Inspection on 20/02/06 for St Marys Continuing Care

This inspection was carried out on 20th February 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Marys Continuing Care 14/03/07

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE St Mary`s Continuing Care St Mary`s Continuing Care Ltd Penny Lane Collins Green, Burtonwood Warrington Cheshire Lead Inspector Anthony Cliffe Unannounced Inspection 20th February 2006 09:00 X10029.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 Continuing Care DS0000063421.V276701.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 Older People and 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 Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Mary`s Continuing Care Address St Mary`s Continuing Care Ltd Penny Lane Collins Green, Burtonwood Warrington Cheshire 01925 294850 01925 294855 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) St Marys Continuing Care Ltd Janet Elizabeth Webb Care Home 63 Category(ies) of Dementia (21), Dementia - over 65 years of age registration, with number (20), Mental disorder, excluding learning of places disability or dementia (11), Mental Disorder, excluding learning disability or dementia - over 65 years of age (11), Physical disability (11) St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 63 service users to include:* Up to 20 service users in the category of DE(E) (Dementia over the age of 65) * Up to 21 service users in the category of DE (Dementia under the age of 65) * Up to 11 service users in the category of PD (Physical disability under the age of 65) * Up to 11 service users in the category of either MD (Mental disorder excluding learning disability or dementia under the age of 65) or MD(E) (Mental disorder excluding learning disability or dementia over the age of 65) The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection 2. 3. Date of last inspection Brief Description of the Service: St. Mary’s care home with nursing is a purpose built two-story building comprising of 63 single bedrooms with en-suite toilets/shower facilities. Each unit has its own dining and lounge facilities. There is a separate activities room and therapy room. The external grounds are landscaped and secure. St. Mary’s care home was registered on 8th September 2005. It is located in the Collins Green area of Burtonwood in Warrington. It is on a local bus route and close to the railway stations at Earlstown and St.Helens Junction St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Due to the number of registered beds two regulatory inspectors undertook this unannounced inspection on 20th February 2006. This was the first inspection of St. Mary’s since it was registered in September 2005. The inspection took place over eight hours. Feedback was given to the manager. Records were inspected and staff practice was observed. Discussion took place with residents and staff. What the service does well: What has improved since the last inspection? What they could do better: Each assessment of prospective residents needs to be completed in full. Care plans need to improve to demonstrate that the health and welfare of residents can be provided for. Notify the CSCI of all incidents that affects the wellbeing of residents. St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 6 The recruitment of staff needs to improve to ensure residents are protected. Staff need to be given training on dementia care and challenging behaviour to ensure the safety of residents. More information needs to be provided for residents on activities, the variety and choices of food and how to make a complaint. Signage in the home should improve to aid the recognition of residents’ bedrooms, toilets and bathrooms and to promote dignity and independence. A system should be introduced which enables staff to comment on the management of St. Mary’s. The quality assurance system should improve in order to produce a robust development plan. A formal system of supervision should be introduced for all grades of staff. 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 Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Not all residents are assessed appropriately prior to moving into St. Mary’s. EVIDENCE: Care documents examined for three residents showed that not all residents who recently moved into St. Mary’s had pre-admission assessment documentation completed. Two pre admission documents were signed and dated by the person that completed them. The pre admission document is detailed; from this a care plan can be developed. The pre admission assessments were supported by assessments and care plans from care managers and NHS facilities. One resident was not assessed by staff from St. Mary’s prior to moving into the younger adults dementia care unit. Information had been obtained from the five boroughs partnership on the resident in the form of the effective standard care coordination document under the Care Programme Approach (CPA). This information detailed the resident’s mental health history and contact with the community mental health services. Prior to St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 9 moving into St. Mary’s the resident had been accommodated in an NHS facility under Section 3 of the Mental Health Act 1983. The documentation present in the resident’s file referred to the resident being at risk of exploitation and a high risk to self from ‘functional deficits’, and ‘chaotic lifestyle’. There was no clear information on what the concerns about the resident entailed other than concerns about road safety for which a risk assessment was completed. See requirement 1. St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Residents’ plans do not ensure that their health and social care needs are identified and met. Care plans need to be clearly written, use plain English, be reviewed regularly and avoid the use of jargon so staff can follow them. Improvement in the management, causes and reporting of challenging behaviour would further enhance residents’ quality of life. The administration and recording of medicines ensures residents receive their prescribed medicines. EVIDENCE: Care plans of three residents were examined. All plans had a wide range of assessment documents completed; with a care plan to address residents’ identified needs. From looking at care plans, and talking with