Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 03/07/08 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 3rd July 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 residents that live there. Most residents have their own rooms, which have been personalised. The staff at St Michael`s are regular and have been at the home for a number of years, which enhances the `family` feel of the Home. Visitors are always made welcome.

What has improved since the last inspection?

Some improvements had been made since the last inspection. There was evidence that staff had attended moving and handling training and safeguarding training. The Proprietor had also started to produce basic written documentation, for the home, to try and evidence that he was meeting the National Minimum Standards. A new manager has been appointed since the last inspection. From the recruitment evidence seen she has NVQ 4 training and also experience of working in a care home. Staff commented that the ethos of the home had changed and they were working more as a team to try and get things right.

What the care home could do better:

Further systems still need to be introduced to help the register provider to produce clearly written records that help identify that the National Minimum Standards and Care Home Regulations have being met. Although slightly better, written records were still not available during this inspection to evidence the care being provided. Care planning is an area that needs to be developed. Some records identified the care needs of the individual resident, but there is no actual plan of care which identifies the need and provides staff with clear guidance on how this is to be met. Also, there needs to be further development on the reviewing and monitoring of residents care needs. Residents cannot be assured that at the current time, all their needs would be met. Choices within the home are fairly restricted and this includes activities, choice of food and the general daily routines of the residents. It is felt that if staff had a better understanding of the needs of those residents with dementia, this could be incorporated into everyday life for the residents and provide them with a more stimulating environment.

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 3rd July 2008 09:00 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.V368117.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.V368117.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.V368117.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st February 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. 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.V368117.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 seven hours. It was a key inspection covering 24 of the National Minimum Standards. The Inspection was conducted by Sharon Lacey and Claire Farrier, Regulation Inspectors for the Commission for Social Care Inspection. 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 gained 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. An Annual Quality Assurance Assessment (AQQA) was sent to us by the Proprietor. The AQQA is a self-assessment, 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. Residents were spoken to during the inspection and their interaction with staff was also observed. All 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 residents that live there. Most residents have their own rooms, which have been personalised. The staff at St Michaels are regular and have been at the home for a number of years, which enhances the family feel of the Home. Visitors are always made welcome. St Michael`s Care Home for the Elderly DS0000069721.V368117.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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.V368117.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.V368117.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 cannot be assured that they are provided with up-to-date information about the home to enable them to make an informed choice on whether the home can meet their care needs. EVIDENCE: In the improvement plan submitted by the Proprietor, it confirmed that an upto-date Statement of Purpose is now in place. When looking for evidence of this, the Statement of Purpose and Service User Guide has been produced into one document and is in the foyer of the home. It was noted that this had been updated since the last inspection, but it still contained details of the National Care Standards Commission, which ceased two years ago. A copy of the last inspection report was not readily available and when staff were asked for a copy, they were unable to provide this. St Michael`s Care Home for the Elderly DS0000069721.V368117.R01.S.doc Version 5.2 Page 9 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. On the day of the inspection there were only six residents present, due to one recently being admitted to hospital. Although no new residents had been admitted and written evidence of the home’s admission procedures could not be obtained, the AQAA submitted stated we carry out a detailed pre-admission assessment before any admission takes place. The pre admission forms use by the home were not viewed, on this occasion, to ensure they covered all the areas listed in Standard 3 of the National Minimum Standards. When looking at the information submitted on the AQAA; when asked what the home could do better it stated none, on how they had improved in the last 12 months it stated none and what were the plans for improvement in the next 12 months the document stated to employ an NVQ 4 qualified person to carry out the preadmission assessment. Intermediate care is not provided at this home. St Michael`s Care Home for the Elderly DS0000069721.V368117.