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Inspection on 15/10/08 for St Michael`s Care Home for the Elderly

Also see our care home review for St Michael`s Care Home for the Elderly for more information

This inspection was carried out on 15th October 2008.

CSCI found this care home to be providing an Poor service.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

St Michael`s is a small home which provides a `family` environment due to the small number of people who live there. Most residents have their own rooms, which have been personalised. Visitors are made welcome.

What has improved since the last inspection?

Over the last two inspections there had been some improvements. Some of the staff have attended training courses, which are relevant to the care provided and should help to provide a better quality of life for the residents. A manager has also been appointed to run the home. Since the new Manager has been in post, areas that have been highlighted in the last three Key Inspections have started to be improved. All residents now have a detailed care plan, which provides staff with in-depth knowledge of their care needs and how these are to be provided. Care plans are also being regularly reviewed and updated, to ensure the individual residents receive the care required. Medication processes have improved since the last inspection. The new Manager has arranged for all residents to have their medication reviewed and up to date records put in place. There is more written documentation available to help identify that the home has systems in place to safeguard both the staff and service users. From discussion with the new Manager she is also aware of the areas that need further development and had already started many of these.

What the care home could do better:

The are still significant areas in the home that need further development and these are areas that have been brought to the Provider`s attention in the last three inspection reports and requirements made. The new Manager had improved some of the areas, but the ones that the provider maintains responsibility for are still much the same. Choices within the home are still very restrictive and this is made worse by the present staffing levels of the home. Practice within the home is still very task orientated and does not involve choice for the residents. Areas that this effects particularly is with regard to choice of food, choice of activities, choice in their daily personal care, when they want to go to the toilet and the times they want to get up in the mornings and go to bed at night. The new Manager has incorporated choice in their care plans, but realistically this cannot be adhered to due to the low staff numbers within the home. There are still limited appropriate activities for residents within the home. This has deteriorated since the last inspection. Also, due to the reduced staffing levels and the fact that staff provide the cleaning and cooking tasks within the home, the organisation of activities is limited and does not provide stimulation.The staff recruitment and induction needs to improve. From the rota it would appear that a new member of staff had been started without the correct information being gained, putting residents and other staff at risk. Due to the recruitment information not being kept within the office for inspection, it is not possible to make the necessary checks to ensure that staff are being recruited correctly. Due to our concerns regarding the quality of care provided we will be seeking legal advise regarding enforcement action.

CARE HOMES FOR OLDER PEOPLE St Michael`s Care Home for the Elderly 20 Meteor Road Westcliff On Sea Essex SS0 8DG Lead Inspector Mrs Sharon Lacey Unannounced Inspection 15th October 2008 10:00 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 Care Home for the Elderly DS0000069721.V372845.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 Michael`s Care Home for the Elderly DS0000069721.V372845.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Michael`s Care Home for the Elderly Address 20 Meteor Road Westcliff On Sea Essex SS0 8DG 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) 01702 354735 01702 301060 Kennethmgshpd@yahoo.co.uk Dr Kenneth Ihuoma Vacant Care Home 8 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (8) of places St Michael`s Care Home for the Elderly DS0000069721.V372845.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd July 2008 Brief Description of the Service: St Michaels Rest Home provides accommodation and care for eight older people with dementia. It is a small family style home. The lounge is situated at the front of the house and the dining room overlooks the garden. Toilet and bathroom facilities are on both floors. The home offers six single bedrooms and one double, which has been separated to ensure privacy. Rooms vary in size, but none have ensuite facilities and some would be too small for wheelchair use. A shaft lift provides access to both floors where residents accommodation is provided. St Michaels Rest Home is close to local amenities, including transport facilities. There is limited parking on site, but additional parking is available on Meteor Road. Weekly fees range from £335.16 to £416.85 depending on the care required. St Michael`s Care Home for the Elderly DS0000069721.V372845.