residents, the St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 11 health needs of residents were generally met. One resident did not have a date of admission recorded in the biographical details on the care plan. The resident’s care plan had detailed action plans that supported the resident to make choices and encourage her independence. The care plan detailed the resident’s food preferences. Reviews of care recorded the resident had been out to buy new clothes, had her hair done and gained weight. A care plan regarding social activities was in place that referred to liaison with the activity coordinator as to the type of activities the resident enjoyed. The review of this noted the resident enjoyed creative and artistic activities in the activities room and enjoyed going out with staff and wished to start swimming. A care plan had been devised to support the resident through periods of feeling helpless and low in mood. This advocated the use of ‘ basic therapeutic communication techniques and multiple skills specifically directed toward her symptoms and behaviour associated with her mood’. There was no explanation to staff as to what ‘basic therapeutic communication techniques and multiple skills ‘ were and how they should be used. Another resident’s care plan was detailed and following a review of his mobility needs by the physiotherapist was revised to incorporate the advice given on the use of a walking and mobility aid. This directed staff on a suitable exercise programme to use them. The resident had complained of memory problems and a care plan devised to address this, which offered the use of a memory board. The care plan of a resident was examined in the older adults dementia care unit. The resident’s care plans were inconsistent with illegible handwriting. The waterlow assessment for the risk of developing pressure ulcers had been completed. This identified that if a score of ten and above was given on it a care plan to manage the risk must be in place. No care plan was in place. A risk assessment for use of disguising medication had been discussed and agreed with the resident’s family, but there was no care plan or reference to medication being administered by disguising it. The nurse in charge verified that the resident was presently compliant with taking medicines. The hand writing in some care plans was illegible and they could not be read. There was a care plans regarding the skin integrity of the resident being at risk. This identified that the resident had two wounds to a leg and a heel. The resident had been seen by the tissue viability nurse in December 2005. The visit was not recorded in the record of professional visitors. The care plans had not been reviewed since the 17th December 2005. The resident had dentures but there was no reference in the care plan for personal hygiene about the cleaning of the resident’s dentures. The resident was referred to by staff as presenting with aggressive behaviour. The resident was reviewed by her social worker and referred to a psychiatric specialist. There were a number of physical assaults by the resident on residents and staff. These had not been notified to the CSCI. In discussion with staff about how they managed aggressive behaviour a staff member was very vague in her answers and said ‘we cannot use restraint’. The staff member was asked how staff would protect other residents and themselves if a resident was physically aggressive toward them and the staff member said ‘I would block a St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 12 resident from hitting or puling a residents hair’. The staff member said the use of physical intervention was ‘unclear as no instructions’ has been given to staff on this. Two staff interviewed confirmed they had not received training on managing challenging behaviour or dementia care. Medication storage and administration was examined on the three units in operation and no errors identified. See requirement 2 and 3 and recommendation 1. St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Activities are well structured and planned but information on what activities are available needs to be made available to residents. Visitors are welcomed to visit at flexible times. More information about the choice of meals would enable residents to exercise choice and control about their daily lives. EVIDENCE: St. Mary’s employs an activity coordinator and has dedicated facilities for the provision of activities. Details of what activities available were not displayed in the units. However residents said there were a variety of planned activities available to them. Social activity care plans were in place and life histories completed for some residents by their families. Residents talked about their daily lives and choices they made. A resident said ‘I have been living here a few months. I need to be here as I have a problem with my memory I have St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 14 amnesia. I have enjoyed living here. The staff are very good. They don’t have to help me much, as I can wash and dress myself. My main carer is Michelle. She is very good always willing to help. We go out for regular walks around and we have been into town. I am hoping we can do it again. Michelle is here to take me out for a walk now. Despite my amnesia I remember I have been out for lots of walks with Michelle. We go out a few times a day and I need someone with me as the roads are very busy and I don’t feel safe. With my amnesia I would forget where I was. I feel bored at times and enjoy having a cigarette. I enjoy sitting and chatting to the other residents. We can make a drink when we want to. I make drinks for the staff and they make a drink for me. There are bread, crumpets and teacakes there. We have a toaster. We have tea coffee and milk. The meals are very good but I don’t have a cooked breakfast I choose not to. I enjoy me meals I’m not a fussy eater. Going back to being bored. I have helped the domestic staff clean up. I could do more but would have to borrow the hoover. I can look after my bedroom. I can go upstairs to the activities room and have done. There is loads to do but I find some of the activities childish and don’t join in them. I enjoy going out for regular walks which helps’. Visitors were seen throughout the day. Staff offered