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Inspection on 25/01/07 for St Michael`s House

Also see our care home review for St Michael`s House for more information

This inspection was carried out on 25th January 2007.

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

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

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

What the care home does well

St Michaels offers a genuine commitment to care with an open and personable approach, which reflects the homeliness of a confident relationship between carer and resident. The establishment of a professionally accountability towards effective assessment, care planning and review of residents` needs are meaningful and robust, in formulating a good standard of care. This highly personable attitude and approach to care is appreciated and welcome by residents and visitors alike. The Home is experiencing a period of profound change and renewal, to which the solid foundation of an experienced team is managing well, in concert with residents and families. The change of emphasis from long stay care to assessment and rehabilitation was seen to be actively pursued by a focused multi-disciplinary approach, led by a committed management.

What has improved since the last inspection?

The Care Manager has demonstrated a purposeful application, following on from recent inspection reports. With the Local Authority there is evidence of tackling requirements directly, in a positive, reflective style. Care planning and resident/family involvement in ongoing review, has shown a high standard in the monitoring and assessment process, which in turn inevitably leads to improved quality and practice. There was evidence of a change in use of the Home, in that an extensive programme of redesign, refurbishment and renewal is in progress, which is being done with a minimal impact on residents. There has been a significant change in the direction of care, which has been eagerly taken up by the staff. The morale of the Home is high, with staff, residents and visitors showing a confident interplay, consistent in maintaining a sound, caring environment.

What the care home could do better:

The Registered providers of care are advised to determine an update of their registration with CSCI, clearly reflecting their aims and objectives for present and future continued use. Continuation of address to Inspection requirements and recommendations will maintain the good standards of care observed. The achievements have been recognised, areas of detail will continue to play a part in the ongoing development and maintenance of an honest, solid and homely service.

