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Inspection on 27/02/06 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 27th February 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. 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

St Martins provides care for people with mental health problems in a relaxed atmosphere. Most residents say that they enjoy the food and all appreciated the easygoing relationship which they have with the staff. Staff are well trained and the home is near to achieving 50% of qualified care staff. The administration of medication is properly organised and recorded.

What has improved since the last inspection?

The home`s programme of NVQ training has continued and a staff supervision programme has begun. The Registered Manager has begun the process of compiling proper care plans, though this is still in its early stages. Recruitment records were properly kept and standards of cleanliness identified at the last inspection had been addressed. A new boiler has been fitted, ensuring that hot water for the use of residents is delivered at a safe temperature.

What the care home could do better:

Adequate care plans are not yet in place and daily reports lack detail. The Registered Person has not yet implemented a quality assurance process. Some maintenance issues still need to be addressed.

CARE HOME ADULTS 18-65 St Martins Residential Home 63 Martins Lane Wallasey Wirral CH44 1BG Lead Inspector Peter Cresswell Unannounced Inspection 27th February 2006 09:00 St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 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.V284530.R01.S.doc Version 5.1 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.V284530.R01.S.doc Version 5.1 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 Mr David Swift Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. One (1) named female service user aged over 65 years (MD/E) within an overall total of 16 MD 5th October 2005 Date of last inspection 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 two 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. 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, lounge, and a spacious 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 Village, only a short walk from St Martins. The Registered Person owns another similar home nearby. St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection and the inspector spoke to most of the residents, the manager, his line manager, the Registered Person and the carer who was on duty at the time. He toured the home, examined medication administration and a range of documents, including residents’ files, staff recruitment files, fire safety records and the accident book. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 Page 6 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.V284530.R01.S.doc Version 5.1 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2. The home has pre-admission assessment procedures to ensure that it can meet the needs of the residents who are admitted. EVIDENCE: No residents have been admitted since the last inspection so it was not possible to check how the home’s admission procedures are working. Appropriate pre-admission assessment documents are now in place. St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9. The process of compiling care plans needs to be completed to ensure that up to date, accessible information and guidance is available to staff responsible for residents’ day to day care. EVIDENCE: The last inspection found that whilst the home had a great deal of information on its residents, there were no care plans in place which set down details of just how care was to be provided. The Registered Manager had drawn up a series of informative pen pictures and has now put in place a care plan format but has not yet translated the information available into a care plan. One of the residents had ‘Management Guidelines’ drawn up with a Community Psychiatric Nurse and an outline ‘individual programme’ for the week. The Registered Manager said that he hoped to complete all of the care plans within the next two weeks - which seemed optimistic - and it is important that the information available is put into a care plan that will act as a detailed guide to the care of the residents. At the moment the daily reports are very brief, and the existence of substantial care plans might stimulate staff to make detailed daily reports that focus on the different elements of the care plan, rather than somewhat bland generalisations. This would be helped further if summaries of St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 Page 9 care plans were kept with the daily reports. The manager said that reviews are carried out every six months but there was no evidence of this on the files. Therefore, once the care plans are in place, reviews need to be recorded and kept on file. Documents on individual residents were kept in different places and it may simplify matters if the manager were to compile individual files for each resident. Residents are encouraged to take responsible risks and most of them go out of the home alone or with other residents. Risk assessments are in place. St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 17. The daily routines at St Martins are relaxed and residents take part in everyday activities of their choice in the community and at day centres. Most residents enjoy the meals in the home and feel that they meet their dietary needs. EVIDENCE: Residents take part in a variety of activities. Several attend local day centres, drop in centres and, in one case, a lunch club; some told the inspector how they visit local shops or travel to visit family and friends. Residents said they take part in activities such as keep fit or line dancing at the centres. The home also arranges some activities and there have been trips to Southport and Conwy. The manager said that the senior carer occasionally takes small groups for a local pub lunch. The home does not have an activities organiser and most of the organised activities in which the residents take