Inspection on 29/06/07 for St Mary`s Mount

This inspection was carried out on 29th June 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Mary`s Mount 09/04/08

St Mary`s Mount 18/10/07

St Mary`s Mount 14/06/06

St Mary`s Mount 07/12/05

St Mary`s Mount 18/05/05

St Mary`s Mount 18/01/05

St Mary`s Mount 29/11/04

St Mary`s Mount 26/01/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St Mary`s Mount Holly Road Uttoxeter Staffordshire ST14 7DX Lead Inspector Mrs Wendy Grainger Key Unannounced Inspection 9:00am 29th June 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Mary`s Mount Address Holly Road Uttoxeter Staffordshire ST14 7DX 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) 01889 562020 01889 562020 stmarysmountenquiry@tiscali.co.uk HAS Careplus Limited Mrs Elizabeth Smith Care Home 30 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (30), of places Physical disability over 65 years of age (7) St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: St. Marys Mount stands in its own grounds within half a mile of the centre of Uttoxeter where a wide range of local shops and services can be accessed. There is a town bus route passing the gateway, and the railway station is about a mile away on the other side of the town centre. There were 19 residents in the home at the time of the inspection. The dependency level of residents is varied and fluctuating. The Home is registered with the Commission for Social Care Inspection to care for a maximum of 30 older people, 14 of who may have dementia care needs and seven a physical disability. There are 28 bedrooms, 26 of which are for single occupation, and two of which are shared. There are no rooms with en-suite facilities at the current time. There is separate smoking area for residents. The pre-inspection questionnaire completed by the manager and sent to the Commission for Social Care Inspection states that the present scale of fees is £362/£377 with an additional top up of £20 per week. Other additional costs would include hairdressing, private chiropody, personal toiletries and newspapers. St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was completed over the period of one day by two inspectors Mrs Wendy Grainger & Mrs Wendy Snell. The inspection included a tour of the home, observations of staff practices, discussions with staff and the people who use the service. Documents, records, and reports including contractual servicing of equipment and medication were provided. Staffing levels qualifications, training and experience were examined. At the time of this inspection there were 19 people who use the service at St Mary’s Mount. The information in the annual quality assurance assessment identified that some people who use the service would require extra care from the staff due to varying conditions. What the service does well: This was the inspectors’ first visit to St Mary’s Mount. No person was admitted to the home without a full assessment of his or her needs, this was completed by the senior management who have experience in pre admission assessments. The person responsible when collating information used a pre printed document. The home had a robust procedure and records, which were maintained in the event that people who use the service or families raised any concerns. The provider continued to make small improvements to the environment with the purchase of new dining room chairs and lounge armchairs. The staff however had taken the responsibility of tastefully decorating the large lounge. From information provided in the annual quality assurance assessment and records in house there had been some mandatory training completed in 2007. Staff were observed to work as a team addressing the people who use the service needs in a sensitive manner, each person spoken with were satisfied with the care they receive. “its nice here” “I like the staff they help me” “ I am well looked after by the “girls” Staff were observed to assist one resident when dining, this was completed unhurried and in a sensitive manner by the agency staff. Each of the people who use the service was well presented with the ladies having had their hairs done in the week. St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 6 Two professional agency visitors were asked their opinion, about the service provided. One person was more positive and expressed that the staff were good, they were called when necessary and referred to the general practitioners. Refer to “What they could do better” The staff had a lot of time for visitors and cared well for people that were confined to bed. Three relatives were spoken with their comments included: ‘The staff are helpful I couldn’t fault them’ ‘They seem very caring’. ‘The staff have a good relationship with dad’. What has improved since the last inspection? What they could do better: The inspectors had concerns as to the staffing levels, the Commission had received a telephone call the previous week when only two staff were on duty for 19 people who use the service, some of who have a high dependency requiring a hoist or two staff to assist. Staffing rotas confirmed this. The provider and care manager are responsible for ensuring that staff are employed in sufficient in numbers to meet peoples needs, and to provide care for the people who use the service over a twenty-four hour period. The inspectors had concerns as to the lack of training for the staff responsible in respect of the administration for any prescribed medication. Concerns were identified to the care manager regarding the agency person on the day, when it had not been checked with the agency if the person had the appropriate qualifications, training or the expected police checks prior to working at St Marys Mount. These checks would have ensured that the people who use the service were safeguarded. While the home was a credit to the housekeeping staff, the provider had a responsibility for the decoration, replacement and if where necessary industrial St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 7 