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Inspection on 21/02/08 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 21st February 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 Michaels is a small home, which has regular staff. Visitors are made welcome and residents are encouraged to have community contact. Work had been done on the medication process since the last key and random inspection. There is now a medication folder in place, which has details of all residents medication and there is also a sample of staff signatures. The registered person has been proactive with regard to training staff for NVQ`s since he took over the home. One staff member has started their NVQ 3 and another their NVQ 2. Another staff member had been recruited with an NVQ 2.

What has improved since the last inspection?

Some slight improvements have been made since the last inspection. Brief written evidence is now available for staff supervision and also an annual appraisal for each staff member was available. The registered provider has started to introduce procedures to try and meet the National Minimum Standards.

What the care home could do better:

Systems need to be introduced to help the registered provider to clearly identify that the National Minimum Standards and Care Home Regulations are being met. Unfortunately, during the last three inspections written records have not always been available and/or they did not meet the required standards. Many of the areas highlighted in this inspection have been around the lack of records and processes. Routines within the home do not always encouraging choice for residents. Areas around food, bathing and general provision of care often offered little choice and where around staff routines. The registered person does not at present have an induction in line with the Skills for Care recommendations. Supervision has started, but needs to be more in-depth and include clearer notes on the areas covered. Staff have completed training in the past, but evidence showed that some staff needed updates on moving and handling, medication, infection control, food hygiene, health and safety and safeguarding adults.

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 21st February 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.V360027.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.V360027.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.V360027.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th November 2007 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. There is a bathroom situated on each floor. Toilet facilities are on both floors. The home offers six single bedrooms and one double, which have 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 service users 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.V360027.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 nil (0) stars. This means the people who use this service experience poor quality outcomes. This was a routine, unannounced Inspection, which took place over five hours with two Inspectors. The site visit focused on all the Key Standards. This was the home’s second inspection since being registered in April 2007 and it had also had a random inspection in November 2007. A tour of the home was completed and a review of documentation took place. Areas looked at included information provided to residents before being admitted to St Michaels Rest Home; information gained when residents first come into the home; how information is 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. The staffing and management of the home were also inspected. During the tour of the home most residents and two relatives were spoken to about their life and experiences at St Michaels Rest Home. Residents were also observed during the day interacting with staff. Two staff were spoken with during the inspection and this feedback has been included as part of the report. A nurse visiting the home was approached regarding her experiences of the home. At the end of the day it was not possible to give feedback to the Proprietor, as he had to leave before the end of the inspection due to a prior engagement. What the service does well: What has improved since the last inspection? St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 Page 6 Some slight improvements have been made since the last inspection. Brief written evidence is now available for staff supervision and also an annual appraisal for each staff member was available. The registered provider has started to introduce procedures to try and meet the National Minimum Standards. 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. The summary of this inspection report can be made available in other formats on request. St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 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 Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents are not provided with the required information about the home to enable them to make an informed choice on whether the home can meet their care needs. EVIDENCE: The statement of purpose and service users guide was not seen within the foyer of the home or visually available. The registered person had to be asked to provide copies of these documents and on requesting the most up to date copy of the service user guide, a copy of a blank resident contract was provided from the office. The registered person stated, that the service user guide and statement of purpose was one document. Another copy of the statement of purpose, with a more current revision date was then provided and the registered person advised that he had changed the title to include the words ‘service user guide’ as well as the statement of purpose. On reviewing this document, the statement of purpose was written in clear language and had quite big print that made it easier to read. However, it was noted that the St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 Page 9 document provided did not include all the information required. Information missing included guidance