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means that people who use this service experience poor quality outcomes. This was a routine unannounced inspection, which took place over five hours. It was a key inspection looking at the outcomes for the individuals against 24 of the National Minimum Standards. Two inspectors undertook the site visit where a tour of the home and an inspection of the environment was completed and records and documentation were viewed. Areas looked at included information given to residents about the home and its services before being admitted, information given by the home from residents when they first come into the home, how this information is then given to staff on the care required, the facilities and environment of the home, and any complaints that may have been received since the last inspection. Also the staffing and management of the home were inspected. We also looked at any information that had been provided to us since the last inspection. An Annual Quality Assurance Assessment (AQQA) had been sent to us by the Proprietor. The AQQA is a self-assessment, required by law, which focuses on how well they considered they are meeting the outcomes of the people using the service. It also provides statistical information about the service and how the service intends to improve over the next 12 months. Information from this document has been used in this report where appropriate. Questionnaires were sent to the home to be distributed. Of these four were returned. Comments received from the questionnaires have been added where appropriate. Residents were spoken to during the inspection and their interaction with staff was also observed. Both staff members on duty were spoken with informally during the inspection and any feedback has been included as part of the report. What the service does well: St Michaels is a small home which provides a family environment due to the small number of people who live there. Most residents have their own rooms, which have been personalised. Visitors are made welcome. St Michael`s Care Home for the Elderly DS0000069721.V372845.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The are still significant areas in the home that need further development and these are areas that have been brought to the Provider’s attention in the last three inspection reports and requirements made. The new Manager had improved some of the areas, but the ones that the provider maintains responsibility for are still much the same. Choices within the home are still very restrictive and this is made worse by the present staffing levels of the home. Practice within the home is still very task orientated and does not involve choice for the residents. Areas that this effects particularly is with regard to choice of food, choice of activities, choice in their daily personal care, when they want to go to the toilet and the times they want to get up in the mornings and go to bed at night. The new Manager has incorporated choice in their care plans, but realistically this cannot be adhered to due to the low staff numbers within the home. There are still limited appropriate activities for residents within the home. This has deteriorated since the last inspection. Also, due to the reduced staffing levels and the fact that staff provide the cleaning and cooking tasks within the home, the organisation of activities is limited and does not provide stimulation. St Michael`s Care Home for the Elderly DS0000069721.V372845.R01.S.doc Version 5.2 Page 7 The staff recruitment and induction needs to improve. From the rota it would appear that a new member of staff had been started without the correct information being gained, putting residents and other staff at risk. Due to the recruitment information not being kept within the office for inspection, it is not possible to make the necessary checks to ensure that staff are being recruited correctly. Due to our concerns regarding the quality of care provided we will be seeking legal advise regarding enforcement action. 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 Michael`s Care Home for the Elderly DS0000069721.V372845.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 Michael`s Care Home for the Elderly DS0000069721.V372845.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. This judgement has been made using available evidence including a visit to this service. People cannot be sure that the home could meet their needs due to incomplete information. EVIDENCE: Since the last inspection, a Manager has been recruited to help the Proprietor manage and run the home. On discussion it would appear that the Service User Guide and Statement of Purpose has not yet been updated to include the new Managers details. The manager advised that she was in the process of reviewing these documents to ensure they met with Regulations and that she aimed to produce this into two documents rather than one, to help make the information for the users of the service clearer. The present document could be found in the homes foyer. St Michael`s Care Home for the Elderly DS0000069721.V372845.R01.S.doc Version 5.2 Page 10 A copy of the last inspection report was not readily available, but on bringing this to the Managers attention she proceeded to place one in the foyer to ensure that relatives and visitors could gain access. There have been no new residents admitted to St Michaels whilst it has been registered to the current provider. At present the home has five residents, all of whom have some form of dementia. The Manager advised that she was in the process of reviewing the present assessment form, to ensure it meets the requirements and also gains sufficient information to ensure the home is able to meet any new residents needs. Although written evidence of the home’s admission procedures could not be obtained, the AQAA previously submitted stated we carry out a detailed pre-admission assessment before any admission takes place. It was confirmed that each resident is provided with a Statement of Terms and Conditions of the home. When looking for evidence on two residents files, both contained a contract, but it was noted that one of these was still under the previous Proprietors name and not the new owner. Feedback from the questionnaires confirmed that two residents had received a contract and two had not. One relative added the terms and conditions at the home were gone through in 2005, but I have never received anything in writing. Intermediate care is not provided at this home. St Michael`s Care Home for the Elderly DS0000069721.V372845.