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Inspection on 10/08/05 for St Michael`s Cheshire Nursing & Residential Home

Also see our care home review for St Michael`s Cheshire Nursing & Residential Home for more information

This inspection was carried out on 10th August 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

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

During this inspection visit the inspectors found that residents reported satisfaction with the care they receive at the home. The home plans and manages the provision of activities for residents very well. The staff team seemed focused in providing a good standard of care for residents and staff reported that the home`s management communicates and supports them in their roles well.

What has improved since the last inspection?

Three requirements were made at the last inspection. The requirements made with regard to weekend staffing levels and carpet cleaning has been met. There remains a requirement to be met regarding staff recruitment records. Since the last inspection there has been success in recruiting staff into most vacant posts at the home. There is much less reliance on agency staff usage at the home. The staff team seem mutually supportive and settled now.

What the care home could do better:

As a result of this inspection two requirements are made. The first is for medication management and the second is for police vetting checks for new staff. Four recommendations are also made. Two concern care plans for residents. The other two recommendations are to improve information held on resident contracts and to provide missing persons information in a convenient format at the home. St. Michaels is a large property of character. Routine redecoration and maintenance is on going. Some areas of the home are in need of upgrade and redecoration. The management of the home is aware of this and has this scheduled into routine maintenance works plans.

CARE HOME ADULTS 18-65 St Michaels Chesire Nursing and Residential Home Cheddar Road Axbridge Somerset BS26 2DW Lead Inspector Judith Roper Unannounced 10th August 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service St Michaels Cheshire Nursing and Residential Home Cheddar Road Axbridge Somerset BS26 2DW 01934 732358 01934 732809 Address Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Leonard Chesire Mrs Helen Bond Care Home with Nursing 36 Category(ies) of Old Age registration, with number Physical Disability of places St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, in the age range 18-60 years, who require nursing care by reason of physical disablement. 2. Elderly persons of either sex, not less than 60 years, who require general nursing care. 3. Up to twelve places for personal care. 4. Up to 30 places for nursing care. 5. Regsitered for a total of 36 places in categories OP and PD. 6. The home must at all times have an appropriately skilled clinical nurse on duty. Date of last inspection 4th November 2005 Brief Description of the Service: The home is formed from the conversion of a former TB sanatorium, managed by the Anglican Sisterhood from 1878 until1968. The home now caters for Younger Adults with Physical Disabilities and is managed by The Leonard Cheshire Foundation. The home is set in large grounds on a sloping site that allows access to the grounds from each floor. Many of the original features of the house have been retained. The home is within walking distance of Axbridge Town where there are shops and other local facilities. Accommodation is on three floors, and there are two adjoining bungalows used as transitional homes for suitable residents. These bungalows are not registered for nursing or personal care. All bedrooms are single occupancy. The home has been well adapted for the younger service user. The home can accommodate self-propelled wheelchair users thereby fostering maximum independence. The grounds are accessible by wheelchair and there are tables and chairs for use on the patio in the warmer weather St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two inspectors and took place over one day between the hours of 9.45 am – 5.25pm. 36 residents were at the home on the day of the inspection. There are currently no vacancies at the home. The inspectors were able to see and spend time interacting with the residents. Many staff on duty were able to give time to speak with the inspectors. The registered manager Mrs. Bond was not on duty but the team leader for administration and finance and the senior nurse were available for comment during the inspection. The inspectors would like to thank the staff for their time and hospitality shown to the inspectors during their visit. The atmosphere at the home was relaxed and informal. Staff carried out their duties in a friendly and professional manner. It was a pleasantly warm summers day and several residents were enjoying the weather by utilising outdoor spaces at the home. This is the first inspection using the new CSCI reporting format, which focuses on outcome statements for National Minimum Standards. The inspector’s aim on this inspection visit was to seek views on the quality of the service from as many service users as possible and to speak to staff and any visiting relatives. Records examined during the inspection were five care plans, staff recruitment files, the fire and complaints logs, Regulation 26 visit recordings on behalf of the provider, equipment servicing records, accident/incident logs, residents finances, resident contracts, staffing rosters, staff training records and medication records; other records will be examined at subsequent inspection visits. What the service does well: During this inspection visit the inspectors found that residents reported satisfaction with the care they receive at the home. The home plans and manages the provision of activities for residents very well. The staff team seemed focused in providing a good standard of care for residents and staff reported that the home’s management communicates and supports them in their roles well. St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5. The home provides information for prospective residents that is informative and clearly presented. This gives potential residents useful information about the services at the home. Pre-admission assessments of residents are complete and give a good baseline assessment of an individual’s needs so that