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Inspection on 08/10/09 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 8th October 2009.

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

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

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

What the care home does well

St Michael`s is a small home which provides a family environment due to the small number of people who live there. Most residents (2) have their own rooms, which have been personalised. Visitors are made welcome. Staff working at St Michael`s Care Home have been there for a number of inspections and there is a low turn over of staff.St Michael`s Care Home for the ElderlyDS0000069721.V378060.R01.S.docVersion 5.2

What has improved since the last inspection?

Over the last four Inspections there have been some improvements made to the home. Staff have now attended training courses, which are relevant to the care provided and this should help provide a better quality of life the residents. Staffing of the home has also increased. There is now a new Manager who has been in post for 5-6 months and also a Deputy Manager. The last three Managers have produced paperwork for the home, that if fully completed and regularly reviewed will help meet the National Minimum Standards and Care Home Regulations. Many of the requirements made at the last inspection have been actioned, but further development is still needed on some.

What the care home could do better:

Although there have been many improvements since the last Key Inspection, there are still areas in the home that need further development. Most of the requirements made at the last inspection and Random Inspection that took place in July 09 had been met, but recommendations have been made in this report to develop these further. The Proprietor was available for this inspection and discussion was able to take place on areas where improvements still need to be made. Lack of choice and person centred care within the home has been an area that has been highlighted in most of the reports since the change of ownership. During this Inspection observations and discussions with staff showed that they are aware of person centred care, but this needs to be reflected in the paperwork and care provided. Areas still affected includes choice of activities, choice in their daily personal care, bathing, when residents want to go to the toilet and the times they want to get up in the morning to go to bed at night. Staffing within the home has also been changed since the last inspection and it is hoped this will have an impact on care provided. There are still limited appropriate activities for residents within the home as a group or as individuals. Some improvements had been made but the organisation of activities is limited and does not provide stimulation. One staff member had attended a training course to assist with activities for those with dementia, but little had been implemented to change the present activities programme within the home. There is still no Manager registered with us. Due to the concerns regarding the quality of care provided and management of the home at previous inspections, the CQC had gained legal advice and started enforcement action.