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 good. This judgement has been made using available evidence including a visit to this service. People can be sure that their care and health needs will be met in the way they would want. EVIDENCE: Poor Individual care plans for residents has been a concern that has been raised with the Proprietor in the last three Inspections. The new Manager has now produced care plans for each of the residents and these are much more in-depth and provided details of the care required and how this is to be provided. The new care plans have been made available to staff, so they are aware of the residents care needs. There was also evidence that relatives had been involved in this process and they had signed the plan to confirm that they agreed with its content. Those care plans seen had been reviewed and information updated as the needs of the residents changed. The Manager stated that she intended to review care plans every three months, but more often if needed. Files also contained evidence that reviews with Southend Borough Council had also taken place since the last inspection. St Michael`s Care Home for the Elderly DS0000069721.V372845.R01.S.doc Version 5.2 Page 12 Files contained evidence of risk assessments, which identified areas of risk and measures that had been put into place to reduce this. Files had evidence of District Nurse, GP and hospital interaction. It was clear that residents had recently had their flu jabs. Weight charts were now in place, which would assist in monitoring residents nutrition and health. Visits from opticians and chiropodists had been arranged by the Manager. Medication was checked as this had been an issue in the last three inspections. Since the last inspection the new Manager had introduced a safer system, which included the receipt, recording, handling and administration of individual residents medication. She had produced a medication folder, which was clearly labelled and had photos of residents to assist staff in identification. There were also signatures of the staff who provided medication at the front, which would assist in any auditing or concerns that may be raised. It was noted that medication had also been covered in the care plan and included what assistance was required. The Manager stated that she was in the process of organising for staff to be provided with guidance on when as and when mediation may be needed for individual residents. She had already contacted the residents GPs to arrange reviews of their medication. Only three of the four staff who provide medication had evidence that they had received training. St Michael`s Care Home for the Elderly DS0000069721.V372845.R01.S.doc Version 5.2 Page 13 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 poor. This judgement has been made using available evidence including a visit to this service. People experience poor quality of life with regard to nutrition, routines and activities. EVIDENCE: The routines of the home were discussed with the Manager and the carer on duty, at the time of the inspection, and care plans were reviewed. Whilst the care plans had been written in a person centred way, with choices and preferences identified, regarding the routines of the day, the reality is that the actual delivery of care is task led rather than resident led. This primarily relates to the current staffing levels and abilities of the staff on duty. For example, residents’ care plans state that they like to get up at 07.00 or 07.45, but staff on duty said that they get all the residents up about 8a.m when they come on duty. The member of staff covering the night duty (the provider) does not get anyone up and it was also noted that he is not trained in manual handling. One relative commented that only one member of staff had been on duty when they had visited. This was reiterated by comments received from the questionnaires regarding the staffing of the home, this included I have noticed that on occasions that there is only one member of staff obviously available. The Proprietor is often the second member of staff, but he is upstairs in the flat and not readily available and I am aware that staff are St Michael`s Care Home for the Elderly DS0000069721.V372845.R01.S.doc Version 5.2 Page 14 expected to work 12 hour shifts, 6 days a week - on occasions I have seen staff working double shifts. The Manager stated that due to the staffing levels and the shift system all the residents in the home are put to bed before 8 pm and there is no choice about this and they cannot get up until after 8 a.m. This means that residents spend twelve hours in bed regardless of their choice or needs. Minutes of the Staff Meeting held in August 2008, showed that the Proprietor had changed the staff shifts and he now expected the residents to all be in bed at 8.pm. Discussion with staff demonstrated further that the care is task led, as staff said that the residents are already waiting for them when they come on duty. Residents are then washed, dressed, given breakfast and medication and then taken to the front lounge. Staff then stated that they then do the cleaning and prepare the lunch. Residents were observed to be automatically toileted before lunch, as part of a task led routine and contact/interaction during the morning with them was limited. Residents were seen to be in the lounge during the morning, with no care staff in attendance the majority of the time. A resident spoken to said that, whilst they are quite happy at the home and some things are improving with the new Manager in post, they had no-one to undertake activities with them, that they liked. The new Manager has made efforts to improve the activities offered to residents since we last visited the home. The activities file was seen to contain a list of activities offered to the residents and the Manager said that the list was