the home can decide whether the admission is appropriate. Dependency levels at the home can be high with many residents having complex needs. Staffing levels are adjusted to reflect current need. There is frequently additional nursing support for a morning shift but not always. Nursing staff said that a second nurse per morning shift helps them manage their duties more effectively. Inspected resident contracts were in order. It is recommended, however, that the room to be occupied be recorded on an individual’s contract, as this is their contracted private space. EVIDENCE: The home has reviewed and rewritten its Statement of Purpose since the last inspection. A copy of this revised Statement of Purpose was supplied for the CSCI local office during the inspection visit. St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 9 Pre-admission assessment records were examined for two newly admitted residents. The assessments were detailed and complete. The two newly admitted residents confirmed that they had made trial introductory visits to the home before deciding to move in on a permanent basis. The home meets the needs of residents by reviewing care plans and completing service reviews with care managers. Staff training to meet clinical needs of residents is organised and planned well. The home admits both nursing and residential service users. It is acknowledged by the home that residential service users may have complex needs and the home has arranged for reassessment of need for individual residents via the community nursing team when the home has felt that an individual requires nursing care. Some residential service users access the community nursing services for short-term community nursing input. The home is aware of the on-going need to assess and review in-house staffing levels, particularly nursing, should the dependency levels in the home rise. Advocacy and self-advocacy schemes for residents are operational at the home. Samples of four case tracked resident contracts were inspected. Information in contracts was appropriate although it is recommended that the room to be occupied be recorded in the individual resident’s contract. St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9,10. Care plans are generally good containing information that reflects current health and social needs. Wound care and pressure area care planning needs to be more instructive and detailed in order for staff to critically evaluate how treatment programmes for wound or pressure areas are progressing. Residents need to be more involved in the reviewing of their individual care plans. Advocacy and self-advocacy is supported and encouraged in the home. This adds to assertiveness and self-worth for residents. Resident confidentiality is respected and maintained. The methods of maintaining confidentiality are explained to residents in the home’s Statement of Purpose and Service User’s Guide. EVIDENCE: A sample of five resident care plans were inspected. The home’s reviewing of the sampled plans did not indicate evidence of resident involvement and this is recommended. The home writes in its Statement of Purpose that care plans are reviewed with the service user. Information in care plans was generally documented well but the inspectors have recommended that where an St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 11 individual has a wound and is receiving wound care that the plan for treatment of the wound be more detailed with evidence of GP/tissue viability advice sought. Pressure areas care needed to more instructive in the individual’s plan where the resident was receiving treatment for a pressure ulcer. The company care model for the Leonard Cheshire organisation promotes independence and choice for its residents. Advocacy and self-advocacy services are promoted and residents have meetings in the home. Residents also form part of interview panels for new staff appointments. Residents are encouraged to retain management of their own personal finances. The home has a small shop that is run by residents in the mornings on a rota basis. Residents spoken with were aware of the organisation’s plans to locate to an alternative site. Those spoken with were aware that no site had yet been identified and most were anxious to what would happen to the St. Michaels site should an alternative site be agreed. Risk assessments for individual activities and environmental risks at the home were present in individual care plans. The home is open for residents to move freely in and out of the building to access the grounds. It was recommended at the close of the inspection that the home devises a missing persons information sheet to be held in an individual’s plan that can be shared with the local constabulary should a resident ever abscond or fail to return to the home at an agreed time. The home has a missing person’s policy to be followed in the event of a resident being missing from the home. Records were held in a manner to protect resident’s confidentiality. The home said that it plans to store care plans in individual’s rooms. This could help in encouraging residents to be more involved in the reviewing of their care plans. St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,16,17. The home has good facilities for providing activities and activities are planned and executed well. Residents enjoy the range of activities offered both in and outside of the home. Staffing for activities provided is skilled and in sufficient numbers to enable residents to be occupied and entertained at the home. Resident’s confirmed that choices and preferences are respected at the home. Residents are encouraged to participate in the home, for example with meal planning or leisure events. Staff provide sensitive and professional support to residents who require assistance with eating and drinking. EVIDENCE: The home has an IT suite that is utilised by many residents. Many residents use email accounts. A skilled staff member and volunteers give assistance. Craft activities are popular and residents have recently had an art exhibition in St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 13 the home. Nature conservation issues are actively pursued by residents with staff support. The home has a physiotherapy rehabilitation suite that is open three days a week, staffed by trained physiotherapists. The physiotherapists assess residents on admission and monitor progress throughout the