Inspection on 12/09/06 for St Michael`s Cheshire Nursing & Residential Home

This inspection was carried out on 12th September 2006.

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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Michael`s Cheshire Nursing &... 02/10/07

St Michael`s Cheshire Nursing &... 20/10/05

St Michael`s Cheshire Nursing &... 10/08/05

St Michael`s Cheshire Nursing &... 04/11/04

St Michael`s Cheshire Nursing &... 06/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 St Michael`s Cheshire Nursing & Residential Home Cheddar Road Axbridge Somerset BS26 2DW Lead Inspector Judith Roper Key Unannounced Inspection 12th September 2006 09:30 St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Michael`s Cheshire Nursing & Residential Home Cheddar Road Axbridge Somerset BS26 2DW 01934 732358 01934 732809 Address 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) www.leonard-cheshire.org.uk Leonard Cheshire Mrs Helen Bond Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Persons of either sex, in the age range 18-60 years who require nursing care by reason of physical disablement Elderly persons of either sex, not less than 60 years, who require general nursing care Up to twelve places for personal care. Up to 30 places for `nursing care`. Registered for a total of 36 places in Categories OP and PD The home must, at all times, have an appropriately skilled clinical nurse on duty. 20th October 2005 Date of last inspection 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 reasonably accessible by wheelchair and there are tables and chairs for use on the patio in the warmer weather. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was carried out by two inspectors and took place over one day for a total of 13.5 hours. 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 available for comment during the inspection. The inspectors would like to thank Mrs. Bond and the staff for their time and hospitality shown to the inspector during her visit. The atmosphere at the home was relaxed and friendly. Staff carried out their duties in a pleasant, unhurried and professional manner. Prior to the inspection the CSCI forwarded 36 service user surveys to the home and received 27 completed returns. 2 professional surveys about the home were sent out to associate community health care professionals and both were completed and returned. The general trends in the responses were shared with the home’s manager via a spreadsheet analysis protecting the identity of respondents. Generally the responses were positive. It is clear that residents at St. Michaels are given opportunities and support to express their views on the conduct of the service through structured and regular consultation by the Leonard Cheshire foundation as well as being able to approach staff and management at the home informally. Records examined during the inspection were a selection of care plans, St. Michaels quality assurance processes, medication management records, staff training records and staff recruitment records, staffing rosters, service user menus, equipment servicing records, fire safety records, information provided by the home to prospective and new admissions, a selection of service use contracts and records of staff meetings. Prior to the inspection the home completed and forwarded to the CSCI on request a pre-inspection questionnaire. This inspection focused on outcome statements for key National Minimum Standards and any standards where a requirement or recommendation were made at the last inspection were also inspected. The aim of this inspection visit was to inspect key National Minimum Standards as part of the Commission’s ‘Inspecting for Better Lives’ strategy. Inspectors focus on outcomes for service users and measure the quality of the service under four general headings. These are - excellent, good, adequate and poor. The judgement descriptors for the eight chapter outcome groups are given in this report. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: St. Michaels is a home that is managed professionally and competently. At this inspection four requirements and three recommendations are made. The requirements are in relation to clear and accurate service user care planning, safe management of medicines in the home, plans for the organisation to meet environmental Standards at the home in 2007 and first aid management at the home. The recommendations are with regard to service user contracts, recording of service users involvement in care planning and care planning review and the recording of service user consent to restrictive bedrails as a safety measure. Please contact the provider for advice of actions taken in response to this St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 9 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 the following standard(s): 1, 2, 3, 4, 5. The overall outcome for these assessed Standards is good. The home provides a range of information formats for prospective residents that are both informative and clearly presented. The information is also available in alternative formats. This gives potential residents useful information about the services at the home. Admission processes for prospective service users are detailed to ensure that the placement at St. Michaels is appropriate. Resident contracts were re-issued in April 2006 as part of an annual service review. Contracts sampled on file in the home had been signed by neither party. This needs addressing as part of necessary record keeping for the service. EVIDENCE: The home reviewed