based upon her knowledge of what they were able to do. The Manager stated that she was planning a meeting with the residents to discuss social activities with them further, so this aspect of their care could be developed. Record sheets of activities that are undertaken are now in place and completed as appropriate. The activities offered include, singing/dancing, colouring books, jigsaws, hoopla, dominoes and build a beetle game. Whilst improvements have been made, the social side of care still needs to be developed in order to stimulate residents, meet their preferences and needs, in relation to retaining skills, independence and promoting self worth. At the current time the staffing levels and/or staff deployment in the home restrict this. When residents were asked whether activities were organised that they could take part in, one stated usually, two said sometimes and one added never. One relative added I have rarely seen any of the staff just sit and chat meaningfully with the residents. Visitors spoken to said that they were made welcome when they visited the home. St Michael`s Care Home for the Elderly DS0000069721.V372845.R01.S.doc Version 5.2 Page 15 The meal service in the home was reviewed. Food stocks, whilst adequate, did not link into the menu displayed in the dining area. The menu displayed also did not outline what was available for the evening meal. Staff spoken to confirmed that they provide meals with the ingredients that they had available to them. For example, the menu listed on the day of our inspection stated braising steak or meatloaf for lunch. The carer cooking the meal provided, a fried egg with salad, mashed potato and a tomato and onion sauce and then rice pudding. A resident who needs a soft diet was given mashed potato with left over cabbage from a previous meal and gravy. This is not seen as a balanced diet. The carer cooking commented that ‘the residents enjoy suede and broccoli, but they don’t have that now, occasionally cabbage, there is a lack of fresh veg’. No fresh vegetables were seen in the kitchen. Residents observed at lunchtime confirmed to us that they enjoyed their meal. One resident had a sandwich for lunch, as she was reluctant to have a meal. Residents spoken to before lunch said that they did not know what they would be having. Of the three residents who fedback about the quality of the food at the home, two stated they usually liked the food, whilst one stated they sometimes did. Comments included food standards have gone down - I have on occasions had to buy biscuits for tea as there have been none available and her diet now seems to have deteriorated over the past 18 months. The Manager stated that she has not been able to review the menus at the home, due to not having control of the food budget and the Proprietor undertaking responsibility for the food shopping. Residents’ nutritional records were checked and they show that sometimes the menu is followed. Occasionally records state that residents had the ‘chef’s choice’. It is unclear as to what this meal is or if the residents had any input to the choice made. The record does not indicate how much they ate, but daily records were seen to record ‘ate well’ for most of the residents. Minutes of the staff meeting held in August 2008, which was attended by the Proprietor, stated that ‘the staff stressed that there are several occasions where there are no choices as stated on the menu and it had been agreed that there was little or no communication between the staff and the management, which resulted in shortage of options’. The dining table had been laid with large colourful plastic placemats, with childlike cartoon characters on them. This was not seen as age appropriate for the resident group and does not promote their dignity. Residents were poured drinks, with no choice given and no condiments or serviettes were available to use. Care staff were observed to be feeding a resident and the interaction observed was seen to be inappropriate with the carer whistling closely in the face of the resident to gain their attention, rather than just speaking to them. Both inspectors found, at different times during the day, that this resident could interact with them following normally speech and smiling etc. The carer was St Michael`s Care Home for the Elderly DS0000069721.V372845.R01.S.doc Version 5.2 Page 16 also observed to feed the resident in an insensitive way, feeding, both food and drink, too much, too quickly and dropping food down their front and there were no serviettes, to help maintain the resident’s dignity. St Michael`s Care Home for the Elderly DS0000069721.V372845.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 good. This judgement has been made using available evidence including a visit to this service. People are protected by the training and systems in place to minimise risks. EVIDENCE: There is a simple and clear complaints procedure, which includes the stages and timescales of the process and details of this can be found in the Statement of Purpose. The new Manager stated that she had updated the CSCI details in the document to ensure these were correct. It was noted that there is a note book in the foyer for visitors to write any complaints or comments. Safeguarding is an area that has improved at the home over the last two inspections. All staff have now attended safeguarding training and when speaking to staff on duty they had an understanding of the issues around whistle blowing and protecting vulnerable adults. St Michael`s Care Home for the Elderly DS0000069721.V372845.