Inspection on 09/04/09 for St Michael`s Care Home for the Elderly

This inspection was carried out on 9th April 2009.

CQC 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.

Other inspections for this house

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

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 9th April 2009 10:00 DS0000069721.V375247.R01.S.do c Version 5.2 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.V375247.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.V375247.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.V375247.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th October 2008 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. There is a small shaft lift that 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. Weekly fees range from £335.16 to £416.85 depending on the care required. St Michael`s Care Home for the Elderly DS0000069721.V375247.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 the service experience poor quality outcomes. This was a routine unannounced Key Inspection, which took place over six hours by two Inspectors. This Inspection looked 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. Questionnaires were sent to the home to be distributed to residents, staff and relatives. Of these two resident and three relative questionnaires were returned and comments from these have been added were appropriate. No staff questionnaires were returned. Residents were spoken to during the inspection and their interaction with staff was also observed. Both staff members on duty were spoken with informally and any feedback has been included as part of the report What the service does well: St Michaels is a small home which provides a family environment due to the small number of people who live there. Most residents have their own rooms, which have been personalised. Visitors are made welcome. What has improved since the last inspection? Over the last three Inspections there have been some improvements made to the home. Staff have attended training courses, which are relevant to the care provided and should help provide a better quality of life the residents. St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 6 Over the last 8 months, the Proprietor has employed two Managers, but these have since left. During their employment much of the paperwork and documentation has been reviewed and updated to try and ensure it met with the National Minimum Standards and Care Home Regulations. Requirements have been made over the last three key Inspections and since the employment of the Managers these have improved. All residents now have a detail care plan, which provide staff with in-depth knowledge of their care needs and how these are to be provided. What they could do better: If you want to know what action the person responsible for this care home is 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.V375247.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.V375247.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. 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 provide with correct information about the home, or that staff working at the home 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 and both documents were available to residents and their relatives. It was noted that these documents had last been reviewed in November 2008; so they did not contain details of the change of Manager or the recent change from the Commission for Social Care Inspection to the Care Quality Commission or its relevant contact details. St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 9 There was a copy of the Homes complaints procedure in the foyer, but this also need to be updated to include the contact details of the Care Quality Commission. 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 five residents, all of whom have some form of dementia. At the last Inspection the previous Manager advised she was in the process of reviewing the assessment form, to ensure it met the requirements and gained sufficient information to enable the staff to identify and then meet any new residents needs. On discussing the assessment form with the person in charge on the day of Inspection, they were unable to advise whether the form had been updated or provide a copy of what would be used. Staff files contain copies of training certificates. Of the staff files inspected one staff member had received training to care for people with dementia. St Michaels is registered with the CQC to provide care for those people who have dementia and it is also part of the services and care it states it provides in the Statement of Purpose. This is an area that has been highlighted in previous Inspection reports, but due to a recent change in staffing this needs to be urgently addressed. All staff should have training to provide them with the skills and knowledge required to be able to meet the needs of the people living there. Intermediate care is not provided at his home. St Michael`s Care Home for the Elderly DS0000069721.V375247.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. 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 want. EVIDENCE: At the last inspection the previous Manager had produced new care plans, which were much more detailed and outcome focussed. These had been signed to confirm that relatives had been involved in this process and that they agreed with the contents. At this inspection, the Manager who had recently left had produced new day-to-day care plans. These contained details of the daily care each individual resident required and how it was to be provided. On the day of the inspection both staff confirmed they had had time to read the care plans to make them aware of the individual residents needs.. St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 11 Although it was felt that there had been some improvements in the care provided to residents over the last few inspections, from looking at the written care plans and general observation, the care is still very task orientated and run in the staffs best interests and is also affected by present staffing levels. Residents are still offered very little choice. It was confirmed by the two staff members on duty that all residents still go to bed before 8 p.m. and none of the residents are assisted to get washed, dressed or have their breakfast before the staff came on duty at 8 a.m. It was also established through discussions with the staff that residents receive weekly showers. The care notes