part are outside of the home. The Registered Manager and his staff are developing weekly planned schedules for each resident. The Registered Person has purchased a minibus for his other home and it is anticipated that this will become available for use by St Martins’ residents in due course. Inside the home, residents mix well St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 Page 11 together and watch television or listen to the radio. One resident has satellite television in his room. Most residents said that they enjoyed the food in the home, though there were some complaints about a recent meal. The cooking is usually done by care staff. Lunch is usually a light meal and the main meal is served in the late afternoon, usually round about 4.30 pm. The menu is based on the preferences of the residents and is often changed at the last minute; on the day of the inspection the evening meal had not yet been decided. Residents said that an alternative to the set meal would be arranged if they wanted one. St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20. Residents have access to all necessary heath services and medication is well organised, protecting the health and welfare of residents. EVIDENCE: Few of the residents need physical personal support. The Registered Manager said he is still working on the introduction of a keyworker system and such a system would help the development of care plans and activities. Residents receive all of the community and specialist medical support that they need and several have the support of a Community Psychiatric Nurse. None of the residents deal with their own medication and the home uses a system based on NOMAD pre-loaded cassettes. Medication is well organised and securely stored. A special cabinet is available for controlled drugs should any be prescribed. The home does not keep any homely remedies. Some residents receive medication which is to be administered ‘as required’ though it is not recorded how staff are to decide when it may be required. This is not uncommon, as it is rarely included on prescriptions, and it might be helpful to include this information on the residents’ records St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. The home has a satisfactory complaints procedure which residents can use to make their views heard, though records of complaints are not filed adequately. EVIDENCE: St Martins has a complaints procedure that includes details of how to contact the Commission for Social Care Inspection. Details of complaints are stored centrally though they were not very well organised and were hard to follow. It might be helpful if a complaints book was made available and reports of complaints kept in a ring binder or similar file in order that the Registered Person can readily comply with Regulation 22(8). The Registered Manager has a copy of the Wirral Adult Protection Procedures and staff receive training in the Protection Of Vulnerable Adults. Since the last inspection there has been an allegation which led to the suspension of a member of staff and a strategy meeting. The Registered Manager dealt with this difficult situation appropriately and the complaint was not substantiated. The member of staff is now back at work. St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30. The home provides reasonably furnished accommodation but some attention is needed to some décor and furnishing in order to fully meet the needs of the residents. EVIDENCE: St Martin’s is in a residential area near to Liscard Village where there are shops and other local facilities for the community, including a post office. The home blends in with the other buildings in the area and the manager said that relationships with the local community are good. St Martins has three floors and a number of changes of level. It does not have a shaft lift and is not suited to wheelchair users or anyone who has difficulty negotiating steps. The one resident who is over 65 has a ground floor room and is in any event physically fit. The home has a dining room, TV lounge and conservatory, which is also the smoking area and is therefore very popular, as most of the residents smoke. During this unannounced inspection the communal areas were very well used. The lounge has comfortable leather sofas and a new television. The conservatory overlooks a large, well-maintained garden. The communal areas St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 Page 15 were clean and well maintained, though one chair in the conservatory needs to be re-covered or replaced. All residents have single bedrooms apart from one couple who share a room by choice. The bedrooms were clean but some of the beds needed to be replaced, in particular rooms 13 and 6. The nature of the bedrooms varied widely, reflecting the personalities of the residents. All of the bedrooms have locks fitted and the security snips have been removed to enable access in an emergency. Although some old mortice locks are fitted they are not operational and no keys are kept in the home. Alarm call points are fitted in each bedroom. The home has sufficient bathrooms and toilets but as pointed out in previous reports, residents might benefit from a walk-in shower on the ground floor. Some of the carpets are approaching the stage where they will need to be replaced; the carpet in the corridor near room 8 certainly needs to be replaced now. The toilet near room 7 has an internal hook and eye lock which would make it unopenable in an emergency; this needs to be replaced by a suitable lock. The toilet near room 8 has an internal bolt which also cannot be opened from the outside in an emergency and must be similarly replaced. Some towels were very worn and frayed, as was one duvet cover. The Registered Manager must assess all towels and bed linen with a view to replacing any that is badly worn. The residents do not presently need any specialist equipment. St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Sufficient staff are employed to meet the needs of the residents though care needs to be taken with their deployment to ensure that sufficient care