Inspection on 26/08/09 for St Martins Residential Home

This inspection was carried out on 26th August 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Martins Residential Home 12/08/08

St Martins Residential Home 17/05/07

St Martins Residential Home 15/08/06

St Martins Residential Home 27/02/06

St Martins Residential Home 05/10/05

St Martins Residential Home 24/01/05

St Martins Residential Home 28/09/04

St Martins Residential Home 05/02/04

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

Key inspection report CARE HOME ADULTS 18-65 St Martins Residential Home 63 Martins Lane Wallasey Wirral CH44 1BG Lead Inspector Diane Sharrock Key Unannounced Inspection 26th August 2009 11:00 St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 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) Assistwide Limited Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category 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 12 August 2008 Brief Description of the Service: St Martins Residential Home is situated in a residential area of Wallasey, close to Liscard Village. It is a detached property with three floors and a number of internal changes of level. The building does not have a lift in situ. The home would not be suitable for an independent wheelchair user or anyone with a physical disability 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 people wanted to. 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, a short walk from St Martins. A service user guide and a statement of purpose, which describe the services offered is made available to people who are interested in St Martins. A copy of the most recent inspection report can be obtained from the manager. The fees to the home are £361.41 per week. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 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 26th August 2008 Our visits 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 visit in a number of different ways. ‘Case tracking’ was used as part of the visit. This involves looking at the support a person gets from the home including their care plans, medication, activities, money and environment, time is also spent meeting people and the staff on duty. Two of the people living in the home were case tracked as part of this visit. We met most of the people and staff who were at St Martins during our visit. Before our visit we sent out survey forms to the home. We have received 5 surveys from members of staff and 4 from people living at Martins. Their replies helped us with planning our visit and in writing this report The manager completed a questionnaire that we had sent before our visit. This is called an annual quality assurance assessment (AQAA). Information from this was used by us to plan our visit and in writing this report. We advised the manager that this questionnaire should be redone so that all sections are completed and to show what actions they were taking to improve services at St Martins. What the service does well: People are supported to remain healthy and staff are supporting people to attend health appointments on a regular basis. We received various positive comments about the manager from people at the home and from the staff, such as, “The manager is really good here we can always go to the manager when we need help and advice”, “If there’s any problems we will always speak to our manager for help and advice”. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 6 Staff showed good knowledge and understanding of the personal needs of the people living at St Martins. During this visit they were observed talking to people in a polite manner and showing a good rapport with people living there and with people visiting. Various positive comments from staff were included in the comment cards submitted to the commission such as, “Supports service users with mental health in daily living for e.g. medication, diet”, “Provides support, help and needs of individuals with mental health disability” and “provides good care to people who suffer problems with mental health.” What has improved since the last inspection? 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 people living at St Martins. These reviews should include staff and residents and their opinions should be St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 7 included in the reviews. Staffing levels must be appropriate to meet domestic chores, catering and care hours needed each day. Updated financial care plans and clear policies are needed for the management of the finances of the people who live at St Martins in order to ensure they are safeguarded from any potential risk of financial abuse. Evidence must always be available to show that people are being supported with their finances to benefit them. Records must show they are managed in their best interest if they do not have capacity to manage their finances personally. The manager must have full knowledge of the appropriate management of people’s finances so she can help safeguard people’s rights. Improvements are needed to the environment in order to ensure that the people who live at St Martins live in a safe, well-maintained, comfortable home. The service must develop environmental risk assessments for any identified hazards within the building to show what actions the company are taking to take risks away and make the building a lot safer. Detailed risk assessments must be in place for all identified hazards such as e.g. doors seen wedged open, infection control risks, and all ruffled flooring that may create a trip hazard, the laundry, the kitchen, the external fire exit and the conservatory smoke room. The risk assessments must say what actions are being taken to reduce any risks help keep people safe. Cleaning schedules should be reviewed throughout the home to include all areas, inclusive of corridors, skirting boards, walls, all woodwork, banisters, bathrooms and moulded tiles, toilets, kitchen area and storage. Improvements to the cleaning schedules will help provide a better standard of cleanliness throughout the home. A development plan should be produced and shared with people, staff and relatives to show what plans are taking place regarding their home and regarding feedback to any of their requests and suggestions including the decoration and maintenance of their home and what investment they can expect to help develop their home. Continued improvements are needed to the homes environment in order to ensure that the people who live at St Martins live in a well-maintained, comfortable home. Staff must be provided with the right training and skills to help them do their job and to help them to support people living at the service in the right way. Updated training must include, e.g., medication, administration, fire training, cosh, challenging behaviour and mental health needs. The manager must be supported with suitable induction training that covers all necessary information covering the care home regulations which are necessary to be followed to show safe management of the home. The statement of purpose and service user guide must be updated further and must be accurate so that everyone has enough information to make decisions about St Martins and are kept up to date with all aspects about the service. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 8 The statement of purpose should include eg the staffing levels people can expect to be provided with, updated contact details for the commission and the current fees. The aqaa must be resubmitted to give the commission enough information to show what the provider and manager are doing about improving standards in the service including the management of health and safety at St Martins. The staff must have access to a full list of updated policies and procedures to help them provide the right support and guidance in working at the service. Policies must include access to e.g., safeguarding, management of peoples finances, regulation 37 reports regarding adverse incidents, procedures for medicines that are given when needed, staff absences and infection control procedures. Regular audits of the management of medications will help to show that it is safely managed and checked to ensure good practices and help reduce potential risks in the management of medications. Two staff signatures should be used in the event of having to administer any handwritten medications prescribed by the doctor. This additional precaution can help to reduce potential risks of human error. The manager should ensure a controlled drugs book is used to record and manage any use of controlled drugs to help show clear records and safe management of controlled medications. Care plans should be developed further for two people identified during our visit who would benefit from having clear plans to show how staff will be supporting them in their personal requests and choices and with their mental health needs. Staff from the home should carry out assessments about people’s care needs before they move into the home. This is so that consideration can be given to ensure the home can meet a persons needs before they choose to move to St Martins. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 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.V377630.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have adequate information to help them make decisions about St Martins. EVIDENCE: An information brochure about St Martins 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 further development. The statement of purpose should include e.g. the staffing levels people can expect to be provided with, updated contact details for the commission and the current fees. We looked at one recent assessment of somebody who had moved into the home and staff had given a lot of support to help the person settle in. However we found that one person did not have an assessment carried out by staff from the home before they moved in. These assessments are necessary so that consideration can be given as to whether the home can meet a person’s needs before they choose to move to St Martins. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 11 We received five comments from staff working at St Martins who all felt they received enough information about the people at the home to help them support each person. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The individual needs of the people living at St Martins are identified by staff and in care plans so staff can support them to meet those needs . EVIDENCE: Following our last visit the staff have developed each persons care plan. We looked at two of the care plans. The plans were well presented and covered most aspects of the person’s personal and healthcare needs and were able to demonstrate they can meet the diverse needs of people including information on e.g. “Healthcare, communication needs, night care plan, mental health needs social support. The plans also had various details showing how each person was supported to stay healthy and safe and supported with specialised healthcare appointments such as visits to the dentist, the doctor and hospital visits. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 13 We met people present at the home who spoke openly about their home and the staff and most people told us they were happy living at St Martins. We received 4 comment cards from people living at the home which overall were mostly positive about their experiences. Two people made comments saying, “Helps people get better, looks wells after people” and “sort a place for me to live…..get place to live at weekends”. One care plan had been developed to indicate one person wanted to move from St Martins. This plan would benefit from being developed further to show how the staff are supporting this person in their request to move. This will also help to make it clear what support is offered to the person so they are fully informed and supported with their rights and requests. We noted that staff were able to talk about how they supported one person with their mental health needs and they felt they could see signs of improvement with continued staff support. However the care plan was noted to be in need of further review. The plan should include the risks identified by staff and should be regularly updated with the person’s mental health needs to ensure staff are provided with the right support and guidance to help support people with their individual needs. Risk assessments were part of each person’s plan of care. These provided staff with updated guidance and where appropriate instructions as to the support and supervision people need in a range of environments and situations. We also noted in reviewing training records and in discussion with staff that some staff had not received updated training in mental health, challenging behaviour and medication. Staff need certain training to help give them the right skills to appropriately and safely support people. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 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): This is what people staying in this care home experience: People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff had developed adequate support and activities for people to try to meet their social needs. . EVIDENCE: The aqaa told us that, “…. they offer their residents individual choices for their leisure,,,,,, “ It stated that the staff have become more comfortable with their key worker role. The aqaa stated they plan to offer more activities and get more entertainers to come to the service and look at getting people involved in the local community with groups and volunteers. People living at the home and the staff have regular ‘meetings’ to discuss the management of the home. We looked at some of the minutes of these meetings which showed regularly discussions taking place about various areas St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 15 and aspects at the home keeping everyone informed and up to date with things such as meals and activities. The kitchen was equipped with domestic style appliances and staff helped provide meals during our visit. Some areas of the kitchen needed cleaning, with some build up of dirt and dust seen around the kitchen area. Some fridges and freezers had a build up of frost and food and needed defrosting and cleaning to improve the standards of food hygiene in the kitchen. Throughout our visit we heard various people give feedback to the cook and staff about the food and we received various compliments about the meals offered. The cook did not come on duty until one pm and support staff continue to be responsible for preparing meals especially for breakfasts and lunch and for serving meals. At weekends the home has no cook. This is similar to what we observed at our last visit. The rotas and staff showed that staff have to incorporate both cooking, laundry and cleaning in their daily care hours. The dining room offered a domestic style area with tables and chairs and a small fridge and kettle were everyone had access to make their own drinks throughout the day. We noticed that this was a good facility that helped to develop people’s independence for people to freely use throughout the day without having to ask or wait for staff to make drinks. The small fridge had a build up of dirt and was in need of being cleaned and had a small break to its seal. Staff had developed the dining area and covered up the tables that are marked and scraped with matching table cloths and napkins which helped to give a better standard of equipment for people to use and helped improve the décor in the dining room. Staff thought they were due to get new dining tables and chairs but they were unsure of when this was happening and didn’t have any dates for when this was to happen. One person had made a comment in the comment card suggesting how the home could be improved, they said, “comfier chairs in dining room.” The dining room had a large notice board which staff had developed to offer a lot of information to everyone to keep them up to date with what was happening at the home. There was a large notice about what activities the staff had developed that week. We watched staff supporting people getting ready for their party in the evening. They provided assistance and encouragement to everyone trying to get them involved with the entertainment and social evening in a respectful and flexible way. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 16 It was noted that some people had not being going out as much as they would like. Some people said they would like to go out on regular trips and thought they may go on the one advertised for September to the Albert Dock. Staff advised that not everyone wanted to go on trips or get involved with the activities but they felt that people were getting used to the activities and they were able to slowly over time encourage people to get involved. They felt that eventually when they got used to developing activities that people liked and responded to they hoped to have something planned every day. Staff felt they tried to develop the activities when they had the time and tried to do their best. We received 5 comments cards from staff who gave various suggestions regarding how they felt the service could develop to improve activities at the home. Comments included, “Employ activities, entertainment.”, “more staff training, better pay, more activities for the residents to keep them motivated,,,,more staff so we can bond and relate to residents more.” “Have more staff, high wages. More staffing training, more activities for the residents, more decoration.” “More staff, pay increase, e.g. unsociable hours, more training, more activities for residents, new décor.” The home would benefit form having the necessary resources, staffing levels and an activities budget to help provide good support socially to benefit people’s quality of life while living at St Martins. Staff have developed care plans to include some basic details of each persons social needs and what they like to do socially. Following our last visit the manager had developed regular records of what activity the staff had provided with a list of who had attended the activity. The records helped in showing how staff were trying to offer some event but the records showed they couldn’t always commit to offer an in house activity every day. As mentioned at the previous visit the home doesn’t include funding and support in providing a holiday each year for everyone living at the home. The home still doesn’t have a designated activities organiser and staff explained that they try their best to organise in-house activities such as painting and discussions. We met people living at St Martins who were able to talk about what they had done that day and some were looking forward to their tea. We looked at a sample of regular residents meetings, the minutes showed a lot of information given to people about the management of the home. When we met people living at St Martins they were all able to say what they would do if they had any questions or concerns they needed to raise and they all knew the St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 17 manager personally by name and were very complimentary about her saying she “…..was very supportive and always listened….” Various activities are provided by those people who have family or friends who provide social support and staff made people welcome throughout their visit. People told us they are always made to feel welcome. Some people had the ability to go out independently and staff explained they tended to go out whenever they wanted and needed very little support. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are treated well and their healthcare needs are monitored and supported to ensure they stay healthy and safe. EVIDENCE: The aqaa told us that they, “…..provide a key worker system, ensure care plans are reviewed each month,,,,,The aqaa also told us that they are building new health and personal care plans with each resident. That they encourage each resident to manage their own health were possible. The aqaa told us they are developing a health charter…….” Most staff who support people with their medication have received training in dealing with medications. We looked at samples of the medication held and records relating to it and found them to be accurate. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 19 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. Medications were found to be stored and recorded correctly, with clear records of medication received and given or not given. This helps to reduce the risk of mistakes occurring and provides a clear audit trail to check people receive their medication correctly. We noticed some handwritten entries for some people’s medications. Two staff signatures should be used in the event of having to administer any handwritten medications prescribed by the doctor. This additional precaution can help to reduce potential risks of human error. The manager should ensure a controlled drugs book is used to record and manage any use of controlled drugs to help show clear records and safe management of controlled medications. Regular audits of the management of medications will help to show that it is safely managed and checked to ensure good practices and help reduce potential risks in the management of medications. One person made a comment in their comment card sent to us saying, “The does well in making sure I take my medicine…” Records and care plans showed that the home provides a good level of support to people in accessing healthcare. This includes regular healthcare and visits to the doctor and specialist appointments. The manager has developed care plans to include mental health assessments to try and improve the records to show what support and care can be given to people with their mental health needs. Care plans should be developed further for two people identified during our visit who would benefit from having clear plans to show how staff will be supporting them in their personal requests and choices and with their mental health needs. One persons plan would benefit from expert clinical review in their mental health needs so that staff can have the most up to date information in how to support the person. Staff comments included, “Provides support with their mental health needs.” “……..provides good care to people who have problems with mental health needs.” St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Adequate systems are in place within the home for dealing with any concerns or complaints that arise which aim to protect people. EVIDENCE: The aqaa told us that they, “….. have regular staff and resident meetings, all staff have pova training has Wirral social service policy and a whistle blowing policy, states they have had no complaints over last 12 months.” We received 5 comment cards from staff and in discussions with us, they all indicated they were aware of the action they needed to take if anyone raised any concerns regarding the service. We received 4 comment cards from people living at St Martins and 3 of them indicated they also knew how to raise a concern regarding the service. Most of the comments received from people living at the home indicated they felt safe and were able to go to staff with their concerns and queries, especially to the manager. The manager has developed a complaints record book which included a section to record any previous complaints so all concerns can be reviewed and acted on appropriately. The manager had reviewed the complaints procedure and St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 21 made sure it was accessible to everyone by displaying it on the notice board in the dining room. The manager had developed a training plan covering all the staff working at St Martins and she was able to use this and staff files to plan any outstanding training that needed to be updated and provided for staff to keep them up to date with the knowledge and skills necessary to safely do their job. The staff told us they received training in recognising and dealing with safeguarding adults and staff were clear about the actions they would take to make sure people were are safe. However in discussion with the manager we noticed they had an old company policy for safeguarding that did not refer to the most up to date guidance linking in with Wirral social services safeguarding procedures. All staff must have access to the most up to date guidance and training so they are able to safely support the people living at St Martins at all times. The manager explained that the main part of the management of finances is currently dealt with in the sister home by the finance officer. However following our last visit the manager had worked hard to develop inhouse records to show accurate methods in storing people’s personal allowances that are transferred to St Martins each week and supporting them in managing their personal allowances. These records showed regular records kept of any ingoing and outgoings with receipts kept on file at St. Martins. The only monies managed and recorded by the homes manager continues to be for personal allowances for a small amount of people living at St Martins. The manager explained that some people have the capacity to organise and manage their own finances and some people get support from their families so they can maintain their own independence in privately managing their own finances. The manager and people living at St Martins had no