visitors the option to use the quiet lounge and a drink when they arrived to visit a relative. Breakfast and lunch were seen being served. Residents have the choice of a cooked breakfast or lighter option. The majority of residents were served fish chips and peas for lunch. No menus were on display to inform residents of the alternative choice. There were no visual displays, which informed residents of the choice of meals available. See recommendations 2 and 3. St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The complaints procedure needs to be more freely available in St. Mary’s so residents and relatives are aware of it. Staff awareness and training of how to manage challenging and aggressive behaviour needs to improve to ensure residents are protected from abuse. EVIDENCE: St. Mary’s have not received any complaints to date. The complaint procedure is thorough and details procedures to be followed should any complaint or concern arise. The procedure includes stages and timescales for dealing with the complaint. A complaint record book is kept for detailing complaints and outcomes of investigations. Although the procedure is on display in reception, it is not displayed on the units. St. Mary’s has clear and detailed policies and procedures regarding the protection of vulnerable adults (POVA). Procedures are in line with those of the local authorities working with St. Mary’s. The Registered Manager has a good understanding of POVA procedures and has shown good judgement when dealing with an issue arising from a Criminal Record Bureau check. Staff are trained regarding POVA via a workbook devised by the Training Coordinator. The Training Co-ordinator stated that plans to extend the training to include group discussions were in place. The policies and procedures regarding whistle blowing are appropriate. There is a good procedure in place for dealing with resident’s finances, and there is a St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 16 policy preventing staff from assisting with or in any way benefiting from resident’s wills. A policy regarding restraint and aggression toward staff is in place, however, staff did not have knowledge of these policies. See recommendations 1 and 4. St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) 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, 21, 22, 23, 24, 25 and 26 Residents live in a safe, comfortable and well maintained environment, which is equipped to meet their needs. The signage of bedrooms, bathrooms and toilets could improve to enable residents who are cognitively impaired to recognise these facilities and aid independence. EVIDENCE: All bedrooms are single with en-suite toilet and shower facilities. Residents can personalise these as they wish. All bedrooms have an electrical profiling bed as standard. The décor and furnishings in St. Mary’s is of a high standard and since the building has been occupied the units have been finished with soft furnishings, paintings and electrical equipment. In the dementia care units St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 18 there was no orientation boards to assist residents in recognising the day, date, time of year, staff on duty or choice of meals available at meal times. The dementia care units had not introduced ‘memory boxes’ outside residents’ bedrooms in which they could display photographs and mementos. This is good practice as it is a discreet way of helping residents orientate themselves and for them to share their life history with other residents and staff. Better signage of bedrooms, toilets and bathrooms would help residents to recognise these facilities and orientate themselves to their home environment. See recommendation 5. St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The numbers and skill mix of staff are adequate to meet residents’ needs. Staff recruitment needs to improve to ensure that residents are protected. All staff should receive training in caring for adults with dementia and dealing with challenging and aggressive behaviour. EVIDENCE: Staffing levels are appropriate and the Registered Manager confirmed that staffing numbers are determined by the dependency of residents and so may change. Each unit has an appropriate mix of qualified and unqualified staff. Eighteen staff are enrolled in NVQ training, both levels 2 and 3. The Training Co-ordinator confirmed that once these staff have gained their qualification then St. Mary’s should meet the 50 trained staff target. St. Mary’s has clear and detailed policies and procedures regarding recruitment. The procedure includes an equality and diversity policy. Staff are employed in line with the General Social Care Council codes of practice, and sign a contract, which includes a statement of their terms and conditions. The Registered Manager had a good understanding of recruitment procedures, St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 20 however, some staff files did not contain all the relevant information. One had gaps in employment history and another contained only one reference. St. Mary’s employs a training and development co-ordinator. He is an enthusiastic and motivated member of the staff team. He is keen to organise appropriate training, develop staff and wants St. Mary’s to be seen as a centre for excellence in staff training and development. Staff are encouraged to gain qualifications including NVQ 2 and 3. This qualification is offered to both care staff and kitchen and domestic staff. An external assessor is involved in NVQ training, however the Training Coordinator is obtaining his assessment qualification and hopes to bring all NVQ training in-house. NVQ workshops and individual mentoring is offered by the Training Co-ordinator, including assistance for individuals with specific learning needs. Records are kept regarding training and qualifications, and a training and development matrix is being completed. The Training Co-ordinator is inducting all staff members in line with both inhouse and Skills for Care standards. Staff are given induction packs and workbooks, which are checked by the Training Co-ordinator. Mandatory training is completed both in-house and using external trainers. This training includes moving and handling, health and safety, fire awareness, infection control and POVA. One member of staff has completed fire