Inspection on 02/11/09 for St. Michael`s Home

This inspection was carried out on 2nd November 2009.

CQC found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St. Michael`s Home 18/11/08

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Heathlands

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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 Name: Address: St. Michael`s Home 251 Warwick Road Olton Solihull West Midlands B92 7AH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Deborah Shelton     Date: 0 2 1 1 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 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. 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 Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: St. Michael`s Home 251 Warwick Road Olton Solihull West Midlands B92 7AH 01217079697 01217079697 dmattu@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Dr Gurdial Mattu care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be acommodated is 21. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 21 Date of last inspection Brief description of the care home St. Michaels is a purpose built care home, which was registered in November 1993. The home, which is privately owned, is on the corner of a main road and is easily accessible by public transport. There is a large car park. The home provides permanent placements for up to 21 frail older people over the age of 65 whose care needs can be met within a residential setting. The home is located over two floors and comprises of 19 single rooms and one double Care Homes for Older People Page 4 of 35 Over 65 21 0 1 8 1 1 2 0 0 8 Brief description of the care home room. All of the bedrooms are fitted with a wash hand basin. Bedrooms may be decorated and furnished to the choice of the occupants. The home has a shaft lift for ease of access to the first floor. The home has two assisted bathrooms and one assisted shower room. There are adequate numbers of toilets throughout the home some large enough to allow full assistance from staff. On the ground floor communal facilities comprise of an open plan small sun lounge, lounge and dining area and an additional small lounge. There are limited garden/patio facilities to the property. Up-to-date information relating to the fees charged for the service is available on request from the home. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection visit and was unannounced. This means that the Home were not aware that we were going to visit. The visit took place on Monday 2 November 2009 between 10am and 7.30pm. The inspection process concentrates on how well the service performs against the outcome for the key national minimum standards and how the people living there experience the service. Before the inspection we looked at all the information we have about this service such as previous inspection reports, information about concerns, complaints or allegations and notifiable incidents. This helps us to see how well the service has performed in the past and how it has improved. An Annual Quality Assurance Assessment Audit (AQAA) was completed by the manager. This document gives information on how the Home thinks it is performing, changes made during the last twelve months, how it can Care Homes for Older People Page 6 of 35 improve and statistical information about staffing and residents. During this key inspection we used a range of methods to gather evidence about how well the service meets the needs of people who use it. Time was spent sitting with people in the lounge watching to see how they were cared for and how they spent their day. Discussions were held with people who use the service, staff and visitors to the Home. Information gathered was used to find out about the care people receive. We also looked at the environment and facilities and checked records such as care plans and risk assessments. Three people living in the Home were identified for case tracking. This involves reading their care plans, risk assessments, daily records and other relevant information. Evidence of care provided is matched to outcomes for the people using the service; this helps us to see whether the service meets individual needs. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? Work has taken place to re-decorate areas of the Home, including providing new carpets and furnishings. Improvements have been made to the range of activities that take place at the Home. Wherever possible people are encouraged to continue with hobbies or leisure interests such as photography, knitting or crosswords. Some improvements have been made to quality assurance systems. Satisfaction surveys have been newly implemented. The Home should consider further ways of monitoring to ensure that the quality of the service provided meets peoples needs and Care Homes for Older People Page 8 of 35 expectations. All machinery in the laundry was in good working order, there was no backlog of items waiting to be laundered and no issues were identified regarding infection control at this inspection. 