Key inspection report 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 Key Unannounced Inspection 8th October 2009 10:30 DS0000069721.V378060.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address St Michael`s Care Home for the Elderly DS0000069721.V378060.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 Manager post 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.V378060.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th April 2009 Brief Description of the Service: St Michaels Care Home provides accommodation and care for eight older people with dementia. It is a small family style home. The lounge is situated at the front of the house and the dining room overlooks the garden. Toilet and bathroom facilities are on both floors. The home offers six single bedrooms and one double, which has been separated to ensure privacy. Rooms vary in size, but none have ensuite facilities and some would be too small for wheelchair use. A shaft lift provides access to both floors where residents accommodation is provided. St Michaels Care Home is close to local amenities, including transport facilities. There is limited parking on site, but additional parking is available on Meteor Road. The fees for St. Michaels range from £373 to £446, with an average of £424 per week. St Michael`s Care Home for the Elderly DS0000069721.V378060.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 1 star. This means that people who use the service experience adequate quality outcomes. This was a routine unannounced Key Inspection, which took place over six hours by two Inspectors. This Inspection looked at the National Minimum Standards and the outcomes for the individuals living at St Michaels Care Home. As part of the site visit a tour of the home and an inspection of the environment was undertaken. Also records and documentation regarding the running and management of the home were viewed. Areas looked at included information given to residents about the home and services on offer before residents are admitted, information given to perspective residents when they 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. Also the staffing and management of the home were inspected. We also looked at any information that may have been provided to us since last inspection. Residents were spoken with during the inspection and their interaction with staff was also observed. Staff members on duty were spoken with informally and any feedback has been included as part of the report. The Proprietor was also available during this visit and assisted in providing evidence for the Inspection. A Statutory Requirement Notice was served on the Proprietor on the 13th July 2009. This was in connection to there being an accurate and up to date duty roster in place at all times. An immediate requirement form was also issued during the last random inspection, due to the bedroom door leading to the fire escape being locked and staff and residents not being able to gain access to the escape route. Our findings regarding these issues have been recorded in the appropriate sections of the report. What the service does well: St Michaels is a small home which provides a family environment due to the small number of people who live there. Most residents (2) have their own rooms, which have been personalised. Visitors are made welcome. Staff working at St Michaels Care Home have been there for a number of inspections and there is a low turn over of staff. St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.2 Page 7 taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Perspective residents cannot be sure that they will be provided with correct information about the home. Residents receive care from staff who have the knowledge and experience needed to care for those who have dementia. EVIDENCE: A copy of the Service User Guide and Statement of Purpose could be found in the foyer of the home. On viewing these documents it was noted that they had last been reviewed in November 2008. The Service User Guide needed to be updated as it included reference to the CSCI, who ceased to exist in April 2009 and it also stated that the CSCI and Fire Rescue visit the home at least twice annually, which is no longer routine practice. St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 Page 10 The complaints process in the Service User Guide presently has the contact details of the CQC as Cambridge, but this has since changed to Newcastle. At the last inspection the Proprietor was advised that both documents needed to include details of the change of Manager and also the change from CSCI to CQC. Both documents were discussed with the Proprietor during this inspection and he was advised that the Service User Guide and Statement of Purpose should be reviewed to ensure the information incorporated in them is correct and reflects the service provided at St Michaels. When completed a review date should be placed at the bottom of both documents. There was a copy of the last inspection report in the foyer, which enabled visitors, residents and relatives to have easy access. There have been no new residents admitted to St Michaels whilst it has been registered to the current provider. At present the home has four residents, all of whom have some form of dementia. The Proprietor confirmed that all present residents were contracted with Southend Borough Council. The Proprietor provided copies of two residents files and these contained a contract, which included details of the room number, costs and any extra charges. The Proprietor confirmed that new residents would be offered trial visits to the home. The Proprietor was requested to provide a copy of the pre-admission needs assessment form that would be used for new admissions. The assessment form contained all the areas listed in Standard 3.2 of the National Minimum Standards and if fully completed would provide sufficient information on the care needs of the individual. At the last inspection it was found that all staff had received relevant training, but there was still further work to be done to ensure that they had received training for dementia care, which the home is registered for. During this inspection it was confirmed that the Deputy Manager had completed an Activities for Dementia course. The Proprietor also advised that he had provided an in-house course on dementia care and staff had been issued with certificates to confirm attendance. The difference between the medical model of dementia and the social model of care were discussed with the Proprietor and staff. On discussion it was confirmed that some of the training was about the actual condition, but it also included the effects this could have on the individual and their care needs. The Manager provided examples of how one resident is now assisting to wipe down the placemats after meals, watering the garden plants and helping to give out breakfast. It was recommended to the Proprietor that he also attended a dementia course to help understand