viewed did not show that residents had been offered the choice of having these more regularly or if they had refused. When speaking to a staff member about the care a resident at St Michaels required in the morning; her reply was very task orientated and not individual to the resident or person centred. She stated we do X she is double handed and then we do two/two. They dont get up early, they get up at 8 a.m. If X gets up before 8 a.m. she will just sit in her room. When asked what time each of the residents like to go to bed, we were advised by staff that they all go to bed around 8 p.m. - after supper. When asked about the continence care of individual residents during the night, the staff member advised that no one has toileting needs during the night. When the staff member was asked what care another resident needed, she stated give a proper wash, put on clothes, hoist in chair and bring down to breakfast. When asked whether the resident was involved in choosing her clothes in the mornings, the staff member said no - but it was noted that in the care plan it stated I would like it if staff would hold up my outfits so I can choose with a nod of my head or smile. There had been notable changes to one resident who on previous Inspections had spent at least 16 -18 hours cared for in bed, as she now spent most of the day in the lounge with the other residents. The previous Manager had arranged for an Occupational Therapist to visit the home with regards to assessing for a suitable chair for the resident to use. On the day of the inspection this resident was sitting in a wheelchair all morning and was finally hoisted into her arm chair after lunch. On viewing a letter from the Occupational Therapist to the home, it advised there is a transit wheelchair in situ which we were advised has been used for X to sit in during the day. However it is a basic wheelchair with no head/lumbar support, which offers no support for X and should only be used as a means of transportation. On discussion with a staff member she stated that at first the resident had been in the comfortable chair all day, but this had then been changed by the Proprietor and she was now only hoisted into her comfortable chair in the afternoon. Neither of these changes of care or the rationale for this had been reflected in the residents care plan. St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 12 There was some positive practice observed during the Inspection. The atmosphere in the home was very relaxed and staff were noted to interact with residents each time they entered the lounge. One resident was knitting most of the morning and the staff member present discussed what she was knitting and provided encouragement. The staff member also held one of the residents hand and spoke to her kindly until the resident responded and smiled. This staff member also provided a blanket to a resident who had difficulties communicating, to help keep her warm. Another staff member spoken with, knew one of the residents preferred names and added that she smiles when you call her this. She also knew the best way to communicate with a particular resident. Care notes showed evidence of choice on the 12/3/09 - it stated that X did not wish to get up at first try this morning or the second try however she got up at 10:30 a.m. The Service User Guide stated the home provides accommodation and care with sensitivity to all residents with due regard to the individual personality, independence and dignity. From speaking to the staff on duty, observing staff and looking at the care plans, the evidence gathered showed that the care plans are not always followed. Also, when questioning the staff they did not always know how the care was to be provided to the individual resident. Care needs to be more person centred and outcome based through offering residents choice where possible. When asked whether they received the care and support they needed, both residents reported usually on their questionnaires. When the three relatives were asked the same question, two stated usually and one stated always. Management need to ensure that staff are more aware of individual residents needs, as stated in their care plans and in line with the statement in their Service User Guide. Files contained risk assessments, which identified areas of risk and measures that had been put into place to reduce this. Files contained documentation on GP and hospital interactions. A staff member 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 by the previous Manager. Weight charts were now in place and completed, which would assist in monitoring residents nutrition and health. One file seen contained evidence that a resident had gained weight since the last inspection. At the last inspection the Manager had introduced a safer medication system, which included the receipt, recording, handling and administration of individual residents of medication. She had produced a medication folder, which was clearly labelled and contained photos of residents, which would help assist staff in identification. There were also signatures of the staff who provided medication at the front of the folder, which would assist when auditing or if any concerns were raised. There was now some guidance to staff on as and when medication, but this was mainly to do with paracetamol and painkillers. On viewing the records there were no missing signatures or anomalies. St Michael`s Care Home for the Elderly DS0000069721.V375247.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. 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 can be sure that their basic care needs will be met in relation to nutrition and activities, but these could be developed further to offer so they offer better stimulation and choice. EVIDENCE: From discussion with staff, the routines of the day remain task rather than resident led. Staff discussing the routine of the day do not identify with residents’ choice. Staff spoken to said that ‘residents get up at 8 o’clock’ and ‘then we pick two each and wash them’. From viewing the care plans, observation and discussion with staff it was noted that individual preferences that had been recorded were not being followed, and this side of the care had not developed since our last inspection. The staffing of the home also continues to affect this, as at times, only one member of staff is available. From viewing the minutes of a residents/relatives meeting, relatives had raised concerns around this issue with the Proprietor. Staff