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): 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents do not have care plans that identify their specific needs and therefore cannot be assured that their care needs can be met safely and in full. Residents cannot be assured that medication practices within the home will keep them safe. EVIDENCE: The individual plan of care for residents has been an issue that has been raised with the Proprietor in the last two key inspections. The improvement plan submitted for the last inspection stated care plans are being reviewed with the residents representatives and they are satisfied with the care plans. The AQAA continued that there is a comprehensive care plan that has been agreed with the service users. On looking for evidence of this, two residents care plans were viewed. The first was for resident who had complex needs and whose individual file had been previously inspected. The file contained a Care Plan Review sheet dated the 15th of September 07, which had been completed by the Proprietor. This document highlighted a range of care needs which St Michael`s Care Home for the Elderly DS0000069721.V368117.R01.S.doc Version 5.2 Page 11 included dementia, wound management, lack of mobility, speech problems, the need for full care (including feeding) and continence care. The Care Plan Review sheet continued that there were no special care plan apart from the areas mentioned. A second file contained a Care Plan Review sheet dated the 30th of August 07, which had also been completed by the Proprietor. This stated that the resident had hearing difficulties, needed glasses, needed assistance with toileting, assistance with dressing, needed encouragement to eat, needed wound management, behavioural problems, and mobility problems. Neither file contained any form of guidance to staff on how these care needs were to be met or monitored. Also, neither file contained any evidence that they had been regularly reviewed or updated, although issues around care plans had been a requirement in the last two inspections to the home. The Proprietor had attended care plan training since the last inspection, but there was little evidence to show that this had yet been put into practice. Evidence showed that there was still lack of actual individual care plans on residents’ files. Files contained limited evidence of risk assessments, although some risks had been identified, there were no measures put in place to reduce the risk. There was no evidence of monitoring of falls - although one lady had had a fall and was admitted to the home in 2006 due to falls. She had recently had another fall, but the file contained only a small mention in the daily care notes and staff confirmed that an accident form had not been completed. There were a lack of nutritional records for residents - although one resident was on a ‘build up’ supplement due to weight loss. Staff were not recording what was being eaten or how much, so there was no way of monitoring food intake. When staff were asked about the lack of records for nutrition, one stated that the lady was only on the supplement for two weeks - so they had not seen it necessary. On discussing the need for records, they then could see the importance of them. The Proprietor had evidence of a meeting that had occurred with the relatives and residents of St Michaels. During this meeting the issue of care plans had been discussed and it was recorded that they were all satisfied with the care plans. Information taken from the AQAA reported that the plans for improve over the next 12 months was to continue as before. Files contained evidence of District Nurse, GP and hospital interaction. There was some concern around the lack of records for pressure care. The District Nurse had introduced a pressure care chart to record details for one resident, but the staff team had introduced nothing to help monitor the situation. Medication was checked. This has been an issue that has been raised in the last two key inspections and also a random inspection completed at the home in November 2007. The Proprietor has rectified some of the issues and residents now have individual Medication Administration Record sheets and photos to try and assist in identification. St Michael`s Care Home for the Elderly DS0000069721.V368117.R01.S.doc Version 5.2 Page 12 In the improvement plan submitted for the last inspection, the Proprietor wrote that staff are aware of correct medication procedures. The Medication Administration Records were checked. It was noticed that staff administering medication had not always recorded why it not been given. One two occasions there was an f (other - define) recorded on the front sheet, but the reason for this had not been recorded on the space at the back of the form. The staff member responsible for medication on the day of the inspection stated that she was not aware of this practice. On checking one resident’s medication we found that there was a discrepancy in the number of tablets that had been administered, compared to the amount delivered and the amount then available. This is a concern. On checking the medication records it was noted that the resident who had been prescribed the food supplement drink was supposed to have one can twice a day (2 cans). On speaking to staff it was established that one can was being split in half and the resident was only having one can instead of two. The medication records showed that staff were signing to confirm that the resident was having two cans per day, which was incorrect. Staff were spoken to and advised to gain clarification from the Pharmacy on the prescribed dosage. On the same resident’s file there was a letter from the resident dated 19/4/08 giving permission to the staff to crush her tablets and place them in jam. The staff member on duty was not aware that some medication cannot be mixed with other foods or drinks and that they should have gained advice from the Pharmacist to ensure this is acceptable and ensure their response is recorded. Both Inspectors felt, from observation during the day that generally the care was being provided appropriately. Many of the staff have been at the home for sometime and residents are familiar with them. Staff were seen talking and encouraging residents and this was more noticeable than on previous inspections. St Michael`s Care Home for the Elderly DS0000069721.V368117.