the personal care/social care needs for this condition and update his present knowledge. Intermediate care is not provided at his home. St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive basic personal and health care but may not be cared for in the way they would like. EVIDENCE: At the last two inspections the previous Managers had produced care plans, which were in depth and included details of the care each individual resident required each day. During this inspection the care plans were viewed with the Proprietor and it was confirmed that the care plan paperwork was the same as on previous inspections and no changes had been made. On looking at one residents care plan it was clear that it had been developed and regular reviews taken place to record changes of care. It was suggested that a system to help record when care plans had been evaluated or reviewed could be introduced, as at present when changes are identified they are being written at the bottom of the care plan, which could make it difficult for staff to identify. The previous Manager had introduced a document called all about me - this included details St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 Page 12 of where residents may need assistance and also their past history. It was a good day to day document, which if staff read they would be aware of the individuals needs and requirements. Comment from the homes quality assurance report included ‘the staff are kind and caring’, ‘I have no concerns and feel cared for in general’ and ‘I think they listen to my concerns’. Care plans needed to be developed further, as often those areas that had been highlighted in risk assessments had not been included as part of the care plan. As an example one resident had a risk assessment due to challenging behaviour, but when viewing the care plan it was found that this had not been included. From observation of the staff and discussions it was clear that staff are aware of the residents basic care needs, but they do not routinely follow the written care plans. Positive practice was observed during the Inspection and the atmosphere in the home was relaxed and staff interacted well with the residents. Both Proprietor and Manager were able to give a good explanation/account of what they felt person centre care was and what it meant for each individual resident; but at present this is not reflected in the documentation or daily records and care is often task orientated and does not offer choice. This is an area that has been highlighted in previous inspection reports and still needs to be developed further. Files contained documentation on GP and hospital interactions. The Proprietor advised that they do not at present have visits from District Nurses, due to none of the residents requiring any nursing care. Visits from opticians and chiropodists had been arranged. The quality assurance report stated that in future a separate survey will be sent out to other agencies involved with the home to help gain their feed back on the care. The medication administration systems in the home were reviewed and found to generally be in good order. Medication administration charts were clear and the medication had been signed for and checked into the home. Staff were reminded that they need to ensure they return any items of medication that do not have a current prescription and any handwritten prescriptions, added during the month must be signed for and checked in by the transcribers. From discussion, medication reviews are undertaken. With ‘as and when’ medication, staff are recording how much medication has been administered where the dose is variable and they are also using the correct coding where medication is not required or refused. The storage of medication is satisfactory. The home does not hold any controlled medication at the current time. St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents’ needs would be met in relation to nutrition, but at present they would still have limited choice in their social care. EVIDENCE: From discussion with the Proprietor, the staff team and review of the records, a generally more person centred approach to the routine of the day for residents is developing. Although, the Proprietor and the staff demonstrate an understanding of person centred care, there is still a mixed approach, but this has developed more since our last visit. This is aided by a larger, therefore more flexible staff team and the promotion of this approach by the Proprietor, as shown in the minutes of meetings. However not all documents evidence that there is a person centred approach in practice, as an example, quality assurance questionnaires states ‘we start waking residents up and giving them a wash from around 7.15 am’. This is not in line with residents’ care plans or what staff told us about the morning routine. More evidence is needed to show that residents are experiencing a person led routine to life in the home. St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 Page 14 Since the last inspection the Deputy Manager had attended a course on activities for dementia, but from the evidence gathered this had not yet been put into practice. From discussion with staff and review of the records, there had been no real development in the social activities programme for residents. Residents continue to be offered a basic and repetitive programme that is not person centred or based upon an assessment of need. Records show that residents are primarily offered the same activities with the occasional alternative pastime, such as gardening or dusting, but records show this is limited. Residents watch television, play dominoes, play hoopla and listen to music. In some of the care plans, there is some social information recorded that would help them start to develop this approach. On our arrival at the home, care staff were noted to be playing dominoes with one resident, whilst the others were asleep. The Proprietor advised that the menus had been reviewed as part of the recent quality assurance, which had been completed at the home. The new menus had been in operation since 1st October 2009. On the day of the inspection, care staff made home made shepherds’ pie for dinner along with fresh carrots and treacle pudding for desert. This was in line with the current displayed menu and the staff confirmed that they had the food they needed to supply what was on the menu. Food supplies in the home were checked and related to the menu offered. Items were stored correctly and dated where need be. Both fresh and frozen food stocks were available. Lunch was observed and this was seen to be a relaxed occasion where residents were able to eat at a time suitable for them. The table was nicely laid, although residents still do not have condiments available to them, and they were given a choice of drinks with their meal. Residents said that they enjoyed their lunch and when offered, had second helpings. Comments include nice thank you and very