are also taken away from residents by cooking and cleaning tasks. However, overall, staff were seen to St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 14 interact with residents more on this visit than our last and this is positive. Staff also spent more time with residents in the lounge. There is now a new television, DVD and video player in the lounge, which the staff advised the Manager who had recently left had arranged. On arrival at the home, staff were seen to be playing Hoopla with residents. Appropriate music was playing, that would generally be acceptable to the age group of the residents in the home. Later on staff put on more current music and one residents said ‘the bumpy music gets on your nerves terrible, bomp, bomp, bomp - drives you potty. Staff need to give more consideration to the music played and encourage the residents to choose. Minutes of the residents meeting from October 2008 show that the Proprietor told residents and relatives that a range of activities are on offer and now colouring was available. There is no evidence in the minutes of actual consultation with the residents. Records show that the activities on offer are knitting, singing, colouring, jigsaws, hoopla, dominoes and build a beetle game. The activities programme remains basic and not very person centred. This issue of activities is something that has been raised since the Proprietor took ownership of the home. Although there have been some improvements, we are not aware of any outside advice being sought to enable the home to develop this further and it is felt that staff may lack the motivation and insight into what else could be offered and training/advice may be of value. Records show that on occasions, where staff are intuitive, residents individual needs are being identified and met, but this is not the case for all residents. On the whole residents all take part in the same activities. Residents do not have an assessment of their social care needs in place. In some of the care plans there is information on residents social/family history and in some cases hobbies/interests, but on discussion with staff, some are not aware of this information and therefore may have a limited appreciation of the resident as an individual. Records show that staff record ‘walking around the home/hallway’ as a social activity. When residents were asked if activities were arranged by the home that they can take part in, both questionnaires responded usually. On occasions the records show that staff have promoted residents wellbeing by letting them get involved in daily living tasks, but on discussion staff feel that they cannot let them do much and show limited knowledge on this aspect of care. For example, staff said that one resident asks to help in the kitchen and they say to the resident ‘no you are too old’ – ‘but occasionally we give ‘x’ the cutlery to put on the table’. The staffing of the home limits the range of options for residents and outcomes are restricted for them. St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 15 Occasionally residents do go out of the home with family members. One resident did go out to walk at the rear of the home and the staff kept bringing them back in and were heard to say to the resident ‘do you want to get me sacked’. On discussing the garden access with the staff member for this resident, we were told that residents may fall over outside and so they cannot stay out there. There have been a number of previous issues and requirements made over the menus and food provided to residents. One staff member on duty stated that the Proprietor had arranged for the new Manager to do the shopping but after two or three weeks he said no and he started doing it again. She added that the last Manager looked at the menus and made changes. She said that they were sticking to the menus and confirmed the food was now available to match the menu. Two care staff are on duty and for each meal, one of the carers has to cook the food provided. On the day of the inspection the meal was sausages, mash, vegetables and onions. This was in line with the new menu that has been put in place since the last inspection. The menu was seen to be basic but better than it was and it contained a range of meals appropriate to the resident group. Nutritional records showed that, on the whole, the menu was being followed and on inspection the appropriate ingredients were available. Staff spoken to confirmed this. Consideration should be given to providing a choice at teatime as the main meal on offer was sandwiches. On discussion with two residents neither of them knew what was for lunch. Staff need to be more proactive in telling residents what is planned so they can have an alternative should they so wish. When one resident was asked what she was having for lunch she replied it would be nice whatever it is. Another was asked whether the meals had improved and she reported about the same - might have improved a bit. When asked whether they liked the meals, one questionnaire stated usually and the other sometimes. Staff were observed to assist residents appropriately and this had improved since our last inspection. Both staff on duty confirmed they had read the care plans and knew what care had to be provided but in one residents care plan it stated I would like staff to occasionally offer me bread and encourage me to try a little independence. When staff were asked whether the resident could help to feed herself, they both stated no. Also whilst eating her meal one resident complained to a staff member that her mouth was sore and she was having difficulties eating - the resident went on to remove her false teeth and complained of a sore mouth. She added I dont know if I can eat it. Although a staff member came over to see if she was alright, she did not offer the resident any alternative to eat. When staff were asked what had happened they stated that one of the residents teeth had come out, but confirmed that no professional help or advise had been gained with regard to new dentures. St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 16 Residents were seen to have a choice of drinks and the table settings were now seen to be more age appropriate than at the last inspection. Condiments were not available to residents on the table. One resident chose to eat later and it was positive to see that staff facilitated this. Drinks were not seen to be available to residents other than at allotted times. This needs to be reviewed to ensure residents have a good fluid intake. Staff reported that breakfast was served at 9.30am, lunch at 12.30 pm, tea would be served around 5.30pm and supper was at 7.15pm. This means that residents were going 14 hours without food or drink. The staff member on duty confirmed that residents did not have anything else until 9.15am to 9.30 am the next morning, when breakfast was served. She asked whether they should wake the residents up and offer them food and drink, but she was advised that perhaps it would be better if they were offered an early morning drink and biscuit when the first woke up. Nutritional records are good and also record the amount that residents have eaten. St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. 