cleaning of carpets, which were badly stained in some areas. There were areas in the corridors that were a potential hazard, with loose uneven carpet evidenced when touring the home. The provider has a responsibility to ensure that all the equipment is in working order including the dishwasher. Some crockery was stained and not thoroughly cleaned. The inspector requested staff to remove a number of items of crockery due to its poor chipped condition and not acceptable for use. Observed during lunch was that the people who use the service had to share condiments with the home only having one of each for the entire dining room tables. This is not acceptable. Areas within the kitchen were extremely dirty, including the paintwork and cills, also around the sinks and floor. The floor was uneven and a potential hazard to the staff, the flooring was split and a possible harbinger for any germs. There remained no ancillary staff i.e housekeeping or laundry staff on duty at the weekends. With the concerns about the permanent staffing levels this practice would incur care staff leaving people who use the service to attend to any other duties. Some fire doors were wedged open. This was rectified at the time. Advice should be sought from the fire officer about appropriate door guards. The provider is responsible for providing nutritious food with a daily alternative; the daily alternative recorded offered no choice, food should be varied at all times. The views about the food varied. One person told the inspector that the “food was horrible” other residents expressed that they had enjoyed the lunch. Staff should be aware that when making beds in the morning that the re-use of dirty sheets and a bed with no pillowcases was not acceptable. To help prevent pressure areas developing; the bottom sheet should be flat and not in the condition observed as seen on two beds. The other professional agency person spoken with felt that better hygienic conditions should be maintained in the surgery and that some staff could be more responsive to guidance given. There was a lot of incontinence within the home in general, it was felt that staff could be better aware of the condition and personal care. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate Standards 1,3,4 were reviewed. This judgement has been made using available evidence including a visit to this service. The notice displayed in the entrance hall told visitors that the Statement of Purpose was available on request. No person was admitted to the home without an assessment of his or her needs. It appeared from information provided that the registration category may have been breached. EVIDENCE: The notice within the entrance hall informed families, visitors that a copy of the homes Statement of Purpose was available. The information in the annual quality assurance assessment provided by the manager identified that St Marys Mount had 16 residents with a dementia and two with a mental health condition. This ratio does not comply with the category of registration for the home. There was a need to complete an assessment of individuals and the appropriate training provided and if necessary a variation needs to be applied for. St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 10 The manager and her deputy had the responsibility for the pre admission assessments. There was written evidence on file of an assessment taking place, more information and support would be gathered during the pre admission visit. The manager needs to devise a letter confirming or not accepting the placement; this would be given to the individual and or their representative prior to admission. St Marys Mount does not provide intermediate care. St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor Standards 7,,8,9 10 were reviewed. This judgement has been made using available evidence including a visit to this service. Of the four care plans sampled there were concerns as to the content and structure, which did not promote the care needs, health and social needs of individuals. Arrangements were in place for the continued health from external professional agencies. There were concerns in respect of the medication system, which were identified to be a potential hazard for the people who use the service EVIDENCE: Of the four care plans sampled and tracked through the system. It was identified that reviews of Moving & Handling was not always consistent, records in general were poor, with, no photograph of the individual, no evidence of involvement from individuals or the person responsible. Risk assessments were not robust sufficiently to protect people who use the service in their daily life style. St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 12 Weight loss was not always seen as a concern to be followed through. There was no evidence of chiropody being arranged for one person. The daily reports would tell the reader no pertinent information as to the care provided or daily routine i.e. “no problem”. Poor intermittent written evidence of nursing/medical requirements could not identify if the instructions had been carried out in respect of blood sugars being tested. At the time of the inspection two professionals visited the home to attend to residents medical needs. They provided the inspectors with information about the home and the manner in which they were accepted. Each found the staff pleasant and felt they were made welcome. One expressed that the staff contacted and referred to the general practitioner as and when necessary. A less positive view was that better hygienic conditions could be maintained in the surgery. There was a degree of incontinence and it was felt that this could be managed better in respect of personal care. During the inspection the staff were observed to interact with the people who use the service in a positive manner assisting and guiding where necessary. Two residents told the inspector “ They like the agency person on duty today” “he was a nice man” Staff were sensitive during the two meal times seen, people who