for people thinking about/using the service, such as the terms and conditions relating to accommodation, the facilities available and services to be provided and the amount and payment of fees, information about accessing the most recent inspection report, service user views of the home, details on how to contact the Commission and a summary of the complaints procedure. There have been no new residents admitted to St Michaels whilst it has been registered to the current provider. At present the home has seven residents, all of whom have some form of dementia. The Proprietor stated that the admissions process would include a home visit to enable information to be gathered on the care required. It was confirmed that there are set forms, which would be completed at the assessment stage, but these were not viewed. On viewing the statement of purpose that was provided, it was noted that the information on admissions did not explain to people what they could expect when they move into the home or that they are welcome to go to the home for a trial visit before making a decision to live there, so with this in mind residents would not receive the information required. It is recommended that this information be included in a service user’s guide. St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, 5 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans do not cover all the residents care needs and those areas not recorded could potentially provide an inconsistent approach to residents needs. Health services are available, which promote the residents assessed health needs. EVIDENCE: Two care plans were reviewed. The first was for a resident who had complex needs. This care plan identified a number of the person’s assessed needs such as personal hygiene/care, religion, nutrition and specific behaviours, but it did not offer any information or guidance to help staff to manage these consistently or in the way that was best for the person. The second care plan contained some information on care required, but needed to be developed further to advise staff on how this care was to be provided. There was little written evidence on individuals files that residents had been involved in their plan of care. St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 Page 11 The registered person had written two reviews of the care plan in recent months, which was positive. However, one identified that the person had speech problems, needed full feeding and was in bed for 18 hours of the day; but did not include information to staff on how the care was to be provided and the registered person had written that there is no special care plan for M. The registered person advised that the resident in question had developed a pressure sore whilst in hospital and the district nurse team had been accessed to care for a resident’s pressure sore and their nursing care plan was readily available in the resident’s file. However, it was noted that the care plan for the home did not include instruction to staff on pressure care or details of treatment and outcome recorded. Furthermore, there was no information on what care the person needed, for example, in relation to personal and oral care, chiropody, communication or social and emotional needs etc. The file did not contain any risk assessments relating to nutrition or pressure area care to help promote health and prevent any other skin breakdowns. The most recent moving and handling assessment on file dated 7th December 2007, identified moving and handling risks and stated that the person could weight bear with two carers and that they need to be hoisted. When a staff member was spoken to regarding the moving and handling needs of this person, they stated that the person was not weight bearing and was hoisted for all transfers, which was contradictory to what was actually documented on her personal file/care plan. Evidence on other files showed that residents had access to community and hospital based healthcare. With regard to privacy and dignity of residents who live in the home, staff were observed knocking on residents’ bedroom doors before entering, asking residents whether they needed to use the toilet and one resident was observed being taken to their own bedroom by a healthcare professional for treatment. One visitor spoken to stated that due to being a small home there was little privacy when visiting their relative, as visiting usually occurred in the main lounge with other residents present. The registered provider’s attention was drawn to dirty hairbrushes and combs in residents’ bedrooms, as it was felt that these did not support their dignity. A staff member advised that the toiletries, shaving razors and the comb in the downstairs communal bathroom belonged to residents, but it was pointed out that this does not support confused people in managing their dignity and the razors raised a potential risk. The staff member could not explain why two pairs of residents’ glasses were stored on the bathroom shelf but advised that these were ‘spares.’ St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 Page 12 Work had been done on the medication process since the last key and random inspection. There is now a medication folder in place, which has details of all residents medication and there is also a sample of staff signatures. Photographs of residents were now on file to assist staff in identification, but it was noted that some of these pictures were very dark and would not assist this process. Most MAR sheets had been correctly completed. On viewing one MAR sheets it was noted that one resident had three blank areas. On speaking to the registered person it was stated that this was due to being an ‘as and when medication’. On further investigation it was noted that this person did not have a PRN sheet to advise staff of signs and symptoms of when this medication may or may not be needed. The registered provider was advised that a record of all medication either assisted with or given must be made. One staff member was observed coming into the office, dispensing medication from a blister pack, signing for the medication and then taking it back to the resident in the dining area at lunch time. This process is not seen as good practice. Staff had evidence that they had received medication training during 2005 and 2006, but one file stated this was only valid until April 06 – there was no written evidence on file that any update had been received. St Michael`s Care Home for the Elderly DS0000069721.V360027.