The complaints procedure in the homes brochure is brief and didn’t have accurate contact addresses for external agencies or numbers for social services. Residents do not have up to date information to support them in taking their concerns to the right organisations to help them in their enquiries. St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 19 The managers explained that the main part of the management of finances is currently dealt with in the sister home by the finance officer. The only monies managed by the homes manager is for personal allowances. These records showed regular records kept of any ingoing and outgoings with receipts kept on file. One residents plan that we looked at had no financial assessment or care plan to support the resident in making decisions as to how to spend their money and in choosing who they wanted in managing their monies. Financial policies and care plans need to be in place to show clear and open management and support to each residents choices in how they want their support or management of personal monies. As an example of good practice the manager stated they do not act as appointee for any of the residents and that Wirral Social Services sometimes act as appointee were the resident doesn’t have an appropriate person or next of kin to support them. St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24.30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. St Martins residential home provides an adequate and comfortable environment for people to live in. EVIDENCE: St Martins residential home is a detached house in a residential area. It is similar to other houses in the local area and does not stand out as a care home. The home is located close to shops, pubs and other community facilities including public transport links. Shared space in the home consists of a domestic style dining kitchen, a small lounge and a conservatory that leads in to the garden were people can currently smoke in. All areas of the house that we saw were clean and tidy. Three comment cards received from residents said they felt the home was, “usually”, fresh and clean. St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 21 We saw a sample of areas throughout the home during our visit. The home was decorated and furnished to an adequate standard in the communal areas. We saw a sample of bedrooms, some were personalised were some people had various personal items to help them individualise their room. Some people chose to keep their bedroom doors locked, which provided them with their own private living area. However some rooms needed some maintenance and showed areas in need of redecoration and updating, one room had scrapes to their bedroom flooring, a broken bed head, old scraped bedroom furniture and old worn curtains. One bedroom carpet was marked with various dark worn stains. One person felt they needed a lot more storage for their belongings. Their room was compact and had just one wardrobe and one chest of drawers. They had not been given any information regarding whether their room was due for redecoration or refurbishment. There was no maintenance, decoration or development plan to let people know when their home or bedroom would be redecorated. There was no written evidence of a planned approach, including residents and staff to the ongoing development and investment to the upkeep of the environment and no evidence of what funds are available to bring the home into a good standard of décor throughout. The home shares a maintenance person with its sister home and he is responsible for weekly repairs and some areas of decoration. The managers were verbally able to say what decoration had taken place recently including a new carpet to the stairwell. One bathroom and toilet had flooring that was ruffled and not sealed to the floor making it potentially unsafe and a trip hazard. Some rooms were seen with doors wedged open, including the laundry, the kitchen, various bedrooms and even a fire exit door, which was seen tied open on the top floor and was opposite a bedroom door also wedged open. There were no risks assessments in place or development plans to state what actions were being taken to reduce any associated risks or improve the safety for the people using the service. There was evidence of signs advising everyone that smoking was not permitted in most areas of the home as a designated areas had been provide for any of the residents who smoked. The potentials risks were discussed at length with the managers, as there was no evidence to show these risks had been acknowledged or considered and St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 22 they accepted the need to put risks assessments in place as a matter of priority. Issues around the management of environmental risks were pointed out at the last inspection and they were found to have been rectified, however further hazards were found during this visit which indicates the overall management of health and safety needs to be reviewed as a matter of priority so that the home always offers a safe environment to be in. A sample of maintenance certificates were seen which showed up to date checks as listed in the homes pre inspection questionnaire which helped show what actions were taken to help keep the home safe to live in. St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32.34.35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living at St Martins are adequately supported by staff however sometimes a lack of staffing can impact on residents’ lifestyle and choices in activities. EVIDENCE: Discussion with the staff working there and observations of how they interact with the people showed that staff have a good understanding of the residents individual support and are able to understand their needs and requests. Several of the staff hold a care qualification (NVQ) and another four staff are working towards this. This helps to ensure staff are aware of current good practice in the area of care and how to support people safely and well. The manager acknowledged the company had not yet arranged any training for the new mental capacity act, or recent training on mental health needs, we discussed the need to look into this and arrange, especially in supporting all of the people with decisions and choices eg with finances and activities. St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 24 Staff have received training in specialist topics such as epilepsy awareness and mental health awareness to help them understand and deal with these conditions which will benefit the residents. Staff comments included, “The information I need to care for the residents is given to me regularly”. Some staff felt happy with the training they had received and felt very supported in developing their skills to meet the needs of residents, some staff gave suggestions to improve the training such as, “…would benefit from more training around the specific mental health needs of the residents. “ “Need a little more training so can better self.” We chatted to residents during this visit who were happy with the staff but felt they didn’t see enough of them as they were always busy, one person said, “They are helpful.” We received ten comment cards from the residents were staff assisted them in their comments and most felt the carers listened to what they say and treated them well. However three people felt that staff, “usually” listen to them and “usually” treat them well. The cook did not come on duty until one pm and support staff were responsible for preparing and serving meals. Staff explained various staffing issues that they felt effected the service such as having just 2 support staff all day to assist all of the residents and no extra cover was given if they went with people on external appointments, sometimes leaving just one staff member. It became clear that when the cook was off for 2 days each week support staff were also expected to provide meals within their support hours and of a Sunday there was no domestic cover and they were expected to do domestic duties also. Discussion followed with managers as there was no evidence to show any recent review and evidence to show resident’s needs were being appropriately met when staffing levels were reduced and taking on other roles. We received four staff comment cards which were mainly positive about working at the home but there