use the service were asked their preference for breakfast. The inspector was told that a hot breakfast was prepared at weekends. Pharmacist Inspection 12th July 2007 On the 12th July 2007 the Pharmacist Inspector visited the home to carry out a full medication management inspection in relation to regulation 13(2) of the Care Homes Regulation 2001. The home had a policy and procedures document for the handling of medicines within the home. Upon examination it was found that the document was very dated and did not cover all of the procedures that the staff were involved in when handling medication within the home. Overall the policy and procedures document for the handling of medicines was not of a standard that would detail to staff how the handling of medication within the home should be carried out. The medication records were poor and could not be used to evidence that medicines were being administered as prescribed. The quantities of medication were not being recorded upon receipt and any medication carried over from the previous month was not being consolidated on the new MAR charts. This meant that the home could not perform any audits to evidence that the residents were receiving their medication as their doctor wished. The handwritten entries on the MAR charts were also poorly written and were not being checked for accuracy by other suitably trained members of staff. A number of the handwritten entries did not correspond with the information displayed on the dispensing label. The handwritten entry for one resident St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 13 displayed “Furosemide 40mg/5ml solution, 1x5ml daily” but the dispensing label showed “one 5ml spoonful to be taken twice a day” another handwritten entry displayed “Hypromellose eye drops, one drop four times a day” but the dispensing label showed “one drops into each eye five times a day”. The disposal records were also not accurate or up to date and therefore as well as having no beginning to their audit trail the home had no ending either. The lunchtime medication round was observed during the inspection. Some failing were identified and these included the handling of medication, carrying medication around the home in small plastic medicine pots and using runners to administer the medication. The administration procedure involved one member of staff preparing medication at the trolley, which was located in the corridor outside the dining room. Once the medication was ready it was then handed to the runner who then went and found the resident and administered the medication. This process is recognised as bad practice due to the following reasons: i) ii) The involvement of two people in the administration process is a recognised contributing factor in drug administration errors. The carrying of insecure medication from the trolley, down a corridor and into the residents room could potentially result in the resident not receiving all or part of their medication because some of the medication may drop out during transportation or if the pot is inadvertently placed down some other residents may take that medication. The home did not appear to be assessing the care workers to check whether they were competent to carry out the administration correctly. The care workers during the process did not have sight of the written administration directions and therefore could not check for themselves that they are administering the right medication to the right resident. The MAR charts are a legal document to confirm that administration has taken place. In this home it was the member of staff, who remained at the trolley, who were signing the MAR charts when they were not in a position to confirm that the administration had taken place. iii) iv) v) Of all the senior staff that were responsible for the handling of medication only the manager and one senior member of staff had received any training on the safe handling of medicines. The senior members of staff also used the runners to administer medication and none of these had received any training on the safe handling of medicines. The one member of the senior staff who had received training had received her training the week before the pharmacist inspector’s visit. This member of staff was observed during the administration round and from the practices seen it was concluded that the training had not been very effective. In the absence of any training it would be expected that the staff would have been instructed on the home’s policy and procedures for safe handling of medication, however as identified earlier these policy and procedures were of a poor standard. Also the staff should have been assessed to see if they were competent to carry out the administration as per the St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 14 home’s procedures, this also had not been carried out. None of the staff had received any training on how to use the Monitored Dosage System (MDS) either. The lack of training and assessments placed the residents’ health and welfare at great risk. The home did not have a Controlled Drugs cabinet or a Controlled Drugs register. Instead the Controlled Drugs were being stored in a small cabinet, which was located within the trolley. This undermined the principles of a facility where Controlled Drugs could be stored securely. Instead of a Controlled Drugs register the home was using small individual notebooks for each resident. The recording of the receipt and disposal were found to be poor. The residents’ medication was stored in a room, which had been named the surgery. This room was found to be in need of a tidy up and a clean. The cabinet, which stored the excess medication, appeared to house discontinued and duplicate medicines both of which had the potential to introduce administration errors by their presence. The mobile medication trolley was found to be too small and not fit for purpose with medication having to be stored on the shelf underneath the locked unit. The administration practices could have developed for the need