individual’s stay at the home. Skills and learning opportunities are encouraged in-house although residents have accessed local colleges in the past. Learning opportunities are arranged following consultation with the individual resident. Currently no residents are able to attend work placements due to physical ability. The home reports good links with the neighbouring villages of Cheddar and Axbridge. The home’s extensive grounds are used for local outdoor events. An extensive volunteer network supports staff to provide activities at the home. The home has its own stunning chapel where several faith denominations hold services on a rota basis. Resident’s spoken with said that the range and frequency of both indoor and outdoor activities in the home was good. Resident’s spoken with also said that staff respect their privacy and knock on bedroom doors before entering. A number of ‘do not disturb’ notices were displayed outside resident bedrooms where occupied. The home has a large dining room where most residents choose to take their meals. The dining room also has a bar, which is open several times a week. There are plans to upgrade the dining room as it presently has what was described by the home as an ‘institutional feel’ about it. Lunch was observed at the home. A high number of residents need assistance with eating and drinking. Staff gave individual attention to resident at the resident’s own pace and in a professional manner. There is a resident’s menu planning group at the home who seek meal preferences from the residents and pass onto the kitchen for menu planning. St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20. Equipment in the home meets the handling needs to residents in order to provide safe systems of transfers for disabled residents. Health needs are monitored and met. Some additional community tissue viability specialist support to the home would benefit residents. Medication is safely administered. Medication records require more stringent monitoring of controlled drug stock levels and variable dose recording. EVIDENCE: Overhead tracking is provided in bedrooms and bathrooms for handling requirements. Nursing support is maintained throughout the 24 hour period. Residents spoken with said that they were care for well at the home. Health care screening and community monitoring was recorded in care plans. Some care plans were in need of a degree of sorting to remove superfluous information that was now not required in order for readers of care plans to find health care information more easily. The home has experienced difficulty in securing a community tissue viability nurse contact for the home. Inspectors discussed strategies for obtaining a named dedicated community contact with the home’s senior clinical nurse. Some nursing staff at the home were due to attend a conference in tissue viability the day after the inspection. St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 15 Medication management and medication record keeping was inspected. Most medication management and record keeping was satisfactory. Where controlled drugs stocks have not been recorded as being checked daily it is a requirement that this is done. It is also a requirement that where a prescription indicates a variable dose, then the dose amount given must be recorded on the Medication Administration Record (MAR) sheet as the inspectors found that variable dosage amounts were not always written on the individual’s MAR records. St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23. The home has a complaints procedure, which is appropriate and is adhered to. Staff in all roles working in the home have benefited from recent training in the protection of vulnerable adults. Staff said that the quality of this thought provoking training was good. EVIDENCE: The home has not received any complaints since the last inspection. The home’s complaints file was inspected. Procedures for handling complaints were demonstrated to have been followed for previous complaints made to the home. Protection of vulnerable adults training has taken place for staff in all roles since the last inspection. Policies and procedures are in place to protect residents from abuse. (See Standard 34 re. Comments made about staff recruitment). St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29,30. The Leonard Cheshire organisation plans to move to a new purpose built facility away from the St. Michaels site in the future in order to meet National Minimum Standards. No alternative site has been identified yet. In the meantime, St. Michaels has been adapted to meet resident needs as far as possible. Disabled access and disabled facilities are good. The home was clean and inviting with resident’s artwork framed and adorning public corridors. EVIDENCE: It is still planned that the Leonard Cheshire organisation will purchase a new site for the service currently offered at St. Michaels. No site had yet been identified and residents at St. Michaels are aware of the organisation’s plan. The St. Michaels site is large and of character. It has been adapted as far a possible to meet National Minimum Standards. The quality of internal décor varies but there is an on-going routine maintenance plan for redecoration. Wheelchair access around the home is good. St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 18 All accommodation offered is in single rooms. Rooms seen were personalised reflecting the tastes of occupants. The home was comfortable, lighting and ventilation was adequate. Toilets and bathrooms are lockable and have disabled facilities. Some bathrooms and shower rooms are functional rather than aesthetically pleasing. There is a range and good choice of shared space. This includes a servery area where residents can get a snack or drink between meals. Smokers have their own designated balcony lounge. The home was sufficiently and suitable clean on the day of the inspection. Infection control measures in place are adequate. The laundry was inspected and laundry staff spoke with one inspector. The facilities in the laundry are sufficient. The home is planning to re-site some washing machines when replacements are needed in order to improve space in the laundry. Laundry staff reported that there had not been any problems with reported ‘lost’ resident laundry in recent memory. St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,34,35,36. The staff team is more settled since the