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 choice in their social activities, what they eat and in their general everyday routines. Visitors can be assured that they will be made welcome. EVIDENCE: Activities at St Michaels has been an issue that has been raised in the last two key inspections and also the random inspection and requirements have been made. There is still no written evidence on residents files that activities have been tailored to meet individual needs and that they reflect peoples interests or abilities. There are also no activities tailored for residents with dementia and there is an overall lack of stimulation. Although residents’ files did not contain individual activities plans, since the last inspection a diary has been introduced to record activities that residents had taken part in. Although many of the pages were blank, written evidence showed that activities included dominoes, songs, hoopla games and build a beetle. On the day of the inspection two residents were observed in the dining room playing dominoes after lunch. In the AQAA submitted by the Proprietor it stated we will offer different activities daily. These include playing cards with St Michael`s Care Home for the Elderly DS0000069721.V368117.R01.S.doc Version 5.2 Page 14 fellow residents, playing dominoes and the hoopla - Staff at times offer a singalong’. When asked what they could do better the AQAA stated none, on how they had improved in the last 12 months it stated none and their plans to improvement in activities in the next 12 months, it stated none. Activities at the home could still be developed further. The issue of activities and what could be provided, was discussed with staff present on the day of the inspection. One resident spoken to stated there used to be other games, and years ago we used to play bingo - there is nothing else now. One resident goes out to a club twice a week and it was confirmed by a staff member that another resident will soon be joining her. The Statement of Purpose reports 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. A visitor to the home confirmed this and stated that staff were very good and he felt he was able to discuss any concerns that he may have. The Statement of Purpose states regular meetings of service users and staff are held to afford the service users an opportunity to express their views on matters of concern to them in a relaxed and informal manner. The AQAA continued that a meeting for residents and relatives will be organised twice a year. There was evidence of hand written notes from a meeting the Proprietor had organised with residents and relatives since the last inspection. The issue of offering residents choice was discussed at the last inspection. The response for the Proprietor in the improvement plan stated that residents do not have the ability to ask for change. This was discussed with staff during this inspection and explained that this is not down to the residents only - it should be recognised by staff and perhaps further dementia training would assist in recognising how this could be done. It was suggested that areas that residents could make an informed decision about could include clothing, activities, menus, routines in the home etc. Observation during the inspection showed residents being given squash and not given the choice of tea or coffee. One resident spoken to advised that they are not offered choice for meals or snacks in the evening and added they just eat what they have been given. One staff member was observed offering one digestive biscuit with a drink and there was no choice. There is a four week menu on show in the dining room. There was evidence that meals had been discussed at the recent meeting with residents and no changes had been made. The meal on the day of the inspection had been liver and bacon and residents confirmed that this had been served with mash and vegetables. They added that they had chocolate blancmange for dessert, but one resident stated that it was served hot. They added you cant grumble or you are told off. When another resident was asked about the food she just pulled a face, shook her head and just said no. A further resident confirmed St Michael`s Care Home for the Elderly DS0000069721.V368117.R01.S.doc Version 5.2 Page 15 we are not offered any snacks in the evening we just receive a cup of tea and no snack.. From the evidence gathered there still appears to be lack of choice in food, although the Proprietor has stated that this has been addressed. No nutritional records are kept for residents, although it had been identified that some residents had nutritional care needs. There was written evidence that one staff member had attended food hygiene since the last inspection. St Michael`s Care Home for the Elderly DS0000069721.V368117.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 good. This judgement has been made using available evidence including a visit to this service. Residents can feel confident that all staff have an understanding of the meaning of safeguarding, which will help to ensure their safety and protection. EVIDENCE: There is now a complaint folder and set form in place to record any concerns or complaints. Details in the Statement of Purpose provide guidance to relatives and residents on how they can make complaints; although it was noted that the National Care Standards Commission had been quoted on two pages, which is incorrect. The Proprietor confirmed that relatives and residents had been made aware of St Michaels complaints procedure at a recent meeting and this was confirmed in the handwritten notes seen. Safeguarding was an area that had improved since the last inspection. All staff had now attended safeguarding training and files contained evidence of training certificates. On speaking to staff on duty, they both had an understanding of safeguarding vulnerable adults and the meaning of whistle blowing. St Michael`s Care Home for the Elderly DS0000069721.V368117.R01.S.doc Version 5.2 Page 17 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 and 27. 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. The infection control and storage of chemicals does not meet 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, which has a large television. Hand rails are available to assist residents when walking along the corridor. Meals are eaten in the dining room at the back of the house and there is a small garden for residents use. During a tour of the home it was noticed that the bedrooms were personalised with items that they had been able to bring in with them, such as photographs and small ornaments. All bedrooms were noted to be reasonably clean and tidy. In one room there were a lot of pads and dressings and it was felt this did not make the room feel homely. It was noted that the downstairs carpet in St Michael`s Care Home for the Elderly DS0000069721.V368117.R01.S.doc Version 5.2 Page 18 the hall was beginning to ruck up and could be a risk to residents and cause falls. The storage of food was looked at and it was noted that in the freezer there were three plastic boxes with covers that had been dated but the food had not been labelled. In the cupboard in the kitchen there