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. This judgement has been made using available evidence including a visit to this service. Whilst the home meets residents’ basic needs, the environment as a whole does not always provide a pleasant, safe and stimulating place in which to live. EVIDENCE: A full tour of the home was undertaken. Overall the décor of the home is at an acceptable standard, although the woodwork in some parts requires attention. The environment is in need of refurbishment in some areas and this primarily relates to the standard of furniture and fittings. Much of the bedroom furniture, including some of the beds, is old and items such as wardrobes do not have doors that shut. Residents were seen to have personalised bedrooms and have the use of a pleasant lounge at the front of the home. The bathrooms need upgrading, although since taking up post the Manager has arranged for integral bath hoists to be fixed so they can be used. The Manager has been using the services of an independent maintenance man to St Michael`s Care Home for the Elderly DS0000069721.V372845.R01.S.doc Version 5.2 Page 19 carry out small repairs in the home and she has also arranged for a new water heater to be fitted later this month, which will help with the control of hot water temperatures within the home. Records show that the Manager has been checking the temperatures of the hot water around the home on a regular basis. Ongoing maintenance is an issue in the home, as toilet seats were noted to be broken, along with furniture and this reflects poorly on the home and the environment for residents to live in. The quality of some of the bedding supplied is poor as sheets and duvets were noted to be thin, as were pillows. It was also noted that areas of hall carpet were rucking up and in some areas coming away from the door grips, creating potential tripping hazards. The Manager acknowledged that this needed attending to. The home has a small garden to the rear that is laid to patio with flowerbeds around the edges. Garden furniture is supplied but overall the garden requires attention in order to make it a pleasant place to spend time and view. The Proprietor does not employ any cleaning staff and these duties are covered by care staff on shift. Since starting at the home, the Manager has been trying, with the care staff, to address the shortfalls previously noted in this area and on the whole the home was seen to be generally clean, but areas such as some skirting boards and unoccupied rooms etc. still require deep cleaning. One relative reported the common areas could be cleaner and some floors and skirtings have a build up of dirt. Generally not too bad - but no soap in the visitors toilet. When we arrived at the home the Manager was in the process of cleaning the cooker, taking her away from her managerial duties. It was noted on the day of the inspection that some bathrooms and toilets did not have paper towels for hand drying and the lifting hoists required cleaning. Unacceptable odours were noted in some bedrooms. There is no carpet shampooer available for staff to use to alleviate this issue. The Manager has some individual risk assessments in place that relate to the risk of fire for some residents, but there is no overall risk assessment for the home itself. This needs to be addressed so that all fire risks are assessed and measures put in place to reduce risks as far as possible. Since the new Manager has been in post there has been a staff fire drill and now the alarms and emergency lighting systems are tested weekly. Annual servicing/maintenance certificates for the fire alarm and emergency lighting are not available. This needs to be addressed to ensure that the system is working correctly throughout the home and is up to current required standards. St Michael`s Care Home for the Elderly DS0000069721.V372845.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. This judgement has been made using available evidence including a visit to this service. People cannot be sure that they will be cared for by safely recruited staff or by staff who are correctly trained, which may be detrimental to the care offered. EVIDENCE: Staffing has been an issue highlighted in the last two key Inspections and also the random inspection. On the evidence gathered during this inspection, there are still concerns. The present numbers of staff are not appropriate to the assessed needs of the service users or the size and layout of the home. On the day of the inspection there was only one care staff member and the Manager on duty. It was established that two staff members had left since the last inspection and staffing of the home now consisted of the Proprietor, the Manager and two care staff, thus not giving any flexibility for staff taking holiday, sickness or attending training. On requesting the present staffing rota, the Manager advised that she did not have access to this and could not provide the document. She added that the Proprietor had taken responsibility for the rota and that she had found this difficult at times as she was unable to book staff training etc and was not aware of who was working when. Later in the inspection, whilst looking through the residents care notes, the rota was found in this folder. On viewing this it was clear that it was incorrect. The rota did not have times of working, just am, pm or long day. Most staff now worked a 12 hour shift at the home each day, meaning they assisted St Michael`s Care Home for the Elderly DS0000069721.V372845.R01.S.doc Version 5.2 Page 21 residents to get up and also go to bed. The Manager worked from 8.00 am to 16:00 pm and another member of staff came in from 16:00 till 20:00pm to help residents to bed. At the weekend two staff members worked a 12 hour shift due to the Manager being off. The Proprietor had also changed the night staffing ratio since the last inspection and instead of having one wake night and one sleep, he only had one wake night staff member. We had not been made aware of these changes. On the rota seen it was noted that the Proprietor was the only person down for the wake night and the rota showed that he had worked 7 wake nights in a row (11/10/08 till 17/10/08). The staff member on duty who was down for working a Thursday, stated that she never worked Thursdays, due