Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: St Mary`s Haven St Marys Street Penzance Cornwall TR18 2DH The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Diana Penrose
Date: 0 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home
Name of care home: Address: St Mary`s Haven St Marys Street Penzance Cornwall TR18 2DH 01736368585 01736368585 mountthehaven@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Denise Susan Maggs-Paulton Type of registration: Number of places registered: The Presentation Sisters care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 26. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP - maximum 26 places Dementia aged 65 years and over on admission - Code DE(E) - maximum 3 places Mental disorder, excluding learning disability or dementia, aged 65 years and over on admission - Code MD(E) - maximum 3 places Date of last inspection 0 0 0 Over 65 3 3 26 Care Homes for Older People Page 4 of 27 Brief description of the care home St Marys Haven is a residential care home registered to accommodate twenty-seven residents over sixty-five years of age. The home is also registered to accommodate three older people who experience dementia. Sanctuary Housing Association along with the home is run by the Presentation Sisters of Penzance and the Sanctuary Housing Association owns the building. Within the grounds is another registered home for nine residents, a day centre for up to fifty older people as well as a group of terraced flats. St Marys Haven is an inter-denominational home working in a Christian atmosphere. Opportunities are provided for regular Christian services, Catholic, Anglican and Methodist Ministers may also attend to the spiritual needs of the people using the service. St Marys Haven is located near the town centre of Penzance and has access to local amenities with good transport links. The home is furnished and maintained to a good standard and is accessible for people who experience disabilities. A passenger lift is also provided at the home to allow easy access throughout. Communal space is situated on the ground and first floors. There are twenty single rooms and three shared rooms and a high percentage of the bedrooms have en-suite facilities and been personalised by the occupants.Information about the home is available in the form of a residents guide, which can be supplied to enquirers on request. A copy of most recent inspection report is available in the home. Fees range from £375 to £425 per week according to the manager, who supplied this information during this inspection. Additional charges are made in respect of private healthcare provision, hairdressing and personal items such as newspapers, confectionary and toiletries. Care Homes for Older People Page 5 of 27 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An inspector visited St Marys Haven Residential home on 06 November 2008 and spent seven hours at the home. This was an unannounced visit. The purpose of the inspection was to undertake a statutory inspection and to gain an update on the progress and compliance of the requirements identified at the last key inspection on 22 October 2007. All of the key standards were inspected. On the day of inspection 25 people were living in the home. The methods used to undertake the inspection were to meet with people using the service, staff, and the registered manager to gain their views on the services offered by the home. Records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection and evidence gathered from the Care Homes for Older People
Page 6 of 27 inspection record and Annual Quality Assurance Assessment document submitted by the manager. What the care home does well: What has improved since the last inspection? The manager said progress has been slow this year due to staffing difficulties and her working on the floor as a member of the care team. However the requirements from Care Homes for Older People Page 8 of 27 the last inspection have been addressed and progression has been made in other areas. The care planning system, introduced at the last inspection has been developed to inform and direct staff. Residents or their representatives are encouraged to sign the care plans to agree to the care to be provided. Risk assessments in place for the people using the service are reviewed and updated as necessary. The medicines policy is being reviewed and updated and the system in place has improved. Hand written entries on the charts are now countersigned. A simplified version of the abuse policy has been produced for staff to follow more easily. Further refurbishment of the home has taken place and has been tastefully done. New carpets have been fitted in some areas and the dining room tables and chairs have been replaced. Recruitment procedures have improved and the manager now ensures that the last ten years of peoples employment history is examined during her interviews. Staff training has improved and statutory training is up to date. The Responsible Individual now visits the home monthly and writes a report on the conduct of the business to provide assurances that the home is in safe hands. Since the last inspection the manager has undertaken a supervision and appraisal course and formal staff supervision has commenced. What they could do better: 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 set out on page 4. Care Homes for Older People Page 9 of 27 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 27 Details of our findings
Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 27 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is suitable information available to prospective residents for them to choose whether or not to live in the home. Prior to admission the manager fully considers peoples needs so that they can be confident the home will be suitable for them. Evidence: There is a suitable statement of purpose that we were told is in the process of being reviewed and updated. It is available in the home and the manager said it is given to prospective residents families. The registered manager said that she or a senior carer goes to visit people before admission to undertake a needs assessment. The assessment documentation introduced at the last inspection as been fully implemented. The records address peoples personal, health and social care needs, including needs relating to their background, religion and culture.