was a large packet of scone mix and sponge mix, which had been opened and not sealed. During the tour of the home the kitchen door (which is a fire door) had been wedged open. On looking in the kitchen cupboards it was noted that they contains a range of chemicals, which should be stored in a locked cupboard. These chemicals were brought staff members attention and moved into the sluice room to be locked away safely, especially due to the home being registered for residents with dementia. There was no evidence that staff had attended infection control training, which has been an issue that has been raised in the last two inspection reports. It was noted during a tour of the home that the bathwater running from the hot tap measured over 50° and there was a high risk of scalding. Staff on duty were asked to produce the written record of water temperatures within the home. They were unable to find this. The temperature of water within the home has been discussed at previous inspections. Many of the individual sinks within the home do not have thermostatic valves fitted and rely on changes to the main water tank. The Proprietor had advised in improvement plan that this was being addressed. St Michael`s Care Home for the Elderly DS0000069721.V368117.R01.S.doc Version 5.2 Page 19 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, 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 can be assured that they will be fully protected by the recruitment process and practice at the home. Due to long shifts residents cannot be assured that they will be kept safe at all times. EVIDENCE: Staffing shortfalls were raised in the last two key inspections and also the random inspection. The staff rota was inspected and this provided details of the staff who are on duty and their title. The rota had week commencing at the top, but this was blank and the days of the week across the top did not include any dates. St Michaels provides two care staff during the day, who also undertake all the cooking and cleaning tasks; and one awake and one sleeping staff member at night. The rotas still showed that staff were working long shifts. Staff spoken to advised that the shifts consisted of 7.00am - 15.00pm, 15.00pm - 22.00 pm and 22.00pm - to 7.00 am. From the rota and also discussions with staff it was established that some staff are working an afternoon shift and then proceeding to do an awake night. Adding the hours together this means that staff are working a 16 hour shift. There were also occasions when staff were working from 7 a.m. till 10 p.m. at night. On further discussion with staff it was established that the person doing the sleep in duty did not have anywhere to sleep and one staff member stated they had stayed awake in the St Michael`s Care Home for the Elderly DS0000069721.V368117.R01.S.doc Version 5.2 Page 20 office. As this person had already completed an afternoon shift at the home and then stayed awake and then commenced the morning shift, they would have worked 24 hours. From the details on the rota they had already completed an afternoon shift and then a wake night the night before. Giving her 8 hours off over three day period. The issue of health and safety for both staff and residents was raised. Recruitment has been an issue raised in the last two inspections and requirements have been made. One new staff member had been recruited since the last inspection and on view in their file it was positive to see that all the information required was present and the staff member had not started due to their CRB not being received back. As no new staff had started there was no evidence of staff induction. The Proprietor stated that he would be contacting Skills for Care to confirm what induction was most suitable for the new staff member, but it was note that she was already NVQ4 trained. Staff had attended training since the last inspection. Staff confirmed that they had watched a fire safety video that morning. Two staff had also attended moving and handling training and three had attended safeguarding training. The Proprietor had attended a course on Person Centred Care Planning in March. St Michael`s Care Home for the Elderly DS0000069721.V368117.R01.S.doc Version 5.2 Page 21 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, 35, 36 37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be assured that they live in a home that is effectively managed or run in their best interests. EVIDENCE: 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. On the last two inspections there have been some slight improvements, but many of the areas still needed further work to meet the National Minimum Standards and Care Home Regulations. The Proprietor was only available at the beginning of the inspection due to another engagement. He provided written documentation to assist the inspection before he had to leave. St Michael`s Care Home for the Elderly DS0000069721.V368117.R01.S.doc Version 5.2 Page 22 Staff supervision has been an area highlighted in previous reports. The Proprietor confirmed that no further supervision had been provided to staff since the last inspection. The Proprietor advised the one relative and resident meeting had occurred since the last inspection and there was written evidence available of this. It was also stated that a quality assurance questionnaire had been sent out, but written evidence of the outcomes was not available. Residents monies are held by St Michaels. On inspecting the records it was noted that there was not two signatures for any monies taken out, which was highlighted in the last inspection report. This was discussed with the staff member in charge, and the reasons for this process. She stated that she now understood why this was needed and would pass this information on to other staff. She also added that this would be implemented from the time of inspection. Issues around ensuring written documentation and records were available to inspection has been raised during the last three inspections. Once again some improvement had occurred at this inspection, but there still needs further development to ensure sufficient information is available to show that the Registered Provider has met both the National Minimum Standards and also the Care Home Regulations. Also if residents were to go into hospital or there were any safeguarding issues, the Proprietor would have some difficulties providing evidence that correct care and procedures had been followed. A new manager