to have one member of staff guarding the trolley during the administration rounds. Due to the lack of space on the trolley the staff also had to share certain types of medication between residents. The maximum and minimum temperatures of the thermometer found on the fridge were being monitored on a daily basis but due to the type of thermometer it appeared that the staff were recording the maximum and minimum temperatures of the room the fridge was located in. On the day of the inspection the temperature of the fridge was observed to be at minus 1.1°C and the minimum temperature was observed to be at minus 4.5°C. As a consequence the home was asked to remove and destroy all of the insulin contained within the fridge and seek new supplies. There also appeared to be a lack of understanding about medicines that needed to be kept in a fridge and the importance of keeping medicines secure. Medication that required cold storage conditions was being kept with medication that did not require cold storage conditions and external medicated creams/ointments were being kept in residents’ rooms and were not being kept secure. St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate Standards 12,14,15 were reviewed. This judgement has been made using available evidence including a visit to this service. There was some social promotion within the home but this needs to be developed further to include all the people who use the service. Menus for the main meal appeared to offer a basic balanced diet. Little or no daily choice was provided as an alternative. Families were observed to maintain contact with their relatives. EVIDENCE: During the inspection the person who provided movement to music came in to do a session with the residents. Some of this was observed. The service users seemed to engage well with the provider of this activity and to enjoy the stimulation. The activity provider stated that she visits the home on a weekly basis. The care manager could not produce written evidence records of activities that had recently taken place. This will be part of the next inspection to fully explore. It is important that each of the people who use the service are included in any activity of their choice. After lunch some visitors came to the home they were spoken with; St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 16 One relative stated that they were happy with the care but had never been invited to the reviews of care. They had never been informed of the complaints process and were unsure if a contract had been supplied. They were unaware of the relevant documents Statement of Purpose and Service Users Guide. The staff in general were very caring but one occasion the family had not been informed of a hospital admission. They felt that “dad” had a “good relationship with the staff” Mother was admitted due to circumstances staff ‘couldn’t be better’ she is in ‘quite a nice bedroom’. They are all ‘very helpful I couldn’t fault them’. They treat me well always ‘offer me a drink’ ‘they seem very caring’ Residents spoken with on the day told the inspector that “the “girls” were good” this person confirmed that when she was poorly the doctor had been called; she had received a lot of visitors when she was in bed” “ The staffs are OK” “ I would speak to the staff if I had a problem” “we could do more I get fed up sometimes” Staff were sensitive during the two meal times seen, people who use the service were asked their preference for breakfast. The inspector was told that a hot breakfast was prepared at weekends. One resident asked the staff to serve a smaller portion this was addressed by the staff at lunch. The meal looked well prepared and served in an attractive manner. The alternative recorded were the same on a daily basis “a salad” there was no choice of a hot alternative; this could result in some residents who choose not to have a salad being served something that may not be to their liking. Observed during the lunch was that the people who use the service had to share one salt and one vinegar pot between all the tables. Temperatures were recorded daily. The inspectors had concerns as to the unacceptable condition of the kitchen; the surround of the sink was extremely dirty; the dishwasher had been out of order for a minimum of two months. Plates, and cups were unacceptable they were chipped and were on request taken out of service. The window cill and plugs on the wall, floor around the dishwasher were extremely dirty, the floor was uneven and split in parts a potential hazard to the staff and a harbinger of germs. St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor Standards 16,18, were reviewed This judgement has been made using available evidence including a visit to this service. The complaints process was displayed in documents and available. Staff training for the safe guarding of people who use the service was not current, leaving people at a potential risk EVIDENCE: Two of the people who use the service told the inspector that they would “speak to the staff or manager” if they had a concern and they were sure it would be sorted. Records provided evidence that the manager had dealt appropriately with an in house complaint brought to her attention in 2006. 