Care Homes for Older People Page 12 of 27 Evidence: Three care files were inspected and there were assessment documents from the NHS and the department of adult social care (DASC) included. Care Homes for Older People Page 13 of 27 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 using the service have individual care plans that include personal, health and social care needs, they are informative and directive to staff. There is a suitable system in place for dealing with peoples medicines and staff do their best to treat people with dignity and respect to ensure their rights as citizens are maintained. Evidence: Each person accommodated has a written care plan. The care plans for three people were inspected and found to be detailed and directive for staff. The manager said they are compiled with the resident or their family and we noted that some were signed by the residents. The manager was advised to state on the document if she is unable to get a signature. The daily records were informative. Relevant risk assessments were seen and reviewed regularly. There was some evidence that care plans are reviewed but not every month. This seems to be due to staffing difficulties in the home. As peoples needs do not change very frequently the manager said she would find it easier to review the care plans
Care Homes for Older People Page 14 of 27 Evidence: three monthly unless anything changed, she will up date her policy accordingly. We were told that there is a good relationship with the GP surgery and Community Nurses. Suitable equipment is provided for moving and handling and pressure relief and continence assessments have been undertaken as necessary. People using the service said their care needs are met and that medical treatment is sought when required. One person commented I am very well cared for, the food is good and I have no problems. There is a suitable system in place for the administration of medicines with a policy, relevant guidelines and reference books available for staff. The manager has almost completed her review of the policy, which was seen. A monitored dose system is in use and medicines are only administered by senior staff who have been trained in the safe handling of medicines. The manager told us she has just completed a medicines course herself. There are secure facilities for the storage of medicines including a medicines fridge, the temperature is recorded daily and was within safe limits. There is a photograph of each resident with their medicine records for identification purposes People said their privacy and dignity are respected by the staff and this was seen to be so during this inspection apart from one issue whereby a person was seen using a toilet with the door open. This was discussed with the manager. Residents are provided with lockable storage space in their bedrooms and people are able to lock their rooms which have safety over-rides for staff should they need to enter. Care Homes for Older People Page 15 of 27 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A variety of activities and social events are provided, visitors are welcomed and good food is provided, people are actively encouraged to live a life of their own preference. Evidence: We were told that activities are on offer to the people using the service and that some people attend the day centre in the grounds of the home. Posters were displayed advertising events and two files were shown to us with previous posters and records, one was more up to date than the other. The manager said that one carer is going to be responsible for organising activities and social events. People talked about the firework display for bonfire night and some spoke about trips out in the daycentres minibus. Other activities on offer include a visiting clown, bingo, quizzes, religious services and singing. Peoples interests and hobbies are recorded in their care plans. The visitors book shows that some people have regular visitors. We were told that visitors could meet with peoples either in one of the lounges or in their bedroom. People said the daily routines are flexible; they can get up and go to bed when they wish. There are choices on the menu. It was evident residents are able to bring
Care Homes for Older People Page 16 of 27 Evidence: personal possessions into the home, for example, people had some small items of furniture, photographs and other belongings in their bedrooms. The daily records indicate that some people choose how to spend their time and that independence is encouraged. There is a four week menu, which has two choices at lunchtime and three at teatime. Fresh fruit and vegetables are included on the menu. The Annual Quality Assurance Assessment (AQAA), provided by the manager, told us that the head cook goes around and asks people if they are satisfied with the food and changes are made accordingly. Records are maintained of the food people choose and if someone has a loss of appetite, for example, this is recorded in the daily records and monitored by staff. People appeared to enjoy the lunch; which was fish and chips and everyone spoken with said the food is very good. Lunch was served in the dining room but those who wish have their meals in their bedroom. Suitable assistance was observed. Care Homes for Older People Page 17 of 27 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 home has suitable complaints and adult protection policies and staff have received training to ensure that people are safeguarded. Evidence: There is a suitable complaints procedure available to the people using the service, staff and visitors. There have been no complaints since the last inspection. Thank you letters and cards are held. There is an appropriate adult protection policy and the home has a copy of the local authority procedures. A new sheet has been developed which simplifies the procedure for staff. The manager said she has undertaken the No Secrets training provided by the Cornwall County Council up to the management level. Staff records show they have attended abuse training in house and staff confirmed this. Posters regarding abuse are displayed in the home. There have been no safeguarding issues reported in the past year. People using the service said they feel safe in the home and if they had any concerns they could talk to the staff or the manager. Care Homes for Older People Page 18 of 27 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 home is clean, warm and comfortable, the building and grounds are well maintained making it a pleasant and safe environment to live in. Evidence: The home was observed to be comfortable, warm and homely. It was clean and every effort was being made to eliminate odours. Several rooms have been tastefully refurbished and the manager has plans for further rooms to be done. New tables and chairs arrived during this inspection to complete the dining room refurbishment. There is evidence of ongoing maintenance of the home. The laundry is away from the home, within the grounds, facilities are suitable with two washers and two driers. Personal clothing is laundered at the home but linen goes out to contractors. People said the laundry system works well although there was a rail of clothes some of which had not been claimed by people using the service. Suitable hand washing facilities are provided for staff along with protective clothing. Infection control training is provided for staff . Care Homes