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. Care Homes for Older People Page 9 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available at the Home before people move in to ensure that staff have knowledge of peoples needs and preferences so that they can provide appropriate care. People receive the information they need to help them decide whether the home can meet their support and accommodation needs. Evidence: The care files of the two people most recently admitted to the Home were looked at to review the pre-admission and admission processes at the Home. The manager is responsible for completing assessments of people before they move in to ensure that the Home is suitable for them. One of the care files seen showed that the person had moved in to the Home in an emergency for respite care whilst their main carer was in hospital. In this case there Care Homes for Older People Page 11 of 35 Evidence: had been no pre-admission assessment as the person was admitted within a few hours of a phone call from Social Services. A care plan was on file from social services detailing this persons care needs and the Home had recorded some basic information for staff to help them meet this persons needs. There was also no pre-admission assessment documentation in the second file seen. The manager said that this was due to difficulties in obtaining the information from the person. Information regarding their care needs had been provided by an external professional and gave the Home the information they needed. A third file was seen which contained a pre-admission assessment. This had been completed in a satisfactory manner. Standardised documentation is used to find out information about the individual needs, how many staff are required to provide assistance and any equipment needed. The Homes Annual Quality Assurance Document records that the manager completes pre-admission assessments to establish whether they can offer the type of Home required by the individual. The manager confirmed that in normal circumstances preadmission assessments are completed and this was evident on one of the files seen. The manager said that people are able to look around, stay for a day and have lunch and a tour around the Home. A pre-admission assessment can be completed at this time. People are encouraged to visit so that the assessment of their needs will be undertaken in the environment in which they will be living. The manager can then decide whether the person would be suited to life at St Michaels and whether staff have the skills and training to meet individual needs. People can also decide whether they would like to live at St Michaels. One person spoken to who had recently moved in to the Home said that they had settled well, food was good and everyone was nice. Another person said I didnt think that I would like living at St Michaels but the day after I moved in I felt that I was at Home. I came to visit for a day and had lunch and evening meal and was shown around. I had lots of information before I moved in. Each person is given a copy of the Service Users Guide and other information about the Home such as a brochure to help them make a decision about whether they want to move in. There was a copy of the most recent inspection report and Service Users Guide available in the entrance of the Home for people to look at if they wish. People are given a four to six week trial period after which they can decide if they wish to live permanently at St Michaels. The updated copy of the Service Users Guide recording Care Homes for Older People Page 12 of 35 Evidence: the new owners information was not available to review at this inspection. Contracts of residency were seen on the care files of two people. One contract seen was blank and had not been completed or signed. Contracts between the Home and the resident and separate contracts between the Home, Social Services were available on the other two care files seen. The manager confirmed that they are currently reissuing contracts of residency to everyone living at the Home as they needed updating with the new owners details. Care Homes for Older People Page 13 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 have good access to a wide range of health professionals and their health and personal care needs are met. People are treated with respect and their rights to privacy and dignity are maintained. Care plans and risk assessments are not always fully completed or reviewed. This could lead to people having care needs not met. Evidence: Three people were case tracked during this inspection. This process involves looking at their care files and other paperwork relating to the way their care is provided at the Home. Talking to staff and to the people and their relatives if possible. Looking at the environment in which they live and documentation regarding health and safety. Conversations where held with the three people being case tracked and other people living at the Home. All were positive about the Home. People said I am happy here, there is absolutely nothing to moan about, I really appreciate everything that they do for me, the food is good and all of the staff are lovely, I am well cared for, no Care Homes for Older People Page 14 of 35 Evidence: concerns at all, its great, there are things to do but I like to do nothing and that is my choice. Its clean, its tidy, my clothes are washed, the Dr comes when I need, I have no problems, they clean my room, they do my laundry, its all good, The district Nurse visits me every week to dress my leg, they call the GP if they need to and the optician but I am well at the moment. Care plans did not all contain pre-admission assessments completed by the home. However, all had information obtained from outside professionals such as social workers and community psychiatric nurses before people moved in. Pre-admission paperwork completed by the Home was available in one file seen. All files contained admission details such as GP, social worker and next of kin contact details. This enables the Home to make contact with these people quickly if necessary. Care files were available for each person. The information recorded in the files varied. Some of the documentation in the files of the two most recently admitted people was blank, this included care plans and risk assessments. More detailed information was availble for the person who has lived at the Home for over a year. The manager said that a consultant is involved in changing care plan documentation and they are in the process of recording all care plans on new documentation. None of the three files seen had documentary evidence to demonstrate that people are