CARE HOMES FOR OLDER PEOPLE St Michael`s House Hewitt Street Chell Stoke on Trent Staffordshire ST6 6JX Lead Inspector Mr Keith Jones Key Unannounced Inspection 25 January 2007 09:00 X10015.doc Version 1.40 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 House DS0000032516.V328407.R01.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 Older People. 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 House DS0000032516.V328407.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Michael`s House Address Hewitt Street Chell Stoke on Trent Staffordshire ST6 6JX 01782 233435 F/P 01782 233436 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) Stoke on Trent City Council Mrs Lesley Kokai Care Home 44 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (5), Old age, not falling within any other category (44), Physical disability (5), Physical disability over 65 years of age (44) St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 5 Physical Disability (PD) - Minimum age 55 years on admission To include one named person under the age of 55 years on admission. Date of last inspection 8 June 2006 Brief Description of the Service: St Michael’s House, Chell is a purpose-built, Local Authority managed home that is registered to accommodate 44 older people. The home was located within the residential area of Chell and was close to local community amenities and public transport. The home is owned by Stoke-on-Trent City Council and operated by Stoke-on-Trent Social Services Department. The home had the benefit of its own garden and patio area with distant views over the city. Pathways were appropriately ramped to provide ease of access and there was a car parking area to the front of the building. Accommodation is provided on two floors accessed by a shaft lift or staircases. There are 44 single bedrooms, none of which had en-suite facilities. Eight of the beds were allocated for short-stay and rehabilitation/re-ablement where service users were admitted to promote independence in order that they may return to their own homes in the community and so avoid moving into residential care prematurely. Located on the ground floor of the home are a large lounge and a large dining room with a separate adjacent smoking room. There is a small lounge/kitchenette area for the specific use of the eight service users admitted for rehabilitation needs. On the first floor there is also a small lounge/dining/kitchenette room and a hairdressing and beauty salon. Resident’s bedrooms are located on both floors and there are four assisted bathrooms with toilets, a shower room and seven separate toilets conveniently sited around the home. St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted with the Care Manager and senior care staff. The last inspection report was discussed, and it was noted that one requirement has, as yet, not been met, although addressed, with recommendations made having been attended to. The inspection of the home was carried out in a courteous and professional manner, everyone concerned expressed confidence in the ‘homely’ atmosphere, liking it to an extended family feeling. Service users approached were highly complimentary of the care, service and attention they received from a willing, experienced and attentive care team. There were 25 service users on the day of inspection, categorised according to certificate, although reflecting the changing patterns of service. The current resident group was: eight people in rehab, eight people in the assessment care beds, nine permanent residents. The Home is in a transitional phase of redevelopment, both structural and organisational, with evidence of significant changes in progress. Four service users were case tracked, confirming the establishment of a well run home, comfortable and relaxed. Relatives who were present were equally complementary of the inclusive approach to care, the freedom they enjoyed and the involvement that the manager and her staff encouraged. Everyone appeared comfortable and at ease with their surroundings. Seven comment cards were received, all complimentary of the care given: “ like a home from home”, “kitchen maids always willing to serve anything we order”, “ friendly, very clean and fresh smelling”, “looks after patient well”, “ we have activities every week, and go on outing to the seaside”. Other comments looked at “ need to build on and have better liaison with hospital, get results from Doctor quicker” and “if there was more money”. A sampled review of the administration confirmed solid practice and effective management. A feedback session was offered at the end of the inspection with open discussion involving the Care Manager. What the service does well: St Michaels offers a genuine commitment to care with an open and personable approach, which reflects the homeliness of a confident relationship between carer and resident. The establishment of a professionally accountability towards effective assessment, care planning and review of residents’ needs are meaningful and robust, in formulating a good standard of care. This highly St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 6 personable attitude and approach to care is appreciated and welcome by residents and visitors alike. The Home is experiencing a period of profound change and renewal, to which the solid foundation of an experienced team is managing well, in concert with residents and families. The change of emphasis from long stay care to assessment and rehabilitation was seen to be actively pursued by a focused multi-disciplinary approach, led by a committed management. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 and 6 The quality in this outcome area is good. This judgement is based on the examination of the homes policies, procedures, practices and discussions with management. St Michaels’ ensures that prospective residents have the necessary information to enable an informed choice to be made. Aims and objectives, terms and conditions are clearly presented in a way to facilitate easy understanding of services and standards of care. The Statement of Purpose represents the foundation on which the home operates upon, offering service users and their relatives the opportunity to make an informed choice about where to live, through the Service User Guide. Following an assessment the senior assessor determines the suitability of the application in view of the facilities available, and of the capacity of the home, to manage the individual and any special needs. The Home has demonstrated their commitment to promote a partnership of care, to meet the objectives of providing a home to meet individual needs. St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 9 EVIDENCE: The Statement of Purpose and Service User Guidelines reflect the mission statement, and have been well established in representing the foundation on which the home operates upon. The statements were well written and sensitive to the needs of the elderly. They present a sound description of the home’s aims and objectives, philosophy of care and terms and conditions. The Care Manager is aware of the need in consistently reviewing the key information policies of