is to start at the home in July 2008. From the recruitment information it appears she has NVQ 4 and previous experience of running a care home. Staff spoken to during the inspection were very positive about the manager starting and both stated they wanted to get things right. They also stated that since the last inspection they have found the Proprietor much more approachable and willing to take advice. It was clear from the evidence seen that there was some improvement at the home. A maintenance book had been implemented since the last inspection. On view in this it was noted to be blank although there are jobs around the home that, from observation, needed to be done. On looking at the fire records it was noted that the fire alarm system had not been tested since the 27th of May 2008. Also fire extinguishers had recently been inspected on the 30th of June 2008 and some had been removed and not returned and this was four days later. There were also some issues around Control of Substances Hazardous to Health which were highlighted in this report previously. St Michael`s Care Home for the Elderly DS0000069721.V368117.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 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 1 8 3 9 1 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 3 17 X 18 3 2 X X X X X 1 2 STAFFING Standard No Score 27 2 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 1 1 2 St Michael`s Care Home for the Elderly DS0000069721.V368117.R01.S.doc Version 5.2 Page 24 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 OP7 Regulation Requirement Timescale for action 30/09/08 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. Previous timescales for action given are 31/01/08 and 31/05/08 - these have not been met. New timescale given. 2. OP9 Regulation There must be clear records on 30/09/08 13 (2) MAR sheets to record all medication within the home. No gaps should be present on the MAR sheets and if refused this should be clearly recorded and the reason why.. Staff should be made aware of good practice when dealing with medication. St Michael`s Care Home for the Elderly DS0000069721.V368117.R01.S.doc Version 5.2 Page 25 Audits on medication should be introduced to ensure that residents are receiving medication that has been prescribed to them. Staff should receive training updates on the administration of medication to ensure the safety of residents. This is a repeat requirement. Previous timescale for action given are 30/03/08. This has not been met. New timescale given. 3. 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. This is a repeat requirement. Previous timescale for action given is 31/05/08 - this has not been met. New timescale given. 31/10/08 4 OP14 12 (2) 30/09/08 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. This is a repeat requirement. Previous timescales for action given are 31/05/08 - this has not been met. New timescale given. 5. OP15 16(2)(i) Residents should be consulted DS0000069721.V368117.R01.S.doc 30/09/08 Page 26 St Michael`s Care Home for the Elderly Version 5.2 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 - this has not been met. New timescale given. 6. OP26 23 (2)(c) The home should be kept safe and risk free for both staff and service users. A safe system needs to be introduced for Control of Substances Hazardous to Health. 30/07/08 7. OP26 13 (4)(a) 31/07/08 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 the present system of regulating the hot water. This is a repeat requirement. Previous timescales for action given are 31/03/08 - this has not been met. New timescale given. 8. OP27 Schedule 4 (7) The staff rota must be up-todate and accurate reflection of staff cover, times, dates and staff on duty. This documentation must be available for all inspections. Systems for night time cover need to be looked at and also the hour’s presently worked by the proprietor and staff, which could DS0000069721.V368117.R01.S.doc 30/07/08 St Michael`s Care Home for the Elderly Version 5.2 Page 27 put the health and safety of residents at risk. This is a repeat requirement. Previous timescales for action given are 30/04/08 - this has not been met. New timescale given. 9. OP27 23 (3)(b) 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. This is a repeat requirement. Previous timescales for action given are 30/04/08 - this has not been met. New timescale given. 31/08/08 10. 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 infection control, dementia, and health and safety should be organised for staff. This is a repeat requirement. Previous timescales for action given is 30/06/08 - this has not been met. New timescale given. 30/11/08 11. OP33 Regulation To ensure that the home is run 24 in the best interests of residents, DS0000069721.V368117.R01.S.doc 30/11/08 St Michael`s Care Home for the Elderly Version 5.2 Page 28 (1)(a)(b)( 2)(3) 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 are 31/3/2008 and 31/05/08. These have not been met. New timescale given.. 12. OP36 Regulation The proprietor must ensure 18 (2) supervision, staff meetings, staff appraisals and staff induction is in place to ensure that staff receive the support they need in their role as a carer. There should be clear informative documentation, which demonstrates this is taking place. This is a repeat requirement. Previous timescales for action given is 30/04/08 - this has not been met. New timescale given. 30/09/08 13. OP37 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 - this has not been met. New timescale given. 30/09/08 The proprietor should ensure St Michael`s Care Home for the Elderly DS0000069721.V368117.R01.S.doc Version 5.2 Page 29 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 OP1 Good Practice Recommendations Ensure the information in the Service users Guide and Statement of Purpose is up to date and appropriate. This was highlighted at the last inspection and some changes made, but the complaint section is still wrong. 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 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 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. 2. OP3 3. OP30 4. 5. OP35 OP31 St Michael`s Care Home for the Elderly DS0000069721.V368117.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. Extracts may not be used or reproduced without the express permission of CSCI St Michael`s Care Home for the Elderly DS0000069721.V368117.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!