Inspection on 09/11/05 for The Hamlets

This inspection was carried out on 9th November 2005.

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

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

Other inspections for this house

The Hamlets 17/05/06

The Hamlets 11/05/05

The Hamlets 25/10/04

The Hamlets 29/04/04

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Alfred House Residential Care Home

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Creative Support

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

CARE HOMES FOR OLDER PEOPLE St Michael`s 93 St Michael`s Church Road Liverpool Merseyside L17 7BD Lead Inspector Pat Kearney Announced Inspection 10:30 9th November 2005 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 Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 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 Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Michael`s Address 93 St Michael`s Church Road Liverpool Merseyside L17 7BD 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) 0151 728 9019 Age Concern Liverpool Care Home 12 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (12) of places St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th May 2005 Brief Description of the Service: St Michaels is a single storey purpose built care home providing nursing care for 12 older people with functional mental ill health. The home is situated within a residential area of Aigburth South Liverpool. The property is within walking distance to shops, pubs, Sefton Park and a bus ride from Liverpool city centre and other places of local interest. The increasing frailty of the service users may prohibit independent access to these community facilities. Accommodation at St Michaels includes12 single bedrooms all fitted with wash hand basins. There is a large lounge and dining room. The dining room leads onto a patio area and large walled garden. Registered by Age Concern Liverpool over 11 years ago the establishment was a home for life for the then Health Authority service users. All service users admitted to the care home would have a diagnosis of functional mental illness. However the increasing age and frailty of the service users has seen the focus of care shift from predominately mental health to both mental and physical nursing care. The care practices within the home have adapted to meet the changing needs of the service users. St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory announced inspection took place on 9th November 2005 and lasted over four hours. A full tour of the premises took place. A range of records such as care plans, staff personnel files, policies & procedures were examined. The acting manager was on duty the senior manager from Age Concern Liverpool was present for part of the inspection. Staff on duty and five service users were spoken to during the course of this inspection. The majority of service users were supported by staff to complete the comment card prior to the inspection. Following the inspection health and social care professionals were contacted by telephone to ask their views about the management and care provided at the home. The inspector was unable to ask the service users relatives’ views due to their individual circumstances. What the service does well: What has improved since the last inspection? The ethos and management of the home has changed since the last inspection there is evidence of a real team approach to meeting the needs of the service users. Staff said that there was clear leadership and direction and that staff morale is very high, the impact on the service users care was evident. Service users were engaged and holding conversations with each other and staff on a range of topics. Service users said that they had enjoyed an extended range of activities and social events and they were looking forward to their Christmas party. St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 6 Staff are supervised regularly and records are kept. The acting manager has with the senior manager had an internal audit devised an action plan and is currently working through the actions plan. Some of the changes include introduction of a new menu which includes the choices and preferences of the service users, new furniture, mattresses and blinds have been purchased. The rubbish which had accumulated has been removed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 7 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 Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 The home’s Statement of Purpose and Service User Guide are well written and detailed providing service users and prospective service users and/or their relatives with details of the services the home provides enabling an informed decision about admission to the home. Service users are only admitted into the home following of a holistic assessment of their individual needs. EVIDENCE: Both the Statement of Purpose and Service User Guide were reviewed and updated in December 2004. The Senior Manager said that they were about to begin the process of reviewing and updating both documents. A copy of both documents are hung in the entrance hall of the home and copies are in all service users bedrooms. Since the last inspection the acting manager said that copies of both documents are also given to the service users next of kin. A comprehensive and holistic pre-admission assessment is completed with the acting manager conducting the assessment. Information from other health St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 9 and social care professionals is included. Every effort is made to involve and engage the service user and or their relatives in the pre assessment process. Service users are able to visit the home several times prior to making the decision to move in. Social care professionals spoken to confirmed that “pre admission visits were a normal part of the admission process and that the number and duration of the visit was tailored to meet the individual needs of the service user”. Copies of contracts are kept on service users files. All service users in the home are provided with a statement of terms and conditions, plus a contract when they move in to the home on a permanent basis. Intermediate care is not provided at the home. St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Care plans, risk assessments, daily health records for each service user are up to date and reviewed monthly by the senior nurses in the home. This ensures that the current and changing care needs of the service users are identified and met. EVIDENCE: All residents in the home have an individual care plan, which is formulated on admission to the home, reviewed by the senior nurses on a monthly basis. Daily health records are documented for each service user this includes any critical incidences plus any visits from GPs, specialist nurses etc. No service user at the home self medicates, all medications for residents are administered by the nurses in the home. The protocols for the receipt, storage, disposal, and documentation of medications in the home are in accordance with the National Minimum Standards (NMS). Since the last inspection a review of the medication ordering system has been reviewed and the pharmacist supplying the medication has been changed. St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 11 All service users in the home are supported by staff to receive their NHS entitlements. The service users’ documentation is kept secure in accordance with the Data Protection Act 1998. Since the last inspection the manager has started to ask service users and/ or their families their individual choices and preferences with regard to their funeral arrangements. St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Service users have choice and flexibility how they spend their day in the home, leisure activities are organised according to their choice and preferences. The meals in this home are good offering both choice and variety and catering for individual dietary needs. EVIDENCE: Service users are offered a choice at mealtimes, specialist diets are catered for and advice has been sought from the community dietician. Since the last inspection a new cook has been recruited who spends time with the service users ensuring that their individual choices and preferences are included into the menu. An increased variety of meals are now offered this has included the addition of curries which the service users said “they enjoyed very much”. On the day of the inspection spare ribs and cabbage were being served all those service users spoken to said how much they had enjoyed the meal. Since the last inspection a core group of staff work with the service users to plan the social and leisure activities. It was