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 Poor 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 training and 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. The complaints procedure, Statement of Purpose and Service User Guide will need to include details of the CQC telephone number and address. There is a notebook kept under the visitors book for visitors to write any complaints or comments they may have, this was blank on the day of Inspection. This process needs to be reviewed, due to confidentiality as comments or concerns raised would be seen by others who may use the book. Staff had attended safeguarding training and the staff on duty had an understanding of the issues around whistle blowing and the protection of vulnerable adults. St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 18 During the inspection, evidence has been gathered that there have been unexplained injuries to two of the residents. Both issues should have been referred to the Local Authority as safeguarding issues, but had not. As the correct safeguarding procedures had not been followed and the issue had not been investigated, this could raise concerns over the safety of the residents. This has since been referred to the safeguarding department at Southend Borough Council for them to investigate. St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 19 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. Whilst the home meets residents basic needs, the environment as a whole does not always provide a pleasant, safe and stimulating place in which to live. EVIDENCE: A tour of the home was undertaken and the majority of bedrooms seen. Overall the home was seen to be clean and tidy and this aspect improved since our last visit. Parts of the home remain in need of refurbishment, primarily in relation to furniture and fittings. One bedroom has an odour issue that needs management, as this is a shared room. However this does not impinge on the whole home. One bathroom was noted to have a new toilet seat and support handles. There are bathing and shower facilities. St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 20 The standard of bedlinen in the home was variable, although some had been purchased since our last inspection, some needs replacement. Kylie’s, used for night-time continence management need replacement as they had come apart and if residents move in the night, this would not be comfortable. Towels in the home had been replaced since our last inspection. The small garden to the rear of the home was observed to be tidier than at our last visit but still requires some significant work to make it a pleasant place for residents to spend time. Garden furniture is available. Hot water temperatures were found to be satisfactory and since the last inspection a new boiler has been installed. One resident’s sink did not have working cold water and others were found to have a poor supply, possibly due to scale. Records show that the hot water temperatures have been checked regularly over the last few months and where required, action has been taken to address temperatures that were too high. Due to the layout of some rooms, residents do not always have access to the call bell system. Some communal rooms, such as toilets and bathrooms have small battery operated call systems and on testing, these were not working. This needs addressing. Fire safety records and checks were reviewed and found to be in good order, with fire drills and system checking in place consistently over the last few months. The fire safety risk assessment required review as this ran out at the beginning of April 2009 and safety certification for the fire alarm and emergency lighting was not available. St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. 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 have received training, but they cannot be sure that they will be cared for by staff who have an understanding of dementia care. EVIDENCE: Staffing has been an issue highlighted in the last three Key Inspections and also the Random Inspection. On the evidence gathered during this inspection, there are still some concerns. There were two staff members on duty and it was established who was in charge of the home for that shift and a copy of the staffing rota was obtained. From viewing the rota the information recorded was incorrect. It showed that one staff member was on the rota to work until 8pm, but she left at 4.00pm and the person who should have been off duty at 4pm stayed until 8.00pm. Also according to the rota there was only one person on duty from 4.00 pm till 8.00pm. Although not recorded the new member of staff arrived for duty at 4.00 pm. On speaking to the person in charge she stated she had telephoned the staff member that morning and asked her to come in on her day off. This person would have now worked seven days in a row. The rotas for the previous St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 22 weeks were not available. From viewing the rota available it was apparent that most staff had worked 12 hour shifts or 8am till 4pm. On viewing details of minutes from a residents/relatives meeting dated 31st October 200, this showed that two relatives had brought to the Proprietors attention that at times there was only one staff member on duty at the weekend. The Proprietors response was there are usually two staff on duty and that due to reduced funding because we only have 5 residents instead of 8 it is difficult to employ two staff in every shift. He added that however he is usually the second staff member on those occasions when it appeared that there was only one staff member on duty. He explained that he would have participated in the morning washing of the residents and given their medication and serving