marshal training and runs the fire awareness course in-house. Another staff member is an approved moving and handling trainer. Other training offered includes first aid. The Training Co-ordinator has links with local agencies to secure funding for and access to training. He has developed links with learning organisations, for example John Moores University, so that qualified staff can access continued professional development training. He recently attended the Skills for Care conference in order to keep updated with what is happening in the training in care sector. He discussed an intention to complete an appropriate qualification in supervision and mentorship so a programme of supervision for care staff and clinical supervision for qualified staff can be implemented. Staff said that they were encouraged to pursue qualifications and that training events were ongoing. Some staff said that training in dementia care and managing challenging behaviour would be useful. The Training Co-ordinator planned to organise this training. See requirement 4 and recommendation 1. St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. The system for staff to share their views on how St. Mary’s is conducted needs to improve to enable the manager to discharge her responsibilities fully. The quality assurance system in use at St. Mary’s is not adequate. Residents’ monies are dealt with safely. Regular maintenance of the building and equipment provided to meet residents’ needs maintains their safety. EVIDENCE: St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 22 Staff interviewed discussed management issues in the home. The need for training in managing challenging behaviour and dementia care was identified. A staff member discussed her concerns that care staff needed to be consistently managed by the qualified nurse in charge. She identified that carers needed leadership and direction and at times did not take the initiative. She said ‘staff wait around being told what to do. They congregate around the nurses’ station. They do not stock up bathrooms and toilets with protective gloves’. She was concerned that a negative culture was developing which meant residents went to bed early and got up late. For some residents this meant they did not have a drink for over twelve hours. ‘The qualified staff should not sit in the office they should be supervising staff’. During the visit staff were seen to come out of a toilet to get protective gloves from a trolley and to congregate around the nurses station. The nurse in charge did remain in the office throughout the visit. There was no evidence of a negative culture but theses matters were drawn to the attention of the registered manager who said she was unaware of the carer’s concerns. The quality assurance procedure is short and limited in scope. The Registered Manager has been trialling an audit document that is thorough and will be useful in devising a development plan. The quality assurance procedure needs to be extended to include a range of methods for gathering information and a clear system for producing an annual development plan. St. Mary’s has clear and detailed procedures with regard to resident’s money. Accounts are easily accessed and records clearly show what happens with resident’s money. No staff at St. Mary’s act as an agent and the home does not hold appointeeship for anyone. Staff interviewed confirmed they had not received supervision but a staff meeting had taken place and it had been confirmed that supervision would be commencing within the near future. Health and Safety training is available in-house and staff are required to update this regularly. Other regular training includes moving and handling, fire safety, first aid and food hygiene. COSHH regulations are met. Fire safety is in good order, with records of risk assessments, drills and various system and equipment tests in place. Other risk assessments and maintenance checks are completed appropriately. An accident book is in place on the individual unit and these are kept updated appropriately. See recommendations 6, 7 and 8. St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 23 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 X 2 X 3 1 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 ENVIRONMENT Standard No Score 19 2 20 4 21 4 22 4 23 4 24 4 25 4 26 4 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 3 34 X 35 3 36 2 37 X 38 3 St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP3 OP7 Regulation 14(1) Requirement Timescale for action 01/04/06 3 OP7 4 OP29 Residents must be appropriately assessed prior to admission. 14 and 15 The registered person must 01/04/06 ensure that records that identify residents’ needs and identify staff responsibilities in meeting their health and welfare are completed in full, kept under review, including appropriate care plans, risk assessments and risk management strategies to meet their needs. 37 The registered person must 20/02/06 inform the Commission for Social Care Inspection of any event in the care home, which adversely affects the well being, or safety of any resident. 19(1)(a)(b)(c) The registered person must 20/02/06 not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2. DS0000063421.V276701.R01.S.doc Version 5.1 Page 25 St Mary`s Continuing Care 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 6 7 8 Refer to Standard OP7 OP12 OP15 OP16 OP19 OP31 OP33 OP36 Good Practice Recommendations Training on dementia care and managing challenging behaviour should be prioritised. Information on the variety and choices of activities available should be displayed on each unit. Food choices should be offered to residents in a format that they can understand The complaints procedure should be more widely publicised. Signage of residents’ bedrooms, toilets and bathrooms should be improved. A system should be introduced that enables staff to share their views on how St. Mary’s is managed. The quality assurance procedure should be developed further in order to produce a robust development plan. A formal system of supervision should be commenced for all grades of staff. St Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Mary`s Continuing Care DS0000063421.V276701.R01.S.doc Version 5.1 Page 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. 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