evident that the number and frequency of social events have increased at the home. Service users confirmed that they were now “doing lots of nice things”. A Christmas party is St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 13 planned for the beginning of December with invites being extended to all relatives and friends of service users. Visitors are allowed in the home at any reasonable time of day, service users may entertain their visitors, in the communal lounges, or in their own bedroom. The gardens and patio area provide a setting for service users to sit with their relatives, especially in the summer months. St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 The home has clear policies and procedures for dealing with complaints and adult protection issues which ensure the safety and welfare of service users. EVIDENCE: There have been no internal complaints since the last inspection. The home has a robust complaints procedure, which is documented in the service users guide. The care home has up to date information on the Protection of Vulnerable adults, this information is communicated to new employees at their induction course. On the day of the inspection there was evidence that staff in the home had completed training on protecting vulnerable adults. Staff spoken to demonstrated their knowledge of adult protection issues and the impact on their practice. St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 15 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 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, 26 The standard of decor within this home is good, with evidence of continuing improvements, through maintenance and planning. The home does present as a homely, safe and comfortable environment for the service users EVIDENCE: The care home environment is good; all areas of the home are clean, light, well decorated and maintained including the rear garden area, which has a patio area. Service users’ bedrooms have been personalised, and contain pictures, and personal memorabilia. Most service users have televisions and/or D.V.Ds. in their bedrooms Service users gave the inspector permission to view their bedrooms. The communal lounge is bright and homely. St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 16 The dining room is bright and overlooks the rear garden. The kitchen was clean and well organised, with fridge and freezer temperatures checked and recorded daily. All bathrooms and toilets in the home provide privacy, and meet individual needs. The home’s infection control policy is in date and valid. St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Staff morale is high resulting in an enthusiastic workforce that works positively with service users to improve their whole quality of life. The staff have a good understanding of the service users support needs. This is evident from the positive from the positive relationships, which have been formed between the staff and service users. EVIDENCE: There is always a first level Registered Mental Nurse on duty who is assisted by care staff and ancillary staff. The majority of the staff group at the home have worked there for a number of years and have a really good knowledge of the service users individual needs and preferences in all areas of their lives. Staff work hard to ensure that the service users receive the best possible care. The homes recruitment policy is robust and in accordance with the National Minimum Standards. All staff in the home has an up to date CRB/POVA enhanced certificate, so ensuring the safety of the service users. The original copy of the staff personnel files are kept at Age Concern Liverpool headquarters based in Liverpool city centre. Copies of documentation is kept at the home. The personnel file for one member of staff was incomplete with relevant documentation not yet available for inspection. St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 18 Mandatory and specialist training for all staff is ongoing in the home. Records of all training completed is kept in the staff personnel files. St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37 The acting manager is well supported by senior staff in providing clear leadership at the home which ensures that service users are provided with a good standard of care. Staff morale is high in the care home, resulting in an enthusiastic workforce that works positively with residents to improve their quality of life. Turnover of staff is low. EVIDENCE: The Acting Manager is a Registered Mental Nurse with many years experience working with the service user group at the home. The acting manager must submit an application to C.S.C.I to become the Registered Manager. The acting manager provides leadership and direction at the home. Since the last inspection the staff group have been able to develop new skills and the St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 20 training opportunities for staff have increased. Service users, staff and health and social care professionals spoken to as part of this inspection all commented on the “positive influence and leadership “of the acting manager and how much the home had improved under her leadership. Service users said that it was “a happy home” and that the manager was “lovely and kind”. Comment cards completed by service users as part of the inspection process confirmed that service users liked living at the home, felt safe and knew who to ask if they were unhappy with the care they were receiving. All said they were treated with respect and their privacy was respected. The inspector was able to observe how much more animated and talkative the service users were and there was a lot of conversations taking place in the lounge. Service users were very comfortable approaching the acting manager. There was evidence that the whole staff group were working as a cohesive team for the benefit of the service users. The staff group have been divided into sub-groups according to their individual strengths and interests each with a particular responsibility, e.g. social and leisure group. The social and leisure group work with the service users to co-ordinate and plan the leisure events that take place in or outside the home. This has facilitated an increase in social and leisure pursuits enjoyed by the service users. All staff are supervised and records are kept. Age Concern Liverpool has introduced an annual appraisal system and a three monthly performance review completed with all staff. Team meetings are held approximately 3 monthly, the acting manager said that she was “planning to hold team meetings on a monthly basis and that minutes of the meetings will be kept”. Since the last inspection the senior manager and acting manager have conducted an internal audit and identified a number areas of the home that need improvement, an action plan has been developed and the acting manager together with the staff group are currently working towards completing the action plan. The senior manager visits the home on a regular basis and completes the statutory Regulation 26 visit copies of the visits are forwarded to C.S.C.I. The home’s certificates of insurance and worthiness for machines, fire equipments, lift, hoists were in date and valid. Liverpool housing Trust who own the building are responsible for the ongoing servicing of the gas central heating, electrical wiring certificates, water checks, including compliance with Legionella , the responsible individual must ensure that copies of documentation that confirms all these checks have been completed to meet the health and safety regulations copies of these records must be kept at the home. St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 21 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 3 3 3 2 St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 22 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 OP29 Regulation 19 Requirement The registered person shall 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 Schedule 2 of the Care homes Regulations copies of that documentation must be kept at the care home and available for inspection at all times. A person shall not manage a care home unless he/she has the qualifications skills and experience necessary for managing a care home. Following the six month probationary period the acting manager must apply to C.S.C.I. to become the Registered Manager. The registered person shall ensure that the records specified in Schedule 4 of the Care Homes Regulations are at all times available for inspection. Timescale for action 01/12/05 2 OP31 9 01/01/06 3 OP38 17 01/01/06 St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Michael`s DS0000025185.V260587.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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