2 staff spoken with said they had not had vulnerable adult training. One agency member of staff was working within the home without the manager ensuring that all safeguarding checks had been made. This could be a potential risk to people who use the service The complaints process was made available in documents displayed in the home and other relevant documents. St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Standards 19 23 24 25 26 were reviewed. This judgement has been made using available evidence including a visit to this service. In general the home was maintained to a good hygienic standard, there were areas of concerns that could compromise the safety of the people who use the service. EVIDENCE: Located on the periphery of the town of Uttoxeter St Marys Mount stands in its own pleasant grounds. Two lounges provided communal space for the people who use the service; these were located near to the dining room. The staff had tastefully decorated the larger lounge. The new floral armchairs lift the room making it a pleasant area. The home had a number of toilets within the vicinity of the communal areas, they were identified as were the bathrooms in need of redecoration and up dating. St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 19 The inspectors had concerns as to the quality and safety of the carpet in the corridors on the ground floor. Each of the manhole inspection covers were identified to be a potential hazard for people who use the service due to the condition where carpet had lifted and become unglued. Bedroom doors were ineffective in the event of a fire as they did not close properly. Bedroom 16 had a wardrobe that required securing to the wall to prevent an accident. It was observed that staff had made two beds with bed linen that was unacceptable; one bed was without pillowcases. This was pointed out to the care manager who would address the concern with the staff responsible. Some carpets would benefit from industrial cleaning due to their badly stained condition. The care manager told the inspectors that she had in fact arranged for the carpets to be cleaned professionally. Staff should cease wedging open the corridor fire door, the wedge was removed during the inspection. In the centre of the home, the external courtyard was so badly overgrown that it would be a potential hazard to people who use the service and the staff; and would require an extraordinary input to recreate the garden. People who use the service were unable to use this area and remained inside. St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor Standards 27,28,29,30 were reviewed This judgement has been made using available evidence including a visit to this service. Staffing levels and recruitment practices are not consistently robust and therefore create a potential risk for service users. Staff have not received training in all core areas which could leave people who use the service at risk. EVIDENCE: The members of staff on shift included the registered manager, a senior care worker, an agency member of care staff, a kitchen assistant and an administrator. The agency member of staff had not worked within the home before and was unfamiliar with the service user group and the routines of the home. A further member of staff was called in after our arrival so that the manager could assist with the inspection. There were 19 service users within the home a number of whom have dementia. Discussions with staff and examination of the staff meeting minutes and the duty rota indicated that at times this home did not have adequate staffing in place to meet the personal and social needs of the service users. Care staff and the manager stated that at night the home is staffed by two care assistants. The care assistants have not received medication training and therefore medication could not be administered at night. This means that service users do not have access to pain relief or other medication throughout the nighttime period. St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 21 On the day the lunchtime meal was being prepared by a member of the care staff who was working an extra shift. Staff stated that carers are regularly asked to cover shifts in the kitchen. The rota for kitchen and domestic staff was not available. The manager stated that kitchen and domestic staff are not included on the rota. This is not acceptable. There must be an accurate record of all staff who work in the home. Staff also stated that they were short staffed in May 2007 and they were regularly asked to cover shifts because staff were off sick, on maternity and annual leave. An immediate requirement was left in relation to staffing numbers. The staffing numbers are of concern to the Commission and must be addressed to ensure that all service users’ care needs are safely met. The recruitment and training files of three staff members were examined. The permanent members of staff had been appropriately recruited with evidence of CRBs, references and other required information on file. However, the agency member of staff had started work without the manager having any clarification of appropriate vetting, experience or identity. The manager and administrator confirmed that they did not have information. The administrator stated that the fax machine was broken and therefore they had not been able to receive the necessary paperwork from the care agency. This is unsafe practice and does not protect service users. There must be appropriate recruitment and vetting information relating to all staff who work in the home. An immediate requirement was left in relation to this. There was some information relating to staff training in the files however, the files and the information was not ordered and was difficult to audit. The training matrix was not up to date. The staff spoken with confirmed that they had completed NVQ 2 or 3. The manager stated that four seniors have NVQ3 and the manager has NVQ4. This percentage exceeds the minimum expected. Gaps in some areas of training were identified in particular in medication, food hygiene, dementia and safeguarding. Staff confirmed that they had not received training in these areas. There was evidence that training in diabetes, first aid, safe handling and fire safety had taken place. Three relatives were spoken with during the inspection. The views about the staff were positive. One said ‘the staff are helpful I couldn’t fault them’ and ‘they seem very caring’. ‘The staff have a good relationship with dad’. St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate Standards 31 33 35 38 were reviewed. This judgement has been made using available evidence including a visit to this service. The manager is appropriately qualified and approachable but needs more supernumerary time to enable her to manage the staff and the service efficiently. EVIDENCE: The manager is appropriately qualified. She stated that she has always worked in the care field and was previously an assistant manager before taking up her present post. The manager confirmed that she undertakes regular training. She is an NVQ assessor and has an NVQ in Health and Safety in the workplace. Staff spoken with stated that the manager was approachable. However, they also stated that staff meetings and supervisions did not happen on a regular basis. The manager stated staff have an annual appraisal and acknowledged that supervisions did not happen as regularly as they should because she spent St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 23 a lot of time carrying out caring tasks. The provider needs to consider ensuring that the manager has adequate time to complete staff management tasks including ensuring training is up to date and that care practices are monitored. The home has a quality assurance system in place. The feed back from service users and carers was examined. The manager stated that they no longer hold service user meetings and rely on the quality assurance system as their main source of feedback. This process, whilst adequate, would be improved if the views of visiting professionals were also included in this process. It should also be clear how the views collected inform the homes development plan. Documents in relation to the health and safety practices within the home were examined. There was evidence of up to date gas and electricity certificate as well as evidence that the lift, fire systems and portable electrical appliances had been appropriately checked. Regular fire drills were also recorded. Staff confirmed that they take part in regular fire drills and were also aware of the evacuation process. Staff training is discussed in the staffing section of this report which highlights that staff have not received training in all the core areas. St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X 3 3 2 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x x 2 x 2 St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15 (1) Requirement To focus on the information and recording contained in all the care plans, to ensure that they are pertinent to the individuals daily routines and care The manager must seek professional guidance from appropriate medical departments. In this case a professional assessment regarding the use of foot plates on wheelchairs. outstanding 01/01/07 Medication must be administered as prescribed and in accordance with the cautionary and advisory labels, with records kept when a prescriber has authorised a change to ensure that medication is given safely and correctly. Accurate, complete and up to date records must be kept of all medication received administered and disposed of to ensure that medication is accounted for, is available and is given as prescribed. DS0000005003.V338299.R01.S.doc Timescale for action 20/08/07 2. OP8 13 1 (b), 13 3 24/08/07 3. OP9 13 (2) 24/08/07 4. OP9 13 (2) 24/08/07 St Mary`s Mount Version 5.2 Page 26 5. OP9 13 (2) 6. OP9 13 (2) 7. OP9 13 (2) 8. 9. OP9 OP30 13 (2) 18 (1ci) Appropriate information relating to medication must be kept for example in risk assessments and care plans to ensure that staff know how to use all medication including when required and as directed medication so that all medication is administered safely, correctly and as intended by the prescriber. Staff who administer medication must be trained and competent and their practice must follow written policy and procedures to ensure that residents receive their medication safely and correctly. Medication must be stored within the temperature range recommended by the manufacturer to ensure that medication does not loose potency or become contaminated. All medication must be stored securely so that only authorised persons has access to it. Food and hygiene training must be provided at the appropriate frequencies. Previous Requirement still outstanding 01/02/07 Training must be provided appropriate to the role the staff are to perform. For example, medication administration and assessment training for all staff who administer medications.Outstanding 01/02/07 To provide sufficient utensils and kitchen equipment in working order must be provided. A wholesome and nutritious food should be available, to maintain satisfactory standards of hygiene in the kitchen and home DS0000005003.V338299.R01.S.doc 24/08/07 24/08/07 24/08/07 24/08/07 24/09/07 10. OP30 18 (1ci) 24/09/07 11. OP15 16 (g)(i)(j) 04/07/07 St Mary`s Mount Version 5.2 Page 27 12. OP19 13(4)(a) 13. OP27 18(1) 14 OP29 19 (1) (a) The responsible person shall ensure that all parts of the home to which people who use the service are so far as reasonably practicable free from hazards to their safety The person responsible shall ensure that at all times there were sufficient staff in numbers to meet the people who use the service health and welfare needs The registered person must not employ a person to work in the home unless the appropriate checks have been carried out 10/08/07 30/06/07 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5 Refer to Standard OP4 OP9 OP9 OP9 OP12 Good Practice Recommendations To devise a letter to confirm the placement of any new admission to the home. It is recommended that the competency of staff administering medication be assessed at least six monthly. It is recommended that the general practitioner be asked to sign the PRN protocols. It is recommended that the staff undertake the ‘Safe Handling of Medicines’ training. To ensure current records for the social care provided at the home were made available. To listen to the people who use the service and develop activities internal & external to the home. It is recommended that the manager is allocated sufficient supernumerary time to manage the service. 6 OP36 St Mary`s Mount DS0000005003.V338299.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Birmingham Local Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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