Statement of Purpose, Service User Guide and Resident’s contract to reflect the changing environment and circumstance. The care management adheres to an admission policy of personal supervision of the pre-admission assessment. Case tracking demonstrated the presentation of a highly personal approach to prospective residents and their relatives on pre-admission. Case tracking of four service users’ care records showed that an appraisal is made, and discussed, to ensure the home can satisfactorily meet those needs. Case tracking and discussion with service users confirmed that this standard continues to be well met. Following an assessment the senior assessor determines the suitability of the application in view of the facilities available, and at the capacity of the home, to manage the individual, and any special needs. Likewise the applicants are informed of those facilities and are encouraged to seek clarification concerning the general and specific services available for the prospective service user. Assessing for rehabilitation and intermediate care is flexible in meeting diverse needs. Case tracking and discussion confirmed that a valuable exchange between service users and assessor took place, and resources made available. These resources were seen to be an appraisal of staffing skills, equipment and general environment. St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 The quality in this outcome area is good. This judgement is based on the examination of four care plans, discussions with service users, staff, managers, general observations and the homes medication system. The care assessment and planning system is an organised, yet personalised process offering meaningful and valid documentation of care administered. A broad vision of needs is addressed through the care planning process, meeting personal and health needs. It is recognised that this reflects an individual profile of needs, discussed fully with family. The provision of a secure and safe medicines administration is managed efficiently. The Inspector was impressed with the confidence and closeness within the Home of staff, residents and visitors, and the mutual respect that prevailed. Staff were seen to demonstrate a personal empathy with residents through a respectful, yet friendly discourse. St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 11 EVIDENCE: Case tracking of four residents clearly showed that this standard is well met, maintaining a high quality process of assessment. The pre-admission assessment represented the foundation for a well-considered and detailed care planning process. The situation of assessing for long term, rehabilitation and intermediate care is flexible in meeting diverse needs. There exists a need to reinforce liaison with the Collaborative Care service based in the General Hospitals to ensure a suitable response in meeting the Service User’s needs. A profile of the service user’s social, physical and psychological status offered an individual plan of care, based upon activities of daily living, to be implemented and frequently reviewed. Each service user’s health, personal and social care needs are carefully assessed in an individual plan of care that is reviewed monthly, including service users and relatives views, to reflect their changing needs. That review is more frequent, dependant upon the individual’s needs and clinical condition. A process of identifying desired outcomes, required interventions, actions and specific referrals are addressed. Case tracking confirmed the extent that the carefully prepared, and well-recorded care plans were appreciated by service users and relatives alike. A daily record needs to be maintained in complimenting a comprehensive monitoring process. There are established multi-disciplinary teams meeting regularly to discuss the plan of care, and action to meet needs. The Inspector was able to sit in on a meeting and discuss the process of care concerning a resident being case tracked as part of the inspection. An impressive style of management of this team was reinforced with contributions from specialist staff as required, presenting a focussed plan. Physiotherapy, Occupational therapy, care and special needs are assessed and documented, along with nutritional screening, hearing and sight tests, etc, as appropriate. One service user case tracked, who had complex health needs, was seen to be cared for in an efficient, yet sensitive manner, with regular contact with the appropriate clinical specialist and out patient support. The GP service is supportive through this service, arrangements are made to provide other professional support as appropriate. The District Nurse was in attendance during the inspection, speaking highly of the quality of care and service. The administration of medicines adheres to procedures to maximise protection to service users. The storage was secure, and staff spoken to were conversant with their responsibilities in the safe storage, handling and disposal of drugs in accordance with the Medicines Act 1968. Drugs returned to the pharmacy was duly recorded. Service users, if capable may be responsible for their own medication, and are protected by the self-medication procedures in place. Case tracking confirmed that the policies were implemented, with all service users spoken with being complementary of the degree of respect given, by St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 12 each and every member of staff. The inspector observed the free, courteous interaction between service users and staff based on a level of confidence of mutual trust and respect. Relatives have freedom of visiting, each remarking on the importance of maintaining social contact. Adequate privacy policies exist for all toilet/bathroom areas and bedrooms. The policy and procedure on care of the dying and death were in place with the full knowledge of both service users and relatives. Individual spiritual persuasions were documented and respected. Relatives are welcome to stay as long as they liked in times of stress, including overnight stay. The Inspector was impressed with the confidence and closeness within the Home of staff, residents and visitors, and the mutual respect that prevailed. St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The quality in this outcome area is good. This judgement is based on discussions with service users, staff, and examination of records in relation to social activities undertaken and general observations during to course of the inspection. Residents informed the inspector that they were extremely satisfied with the way the home met their social needs, encouraged their family and friends to visit, allowed them to take decisions that affecting their lives. Routine is seen as flexible to acknowledge individuality, yet maintain a focal point for service users to recognise, without dictating events. Service users’ life-styles and interests are recorded in their care plan, discussed with their relatives prior to admission, and documented as far as possible to enhance a position of supported independence. Personal choice and relative self-determination are respected in policy and action. Those