involved in the care planning process. People had not signed their care plans. There was no evidence of monthly review of care plans or regular review of risk assessments. Some of the risk assessments identified a risk but there was then no information to tell staff what to do to reduce the risk. Some of the risk assessment forms were not fully completed i.e. no height and weight on the falls risk assessment, no information regarding the number of carers to assist with tasks and details of any equipment needed on the moving and handling assessment. A lot of information in care files had not been dated or signed by the person completing the information. It was therefore difficult to identify whether this information was recent, was in need of review or was out of date. One risk assessment was dated December 08. There was no evidence that this had been reviewed. The risk assessment records the risk and the action to take once the person has fallen, it does not mention the action to take to reduce the risk of the person falling. A risk assessment summary sheet in one file used a colour coding system. There was no written information to say what the colours meant and what action was to be Care Homes for Older People Page 15 of 35 Evidence: taken. The manager said that this is not their form and she does not know what the colour coding means. This documentation may be confusing for staff if they are not sure of the significance of the colours for each risk identified. Large sections of information were left blank in one file. The manager said that this is because the person is staying for respite and they did not have the time to complete all of the details. However, it is important to have as much information as possible to enable staff to provide care for the person and to ensure that regular routines, hobbies and interests are followed as much as possible whilst they are staying at the Home. A document entitled Pressure care and sore prevention recorded standardised statements which did not give staff specific instructions of the assistance required by the individual i.e. pain - appropriate pain control, client handling - correct moving and handling techniques. The information was not dated or signed. Information in one file recorded that the person needs to be monitored on food and fluid intake. To give fortisip twice a day, to record food and fluid intake. Food intake charts were available on file up to 5 January 09. It was not evident why these were no longer available. A conversation was held with the manager who later produced some records starting 1 November 09. Paperwork was disjointed and difficult to follow, there were no care plans in two files but some of the information was recorded in separate sections in the care file. Care files contained evidence that people see the GP, optician, dentist, district nurse and other external professionals as needed. Copies of correspondence from hospitals were also on file. Documentary evidence was available to demonstrate that peoples personal hygiene needs are being attended to. Preferences regarding having a bath or shower and the time of day that the person prefers to bathe are recorded. Day and night reports are available and staff make a record per shift. At night staff are initialling records each half hour and further recording if the person is awake or asleep, wandering, in/out of bed. Records occasionally state awake in the middle of the night but there was no additional comments as to what action staff took, ie offered drink, comforted etc. Standardised documentation is used to record daily records. Records were up to date and recorded information regarding food intake, activities and general health and wellbeing on most occasions. Care Homes for Older People Page 16 of 35 Evidence: A social worker visiting the Home at the time of the inspection said that they cannot speak highly enough of the Home, XX has settled really well, the Home contact me for advice and support whenever they need to. XX seems happy, we found it extremely difficult to find a more suitable home to meet XXs needs. We are happy that the placement is working out, there are no problems at all. The medication and records of the people being case tracked were reviewed. Medication is stored appropriately in trollies, cabinets and lockable fridges. The temperature of the medication fridge is recorded on a daily basis. Medication administration records seen were correct and up to date. The controlled drugs cabinet and records were also reviewed and found to be up to date. As an extra safety measure staff are recording the number of tablets remaining in each box following administration of a controlled drug. There were no stocks of excess medication. All medication is returned to the pharmacy at the end of the cycle and new stock is delivered if needed. The manager confirmed that only those staff who have undertaken medication administration training are able to give medication to people. Key custody practices were discussed and found to be satisfactory. Copies of prescriptions are kept on file and are used to check that the medication received is that which has been ordered. Medication and records at the Home are audited twice per year by an NHS pharmacist. At this inspection medication systems and practices were found to be satisfactory. All people seen at the Home had their hair nicely brushed and were dressed appropriately for the time of year, nails were short and clean and some ladies were wearing nail polish. People commented that their privacy and dignity is maintained at all times. The manager said that people are offered the choice of having care provided by either male or female staff although this was not documented on care files. People seemed to be at ease in their surroundings. Care Homes for Older People Page 17 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to