access to any details of were peoples monies are stored at the sister home. They had no details of the name of the account were the monies are held in or details of any savings or updated statements. There was no information regarding what benefits each person had been supported with and how much they claimed and stored in the sister homes offices or the name if any of an agreed appointee. The service had no policies or procedures to describe the current processes offered to people to support them with their money. There was no written consent or protocol to tell people how their money was stored and managed at the sister home. Clear and accurate financial policies and care plans need to be in place to show accessible and transparent management of each persons finances. Capacity assessments will help show how people are included in their support plan and St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 22 are giving their consent in choosing how they want their support or management of their finances. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. St Martins provides an adequate and comfortable environment for people to live in. EVIDENCE: The aqaa told us, “…that the garden has been done, have wider range of topics to discuss at meetings including environment, residents can pick their décor and room, has a smoke room, has risk assessments in place and maintenance contracts for all systems and appliances…” St Martin’s 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. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 24 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. 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 and was tidy throughout. The gardens were well maintained and offered a nice area for people to look at and enjoy with a safe patio area for people to freely use whenever they wanted. The conservatory leads out into the garden and remains the designated smoking area. This was evident as the blinds had a build up of yellow stains and would benefit from being removed or cleaned. Investment in adequate extractor fans would help in the regular build up of smoke and stains in this area. 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. One persons advised they did not have anywhere safe were they could lock any personal items or valuables as their lock was broken to their wardrobe. They felt this gave other people the ability to have access to their room and belongings whenever their bedroom door was open. The manager agreed to review these concerns raised and to keep the commission up to date with any necessary actions she may need to take with the local authorities safeguarding procedure. Some rooms, toilets and bathrooms were noted to still be in need of maintenance and showed areas in need of redecoration and updating. One room had scrapes to their bedroom flooring, old scraped bedroom furniture and old worn curtains, faded dusty light fitting. Some of the floorings in the bathroom and toilet areas were still loose around the edges and presented as potential trip hazards. Some tiles had a build up of what looked like “mould” around its edges in the bathroom and shower room. One person felt they needed a lot more storage for their belongings as they currently had a small bedroom that accommodated 1 small scraped wardrobe which did not match their 2 side chest of drawers. They did not have an inventory of their furniture or belongings and staff were unsure as to were this persons own wardrobe was which the person felt was much nicer than their current one and matched their own personal bedroom furniture. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 25 Staff advised they were hoping to provide more storage with the use of shelves but it became clear within discussions that the person would rather have a matching wardrobe to safely keep all of their belongings. Regular communication with people should take place in gaining their opinions of what they would like to help improve their rooms and facilities. This should then be used to help influence a planned maintenance, refurbishment and redecoration plan to keep people informed about what their requests and suggestions. We noticed that some rooms were darker than others depending on which side of the home they were positioned. One room was dark as the bedroom window looked out to the wall of the house next door which limited the light being able to get in. The maintenance man had been asked to go and speak to the person to offer them a choice of repainting their room in the colour of their choice which they are hoping will help brighten the room. The manager and staff had tired to develop the environment with the use of table cloths and napkins in the dining room and the landscaping of the gardens to help improve facilities at the home. However there was no maintenance, decoration or development plan to let people know when their home would be redecorated or refurbished. There was no written evidence of an ongoing and no details 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. One bathroom and toilet had flooring that was ruffled and not sealed to the floor making it potentially unsafe and a trip hazard. 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 living at St Martins. Issues around the management of environmental risks were pointed out at the last inspection. This 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.V377630.R01.S.doc Version 5.3 Page 26 St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at St Martins are adequately supported by caring and competent staff. EVIDENCE: The aqaa (pre inspection questionnaire told us, “ Encourage staff to undertake training, appraisals and supervision says they have low staff turnover, has regular staff meetings listens to staff. “ Discussion with the staff working there and observations of how they interact with the people showed that staff have a good understanding of the people they support and are able to understand their needs and requests. Several of the staff hold a care qualification (NVQ called a national vocational qualification) and other 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. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 28 The manager had developed a detailed training plan displayed in the main office so that all staff could be included and updated on the mandatory training that would be offered to them. The manager acknowledged that some staff had not yet received training in mental health and challenging behaviour. The manager agreed to look into this and arrange updated training for staff. Updated training must also include various training updates for some staff in, e.g., medication administration, fire training, cosh and challenging behaviour. Good management of staff training is needed to demonstrate that staff are provided with the right training and skills to help them do their job and to help them to support people living at the service in the right way. Some staff felt happy with the training they had received and felt very supported in developing their skills, some staff gave suggestions to improve the training such as, “…would definitely like more training on the residents mental health needs, we find this really interesting and useful. “ “Would like to do an update in first aid training…..” We chatted to people during our visit who were happy with the staff especially the manager. The people living at St Martins, visitors and 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. Following our last visit there have been some changes to staffing levels in that the manager has been given 20 hours a week supernumerary to manage the home. We noted that the cook still doesn’t come on duty until one pm and support staff were responsible for preparing and serving meals when the cook is off including weekends and every morning and lunch time. Staff explained the various staffing levels and cover provided by care staff. As noted at our last visit the home still has just 2 support staff all day to assist people. Care staff are also responsible for organising activities and at weekends they are also responsible for cleaning the home and doing the cooking as the home did not provide any staff for domestic or catering duties at the weekend. The provider and manager had still not demonstrated how they had calculated the current staffing levels to show how they meet the dependency needs and choices and requests of people living at St Martins. There was no evidence to show people’s needs were being appropriately met when staffing levels were reduced and taking on other roles, including catering, activities and domestic duties. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 29 We received five 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 which was similar to the evidence and comments made at the last key visit. Five staff stated they felt they “usually”, had enough staff on duty to meet peoples needs. Staff comment cards included comments such as, “Provides support, help and needs of individuals with mental health disability.” “provides good care to people who suffer problems with mental health.” Staff made various suggestions in their comment cards to help develop the service further such as, “more staff training, better pay, more activities for the residents to keep them motivated,,,,more staff so we can bond and relate to residents more.” “Have more staff, high wages. More staffing training, more activities for the residents, more decoration.” “More staff, pay increase, e.g. unsociable hours, more training, more activities for residents, new décor” “Have more staff and higher wages….” Records showed that before anyone is appointed to work at St Martins a series of checks are carried out. The manager had developed these records to show good support and supervision of her staff to help them do their job. These records included 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. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 30 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is adequately managed for the benefit of everyone at St Martins. EVIDENCE: The aqaa (pre inspection questionnaire told us, “….more staff meetings supervision and listening to staff, more training and responsibility for care plans, has open door policy, low staff turnover,” The manager of St Martins has been in place for over 2 years and she has recently been for her interview with the commission to apply for registration as the manager. This process helps to ensure the suitability of managers to manage a registered care home. The manager acknowledged her short comings and lack of knowledge and skill base in management and the Care Home Regulations 2001. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 31 The manager had not covered various areas of importance about the regulations in her induction and support over the last 2 years while managing St Martins including regulation 37 reports. These reports are necessary and are required by law to be reported to the commission to show how serious incidents are managed and to show what actions are taken by managers and providers to ensure people at the service are safe. We also noted that the homes policies and procedure file had old out of date policies and the manager did not have a policy or guidance to show her what to do regarding adverse incidents regarded as regulation 37 reports. The manager must be supported with suitable induction training that covers all necessary information covering the care home regulations which are necessary to be followed to show safe management of the home. During our visit the manager displayed a good awareness of the support needs and choices of the people living in the home and there had been various positive comments from everyone about her skills and rapport with everyone. We chatted to several staff during our visit and they were very complimentary of the manager and the way she runs the home The manager was seen to have an open door policy and everyone had access to the manager and we noted that she also works regularly as part of the team. In reviewing staff rotas we noticed that following our last visit the manager had been allocated 20 hours a week supernumerary to support hours to help her to manage the home. Records and certificates showed that regular checks are carried out on the building and equipment. This includes checking the gas supply and regular fire checks. These checks help to ensure that the home is a safe place to live and work in. As part of the homes quality assurance process and in accordance with Regulation 26 of the care homes regulations the owner has started 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 been carried out at least monthly and staff told us that the owner is at the home most days. During our visit we found that the information contained in the services aqaa didnot really tell us how they had evidence in place to show improvements in the overall management and monitoring of quality in the service. 