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): 12, 13, 14 and 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living at St Michaels can expect limited opportunity to take part in meaningful social activities, and limited opportunity to make choices about the everyday things in their lives or in the meals they eat. Their visitors will be welcomed. EVIDENCE: Activities in the home had been highlighted in the last key inspection and also the random inspection and requirements made. The registered provider kindly made the record of activities available. Evidence showed that this was completely blank for the month of January, but had ten entries for the month of February, including dominoes, cards, reading, listening to radio book, singing and clapping, chattering to self, walking up and down, watching television and sleeping. One resident goes to a club outside the home and the mobile library visits every three weeks. Staff were seen to play a hoopla game with residents during the morning and then again in the afternoon. Relatives spoken to stated this was new and they had not seen this before. Some residents were observed playing dominoes in the dining room after lunch. There was no written evidence on files of activities tailored to individual needs and reflecting people’s interests or abilities. St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 Page 14 An activity plan was not available on the care plan sampled. On another file the care notes stated ‘watching television’. Staff on shift are required to provide any activities within the home. It was recommended in the last inspection report that an activity co-ordinator was employed as staff had little time to fit in any ‘quality’ 1-1-activity time for residents on a day to day basis as their tasks also consisted of cleaning the home, laundry, care and also the cooking of meals. A weekly activity programme should be produced to accommodate residents interests and abilities. . The statement of purpose clearly shows that residents are encouraged to maintain regular contact with their family and friends and that there is a flexible approach to visiting times at the home. Relatives spoken to stated they felt welcomed at St Michaels. Although a bath with assisted seat is situated on the first floor, both care staff and the register provider stated that all residents at St Michaels are given a weekly shower on Sundays. When asked about offering residents the choice to have a soak in a bath, the registered provider stated they are given showers as he thinks it is best for them to shower in terms of risk, due to the risk of drowning. Relatives spoken to stated that they felt they could no longer bring gifts such as nice biscuits for their own relatives use, as these had recently been put in the kitchen for the use of all residents at St Michaels. The statement of purpose states that service users are offered plenty of choice relating to mealtimes and are offered a four-week rotating menu. On the day of the inspection, staff advised that all residents had chosen to have beef burgers, as none of them liked the other option of sausage toad. This was pointed out to staff that it restricted resident’s choice. It is recommended that the menu be reviewed to remove items that are not to be liked by the residents, as this is not offering an active choice. Residents spoken to at lunchtime said they had enjoyed their lunch. The registered provider confirmed that much of the food in the fridge belonged to staff. It was noted that there were no obvious sandwich fillings such as cheese or cold meat in the fridge, when asked, the registered provider stated that residents would not be able to choose to have a sandwich during the afternoon or for tea as this was not what was on the planned menu. The registered person stated that hot drinks and biscuits were provided at certain intervals throughout the day. Issues around food were highlighted in the random inspection regarding nutritional diets and choice of food. St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 Page 15 The care staff member cooking at the time of the site visit was seen to wear appropriate protective clothing. Staff had received food hygiene training, but four other staff required further updates. There were several frozen items of meat in the freezers, but these had not been labelled to identify content or the date they had been frozen. Some partly opened items were shown to a staff member who then disposed on them. A recent environmental health inspection had been undertaken. Not all actions identified were seen to have been completed, such as the proper date labelling of foods (as stated above) or the provision of a food safe disinfectant / sanitizers in the kitchen. A Residents meeting took place when the registered person took over the home in June 2007 – but none had taken place since. When the registered provider was asked how often residents/relatives meetings would occur, to help establish their thoughts and feelings on the way their home was run, he advised that an annual meeting would be arranged. St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 Page 16 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): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is not an accessible, clear and up-to-date complaints procedure within the home for residents or relatives to use. Not all staff had an understanding of the meaning of safeguarding residents, which reduces the safety and protection of residents. EVIDENCE: The statement of purpose advises that the registered person “aims to deal with any complaints in a