keep in contact with family and friends and visiting is flexible. People are assisted to pursue interests and evidence suggests that the lifestyle experience in terms of social and leisure activities meets the needs of those that live at St Michaels. Evidence: Discussions were held with the manager, staff and four people living at the Home regarding aspects of daily life such as activities, food, visitors and choice. The manager confirmed that a member of care staff now has some time set aside to coordinate activities. During the morning of the inspection a member of staff asked people if they wanted music on instead of the television and encouraged them to join in throwing a sponge ball into a hoop. People participated willingly and the activity lasted for approximately 45 minutes. During the afternoon a member of staff was seen playing a game of connect four with one person. An activities file is kept to record any activities undertaken and the number of people who have joined in. Records for one person for October showed that the person had Care Homes for Older People Page 18 of 35 Evidence: joined in various activities on ten occasions. Details of religious needs, hobbies and interests that people wish to pursue are recorded in their care files. This helps to ensure that staff provide activities suited to peoples wishes. One person living at the Home has an interest in photography and has been taking pictures of people. A photograph album is being put together with pictures of everyone living at the Home. There is a fish tank in the reception area which one person said that they enjoy looking at and a member of staff said that one person enjoys playing the accordion for everyone to listen to. People spoken to about activities said There are activities, twice a week people visit with their dogs, I like pets so that is good. Once a week a man visits to do activities, he plays old music and has a joke with you which makes the activities more fun. We have a communion once per week, they are really lovely, they sing hymns and then sometimes someone will ask if we can sing My Old Mans a Dustman and they are obliging and they sing it without fuss, I think that would make god smile. You dont really go outside, there is not much garden, they say that you can sit out in the front if you want but it is a busy road and we havent had much summer. The only thing is you dont go out on trips, I dont really mind, it must be difficult to do trips for everyones tastes. two people visit and bring their dogs in every week which I enjoy, progressive mobility takes place once a week and holy communion once a month. The manager said that they are developing an activity programme, this will include reminiscence cards, newspaper discussions, quizzes, singing, pets as therapy and church services. The activity list has been developed following discussions with the people who live at the Home. The manager has recently undertaken a training course to enable her to provide meaningful activities for people with dementia. The manager confirmed that a male choir is coming in to the Home at Christmas to sing and also the Choir from a local church are going to be singing. It was noted that contact with the local community is maintained by inviting local groups in to provide entertainment and those that are able can access local shops, restaurants or churches. Visitors were seen on the day of inspection. They are able to chat with the relative in Care Homes for Older People Page 19 of 35 Evidence: their bedroom, lounge, quiet lounge or small conservatory at the front of the Home. The people who live at the Home have the choice of whether they wish to see their visitors or not. This was evident on the day of inspection. The manager said that the Home has an open visiting policy. People are welcome at any time, they can stay and have a meal with their relative if they want to. People have access to a pay phone if they wish to make contact with anyone, the manager confirmed that some people have their own mobile phones to keep in contact with their friends and relatives. One person said that visitors are made welcome, my sister in law visits and we go out. Visitors can come at any time. Care files seen recorded peoples preferences regarding times for getting up in the morning and going to bed at night, preferred names, likes and dislikes regarding food. People were seen wandering freely around the Home and where are able to eat their meals in their bedroom, the lounge or the dining room. When speaking about choices to one person they said I dont mind the male or female staff helping me out, they are all lovely. I like my room, I can lock the door if I want but I dont want to. I can lock my personal belongings away if I want in the cupboard but I dont. You can go to bed when you want, get up when you want, go where you want. It is all lovely I am really glad to be here. Food available at the Home was discussed with four people and the Homes four week menu was seen. The menu demonstrates that a varied choice of foods are available on a daily basis. Care files showed that information regarding food likes and dislikes is recorded upon admission to the Home, this includes information regarding allergies and dietary needs i.e. diabetic diet. People spoken to said the food is generally good, they do a good breakfast, there is a choice of meal each day the pie was nice, the food is usually good. I am a diabetic and that is why I am not allowed to eat the same desert as everyone else. The diabetic puddings are still nice and there is a choice of puddings you dont get the same pudding all of the time. There is a choice of food every day and on a Tuesday and Saturday you get a full cooked breakfast. If you didnt like the choice of two meals offered you can have something else. Care Homes for Older People Page 20 of 35 Evidence: On