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 people. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 32 We looked at a sample of staff minutes of recent meetings which showed details of various topics about the management of the home, e.g. such as, training, activities, the trip to the Albert Dock, the party night and music entertainer. St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 33 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 2 25 X 26 x 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 x LIFESTYLES Standard No Score 11 x 12 3 13 2 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 X 2 X X 2 x Version 5.3 Page 34 St Martins Residential Home DS0000018941.V377630.R01.S.doc 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 YA38 Regulation 13(4) Requirement All actions must be taken to eliminate risks for peoples safety and must ensure that risk assessments are in place for all environmental hazards such as,eg, doors wedged open, All loose flooring including toilets and bathrooms which may cause a trip hazard, the kitchen and laundry infection control risks, and the conservatory smoke room. The risk assessments must say what actions are being taken to reduce any risks help keep people safe. This is a repeated concern from last inspection. The aqaa must be resubmitted to the commission. The provider must make sure that this document is kept up to date and is accurate to show what the provider is doing about improving standards in the service. DS0000018941.V377630.R01.S.doc Timescale for action 30/10/09 2. OP33 17 30/10/09 St Martins Residential Home Version 5.3 Page 35 3. YA33 18 1a Staffing levels must be reviewed and evidence must be in place to show that staffing levels are appropriate to the needs of people living at St Martins. Staff must show evidence of how they have covered any staff absences including domestic and catering staff so that enough staff are in place to provide the right support for people at all times. All staff must be suitably qualified and competent and must be given the right training to do their work so that they can always support the health and welfare of people living at St Martins. Updated training must include, e.g., medication administration, fire training, coshh, challenging behaviour and mental health needs. Updated financial care plans and clear policies are needed for the management of the finances of the people who live at St Martins in order to ensure they are safeguarded from any potential risk of financial abuse. Records must show they are managed in their best interest The manager must have full knowledge of the appropriate management of people’s finances so she can help safeguard people’s rights. DS0000018941.V377630.R01.S.doc 30/10/09 4 YA35 18 30/10/09 5 YA23 20 30/10/09 St Martins Residential Home Version 5.3 Page 36 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 include the fees, the staffing levels people can expect to see and the updated contact details for the commission so they are kept informed about all aspects of the home. Care plans should be developed further for two people identified during our visit who would benefit from having clear plans to show how staff will be supporting them in their personal requests and choices and with their mental health needs. Pre assessments should be carried out by staff prior to any admission being arranged so that consideration can be taken to ensure the home can meet a persons needs before they choose to move to St Martins. 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. Regular audits of the management of medications will help to show that it is safely managed and checked to ensure good practices and help reduce potential risks in the management of medications. Two staff signatures should be used in the event of having to administer any handwritten medications prescribed by the doctor. This additional precaution can help to reduce potential risks of human error. The manager should ensure a controlled drugs book is used to record and manage any use of controlled drugs to help show clear records and safe management of controlled medications. There should be clear financial care plans and up to date policies relating to the management of the monies held on behalf of the people who use the service. To make sure DS0000018941.V377630.R01.S.doc Version 5.3 Page 37 2. YA6 3. YA14 4. YA20 5 YA23 St Martins Residential Home that resident’s have enough choices and information to have their monies managed how they would want it to be. 6 YA27 A maintenance, decoration and refurbishment plan should include the development and modernisation of the home to give a better standard of facilities to live in. Cleaning schedules should be reviewed throughout the home to include all areas, inclusive of corridors, skirting boards, walls, all woodwork, banisters, bathrooms and moulded tiles, toilets, kitchen area and storage. Improvements to the cleaning schedules will help provide a better standard of cleanliness throughout the home. The provider must review staffs opinions and look at what actions can be taken with staff’s suggestions regarding staffing levels. Staffing levels must be kept under review in order to make sure that staffing levels are appropriate to the needs and dependencies of the people living at St Martins. Staffing levels must be appropriate to meet domestic chores, catering and care hours needed each day. The manager must be supported with suitable induction training that covers all necessary information covering the care home regulations which are necessary to be followed to show safe management of the home. The staff must have access to a full list of updated policies and procedures to help them provide the right support and guidance in working at the service. Policies must include access to e.g., safeguarding, management of peoples finances, regulation 37 reports regarding adverse incidents, PRN medication procedures, staff absences and infection control procedures. 7 YA31 8 YA37 9 YA42 St Martins Residential Home DS0000018941.V377630.R01.S.doc Version 5.3 Page 38 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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