fair and expeditious manner”. It is recommended that it includes some more information on the availability of the home’s complaints procedure and how to access it. Details of the complaints procedure was not on display or easily accessible to residents or relatives. The statement of purpose provided by the registered person identified the previous registered manager as the named complaints manager, and had not been updated to include accurate information. It also had the CSCI office address in Southend, which was closed in November 2007. It is recommended that it be produced in an easy to read format taking into account the needs of the people living at St Michaels and made easily available. The registered person stated that no complaints had been received. He advised that the complaints book was the wire bound shorthand type notebook that was kept in the entrance foyer underneath the visitor’s book. A clearer logging system for complaints was available, which is positive, and guidance was provided on producing an organised format and system for recording and investigating any complaints received in the future. St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 Page 17 The registered person stated that the he had a procedure for dealing with resident’s monies. One resident’s money was checked and this was in order. Information on advocacy services was displayed in the hallway. The registered person stated that policies and procedures were in place for Safeguarding Adults and Whistle Blowing, but these were not viewed at this inspection. Evidence showed that all staff had attended training, but one required an update. Staff on duty were asked what their understanding of the word ‘whistle blowing’. One gave a correct answer, whilst the second stated it was when an alarm or noise that was made due to a fire or an emergency. The home has had one safeguarding referral since the last inspection. St Michael`s Care Home for the Elderly DS0000069721.V360027.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): 19, 22 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable environment for residents to live in. Infection control issues do not meet standards of good practice and ensure residents are kept safe. EVIDENCE: St Michaels is a small family style home. Residents have the use of a pleasant front lounge where relatives advised the television had recently been replaced. Handrails were available to assist residents when walking along the corridor. Meals are eaten in the dining room at the back of the house and the recent rearrangement of the furniture makes the room look and feel more spacious and accessible. There is a small back garden for resident use. During a tour of the home it was noted that residents bedrooms were personalised with items that they had been able to bring with them, such as photographs. It was noted that some of the vanity units were in poor condition. In one residents room the wardrobe door could not be closed. The registered person stated there was a ‘knack’ with the lock and it was pointed St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 Page 19 out that this form of closure would be unsuitable for a confused or a frail older person. It was noted that some of the metal window frames in bedrooms had black areas along the bottom and much of the way up the sides. The registered provider stated it was white paint, but he was advised to ensure this did not prove unhealthy for residents and that the windows still opened. A curtain rail in a resident’s bedroom had partly come away from the wall making the curtains difficult to open and close. The registered provider said this would be addressed and it was planned to buy a new one. No date was made available for this and no record of maintenance or audit of the premises was available for inspection. Relatives spoken to on the day of the inspection advised that the curtain rails had been like this for some time. There is a downstairs shower room and toilet and a separate toilet for resident use. The bathroom on the first floor has an assisted bath chair, which the registered provider confirmed had been recently serviced. A separate toilet is also available on this floor. Infection control issues were sampled and found not to reach standards of good practice in some aspects. The laundry is sited on the ground floor. The registered provider was unsure if the washing machine had a sluice cycle, but advised that all laundry, including any soiled laundry, is put together in the one available white basket to be brought downstairs to be washed. A staff member said they have access to adequate protective equipment such as gloves and aprons. Four staff needed training in infection control. It was noted at the last random inspection that the staff toilet seat was broken, this was still the same on this inspection. There were hand-washing facilities in the toilet, but it was pointed out to the registered person that the soap would not come out of the dispenser. The registered person had to massage the liquid soap to assist a solid lump of soap to come out and this raised questions on how staff had managed to wash their hands during the morning shift. It was also noted that the sink in the utility room had not been washed round after being used and looked dirty. One relative spoken to stated that they had hoped that the home would have been improved when taken over, but added that to date no decorating or new furnishings had been bought. A programme of routine maintenance was not available. Some radiators have not been covered throughout the home, but the registered person stated that risk assessments had been completed. It was stated that these need to be reviewed on a regularly basis to ensure they meet the present residents safety needs, especially if new residents are admitted to the bedrooms. St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 Page 20 The registered person stated that water temperatures are checked regularly, but was unable to produce the record book that evidenced this. The book was produced after the