the morning of the inspection the cook was seen asking people what they wanted for lunch and evening meal. Two choices were available for each meal and peoples requests were recorded. This enables their choice of food to be provided. People were offered hot or cold drinks with a biscuit during the morning and afternoon of the inspection. Dining tables were laid out nicely for the main lunchtime meal with table clothes, salt and pepper and flowers. Staff were seen asking people individually if they wished to have gravy pored on to their meals and also if they wanted any sauce. People appeared to enjoy their food and were able to ask for more if they wished. The atmosphere at lunchtime was relaxed and friendly. Staff were seen encouraging one person who had said that they did not want a lunchtime meal. Staff continued to persuade the person to try some food even after everyone else had finished their meal. Care Homes for Older People Page 21 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People felt confident to report any concerns or complaints as they would be listened to and acted upon by staff and management. Evidence: There have been no complaints made to the Home or the Care Quality Commission since the last inspection. The manager said that any grumbles are dealt with immediately and therefore do not escalate into complaints. Grumbles are recorded in a log book with the date received and details of any action taken to address the issue. People spoken to on the day of inspection said that if they had any worries they would speak to the manager. All felt sure that the manager would sort out any problems that they may have. A copy of the complaints policy is on display on the noticeboard along with copies of complaints forms for people to record any issues. The complaints procedure is also in the Service Users Guide which has been given to people. The home has an adult protection policy to give staff direction on how to respond to suspicion or incidents of abuse. There have been no allegations of abuse since the last inspection. Staff have undertaken training regarding protection of vulnerable adults. Newly employed staff will be undertaking this training shortly. Discussions with the manager established that she was familiar with local Adult Care Homes for Older People Page 22 of 35 Evidence: Safeguarding Procedures and how to refer allegations of abuse. Deprivation of liberty was also discussed and the manager was aware what constitutes deprivation of liberty and the action to take should they need to, for example restrict, someone from leaving the Home alone due to ill health. The Home have their own policies and procedures regarding the protection of vulnerable adults, the policies developed by Solihull Council are also available. These give staff additional information of the action to take if abuse is suspected. Care Homes for Older People Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Fixtures and fittings are generally in a good state of repair and the Home is clean, warm and comfortable. Evidence: St Michaels is a Care Home set in a residential area in Solihull. The Home was purpose built as a Care Home in 1994 and has the adaptations to meet the needs of those that live there. Bedrooms are located on the ground and first floor. There are nineteen single and one double room, all with a wash hand basin, some have en suite toilets. A passenger lift and a staircase give access to first floor. Communal areas consist of a lounge/dining room, a small conservatory area attached to the main lounge, and a quiet lounge. A person that lives at the Home showed the inspector around. The bedrooms of those people being case tracked plus two others, the bathrooms, toilets, laundry and sluice room as well as communal areas were all seen. All areas of the Home seen were clean and no unpleasant odours were noted. Furnishings in the main lounge were in a reasonable state of repair, foot stools are available for those people that need one. The small conservatory area has seating for three people and coffee tables, there is no access to grounds from the conservatory as Care Homes for Older People Page 24 of 35 Evidence: it looks over the front of the building and the main road. The quiet lounge had a television, table and books. This room is apparently used by people who wish to sit quietly and read or who wish to meet their visitors in private. The laundry was clean and there was no backlog of items waiting to be laundered or returned to bedrooms. There is one washing machine and one dryer. The washing machine has a sluice cycle for washing soiled laundry and a hot wash to maintain infection control standards. Red bags are used to transport and wash soiled laundry. This helps reduce the risk of cross infection from excessive handling of soiled laundry. Disposable gloves and aprons are kept by the dining room. Staff spoken to were aware of the location of these items and confirmed that they are for use in the laundry. The sluice room door was not locked shut when not in use. Although no cleaning chemicals are stored in this room, it should be locked to prevent unauthorised access which could increase the risk of spread of infection. All bathrooms seen were clean. There is a toilet and wet room were people can shower on the first floor and a separate toilet. There are two assisted bathrooms on the ground floor. Separate toilets are provided for catering and care staff. Liquid soap and disposable hand towels are available for use in toilets. There are three toilets for use by the people who live at St Michaels located on the ground floor. Apart from the bedroom of the person staying for respite care, all rooms seen had been personalised with pictures and personal possessions. Rooms had a homely feel. Some of the ceiling tiles in one bedroom were being held together with tape. This looks unsightly