their breakfast, but when he finds he is not longer needed, he went upstairs to get on with other work and occasionally went out briefly to purchase items for the home. A memo had been sent to all staff on the 2/2/09 stating this is to let all staff know that the nightshift at St Michaels care home is one wake night until we have a full complement of residents when it will refer back to one wake and one sleeping. The Statement of Purpose continued to say that St Michaels has appointed a manager and has two experienced carers on duty per shift during the day to assist the service users. When the home is at full occupancy there are two carers at nights one awake and one asleep. As there is only one staff member on duty at night and also on occasions during the day, this could have health and safety implications for both the staff member and the residents and also impact on staff not being available to meet the present residents needs, due to some needing two carers to provide their care. The Service User Guide states the home ensures that the current level of staff is able to provide a level of care to meet the varying needs of service users. This was not our findings. It was felt that the present staffing levels have an impact on the care being provided to the residents and may be why the care is more task orientated than person centred or individual. When residents were asked whether staff were available to support them when needed, both reported usually. 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 viewing this file it contained proof of identity, details of criminal offences, certificates relating to relevant training and qualifications and a full employment history. Although there was a criminal record bureau check been completed, only half the form was on the file. The folder did not contain any written references gained on behalf of St Michaels, but there were copies of testimonials in connection to the applicants previous employers in other countries. There was a copy of the applicants passport and further clarification is being sought to establish whether a work permit is also required. The file contained evidence of an interview form, which had been completed by the previous Manager and the Proprietor. St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 23 On looking at the induction of the new member of staff, it was noted that there were areas on the induction form that had not been completed. These included guidance on the ethos of the home, reading the policy procedures, reading through Person centred care plans, choices, health and safety, the use of hoists and medication. All of which are essential areas. Since the last inspection a training matrix had been introduced and this provided up-to-date information on the training completed and when updates were required. Training was recorded as having been completed since the last inspection. Three staff files were inspected and all staff had now attended moving and handling training, health and safety, safeguarding, infection control, fire safety and those working with food had food hygiene certificates. One staff member spoken to during the inspection confirmed that she had also attended first aid and medication training since the last visit. She also added the Manager who had recently left had organised some in-house training with regard to infection control and fire safety. It was noted that very few staff had completed training on dementia. Due to home being registered for dementia and all its present residents having some form of dementia, it is felt that formal training is essential to ensure staff have the understanding and skills required to care for the present individuals St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 24 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not live in a home that is effectively managed or run in their best interest. EVIDENCE: Since the last inspection two managers have left the employment of the Proprietor. On discussion with staff, they said that they were aware that the Manager had left recently, but were unsure of the current management arrangements. Whilst at the home a person arrived and introduced herself as the new manager and said that this would be a 6 month to 1 year placement for her. Whilst at the home the new manager arrived to introduce herself and said that this would be a 6 month to 1 year placement for her. Whilst it is St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 25 positive to see that another manager has been employed, it is a concern as the home remains without any long term stable management since the present Proprietor took ownership. Due to the changes in the managers there has been insufficient time to enable them to help drive forward changes and improvements that are needed to provide residents with sustained good outcomes. Areas that have been raised as concerns during this inspection include safeguarding procedures, staffing of the home and incorrect rotas, staff not having the skills and knowledge to care for those with dementia and the induction of staff. Although there has been some improvements, the care provided by staff still lacks understanding of person centred thinking and residents cannot be assured that they will receive quality care at all times. Both manager’s who have left the home have contacted us to express their unhappiness about the Proprietors management of the home as a whole. They have raised concerns that there are restricted finances available and this is having an impact on their ability to manage the home, the staffing levels and general care provided to the residents. The Proprietor’s policy states that an annual quality assurance questionnaire is issued to all service users and their families etc. The last questionnaire was conducted in May 2008. The policy says that a follow up report would then be written and be available in the main hall. Staff spoken to were unaware of the quality assurance systems in place for the home and the follow up report was not available. Subsequent to our inspection the Proprietor sent us a copy of the report. The team at the home looked after small amounts of residents’ monies on their behalf. Appropriate records were seen to be in place and recording with two signatures was seen to have improved. Monies were checked at random and found to be in good order. Lifting hoists had up to date safety certificates in place and from observation, lifting slings were in a good condition and were clean. No COSHH shortfalls