and updated both the Statement of Purpose and Service User Guide in May 2006. The CSCI holds copies of these current documents. In addition to this, other professionally presented brochures and information giving booklets about St. Michaels and the wider Leonard Cheshire organisation are available for prospective service users. In feedback surveys service users reported that they had received sufficient information about the home before St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 10 admission. Only a minority of those admissions arranged via social workers/family members replied that they had not received information about the service prior to moving in to the home. Inspectors were able to evidence that pre-admission assessments by the home for prospective new admissions had been carried out. Information sharing about prospective resident current needs from placement agencies had also taken place prior to a new admission being accepted at the home. Resident contracts were routinely re-issued as part of the service review in April 2006. Contracts for 3 service users were sampled. Neither party had signed the contracts sampled and the home is therefore unable to demonstrate agreement between service user and the Leonard Cheshire organisation for contractual terms of stay at the home. The Commission recommends that the home manager arranges for two signed copies of contracts on behalf of Leonard Cheshire be sent to the service user, with a request that the service user retains one copy and a copy be returned to the home. A record of when the contract was issued to trace progress is also recommended. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 11 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 the following standard(s): 6, 7, 8, 9. The overall outcome for these assessed Standards is adequate. Care planning could improve significantly by adopting a greater person centred approach to the care planning and review processes. Personal care records were poorly completed in sampled care plans. Advocacy and self-advocacy is strongly supported and encouraged in the home. This adds to assertiveness and self-worth for residents. There are a range of advisory committees within the Leonard Cheshire for residents to sit on. This ensures that residents are part of the structured policy decision making within the Leonard Cheshire foundation. Risk taking is recognised as part of normal life for residents. A recommendation remains from the previous inspection that service user consent be recorded for use of a risk assessed restraining aid such as bed rails. EVIDENCE: St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 12 A sample of seven resident care plans were inspected. As at the previous inspection residents spoken with were either not aware of their care plans or did not express a desire to be consulted in the writing of their individual plans of care. This sits incongruously with the ethos of the home that is so resident voice focused and greater resident participation in the care planning processes would be encouraged by the Commission to enable person centred care planning to be realised. There were some resident life histories completed in care plans inspected, more so for nursing care service users rather than service users receiving residential care. Some personal care records were poorly completed making monthly records meaningless to interpret or assess. One person reliant on insulin did not appear to have full information in their care plan on how to manage their diabetes. Wound care records and wound care planning was very well recorded and tracked. Where service user had bed rails installed following a detailed risk assessment there was not evidence that consent for bed rails had been obtained from the service user or a record of consultation with next-of-kin if the service user was unable to give their consent. This is recommended. The company care model for the Leonard Cheshire organisation promotes independence and choice for its service users. Advocacy and self-advocacy services are promoted and residents have a range of 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. Service users spoken with were aware of the organisation’s plans to locate to an alternative site. Service user feedback survey responses scored highly in areas asking if choices were promoted at St. Michaels. 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. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 13 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 the following standard(s): 11, 12, 13, 14, 15, 16, 17. The overall outcome for these assessed Standards is good. Service users gave feedback confirming that the home and wider organisation supports family and friendship links and that there is opportunity to choose to be part of social events or clubs locally. There is a range of in-house and community based activities available for service users that are age and ability appropriate. Meals offer choice and opportunity for good nutritional value. EVIDENCE: Surveys were received from service users as part of the inspection process and inspectors spoke with service users at the home on the day of the inspection. Survey responses and service user conversations gave testament to the variety of activity taking place at the home and the opportunities available to participate in educational or leisure pursuits. Dedicated activity and learning St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 14 staff are employed at the home and the home employs a part-time psychiatric nurse who