nice. Nutritional records seen, were linked to the menu and staff have also started to record what the residents have actually eaten and how much, which is good practice. Relatives who commented said ‘the menu is adequate and my relative enjoys the food’ and ‘my relative would like more salad and to have fresh fruit available at snack times’. One relative said it would be nice for the residents to have a fish and chip supper from a chip shop occasionally. We were informed that this has been introduced into the menu. St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service cannot be confident that they will be protected by the financial systems in place. EVIDENCE: The complaints procedure could be found in the foyer of the home. This document contained details of the process and also timescales in which the home will deal with complaints. Details of the complaints procedure could also be found in the Service User Guide and Statement of Purpose, but the contact details of the CQC telephone number and address had not been updated. This was brought to the Proprietors attention at the last inspection, but had not been actioned. Staff had attended safeguarding training and those on duty had an understanding of the issues around whistle blowing and the protection of vulnerable adults. There were also policies and procedures on safeguarding and whistle blowing and these were made available. The issue of safeguarding was discussed with the Proprietor and the importance of reporting any issues so it can be appropriately investigated; this has been an issue that has been raised in previous inspection reports, due to the correct procedure not being followed. St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 Page 16 The financial records of two residents were viewed. One was correct, but the second was not. This was brought to the Proprietors attention and confirmation was received that corrections had been made. On further investigation it has became clear that there is presently no financial policy/procedure in place regarding dealing with residents finances and this needs to be rectified. St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home, whilst basic, is safe and clean. EVIDENCE: A tour of the home was undertaken with the Manager. Following an immediate requirement being issued at the last inspection, relating to the access of fire escapes, this was checked upon our arrival at the home and was found to be in order with access through an unlocked/unused bedroom. Since our last visit, the majority of the garden has been tidied up and items, such as scooters etc. removed. This means that the garden is a pleasant and safe place to sit, should the residents so wish. Staff have also planted tomato plants, which residents were involved in their care. Broken items and debris still needs to be removed from underneath the external fire escape. St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 Page 18 Since our last visit the battery operated call bell units in the bedrooms etc. have been checked and new batteries installed. These were checked and found to be in working order. There are still some old call bell leads that are attached to a system that is not operating and this could potentially cause confusion for both residents and staff. Odour control in the home has improved and no bedrooms were noted to be an issue. It was also noted that new kylie sheets had been purchased to help with residents continence needs through the night. A more person centred approach to care in relation to the management of specific needs has also helped in this area. Overall the home was seen to be clean. Staff reported that there is now money available for light bulbs and furniture polish etc. Relatives who commented said ‘the home is maintained in a clean condition’ and ‘there have not been any cleanliness problems in my experience’. Overall the standards in the home are basic but serviceable. Parts of the home remain in need of refurbishment, primarily in relation to furniture and fittings. Some of the cold tap outlets in residents’ bedrooms’ need attention as these have seized up and are not working, as at the last inspection. A new battery pack has been purchased for the bath hoist and this was seen working, which means that residents are now able to have a bath, should they so wish. Other new small items have also been installed such as toilet roll holders. Staff are checking and recording hot water temperatures. In some instances the hot water was found to be above the 43oc recommended level. Where this is the case, staff should record what action, if any has been taken to address the matter. Records in relation to fire safety were checked and found to be in good order, with systems being maintained and checked regularly. Staff had also held a fire drill and the management team had undertaken a fire safety risk assessment. St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that staff at St Michaels have received training, and they will be cared for by staff who now have a better understanding of dementia care. EVIDENCE: It was confirmed that the Manager was in charge of the home on the day of the inspection. The staffing rota for the week was requested and this was provided. The rota was correct on the day of the inspection and on questioning staff on duty they were able to confirm the days they had previously worked. It was noted that only one staffing rota is kept in the office, so it was difficult to establish the previous weeks rotas. Due to issues that had been raised around the home not having an up to date staffing rota, a Statutory Enforcement Noticed was served on the 13th July 2009. Documentation seen during this inspection confirmed that this had now been met. The rota showed that two staff were on duty until 8pm each day. The Proprietor advised that there is now two staff on duty at night - one awake carer and one a sleep and this had been in place for a number of weeks. It was requested that the Proprietor wrote in to confirm the arrangements, due St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 Page 20 to the CQC not being advised of any changes. The Proprietor also advised that he has had a change in his working commitments, so he was able to spend more time at the home. All staff now have separate files and these contain details of their personal data, training and supervision. One new staff member had been recruited since the last inspection. On checking the file it was found that all the correct documentation was in place. This included an application form, a medical questionnaire, POVA first check, references x 2 (testimonials), declaration of criminal convictions and a student visa. On looking at the reference request form it was difficult to establish who it had been sent to for completion and also who had completed and signed the form. The Proprietor was advised that the reference request form needs to be clearer to help with the recruitment audit trail. The Proprietor advised that