to being at college, as the only other staff member was already working a long shift that day she was unable to say who would be covering. The Manager was unaware of the issue, as she had not had access to the staffing rota. It was noted there was a new staff members name on the rota and when the Manager was asked about this person, she stated that they had not started work yet as not all their recruitment checks had been completed. On viewing the rota it was pointed out to the Manager that this person had worked on the previous Saturday and Sunday (11 & 12 Oct 08) and this was confirmed as the staff member on duty had worked with them. No domestic staff, activities co-ordinator or cook is employed at the home and these tasks are seen as part of the duties of the care staff, which takes them away from the care of the residents. Recruitment has been raised in previous inspections and requirements have been made. The Manager was unable to provide details of the new staff member, who from the evidence on the rota had already worked at the home. She reported that she was not involved in the recruitment of new staff and that the Proprietor did this. No induction details of the new staff member were available, but the Manager stated that she intended to use the Skills for Care induction for all new staff. Staff had attended training since the last inspection and the new Manager had also organised a list of further training both she and the care staff were to attend. The Manager has achieved NVQ 4 and a member of the care staff has their NVQ 2 in care. Another member of staff is at present working towards their NVQ 3. All staff were well trained, although it was highlighted that further updates on dementia training may be useful, especially as that is the client group that they care for. The Manager was already booked for a course on dementia on the 3/11/08. it was noted that the proprietor is working at the home in the role of a care worker and had sole responsibility for the care of the residents at night, but the only training he had completed was Person Centred Planning and Safeguarding. The Proprietor had not completed medication training, health and safety training, moving and handling, dementia awareness or infection control training. There was evidence that the Manager had recently started to supervise staff. St Michael`s Care Home for the Elderly DS0000069721.V372845.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 poor. This judgement has been made using available evidence including a visit to this service. Users of the service do not live in a home that is always effectively managed or run in their best interests. EVIDENCE: The new Manager has worked at the home for approximately three months. She has a social work background and experience of working in residential and home care settings. She also has achieved an NVQ level 4 in care and has completed the Registered Managers award. Training records show that she is up to date with all the required training and has evidence that she has completed additional training relevant to her role. Since the manager’s appointment, there had been no Regulation 26 reports available from the Proprietor to evidence their working relationship and differing responsibilities within the home. Since she has been managing the St Michael`s Care Home for the Elderly DS0000069721.V372845.R01.S.doc Version 5.2 Page 23 home, there is evidence that she has made improvements with regard to several management and care aspects of the home, which had been repeated requirements. However, it is clear that her limited roles and responsibilities restrict what she is able to d, for example, not having access to the staff rota – set by the Proprietor, not being involved in the recruitment of staff and not having input to the meals service in the home. These were all areas that had little or no improvement since the last inspection. It was clear from discussions during the day that the manager had a good understanding of the Regulations and the systems she had put in place would improve the quality and safety of residents lives. Although this has been highlighted in previous inspection, the Manager confirmed that there is no formal quality assurance system within the home. Since our last visit the Proprietor has held one residents and relatives meeting. Minutes were available for inspection and these did not show any resident involvement or consultation. There is evidence that the Proprietor had asked the relatives during the meeting ‘what areas needed to be improved’, but there was no evidence that any further action had been taken regarding this. The Manager holds monies on behalf of residents and these were checked and found to be correct. It was reemphasised that two signatures should be gained for any monies taken out of individual residents finances, to help audit the accounts and keep the records in order and up to date. On touring the home it was noted that the Control of Substances Hazardous to Health guidance was not always followed and unlabelled cleaning items were freely accessible in the kitchen, which is open to residents. This risk was highlighted to the Manager. She was somewhat disappointed as she stated she had already done the COSHH assessments and these were in place, but other cleaning chemicals had been brought into the home without her knowledge. A random sample of safety and maintenance certification for fixtures, fittings and equipment in the home showed that the lifting hoists had been maintained, but the Proprietor does not have a safety certificate for the wiring of the home and this needs to be addressed to help ensure the safety of residents and staff. Accident records were reviewed and the Manager confirmed that there have been no accidents recently. Older records were seen to have been completed fully. St Michael`s Care Home for the Elderly DS0000069721.V372845.