who wish to bring in personal possessions are encouraged to do so. Choices were available for every aspect of daily living, and menus provided a varied and good choice of food available on a three weekly programme. St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 14 EVIDENCE: St Michaels House main objective is to respect the individual, thus delivering care in a relaxed and easy environment, with routine flexible to accommodate needs, and not dictate daily life of service users. The Statement of Purpose and Guide indicate a flexible routine, established to meet the preferences of service users. It was evidenced that service users could ‘lie-in’, eat in bedroom and stay up late if they wished to. Several residents expressed their appreciation for the freedom they enjoyed, with the security that there are familiar events to the day they could relate to. The incidence and recording of social activities was seen to be an integral and essential part of care reporting and planning. Religious preferences and needs continue to be documented and reviewed. Residents informed the inspector that they were extremely satisfied with the way the home met their social needs, encouraged their family and friends to visit, allowed them to take decisions affecting their lives, and maintained a good choice and provision of food. The home operates an established open visiting policy, which was seen during the inspection. Relatives and friends are encouraged to maintain social links as part of the planning of care. Personal choice, and relative self-determination are respected in policy and action. Those who wish to bring in personal possessions are encouraged to do so. Those service users’ rooms inspected showed a significant influence of personalisation in the inclusion of belongings, some furniture and general décor. If anyone who is able wishes to handle their finances, or self-medicate, they do so, otherwise family are usually prepared to take responsibility for money matters. Three service users wanted to take up that option at the time of inspection. Access to personal records was held in accordance with the Data Protection Act 1998. St Michaels offers a good service, to which all service users spoken to were complimentary of all aspects of quality. A menu on a three weekly cycle offered a wholesome, varied and excellent choice, to which the cook emphasised, was consumer led, often well opinionated. Individual preferences were recorded in assessment and conveyed to cook, who met with, and discussed their requirements. It was confirmed that the cook knew each service user, and some of the relatives. Diversity was discussed and appreciated by the cook. It was noted that there were diabetics, all receiving the cook’s personal attention to needs. Lunch was served during inspection, served in a large, canteen-style dining room, which would benefit from a re decoration and review to introduce a more homely feel. St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 15 The kitchen was inspected with the cook and found to present a well equipped and organised area. All fridges and freezers were well maintained and checked daily by the kitchen staff. A cleaning schedule was in place, with the kitchen seen to be presented in a very organised and clean manner. COSHH signs and notices were in evidence with cleaning chemicals secure, appropriate and under control. St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 and 18 Quality in this outcome area is good. The home has a meaningful complaints policy, clearly identifying the CSCI as a resource to approach with a complaint or grievance. Service users’ legal rights are protected by the systems in place. Staff induction and in-house training programmes clarified the responsibilities of all staff in their daily contact with service users. EVIDENCE: A complaints book is maintained which shows a responsible approach in handling complaints appropriately. Experience has proven the depth of sensitivity of senior staff to addressing complaints in an effective manner. This includes a book for minor concerns received in-house, and found to be resolved to complainant’s satisfaction. No complaints have been received directly at CSCI. Records show that 3 complaints have been handled internally, satisfactorily, with the knowledge of CSCI. 2 allegations have been dealt with through Social Services effectively, with CSCI awareness. Staff induction and in-house training programmes clarified the responsibilities of all staff in their daily contact with service users, especially their privileged position in protecting service users from abuse, of all natures. It was advised that training on abuse should be for all staff annually. St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 17 There is an in-house code of conduct presented to staff on induction, which would be complemented with the provision of the General Social Care Council’s recognised code of conduct booklet, for the attention of all staff. St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 and 26 The quality in this outcome area is adequate. This judgement was based on discussions with service users, staff and a tour of the premises. The home is well appointed to meet the needs of service users who require enablement and assessment, as well as a small number of long stay residents, in providing a safe and comfortable environment. There is extensive activity in the refurbishment and development programme, which has reduced beds available to 30. Sections are presently closed off for this work. The observed impact on Service Users is minimal, and attracted no adverse reaction. Bedrooms were well maintained to meet service user’s personal preferences; although there was evidence of some rooms needing decoration. The outcome is nevertheless a comfortable and familiar private domain that reflects the service user’s preferences. Individual rooms are presented as highly personalised and inviting individual domains. There is evidence of an awareness of health and safety issues being high on training and supervision priorities, especially during this period of renewal. The Home continues to present a clean and pleasant, odour-free atmosphere, much to the credit of staff. St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 19 EVIDENCE: The external state of repair and maintenance is generally very good. The grounds are kept tidy, safe and are tended regularly, offering pleasing recreational areas for service users. Pathways were appropriately ramped to provide ease of access and there was a car parking area to the front of the building. The interior state of repair is receiving extensive renewal, with plans advanced to redesign the structural layout to meet the change in use as envisaged. Certain areas are closed to allow work, with minimal effect on residents. However corridors are showing wear and tear in décor and maintenance. Bedrooms are well appointed, of a good size and most are accessible for wheelchairs and walking aids. All bedrooms inspected were of a satisfactory standard, offering a personalised domain, each expressing the individuality of residents, although some rooms showed signs of