new staff are now completing a three day induction course in London, but the new staff member did not have any documentation to confirm this. Documentation was available to show that she had started to complete the Skills for Care induction. Looking at the information recorded on the training matrix it was clear that all staff have up to date training and had completed courses on moving and handling, health and safety, safeguarding, infection control, fire safety, medication and first aid. Individual staff had also attended a course on Deprivation of Liberty, dementia activities, challenging behaviour and the Mental Capacity Act. The Proprietor advised that he had also arranged an inhouse course for staff on dementia. The content of the course was discussed and it was suggested that the Proprietor and staff may benefit from training more specific to the social model of care around dementia. It was confirmed that two staff had achieved their NVQ2, one was working towards their NVQ3 and the Deputy Manager and Manager were doing their NVQ4. St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home has generally improved and this will reflect positively on the outcomes for the present residents. EVIDENCE: The Proprietor has a Manager in place who is a qualified nurse, who plans to undertake the Registered Manager’s Award. In the long term the Proprietor plans to make the current Deputy Manager the registered manager and this person is already undertaking the Registered Manager’s Award. At the current time the Proprietor has fewer external work commitments and is therefore spending more time concentrating on the needs of the home and the work undertaken by the current management team is reflected in this report. We St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 Page 22 look forward to these improvements being sustained and developed further. The home does not at present have a registered Manager and an application is required to ensure that there is a manager registered with us. Combined resident, relatives and staff meetings are held, with the last one being in April 2009. These are held bi-annually. Minutes show that relatives have been concerned about the turnover of managers’ at the home and the Proprietor has tried to reassure them on this front. Additional staff meetings are also held by the new Manager and minutes show that they have discussed swine flu management, cleanliness, menus, kitchen duties and residents’ activities. Staff supervision had also been provided to staff, but the frequency differed for each staff member. One had not received any individual supervision since January 09; another had been seen bi-monthly until June 09, but not received any further supervision since then. This is an area that needs further development. A quality feedback questionnaire was sent out to residents and relatives in May 2009 and the results and action plan were available to view in the main reception area. Comments were positive overall and are reflected throughout this report. They included ‘I find all the staff and management responsible and approachable’. Accident records were reviewed and found to be completed well and body maps are also now in use. A random sample of maintenance certificates for equipment and fittings in the home were checked and these included the lift, hoists, electrical safety and gas. These were found to be in good order. The Proprietor had a gas safety commissioning certificate for the new boiler that had been installed, but should check whether he still needs a yearly ‘landlords gas safety certificate’ in addition to this. St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X 2 2 3 St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 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 15(1)(2) Requirement Continue to develop individual residents care plans and ensure they are regularly reviewed. These should include details of the care required and how this is to be provided. They should be written in a person centred way and include choice and independence were necessary. Timescale for action 18/01/10 2. OP33 Regulation 24 (1)(a)(b)( 2)(3) The registered provider shall 18/01/10 appoint an individual to manager the care home. This is to ensure that residents live in a home that 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. They should be qualified, competent and experienced to run the home and meets its stated purpose, aims and objectives. This is a repeat requirement, previous timescales of 30/09/09 have not been met. New timescale set. St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 Page 25 3. OP12 16 (2)(n) Although some work has been 18/01/10 done around activities within the home, there should be further consultation with service users to arrange and develop a programme of activities (both group and individual) within the care home that meets their needs and interests. At present this is very limited. This is a repeat requirement; previous timescales of 30/09/09 have not been met. New timescale set. 4. OP36 18(2)(a) Persons at the home must be appropriately supervised to ensure they receive the support required in their role as a care worker. 18/10/10 St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 Page 26 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. The Statement of Purpose and Service Users Guide needs to be updated to incorporate the recent changes to the Quality Care Commission and your present management structure. Recommend that further training is provided to staff on regarding dementia and social care. The Statement of Purpose, Service Users Guide and complaints procedure needs to be updated to incorporate the new contact details of the Care Quality Commission. It is recommended a set form is introduced to help record any complaints received, the investigation and outcome. It is recommended you continue to develop the present safeguarding practices and procedures within the home. A policy and procedure should be in place to regarding the homes practices regarding service users money and financial affairs. It is recommended that you develop community involvement with the home to enhance the activities within the home and offer residents better stimulation. It is recommended that your reference request form is updated to assist your recruitment audit trail. It is recommended that further training is completed to help the registered person to gain knowledge and a better understanding on how to manage a care home. 2. 3. OP4 OP16 4. 5. 6. OP16 OP18 OP18 7. OP13 8. 9. OP29 OP31 St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 Page 27 10. 11. OP36 OP37 It is recommended that staff are supervised at least 6 times year and this is clearly recorded. It is recommended that you continue to develop your quality assurance systems . St Michael`s Care Home for the Elderly DS0000069721.V378060.R01.S.doc Version 5.3 Page 28 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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