inspection and it was noted that some of the temperatures were over what is recommended. On further discussion the registered person stated that individual sinks did not have thermostatic valves fitted and any changes to the water temperatures were through the main water tank. It was pointed out that this is dangerous practice due to water temperatures in the kitchen and utility room needing to be a higher temperature than the bedrooms and also the risk of legionella. The registered person was advised that this needed to be addressed. St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 Page 21 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): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are still not fully protected by the recruitment process and practices. Residents cannot be sure that new staff would received a full induction to ensure they are competent in meeting their care needs. EVIDENCE: Staffing has been an issue raised in both the last key inspection and also the random inspection. The staff rota provided by the registered person was now accurate regarding the staff on duty. However, it did not show the start and end times of the shifts worked by staff, recording block periods such as morning or afternoon. St Michaels provided two care staff during the day, which also undertake all the cooking and cleaning tasks, and one awake and one sleeping in staff member at night. The rota showed staff working long shifts for the morning and afternoon. A staff member advised an afternoon shift finished at 10pm. The rota also showed a staff member working an afternoon shift, advised by staff as 3pm to 10pm, followed by an awake night shift, meaning that the staff member was on awake duty and responsible for the care of the residents for a minimum period of sixteen hours. This is not good practice as tiredness potentially puts both the residents and staff at risk. One staff member confirmed that she did a sleep night at the home once a week and also a wake night and slept on a ‘Z bed’ in the small office. On viewing the night care records on the night she completed a wake night, it was noticed that the registered person had written the care notes even though he was not present or on the rota during the night St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 Page 22 shift. This was brought to the registered persons attention and calls into question the validity of records in the home. Recruitment has been an issue raised in the last two inspections and requirements have been made. One staff file was inspected. This contained all the required information, but it was noted that the application form had gaps in the applicant’s employment and no record for the reason for this had been recorded. Also the health declaration had not been signed and dated. The registered person had introduced a new reference form, but it is recommended that the referee provide either a compliment slip or stamp, as it is difficult to authenticate where the references have actually come from. The registered person has been proactive with regard to training staff for NVQ’s since he took over the home. One staff member has started their NVQ 3 and another their NVQ 2. Another staff member had been recruited with an NVQ 2. The registered person stated during the registration process that he would be doing his NVQ 4, but to date he has not applied to start this. The issue of induction had been raised in the key inspection and also the random inspection and requirements made. The registered person has an internal induction of the home, but does not at present have an induction in line with the Skills for Care recommendations. The registered person stated he had not yet registered with Skills for Care. Staff training had been an issue raised in the last two inspections and requirements made. Staff training certificates had now been placed in a folder, but it was still difficult to gain clear evidence due to not being in order of any particular staff member. Also, it was noted that some of the staff files contained details of other training that staff had completed, so it was difficult to establish an overall picture of the competency of staff. It was established that updates in training were needed for some staff in moving and handling, infection control, safeguarding adults, food hygiene, fire and health and safety. It is recommended that the training details are developed to ensure information is easily seen. The registered person did confirm that he had arranged for one staff member to attend an update on food hygiene. St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 Page 23 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): 31, 33, 35 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents live in a home that continues not to be effectively managed or run in their best interest. The care provided does not always promote residents well being and dignity. EVIDENCE: The statement of purpose identifies that the registered person is a part time general practitioner. It states he has had a six-month training in care of the elderly, additional training courses relating to older people and “ extensive experience in management”. The registered person does not have previous experience in running a care home. This was identified during the registration process and the previous manager stayed at the home to enable him to gain some experience. It was also suggested that the registered person completed training relevant to the running of the home and providing care to the residents, to date no further training has been completed. St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 Page 24 Evidence gained from the staff rotas showed the registered person had been working four waking nights, two sleeping night shifts and one unspecified period for administration. In addition to this he has other employment as a locum GP, which demonstrates limited time available to effectively manage St Michaels on a day-to-day basis. Many of the issues highlighted in the last three inspections have been around