last inspection. Staff reported that they were supported in their roles by the management and staff appeared happy in their roles. There are sufficient numbers of staff rostered on duty to meet the current needs of residents. Staff training is structured and organised well. Staff reported that training had improved at the home and that training sessions were thought provoking and instructive. Staff recruitment is required to be more robust in order to protect vulnerable adults living at the home. Staff are supervised regularly and staff value supervision sessions. EVIDENCE: Roles and staff responsibilities are defined within the staffing structure at the home and are detailed in the Statement of Purpose. The home also uses Community Service Volunteers from across the world. These volunteers are not included in the duty staff rotas. There has been success in recruiting into most vacant posts since the last inspection. Agency staff usage is much lower now. Staff and residents spoken with at the inspection said that they felt staffing levels to be adequate. Nurses valued the support of a second St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 20 registered nurse on the rota, when rostered. Copies of a months staffing rotas were supplied to the inspectors for scrutiny to check that staffing levels remained as planned. The rotas confirmed this. A team of administrative, management, physiotherapy, activity and ancillary staff supports direct care staff and nurses. Three staff recruitment files were inspected. Those inspected were satisfactory. However, it was reported that the organisation was planning to start a newly appointed staff member without POVA first clearance, whilst the CRB check was being processed. Staff cannot start supervised shifts unless the POVA first check is clear in addition to the receiving of two satisfactory written references. It was also reported that overseas staff have a police check from their mother country but not the UK. It is required that a UK CRB is sought for overseas staff as well as the mother country in order to protect residents. The home employs a staff trainer. Staff training records were maintained well with a good range of staff training in-house events scheduled throughout the year as well as staff accessing external training events. Staff reported regular meaningful supervision on a 1:1 basis with their supervisor. Staff meetings are held regularly and minutes are produced. St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 40,41,42. Policies and procedures at the home are endorsed by the Disability Forum adding weight to the professionalism of policies adopted by the organisation. Health and safety issues are monitored on a monthly basis with a report sent to the CSCI. This report included timescales given by the organisation for issues to be addressed by and is followed-up by the next months visit. EVIDENCE: The home has adopted all Leonard Cheshire policies and procedures and codes of practice. The Disability Forum endorses these. These documents are updated centrally. Records are stored appropriately. Regulation 26 visit reports by the provider are copied to the CSCI on a monthly basis. The home has also notified the CSCI of reportable events between inspections via the Regulation 37 reporting process. The report of the home’s recent health and safety meeting was provided for the inspectors. Timescales for issues to address are included in the report. St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 22 Equipment servicing records were inspected. Just one patient airflow overlay mattress was identified by the inspectors as being overdue a servicing visit. One inspector brought to the attention of the senior nurse an issue of electrical safety in the home where eight wheelchair chargers were observed to be switched on but disconnected from wheelchairs with the leads trailing on the floor. The nurse remedied this immediately and staff were to be alerted to this via an internal memo. Fire records and staff training in fire safety records were inspected. They were both in order. There are several potholes in the drive approaching the home. These are scheduled to be filled at the end of the month. St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x 3 3 Standard No 31 32 33 34 35 36 Score 3 x 3 1 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 St Michaels Chesire Nursing and Residential Home Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x 3 3 3 x D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 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 YA20 Regulation 13(2) Requirement It is a requirement that the dose administered must be recorded for all administrations of medicines that are prescribed as having a variable dose. The stock levels of controlled drugs held in the home must be recorded daily. Newly appointed staff must have a POVA first check confirmed prior to starting supervised shifts. Staff recruited from outside of the UK must have a CRB check completed from the UK as well as their mother country. Timescale for action 10/09/05. (Timescale of 14/1/05 not met for previous inspection report). 10/09/05 2. YA34 19(1) (b)(i). Schedule 2. 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. 2. Refer to Standard YA5 YA6 Good Practice Recommendations It is recommended that the room to be occupied be recorded in the residents contract. It is recommended that residents who are able to assist staff in the formation and review of their care plans are encouraged to do so. This would make care plans D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 25 St Michaels Chesire Nursing and Residential Home 3. YA6 4. YA9 meaningful to the individual and person centred. It is recommended that wound care planning in care plans is more detailed, including tracing/photograph evidence (with resident consent) so that treatments can be evaluated more effectively. It is recommended that the home devises a missing persons sheet with information about a resident that can be conveniently presented to the local constabulary should a resident abscond from the home or fail to return to the home within an agreed timesale. St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Michaels Chesire Nursing and Residential Home D53 - D02 S3291St Michaels V231649 100805 Stage 4.doc Version 1.40 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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