and should these should be repaired or replaced. Carpets have recently been replaced in the upstairs corridor and in some bedrooms. Security measures are in place to protect the people that live at the Home. The front door is locked so that people cannot easily walk out on to main road and to prevent intruders. Restrictors are on windows so that they cannot be fully opened to again prevent intruders and to stop people from falling. Care Homes for Older People Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient numbers of competent staff on duty to meet the needs of people living in the Home. Evidence: During the inspection staff were seen to have a good relationship with those under their care. They spent time chatting to people. The manager also spent time chatting to someone, giving reassurance as the person was getting upset. Staff were seen to be patient and kind. People spoken to appreciated this. One person said staff are all lovely Ann Marie takes an interest in you she stops when you speak to her and you can tell that she is listening to you, her attention is focused on you and she is interested in what you have to say, you feel like you are one of the family and are made to feel important. All people spoke positively about staff saying all of the staff are lovely, I would speak to them if I had any problems. The staff are all nice, if I had any worries I would speak to someone. They clean my room, they do my laundry, its all good. I am well cared for. A copy of the Homes staff duty rota was taken for review. The number of staff on duty on the day of inspection was the same as recorded on the duty rota and there appeared to be enough staff to be able to care for everyone living at St Michaels at Care Homes for Older People Page 26 of 35 Evidence: the time. The manager confirmed that the usual numbers of staff on duty are 3 care staff - early shift (7 days per week) 3 care staff - late shift (7 days per week) 2 waking care staff - night shift (7 days per week) As well as care staff a cook and a relief cook who also completes some domestic shifts are employed. The cook works from 7.30am - 2pm for five days per week and the relief cook works from 8am - 2pm at the weekends. Domestic hours are provided between 9am - 2pm for three days in each week. A member of staff confirmed that if needed, the domestic will help out with the laundry but care staff, including night staff are mainly responsible for laundry duties. The hours that the manager works were not recorded on the duty rota seen. These should be included to demonstrate that enough management hours are provided. The manager shares the on call rota with a senior carer. This helps to ensure that there is always someone available to give help and advice twenty four hours per day. Regular spot checks are also undertaken by the manager at night to ensure that staff are working as they should be. According to the manager agency staff are rarely used but would be in case of emergency. The Annual Quality Assurance Assessment document (AQAA) completed by the manager records that only six staff shifts have been covered by agency staff within the last three months. Two volunteers have been interviewed and once their Criminal Records Bureau checks have been returned they will be able to help out with activities or just visit and chat to people. This will help to ensure that further activities/interests are made available to those who live at St Michaels. According to the Homes AQAA ten care staff are permanently employed at the Home, eight of these have undertaken induction training in line with the Common Induction Standards/Skills for Care recommendations and seven of these staff have undertaken a national vocational qualification in care at level 2. Undertaking this training helps to ensure that staff have the necessary basic skills and knowledge to be able to provide care to those at St Michaels. At the time of the inspection, staff personnel files could not be reviewed. The key to the locked cupboard where the staff files are stored was not available. As no issues were identified at the last inspection regarding staff recruitment practices a further Care Homes for Older People Page 27 of 35 Evidence: visit did not take place to review the files. According to the manager two night carers plus a cook have been employed recently. Staff files will be reviewed at the next inspection. A file seen contained evidence of training undertaken. Certificates for one staff member show that they had undertaken training regarding dementia, infection control, moving and handling, food hygiene and health and safety. During discussion it was noted that staff are issued with the General Social Care Council Code of Conduct. An in depth in house induction takes place plus staff shadow a senior staff member for two weeks. Staff receive supervision after the first 13 weeks of employment. Supervision records were not evidenced. A blank contract of employment and application form showed that these documents have been changed to show the ownership details following the purchase of the Home by a new owner. Care Homes for Older People Page 28 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements ensure that the Home is well run, which benefits the people at St Michaels. The health, safety and welfare of the people living there is not always promoted and protected which could put them at risk of injury. Evidence: St Michaels has a manager who is registered with us and has the knowledge and experience to be able to effectively manage this Home. Improvements have been made to systems such as care planning and quality assurance. The manager is aware of the issues that need to be addressed to ensure that the Home provides a good service and of the action to take to address issues identified in this inspection report. To ensure the people living at St Michaels are