is also a trained psychosexual counsellor. Four people commented that that ‘The Centre’, where many in-house activities take place is closed at weekends, and that this is a negative aspect of an otherwise busy home. There is good commitment by the home to sourcing and providing appropriate communication aids for service users with communication difficulties and supporting effective communication via electronic communication aids via ongoing staff training. There is very good IT training and support provided for service users in-house. St. Michaels has its own beautiful chapel, where Church of England and Methodist denominations hold Sunday services on a rota basis. A new service user coffee bar has been opened at the home since the last inspection, in addition to existing communal facilities. Meals provided offer choice within the menu and service users spoken with commented that additional dishes are available if someone does not fancy what is on the daily published menu. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 15 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 the following standard(s): 18, 19, 20. The overall outcome for these assessed Standards is adequate. There were some mixed comments received as part of the inspection process regarding staff attributes but overall service users seemed satisfied with care delivery at the home. The home works in partnership with Community health care professionals to meet service user’s physical and emotional needs and St. Michaels provides good physiotherapy and psychological therapy in-house. Medication systems are generally safely managed but some medication management has been identified by the inspectors as requiring improvement. EVIDENCE: During the inspection staff were observed giving un-hurried attentive care to service users. Verbal responses from service users about staff to inspectors during the inspection were positive and typical comments about staff on service user surveys stated, for example, “Staff treat me well.” “Staff all respect me.” “Everyone is fantastic.” There were some variable results regarding staff attributes in service user surveys, however, with 18 responses St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 16 stating that staff always treat them well, 8 responses saying that they were usually treated well and 1 response said staff sometimes treat them well. There was a similar statistical breakdown for service user survey responses to the question, ‘Do carers listen and act on what you say?’ No survey responses indicated that staff never treat service users well or never listen to service user views. Some respondents commented that it depended who was on duty to how their day went. One community health care professional providing services to the home also commented via a feedback form that they felt the quality of care at the home was affected by the lack of knowledge of service user current needs by some care staff. Involving care staff who act as key workers for service users in care planning and care review processes is a suggestion to how this perception may improve. Community health care screening and monitoring of chronic clinical conditions in partnership with NHS specialists via out patient appointments or placement review were clearly recorded in care plans sampled. The service benefits from an in-house physiotherapy department where maintenance and slow-stream rehabilitation packages are provided by a skilled and dedicated physiotherapy team. Medication management and medication record keeping was inspected. Medication Administration Records (MAR sheets) inspected were generally maintained in good order for oral medications. Topical medicine administration was poorly recorded and the registered manager is required to devise a system for ensuring that a record is maintained for the administration of all prescribed medicines. There was not evidence that medicines being crushed for enteral administration was authorised by the G.P in writing. This must be obtained to demonstrate that it is the prescribing Doctor who has authorised the administration of a medicine in a form other than dispensed to the home. The cold storage of medicines was inspected and there was evidence that the fridge temperature had been running outside of the recommended range for stock insulin stored within. Insulin is required to be stored refrigerated when not in use between plus 2 and plus 8 degrees Celsius. Advice from the dispensing pharmacist regarding destruction of the medicine must be sought should the temperature of the insulin in storage fall below plus 2 degrees Celsius. Where a service user was supported to manage their own medications there was evidence of good practice in the assessment of ability to self medicate and review of on-going ability. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 17 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 the following standard(s): 22, 23. The overall outcome for these assessed Standards is good. The home has a complaints procedure, which is appropriate and is adhered to. The home demonstrates good staff training and staff awareness in abuse detection and the protection of vulnerable adults. EVIDENCE: The home has received one complaint since the last inspection and the inspectors were able to track a clear process of dealing with the complaint following the Leonard Cheshire complaint’s procedure. At the inspection service users spoke of being empowered and confident in feeling able to raise concerns or complaints to staff or management at the home. Service users surveys results from 9 out of 27 respondents indicated that they were not aware of the home’s complaint’s procedure, but almost all responses via survey reported that respondents felt able to approach staff in order to raise concerns. During the inspection staff questioned were able to report that they had undertaken training in the protection of vulnerable adults and abuse detection and staff were aware of Whistle Blowing processes. There is a good commitment to staff training in the protection of vulnerable adults throughout the Leonard Cheshire organisation, starting at the staff induction level. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 18 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 the following standard(s): 24, 26, 28, 30. The overall outcome for these assessed Standards is adequate. The Leonard Cheshire organisation plans to move to a new purpose built facility away from the St. Michaels site in order to meet National Minimum Standards. The Commission requires an update in the progression of securing an alternative site. In the meantime, St. Michaels has been adapted to meet resident needs as far as possible. EVIDENCE: It is understood that the Leonard Cheshire organisation still has plans purchase a new site for the service currently offered at St. Michaels. The new build would be designed to meet National Minimum Standards. Residents at St. Michaels are aware of the organisation’s plan to move to an alternative site. At the inspection current residents had mixed views and emotions concerning moving to a new building. The St. Michaels site is large and of character. It has been adapted as far a possible to meet National Minimum Standards but will not presently meet the environmental standard 24.3 expected by the Commission by April 2007. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 19 The quality of internal décor varies in corridors but there is an on-going routine maintenance plan for redecoration. Many bedrooms and bathrooms have been routinely redecorated since the last inspection. Wheelchair access around the home is good. Some service users spoken with said that they would like the extensive outdoor grounds to be more accessible. All accommodation offered is in single rooms. Rooms are personalised reflecting the tastes of occupants. Bedroom doors are not lockable; this is stated in the home’s Service User Guide. There is a lockable facility for valuables provided in each bedroom. Toilets and bathrooms are lockable and have disabled facilities. 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 and a new coffee bar. Smokers have their own designated balcony lounge. The laundry facility has been moved in-house since the last inspection and is equipped with modern industrial facilities. The home provides suitable facilities and equipment for staff to manage the risk of cross infection. The home was clean at this unannounced inspection. In service user surveys 1 person out of 27 stated that in their opinion the home is never sufficiently clean. 10 respondents said that the home is usually clean and 16 said that the home is always clean. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 20 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 36. The overall outcome for these assessed Standards is good. The staff team is settled and there is a very good structured programme of staff training. The staff induction programme provides an excellent introduction to the service requirements. There are sufficient numbers of staff rostered on duty to meet the current needs of residents. Staff recruitment processes are robust to ensure that vulnerable adults are protected. Staff are supervised and they receive constructive managerial feedback on their work performances. 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 are minimal vacant staffing posts at the home in ancillary staff areas. The existing staff team or agency workers St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 21 cover required staff shifts. A team of administrative, management, physiotherapy, activity and ancillary staff support direct care staff and nurses. The home employs a staff training development officer. Staff training records are maintained well with a good range of staff training in-house events scheduled throughout the year as well as staff accessing external training events. The staff induction programme is linked to the Skills Council guidance and is an excellent full and useful induction programme that can be tailored to individual staff training needs. Induction follows current best practice guidelines from respected clinical and teaching sources. There are currently just under 50 of employed care staff holding the NVQ level 2 in care award with many others studying to achieve this award at levels 2 and 3. Samples of staff recruitment records were inspected. Appropriate and robust recruitment practices were found to be followed. Staff spoke of feeling supervised in their work and there are clearly maintained staff supervision records, signed by both supervisor and supervisee. Staff meetings are held regularly and minutes are produced and circulated in the home. Resident meetings are also held, chaired by service users, and minutes produced. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 22 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42. The overall outcome for these assessed Standards is good. The home is managed well with strong leadership and the Leonard Cheshire foundation’s ethos of empowerment for residents is actively pursued. The Disability Forum endorses policies and procedures at the home. Having current residents sitting on an internal policy panel adds weight to the professionalism of policies adopted by the organisation. Quality assurance processes at the home are self-critical and robust in order to continually improve the service provision. Health and safety issues are monitored on a monthly basis with a report sent to the Commission. This report included timescales given by the organisation for issues to be addressed by and is followed-up by the next months visit. Additional first aid training is required for staff to ensure that there is a qualified first aider in the building throughout the 24 hour period. Greater attention to first aid box stocking is required to ensure sufficient first aid supplies are immediately available. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 23 EVIDENCE: A structured team manages the home and the registered manager holds a high level of qualification for this role. She keeps her continuing professional development up to date by attending relevant regular training sessions. The home has adopted all Leonard Cheshire policies and procedures and codes of practice. The Disability Forum endorses these. These documents are updated centrally. The recommendation made at the last inspection that the Leonard Cheshire’s organisations’ policy on resuscitation be clarified and reviewed, is still being considered within the Leonard Cheshire group. The organisation has developed robust quality assurance reporting processes, ahead of the Commission’s recommended timescales. Records are stored appropriately. Regulation 26 visit reports by the provider are copied to the Commission on a monthly basis. The home has also notified the Commission of reportable events between inspections via the Regulation 37 reporting process. Records of equipment servicing were provided to the Commission in the preinspection questionnaire. This was discussed and followed up by inspecting servicing records during the inspection. Records were in order. Fire records were inspected and were maintained appropriately. The home is unable presently to ensure that there is at least one staff member rostered on duty throughout the 24 hour period who holds a current first aid certificate. This is identified and required as a training need to protect the health and safety of service users. First aid boxes sampled also did not have full contents or a content list. This requires addressing to ensure that staff have immediate access to appropriately stocked first aid supplies. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 24 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 Standard No Score 1 3 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 X 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000003291.V308378.R02.S.doc 2 3 4 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 4 3 4 X X 2 X Version 5.2 Page 25 St Michael`s Cheshire Nursing & Residential Home N/A 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 YA6 Regulation 17 (3) (a) Requirement It is a requirement that service user care plans give a clear audit trail of records of personal care provided. This refers to bathing and bowel records. It is required in relation to medication management that: * The cold storage of insulin is maintained within 2 – 8 degrees Celsius. * G.P. written authorisation is obtained for any medicines that are crushed before enteral administration. *. Staff record when prescribed topical medicines have been administered. Timescale for action 12/12/06 2 YA20 13 (2) 24/10/06 3 YA24 23 (2) (e) and (f). It is required that the Registered 07/11/06 Manager forwards to the CSCI an updated action plan to how the Leonard Cheshire Foundation will meet the April 2007 deadline for environmental standard 24.3 at St. Michaels. It is required that the registered manager makes arrangements for suitable training to ensure DS0000003291.V308378.R02.S.doc 4 YA42 13 (4) 12/01/07 St Michael`s Cheshire Nursing & Residential Home Version 5.2 Page 26 that a qualified first aider is on duty at all times. First aid boxes must also be restocked when supplies used. 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 YA5 Good Practice Recommendations It is recommended in order to track contracts issued by St. Michaels that a note with date of issue is recorded on the service user’s file as a record that two contracts have been issued to the service user. St. Michaels should sign both copies, with a request for the service user to sign both copies and return one. It is recommended that service users who are able to assist staff in the formation and review of their care plans be encouraged to do so. This would make care plans meaningful to the individual and person centred. Where a service users expresses that they do not want to contribute to their care plan, this should be recorded. It is recommended that where a risk assessment for a resident indicates that a restraining aid be used (such as bed rails or lap straps), that this is discussed with the resident and their consent clearly recorded. If the resident is unable to consent a record of this being discussed with next-of-kin or the care manager should be recorded. This should be reviewed at least annually. 2 YA6 3. YA9 St Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street 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 Michael`s Cheshire Nursing & Residential Home DS0000003291.V308378.R02.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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