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 3 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 2 St Michael`s Care Home for the Elderly DS0000069721.V372845.R01.S.doc Version 5.2 Page 25 yes 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. Standard OP12 Regulation 16 (2)(n) Requirement There should be consultation with service users to arrange a programme of activities within the care home that meet their needs and interests. Any activities should be clearly recorded. This is a repeat requirement. Previous timescale for action given is 31/05/08 and 31/10/08 - these have not been met. New timescale given. 2. OP14 12 (2) 02/01/09 Care should be provided which enables service users to make decisions with respect to the care they are to receive and their health and welfare. This is in connection to ensuring residents have choice in the daily routines of the home as there is evidence of restriction of choice in food, care and bathing. At present the care is very task orientated. This is a repeat requirement. Previous timescales and 30/09/08 - these have not been St Michael`s Care Home for the Elderly DS0000069721.V372845.R01.S.doc Version 5.2 Page 26 Timescale for action 02/01/09 met. New timescale given. 3. OP15 16(2)(i) Residents should be consulted with and provided with suitable, wholesome and nutritious food, which is varied and available at reasonable times. Residents should be actively involved in producing the menu and ensure there is a choice of main meal and also alternatives if they do not like the choice on offer. This is a repeat requirement. Previous timescales for action given are 31/05/08 and 30/09/08 - these have not been met. New timescale given. 4. OP26 23 (2)(c) The home should be kept safe and risk free for both staff and service users. A safer system needs to be introduced for Control of Substances Hazardous to Health. This is a repeat requirement. Previous timescales for action given were 30/07/08 - this has not been met. New timescale given. 5. OP27 Schedule 4 (7) The staff rota must be up-todate and accurate reflection of staff cover, times, dates and staff on duty. Systems for night time cover need to be looked at and also the hour’s presently worked by the proprietor and staff, which could put the health and safety of residents at risk. This is a repeat requirement. Previous timescales for action St Michael`s Care Home for the Elderly DS0000069721.V372845.R01.S.doc Version 5.2 Page 27 02/01/09 02/01/09 02/01/09 given are 30/04/08 and 30/07/08 - these have not been met. New timescale given. 6. OP29 19(4)(b) Staff should not be working at the home until the employer has obtained the information and documents specified in paragraphs 1 to 7 of Schedule 7. This is to ensure the safety and welfare of the residents at the home. 7. OP30 Regulation To ensure that staff have the 18 knowledge and skills to safely (1)I(i)(ii) meet residents’ needs, they must receive regular relevant training. The home therefore must implement a clear training and development programme for all staff, and ensure clear documentation is in place demonstrating this. Evidence gathered during the inspection shows that training updates for dementia, and health and safety should be organised for staff. Also the registered person must also attend courses relevant to providing hands on care within a care home as he is providing personal care to many of the residents and covering their night care needs. 8. OP33 Regulation 24 (1)(a)(b)( 2)(3) To ensure that the home is run in the best interests of residents, the home should establish and maintain a system for evaluating the quality of services provided at the care home. This must include systems for obtaining feedback from residents and their representatives about the DS0000069721.V372845.R01.S.doc 02/01/09 02/01/09 02/01/09 St Michael`s Care Home for the Elderly Version 5.2 Page 28 quality of care in the home, but should also include other quality monitoring processes, including an annual development plan and internal auditing practices. That this documentation is in place and available for inspection. This is a repeat requirement. Previous timescale given are 31/3/2008, 31/05/08 and 31/3/09. These have not been met. New timescale given.. 9. OP37 OP38 Regulation That all records and essential 17(1)(3)( documentation is in place and b) available for inspection. This is a repeat requirement. Previous timescale for action given is 31/03/08 and 30/9/08 this has not been met. New timescale given. The proprietor should ensure that all safe working documentation relating to . These should include fire checks and wiring of the home. 02/01/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations Ensure the information in the Service users Guide and Statement of Purpose is up to date and appropriate. It is also recommended that residents and relatives receive an updated copy. St Michael`s Care Home for the Elderly DS0000069721.V372845.R01.S.doc Version 5.2 Page 29 2. OP2 All residents should receive an updated contract with the present Proprietor which includes details of the terms and conditions of the home and also the room number. It is recommended that the pre admission assessment form be checked against the list under 3.3 of the NMS to ensure all the information required is collected at the assessment stage. It is recommended that you develop community involvement with the home. It is recommended that a training matrix is introduced which clearly shows what training has been completed by staff and when updates are required. It is recommended that two staff sign to confirm withdrawals of resident’s money. It is recommended that further training is completed to help the registered person to gain knowledge and a better understanding on how to manage a care home. 3. OP3 4. 5. OP13 OP30 6. 7. OP35 OP31 St Michael`s Care Home for the Elderly DS0000069721.V372845.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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