happy with the service provided, the manager said that they are going back to basics and discussing simple things such as; do people prefer jam or marmalade on their toast in the morning, preferences regarding activities and care. Care Homes for Older People Page 29 of 35 Evidence: Quality assurance systems also include observation and audit of systems and practices. The manager said that when peoples bedrooms are decorated they are able to choose their own colour schemes and carpets. This was confirmed by one person who was proud to show her bedroom and said that she had enjoyed looking through books to pick the colour of the paint. Residents meetings are held but there are no typed minutes of these meetings as yet. A relatives meeting was held in January with the new owner of the Home. Residents and relatives are able to meet with the manager or the owner on a one to one basis if they wish. Regular monthly staff meetings are held, issues identified by the manager during any spot checks are discussed, as well as information sharing regarding current practice, training courses and any issues that affect the Home. Minutes of a recent meeting were seen. The manager has recently started sending out satisfaction surveys. It was noted that surveys will be sent out every month to a cross section of residents. There were no completed surveys to review. Various audits are completed to try and ensure that the quality of the service provided is satisfactory. Accident audits, medication and room audits take place regularly. Staff write down issues identified and details of any action taken to address issues. The Home have developed a kitchen audit and also use the audits included in the safe food, safer business folder provided by Environmental Health. People spoken to were happy in the Home and all gave positive comments such as I cant fault the Home, there are no problems, the food is good and the staff are all nice, everything is great, I cant find fault, they do everything well. I have no concerns at all its all great, there are no problems, I am totally happy. The Home handle finances on behalf of one person. Receipts are available for any expenditure and records are signed by staff. Finances and records were checked and found to be in good order. The relatives of all other people look after the finances. Families pay for items such as hairdressing, chiropody or toiletries. Staff supervision records were not available to review as they were in a locked Care Homes for Older People Page 30 of 35 Evidence: cupboard which could not be opened at the time of inspection. A selection of health and safety records were reviewed to see if health and safety systems ensure that people are safe. Records show that the fire panel covering is broken and awaiting repair. This does not affect the function of the fire panel but should be repaired as soon as possible to prevent further deterioration. Fire records show that weekly fire alarm tests take place. Emergency lights were last tested in September 2009 and records show that one bulb was not working. There was no written evidence that this has been replaced. Records show that lifts and hoists were serviced and tested in October 2009. Records show and the manager confirmed that the call alarm system needs servicing and the portable electrical appliances need testing. The Homes AQAA records that the last servicing of the fire detection and alarm was in April 2008, this must be undertaken on at least an annual basis. It also records that policies and procedures were all reviewed during 2009. Care Homes for Older People Page 31 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Service Users Guide should be updated to include the details of the new owner of the Home. This document should be available for review and for any person who comes to live at the Home. All people should be issued with a terms and conditions of residency. These documents should be signed and dated by all parties involved. All documentation in care files should be fully completed, dated and signed by the person recording the information. Care plans should be reviewed on at least a monthly basis and updated as necessary. Risk assessments should be reviewed on a regular basis and information updated as necessary. Care plans should be available for all people for every area of need. Documentary evidence should be available to demonstrate that people are involved in the care planning process, including agreeing to care to be provided. 2 2 3 4 5 6 7 7 7 7 7 7 Care Homes for Older People Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 8 19 A repair should be made of the ceiling which has the ceiling tiles attached by tape. This looks unsightly and does not give a homely, welcoming feel. The sluice room door should be kept locked when not in use, this is to prevent cross infection. The hours that the manager works in the Home should be recorded on duty rotas to demonstrate that sufficient management hours are provided each week. Staff personnel files should be available for review on all occasions. Further improvements should be made to quality assurance systemst to demonstrate that the services and care provided meets the needs and expectations of those people that live at the Home. Documentary evidence should be available to demonstrate that regular residents meetings take place. Details of any action taken to address issues/suggestions raised should be recorded. Documentary evidence should be available to demonstrate that all health and safety checks and records are up to date, for example records show that emergency lighting was last checked in September 2009, fire alarm systems in 2008 and call alarm and portable electrical appliance checks are now due. 9 10 26 27 11 12 29 33 13 33 14 38 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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