staff are always available to meet their needs. EVIDENCE: Ten care staff are employed, three of whom have NVQ2. Four more are currently studying for NVQ2 and one is studying for NVQ3. The home therefore falls slightly short of the standard of 50 of care staff qualified to NVQ2. New staff receive TOPSS induction training and the Registered Manager shows a commendable commitment to staff training. Recent training has included the Administration of Medication (from Halton College) basic Food Hygiene, First Aid and Mental Health Awareness (from Wirral MIND). The home provides enough care hours, with two care staff on duty at all times as well as domestic staff and a handyman shared with the nearby sister home. However, the rota is not as clear as it might be and on some days, as the care staff do the cooking, the home appears to have been short staffed. The Registered Manager said that this was because so many staff were attending NVQ training. No new staff have been recruited since the last inspection but all of the relevant checks have now been completed on the staff who did not have such St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 Page 17 checks in place at the last inspection. The Registered Manager supervises staff; supervision sessions take place every two months and are recorded. St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42. St Martins does not have a quality assurance system, so there is no development plan to improve the home to enhance the residents’ quality of life. The home has appropriate safety policies and procedures to protect residents’ safety. EVIDENCE: The Registered Manager has an NVQ4 and the Registered Manager’s award. He has managed the home for three years and is line-managed and supervised by the manager of the Registered Person’s other nearby home who is in effect the group manager. There was an easygoing and friendly atmosphere in the home during the inspection and the relationship between staff and residents was relaxed and informal. St Martins still does not have a quality assurance system, though the views of residents are gathered at meetings. The inspector discussed with the Registered Manager ways in which a QA system could be put in place, including the use of questionnaires to provide feedback that can be fed into the periodic reviews required by the Care Homes Regulations. In addition, a recognised QA tool could be used. The Registered Person visits the St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 Page 19 home more than once a week and prepares reports to meet the requirements of Regulation 26 but although copies were on file they have not been received by the Commission for Social Care Inspection. This may be an administrative problem and the Registered Manager will check that the reports are sent on time and to the right address. The kitchen was clean and well organised, with food stocks regularly rotated and checked. Fridge and freezer temperatures were checked and recorded except for the small residents’ fridge in the dining room. This does need to be checked in the same way as other fridges but its door is broken anyway so it needs to be repaired or replaced. Fire safety records and safety certificates were up to date, other than checks carried out in the last week, which had not been recorded. The Registered Manager needs to ensure that these are promptly recorded. The checks were completed and recorded before the inspection was completed. A new boiler has been fitted since the last inspection and water was being delivered to baths and wash handbasins at a safe temperature. Accidents are properly recorded. The Employers Liability Insurance Certificate was displayed in the corridor near to the office and was up to date. A plastic bag was being used as an ashtray in the conservatory; this may have been an innovation of a resident but staff should be alert to such a practice, which is plainly dangerous. St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 Page 20 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 3 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 3 26 3 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 2 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 X 3 3 2 X X 3 X St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 Page 21 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 YA6 Regulation 15 Requirement The Registered Person must prepare for each resident a care plan (the ‘service user’s plan’), setting out how their needs are to be met, and must keep the plan under review. (Original timescale of 24 February 2005 not met.) 2. YA26 16(c) The Registered Person must provide adequate furniture and bedding and must therefore: *review the quality of bedding and towels and replace any which is inadequate. *replace or repair the armchair in the conservatory. *replace the carpet in the identified corridor. *repair or replace the fridge in the dining room. 3. YA38 13(4) The Registered Person must eliminate risks to the safety of residents and must therefore ensure that: * the unsuitable locks to the identified toilets are replaced St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 Page 22 Timescale for action 01/04/06 01/05/06 01/04/06 with locks that can be opened from the outside in an emergency. *cigarettes are disposed of safely. 4. YA39 24 The Registered Person shall establish a system for reviewing the quality of care provided at the home. 01/05/06 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 YA14 Good Practice Recommendations The Registered Person should consider the appointment of a person to organise activities for residents. 2. YA22 A record of complaints and action taken to investigate and resolve them should be kept in a single, central file. 3. YA32 The home needs more staff with at least NVQ2 to meet the standard of 50 of care staff with this qualification. St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Martins Residential Home DS0000018941.V284530.R01.S.doc Version 5.1 Page 24 - 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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