for Older People Page 19 of 27 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures are robust, staff receive update training and there are a suitable number on duty at all times; this helps to ensure that residents are in competent hands and are well cared for. Evidence: The duty rota shows that there are a suitable number of staff on duty at all times to care for the people using the service. There are sufficient ancillary staff to cover, catering, housekeeping, laundry and maintenance. The manager and staff told us that there have been staffing problems over the past year but the situation has improved. People told us that there are usually enough staff to meet their needs and that the manager helps out on the floor when needed. The induction training programme is in line with the skills for care standards and evidence of induction was seen in the staff files. We were told that care staff have the opportunity to complete a National Vocational Qualification (NVQ) in care. The AQAA states that 56 of care staff are qualified to at least NVQ level 2 in care and there was evidence in the files to show that people have NVQ qualifications or are working towards them. Three staff files were examined for people who have recently commenced work in the
Care Homes for Older People Page 20 of 27 Evidence: home. Recruitment procedures are robust with all of the records required by legislation in place and all recruitment checks done prior to employment. Interview records show that there is a set format of questions for all people and there is an equal opportunities policy in place. Two files lacked photographs of the staff member but the manager said these would be done. There is evidence that staff have regular training to keep up to date with statutory training such as moving and handling, fire, health and safety and so on. There needs to be more training in specialist subjects relevant to the client group, for example dementia, diabetes and strokes. A training system from a reputable company is used and there are packs for several different subjects. Staff undertake training at their own pace and then undergo a test paper that is sent to the company for assessing. Certificates are provided for all training. The administrator co-ordinates staff training and records are maintained. The manager said that soon another member of staff will be helping with training and this area will improve. The manager said she is delegating the staff training plan to the people who will be responsible for staff training. This will mean that training needs will be readily identified and prioritised for the protection and welfare of the residents. Care Homes for Older People Page 21 of 27 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 registered manager is competent and runs the home well, she strives for continual improvement and health and safety systems are in place for the safety of residents, staff and visitors. Formal systems for supervising staff have been set up so that their skills and competence to work with residents will be monitored on an ongoing basis. Evidence: The registered manager is experienced in working at the home and was previously employed as a senior carer. She is qualified to NVQ level 3, has achieved the registered managers award and she is also is a qualified assessor. She said she keeps up to date with current care issues by reading books, using the internet and going on courses. Recent training includes abuse and the Mental Capacity Act. Staff said the registered manager is supportive to them and has an open door style of management. The people using the service said she is approachable and sees them every day. One person said I knew her when she was a carer and she has worked her way up the ladder. She works hard and is often here late in the evenings.
Care Homes for Older People Page 22 of 27 Evidence: There are formal quality assurance procedures in place, which includes an annual survey, sent to the people using the service and relatives. A quality assurance report is compiled and this was seen on a notice board. Staff meetings are held every two months and minutes show that staff can air their views and things get done. The manager said she sees all of the residents each day and residents meetings take place, the last minutes were dated October 2008. The Responsible Individual, who is one of the trustees, visits the home monthly and writes a report on the conduct of the business to provide assurances that the home is in safe hands. These were seen in a file. The home provided an Annual Quality Assurance Assessment (AQAA) prior to this inspection and the information provided was supported by evidence seen in the home. It was recommended at the last inspection that there be an annual development plan for the home based on a systematic cycle of planning-action-review, reflecting the aims and outcomes for the people using the service. This has yet to be done and we were told the trustees are involved with this. There is a policy for the safeguarding of residents monies, a few changes to the policy were discussed with the administrator. Some people control their own money and some have relatives or representatives that do it for them. The home holds personal money for some people so that they have access to cash to buy personal items. It is held in separate pockets in a locked facility, the monies checked were correct with the records. There is a record book for each person and two people sign the transactions. A receipt is kept for all purchases and numbered for audit purposes. Since the last inspection the manager has undertaken a supervision and appraisal course and formal staff supervision has commenced. The manager told us that she does most of it but the senior care staff are involved as well. This is an area to be developed. The management endeavour to ensure that working practices are safe. Statutory training is provided for staff and records show this is up to date. The manager told us that a health and safety consultant advises on health and safety, food safety, infection control and fire safety. A report has been compiled with an action plan that is being worked through. The responsibility for fire matters has been delegated to the administrator who has taken staff through the fire procedures for the homes. Service and equipment checks are undertaken regularly. However testing of the homes electrical hardwire circuit needs to be undertaken, this test has to be done every five years. Accidents are recorded and reported appropriately and regular audits take
Care Homes for Older People Page 23 of 27 Evidence: place. The home has few accidents. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations
These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 30 There should be a whole team staff training plan in place, so that training needs can be readily identified and prioritised for the protection and welfare of the residents. The registered person should implement an annual development plan for the home based on a systematic cycle of planning-action-review, reflecting the aims and outcomes for people using the service. Testing of the homes electrical hardwire circuit needs to be undertaken to ensure the home is a safe place to live and work in. 2 33 3 38 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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 © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