procedures within the home and the availability of written documentation for evidence. Some slight improvements had been made, but many of the areas still need further work to meet the National Minimum Standards and Care Home Regulations. The registered person was only available for part of the inspection. Staff members spoken to stated that they received sufficient support and are generally happy. The statement of purpose states that regular meetings of service users are held to allow service users an opportunity to express their views on matters of concern to them in a relaxed and informal manner, thus enabling staff to provide a greater level of care. The registered person stated that they feel that a residents meeting once a year is an adequate frequency to gain their views, and this is what will occur at St Michaels. Staff supervision has been an area highlighted in previous reports. There was now some evidence that this had been put in place and all staff had received an appraisal since the last random inspection. There was also some hand written minutes of one team meeting that had taken place. With regard to one to one sessions a form had been used to record the date and short sentences such as ‘discussed about bathing residents’, ‘discussed manual handling’ and ‘discussed activities for residents’. These forms did not contain a signature of the staff member or any further details on what had actually been discussed. Further development needs to be made on staff supervision and records. The registered provider confirmed that there were systems in place to look after money for residents. Records were reviewed for one person and the balance on the records and the cash available tallied accurately. Receipts for withdrawals such as hairdressing and chiropody were safely retained and available, which is good practice. Records show cash received and money paid out/withdrawn, but it was noted that there were no signatures for any of the entries to show who was responsible for the entry. It is recommended that two signatures be used for all withdrawals. It was also noted that an invoice with the name of one resident had been crossed out and another resident added to record payment for particular type of pillow. This showed a contribution from the resident of five pounds and this was recorded as a withdrawal on their records. It was unclear why another residents invoice had been used or why this resident was contributing to a piece of equipment as there was no evidence on their file to establish whether they had either requested or agreed to this or why the invoice was not in their name. St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 Page 25 Aspects of health and safety were reviewed to look at how well this was managed to ensure the safety and well-being of those who live and work there. Inspection certificates were available relating to the fire alarm and fire equipment, gas and electrical fixed wiring. The registered provider stated that they were unsure whether the home had emergency lighting fitted when asked for copies of the inspection certificates and routine in house checks. A copy of the most recent fire officer’s report was requested, the registered provider was unable to find it and provided it following the inspection. The registered provider stated that the record of testing the fire alarm was the same record as the record of checking door guards and was also the record of fire drills, although the information did not include which staff attended, the time of the exercise etc. Records of routine testing of water temperatures were not available. An inspection certificate was available for the lift that stated that the next inspection was due in September 2007. No further inspection certificate was available, but routine maintenance sheets were available including one dated September 2007. The registered provider is responsible for ensuring the safety of all equipment at St Michaels. Limited quality assurance had been completed on the home since the new proprietor had taken over. There was very limited written evidence that regular meetings with staff and residents/relatives had occurred to gain their views on the home. Only one relative meeting had occurred in June 2007. No quality questionnaires had been sent out to gain other peoples views of the home. Issues around ensuring written documentation and records were available during inspections had been raised during the last two inspections. Some improvements had occurred at this inspection, but there still needs further development to ensure sufficient information is available to ensure the registered provider has met both the National Minimum Standards and also the Care Home Regulations. St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 X X 3 X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 2 1 1 2 St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 Page 27 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 OP1 Regulation 4(1)(2) Requirement The Statement of Purpose must include all the areas listed in Schedule 1 of the Care Home Regulations. A copy of the Statement of Purpose must be made available to every service users or their representative. The Service Users Guide must include all the areas listed in Regulation 5 of the Care Home Regulations. Also it should list the areas listed in 1.2 of the NMS and a copy be given to all service users. Timescale for action 31/05/08 2. OP1 5 (1)(a) (b) (c) (d) (e) (f) 5 (2) 31/05/08 3. OP7 Regulation Care plans must be developed to 15 (2)(c) ensure that these contain all (d) actions required by staff to meet each person’s need. Where possible residents and their supporters should be involved in the development of care plans, and this should be clearly evidenced. This is a repeat requirement. First timescale for action given as 31/01/08 – this has not been met. New timescale given. 