were various comments about the staffing levels not always being sufficient. Four staff stated they felt they “usually”, had enough staff on duty to meet the resident’s needs. St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 25 Records showed that before anyone is appointed to work at St Martins a series of checks are carried out. These include obtaining written references and checking with the Criminal Records Bureau (CRB) and register of people unsuited to work with vulnerable adults. These checks help to ensure the people living there are safe and that staff are suitable to support them. Following our visit the manager has supplied details of various checks that had been carried out but could not be found during our visit. The only outstanding check was of a written reference as there was just one on file and 2 written references must be in place to show a robust recruitment check in employing the right type of people to work at St Martins. Staff that we met were very happy with the manager and felt that staffing had been a lot more stable and happy since she had been in post. Staff comment cards gave positive information about working at the home saying, “I have regular supervision – and if I require any other help my manager is always happy to assist me.” “Manager is there on the hand over to speak to staff and offer support.” “The service we offer is to meet the residents needs to the best of our ability.” St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37.39.42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is adequately managed for the benefit of the residents and staff. EVIDENCE: The manager of St Martins has been in place for the last 12 months. She has explained that she will apply to the Commission to become registered as the manager of the home. This process helps to ensure the suitability of managers to manage a particular care service. The home has not had a registered manager for some time and this is an outstanding issue that was noted at our last visit. The application must be submitted as a matter of priority so the home will then have a suitably registered manager in place. During our visit the manager displayed a good awareness of the support needs and choices of the people living in the home. St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 27 Records and certificates showed that regular checks are carried out on the building and equipment. This includes checking electrical appliances, the gas supply and regular fire checks. These checks help to ensure that the home is a safe place to live and work in. The manager was seen to have an open and positive management approach and worked regularly as part of the team. In reviewing staff rotas we noticed that the manager is always included in the staff team numbers and does not have any supernumerary hours to effectively manage the home. As part of the homes quality assurance process and in accordance with Regulation 26 of the care homes regulations the owner used to provide reports on his visits to the premises. It is important that this is done to check the standard of care and management in the home. Records show that the visits and reports have not been carried out recently as required. The manager continues to organise regular staff meetings. This ensures that staff members have a regular forum to discuss issues that may affect the service provided to residents and the implementation of polices, procedures and practices within the home. Staff minutes were seen of recent meetings and showed details of various topics about the home. We chatted to several staff during the inspection visit and they were very complimentary of the manager and the way she runs the home The following comments, which were made by staff during the inspection visit, supported this: “Manager is there on the hand over to speak to staff and offer support.” “The manager is brilliant”. “The manager is understanding and approachable.”. “The manager is very good.” St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 2 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 2 x 2 X X 2 x St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 29 yes Are there any outstanding requirements from the last inspection? 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 YA6 Regulation 15 (1) Requirement Care plans must clearly indicate the support the people who use the service need with their social support and mental health. So as to provide staff with the information they need to fully support the people using the service and to help provide the right quality of life for each resident. Staffing levels must be kept under review in order to make sure that staffing levels are appropriate to the needs of the residents. These reviews should include staff and residents opinions. Staff must show evidence of how they have covered any staff absences so that enough staff are in place to provide the right support for residents. All actions must be taken to eliminate risks to the safety of residents and must therefore ensure that risk assessments are in place for all environmental hazards such as, DS0000018941.V363535.R01.S.doc Timescale for action 24/09/08 2 YA35 18 1a 24/09/08 3 YA38 13(4) 24/09/08 St Martins Residential Home Version 5.2 Page 30 doors wedged open in bedrooms, laundry and kitchen and fire escapes tied open that may cause a fire risk in the home. All loose flooring including toilets and bathrooms which may cause a trip hazard.. 4 YA39 26 As part of the homes quality assurance process and in accordance with Regulation 26 of the Care Homes Regulations a representative for the company must visit the premises at least monthly. It is important that this is done to check the standard of care and support in the home. 24/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations An updated copy of the statement of purpose and service user guide must be forwarded to the Commission and also be accessible to everyone at the home so they are kept informed about all aspects of the home. A maintenance, decoration and refurbishment plan should include the development and modernisation of the residents bedrooms and dining room to give a better standard of facilities to live in. Medication records and care plans should include details of the circumstances in which medication is to be given ‘as required’ (PRN) and when to use. To support and facilitate residents to access a variety of age and culturally appropriate activities on a regular basis and make sure staffing levels meet the resident’s needs and never restricts their daily living and quality of life. DS0000018941.V363535.R01.S.doc Version 5.2 Page 31 2 YA27 3 YA20 4. YA12 St Martins Residential Home 5. YA22 A complaints procedure must be developed so that it can be understood by the people who use the service and is readily accessible for them, their relatives/advocates needs to be available The way in which money belonging to the people living at St Martins is managed must be reviewed and must take the resident and their representative’s opinions into account and shown to be managed in their best interest. To make sure that resident’s have enough choices and information to have their monies managed how they would want it to be. Training should be provided in the mental capacity act and mental health needs. This would help to ensure that staff have the skills to meet peoples support needs and that they are up to date with current good practice and make sure residents are safe at all times. The manager must apply for registration to the commission and provide evidence of her registration in NVQ 4 In order to maintain good standards and a good quality of care for the people who use the service the manager should have specific time allocated for managerial tasks. A system for regularly reviewing the quality of the service must be implemented and reviewed. Residents, staff and relatives opinions must be taken into account regarding the development of their home. eg Opinions should be sought about the decoration, maintenance, food, activities and holidays . 6. YA7 7. YA32 8. YA37 9. YA39 St Martins Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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 Residential Home DS0000018941.V363535.R01.S.doc Version 5.2 Page 33 - 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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