were noted on touring the home and sufficient gloves and aprons were available. Wheelchairs in the main hallway were noted to have footplates missing and this needs to be addressed to ensure resident safety, if they are used. On the day of the Inspection the home still did not have a safety certificate for the wiring of the home. This had been raised at the last inspection and had not been addressed by the proprietor. This has since been sumbitted, but the proprietor needs to gain written clarification from the company that provided it to gain confirmation on the expiry date, as this information is not present on the certificate. St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 26 The previous manager had completed a risk assessment for the home and identified items that needed to be addressed and had actioned them, for example the tripping hazard into the lounge. Accident records were reviewed and found to be acceptable but could be tightened up with staff recording in sufficient detail. It was noted that the proprietor had recorded in one resident’s daily notes that they there had been an accident and they had sustained a bruise and laceration that had been dressed. However this was not recorded in the accident book. An immediate requirements form, to say that all accidents must be recorded in a recognised accidents book, was left and the Proprietor responded to us saying that injury sustained could have been spontaneous, self harm or accidental and it was felt that this did not warrant recording in the accident book. As it would than appear that this was an unexplained injury, this should have been regarded as a potential safeguarding issue. The resident concerned did not have any reference to self harming behaviour in their care plan. This is a concern as the Proprietors understanding of accident recording and adult safeguarding referrals with regard to unexplained injuries. Staff files showed that supervision had been implemented and this included meetings as well as individual supervision sessions. A supervision matrix had been produced since last inspection. Staff meetings had occurred on 23/1/09 and 31/10/08 and minutes of the meetings were available. Staff report that they recently had a meeting with the Proprietor and previous manager but no minutes could be located. St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 27 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 2 2 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X 3 2 2 St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 28 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 12(2) Requirement Service users should have a plan of care in place and be encouraged where possible to make decisions on how their care is to be received. Although care plans are now in place, on observation during the Inspection and discussions with staff they did not always reflect the care being provided. 2. OP12 16 (2)(n) Although some work has been 30/06/09 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 timescale for action given is 31/05/08, 31/10/08 and 02/01/09 - these have not been met. New timescale given. Timescale for action 30/06/09 St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 29 3. OP14 12 (2) Care should be provided which 30/06/09 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 activities, care, bathing and general day to day living. At present the care is still very task orientated. This is a repeat requirement. Previous timescales 30/09/08 and 02/01/09. - these have not been met. New timescale given. 4. OP18 13(6) Systems must be in place to prevent service users being harmed or suffering abuse or being placed at risk of abuse or harm. This is in connection to ensuring that the correct safeguarding procedures are followed when areas of concern or unexplained injuries are received. The CQC should also be made aware of any issues that are concerning the welfare and safety of the service users via Regulation 37. 09/04/09 5. OP27 Schedule 4 (7) 30/06/09 The staff rota must be up-todate and accurate reflection of staff cover, times, dates and staff on duty. Although the staffing rota was made available during this inspection it did not reflect a true account of who was on duty and on the day of the Inspection only showed one person for the afternoon shift. DS0000069721.V375247.R01.S.doc Version 5.2 Page 30 St Michael`s Care Home for the Elderly A safer systems for night time cover need to be looked at, as the present staffing levels could put the health and safety of residents and staff at risk. This is a repeat requirement. Previous timescales for action given are 30/04/08, 30/07/08 and 02/01/09 - these have not been met. New timescale given. 6. 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. Evidence gathered during the inspection shows that staff have not attended or received any training for dementia care. This was a requirement from the last inspection and updates for dementia should have been arranged for staff, but due to the changes in the staffing at the home this is now essential and must be arranged as soon as possible. 7. OP30 18 (1)(c) (i) All staff that are employed should receive an Induction in line with the Skills for Care guidance to help ensure they are competent to do their job. This should be clearly recorded on their file. 30/06/09 30/06/09 8. OP31 8 (1) 30/06/09 The registered provider shall 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 DS0000069721.V375247.R01.S.doc Version 5.2 Page 31 St Michael`s Care Home for the Elderly responsibilities fully. They should be qualified, competent and experienced to run the home and meets its stated purpose, aims and objectives. 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. The pre admission assessment form to be used for new residents needs to be checked against the list under 3.3 of the NMS, to ensure all the information required is collected at the assessment stage. It is recommended that you develop community involvement with the home to enhance the activities within the home and offer residents better stimulation. 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 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. OP13 4. OP16 5. OP31 St Michael`s Care Home for the Elderly DS0000069721.V375247.R01.S.doc Version 5.2 Page 32 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastern@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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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