31/05/08 St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 Page 28 4. OP9 Regulation There must be clear records on 13 (2) MAR sheets to record all medication within the home – even if it is an ‘as required medication’. No gaps should be present on the MAR sheets. Staff should be made aware of good practice when dealing with medication. Staff should receive training updates on the administration of medication to ensure the safety of residents. 30/03/08 5. OP12 16 (2)(n) 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. 31/05/08 6. OP14 12 (2) Care should be provided which 31/05/08 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. 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. There should be a robust complaint procedure that is DS0000069721.V360027.R01.S.doc 7. OP15 16(2)(i) 31/05/08 8. OP16 22 31/05/08 Version 5.2 Page 29 St Michael`s Care Home for the Elderly accessible to all residents and relatives. It should set out the process for making complaints and include details of the actual process, timescales and also who is responsible for investigating complaints. There should be a system for recording complaints, which includes how the complaint was investigated and the outcome. The complaint procedure should be reviewed regularly and part of the Statement of Purpose and Service Users Guide, so relatives, residents and prospective residents are able to access this process easily. 9. OP18 13(6) 30/06/08 To ensure the protection of residents, all staff must complete appropriate training and updates in safe guarding awareness and the home’s procedures for responding to suspicion of abuse. Staff must be aware of safeguarding and whistle blowing process to safeguard residents. This is a repeat requirement. First timescale for action given as 31/01/08. New timescale given. 10. OP19 23 (2)(c) The home should be kept safe and risk free for both staff and service users. A maintenance book should be introduced to identify any health and safety issues and record when they had been rectified. Water temperatures within the home should be regularly checked and recorded. Action should be taken to ensure residents at not put at risk of scalding or Legionella; due to DS0000069721.V360027.R01.S.doc 30/04/08 11. OP26 13 (4)(a) 31/03/08 St Michael`s Care Home for the Elderly Version 5.2 Page 30 your present system of regulating the hot water. 12. OP27 Schedule 4 (7) The staff rota must be up-todate and accurate reflection of staff cover, times and staff on duty. This documentation must be available for all inspection. Systems for nighttime 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. Staff should be provided with sleeping accommodation when completing a sleep over at the home. The present facilities for staff having a bed in the office is not acceptable. To ensure the protection of residents, robust recruitment procedures must be followed and all required checks must be carried out on prospective staff prior to them starting work. Documentation demonstrating this must be in place and available for inspection. Gaps in employment should be discussed and recorded. Forms should be appropriately signed and dated. Having taken into consideration the Statement of Purpose and size of the home and needs of the service users; all staff should received training, which is appropriate to their work and regular updates. New staff should receive structured induction training, which is in line with Standard 30 of the N.M.S and Skills for Care. 30/04/08 13. OP27 23 (3)(b) 30/04/08 14. OP29 Schedule 2(2)(1)(2) (3)(4)(5)( 6)(7)(a)(b ) Schedule 4(a)(b)(c )(d)(e)(f) 31/03/08 15. OP30 18(1)(c ) (i) 30/03/08 16. OP30 Regulation To ensure that staff have the DS0000069721.V360027.R01.S.doc 30/06/08 Page 31 St Michael`s Care Home for the Elderly Version 5.2 18 (1)I(i)(ii) knowledge and skills to safely 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 moving and handling, infection control, POVA, food hygiene, fire safety and health and safety needs to organised for staff. 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 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 was 31/3/2008. New timescale now set. 31/05/08 17. OP33 Regulation 24 (1)(a)(b)( 2)(3) 18. OP36 Regulation The proprietor must ensure 18 (2) supervision, staff meetings, staff appraisals and staff induction is in place. There should be clear informative documentation, which demonstrates this is taking place. Regulation That all records and essential DS0000069721.V360027.R01.S.doc 30/04/08 19. OP37 31/03/08 Page 32 St Michael`s Care Home for the Elderly Version 5.2 17(1)(3)( b) OP38 documentation is in place and available for inspection. This is a repeat requirement. New timescale given. The proprietor should ensure that all safe working documentation relating to certificates should be in place and available for inspection ie. lift, water temperatures, fire checks etc 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 OP3 Good Practice Recommendations It is recommended that the homes 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 your Service Users Guide include details regarding trial visits to the home. It is recommended that the photos of residents on the Medication Administration Record are clearer to aid identification. It is recommended that PRN medication forms are introduced to help staff to identify the symptoms of when ‘as required’ medication may be needed. 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 DS0000069721.V360027.R01.S.doc Version 5.2 Page 33 2. 3. OP5 OP9 4. OP9 5. OP30 6. OP35 St Michael`s Care Home for the Elderly withdrawals of resident’s money. 6. OP31 It is recommended that the registered person 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. It is also 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 is gained i.e registered managers award or NVQ4 in Care. St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 Page 34 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. Extracts may not be used or reproduced without the express permission of CSCI St Michael`s Care Home for the Elderly DS0000069721.V360027.R01.S.doc Version 5.2 Page 35 - 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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