damaged décor and furniture. A maintenance operative addresses day-to-day issues, meeting routine statutory monitoring work, and attempting to contribute to the process of renewal. Communal areas are furnished and decorated to a satisfactory standard to present a homely and comfortable environment, in spite of refurbishment, and bedroom upgrades. The main dining room offered a sense of ‘canteen’, and was somewhat Spartan, requiring some consideration into presenting a more ‘homely’ effect. The Home was asked to prepare a development programme for 2007/08 to CSCI. The home complies with the fire service requirements, following a detailed report and implementation of systems upgrade, that now complies with Regulation (19/12/06). All equipment inspected was well maintained. Staff receive at least two fire lectures/drills per year. Service users have the provision of sufficient and suitable lavatories and washing facilities within the home. The standard and presentation of all the toilets and bathrooms were of a satisfactory quality, clean, uncluttered and odour-free. One bath (Parker) was not in use, and presented a safety problem, requiring a suitable response. Adequate attention has been given to ensure maximum privacy within risk-assessed boundaries. Toilets are accessible to all and within close proximity to all communal areas. Notices regarding chemical handling in areas that store chemicals were evident, although appropriate COSHH posters and information charts would enhance the safeguard. St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 20 The home is well equipped to meet the demands of the elderly, with appropriate movement and handling facilities, hand and grab rails, ramps and call alarms. The Care Manager confirmed a willingness on the part of management to meet any reasonable demand for special needs. Wheelchairs and hoists are serviced annually, to which the Care Manager considered a 6 monthly check could be appropriate. Risk assessment is conducted on the same lines of preventative assessment. The call alarm system was satisfactorily tested and service record checked. The overall environment was found to be safe for service user’s comfort within risk assessed limits. The heating provided a comfortable ambient temperature with radiators and piping suitably guarded. Lighting was seen to be satisfactory including emergency and bedside lights, and tested on a monthly basis. The water supply was tested for temperature control and within acceptable limits, i.e. a 40 degree C consistency. A certificate for water chlorination clearance was seen to be up to date (April 2006). Electrical appliances/equipment in the home were seen to be PAT tested. Ventilation was by standard door and window control offering a pleasant, airy yet warm environment.. An awareness of health and safety issues was high on staff training and supervision priorities. The standard of cleanliness was seen to be satisfactory throughout; there was no evidence of offensive odours in any of the rooms inspected, presenting a pleasant and fresh environment. The laundry was well organised and equipped to a good standard. COSHH regulations were clearly displayed and relevant to solutions in use. Infection control was efficiently organised. At the basement level offices and meeting rooms have been created to accommodate the requirements of visiting Social, Medical and other professional staff, in contributing to the redirection of services to an assessment and re-ablement, community service. St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. Staffing levels were seen to be satisfactory, the daily care staffing rota showed adequate balance between skills, qualifications and numbers to provide a good standard of care. The improvements made in staff selection/appointment have had a significant effect upon the provision of cares to ensure protection of service users. Records show improved staff training had a broad spectrum of care and allied subjects covered, ensuring that staff fulfil the aims of the home and meet the changing needs of service users. EVIDENCE: There were 25 service users receiving care at the time of the inspection, 9 in long stay, 8 on rehabilitation and 8 on assessment. Since the last inspection, staffing levels have maintained consistent levels to ensure equilibrium between numbers, skills and qualifications, with a strong presence of long serving experienced staff. Two weeks of off-duty were examined, providing evidence that the home is suitably staffed in numbers, skills and qualifications to ensure the needs of the service users are met. On the day of inspection the staffing levels were: - St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 22 am - 2 Senior 5 care assistants pm - 2 Senior 4 care assistants ND - 1 Senior 2 care assistants (including a sleeping manager) Staffing levels adheres to the previously issued Notice of Staffing. Bank staff, overtime and flexible rostering are used to accommodate shortfalls, agency staff are rarely used. The home employs a full complement of support staff. The home has a solid foundation of staff training, supervision and communications, with an acceptable arrangement for staff training for the immediate future. It was advised to establish a programme for 2007/08, and to reinforce the records to reflect the good standard of a meaningful training programme to compliment the TOPPS induction course. Seventeen members of staff have received training in first aid, with up to date certification. The home manages to maintain pressure in attempting to meet the NVQ targets for level 2, with 17 trained, 2 on training and 4 identified for training. The Home has reviewed and established a comprehensive procedure for interview, selection and appointment of staff. This involves a standard application form to assess and profile, 2 references taken and CRB (enhanced) checks gathered before a contract is offered to successful candidates. Fire lectures are recognised, by all staff receiving at least two lectures/training sessions per year. It is a declared policy that recruitment is based on equal opportunity. The staff selection process has a significant effect upon the provision of care, to ensure protection of service users. Three staff files were tracked and confirmed the policies in action. All staff need to be offered the GSCC code of conduct to supplement internal policies. Records demonstrate an on-going process of supervised practice with regular reviews taking place. The process continues to develop through cascade to involve all staff, to meet the required 6 times a year. St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 - 38 Quality in this outcome area is good. The manager has the appropriate skills and experience to manage the home. There is a confidence apparent in the interaction of residents, staff and the Home’s management, that demonstrated a positive relationship that pervades throughout the Home. Age Concern is an active participant in the managing of all aspects of care and service provisions. EVIDENCE: The Care Manager, Lesley Kokai, has demonstrated competence in running St Michaels House, in establishing a solid professional policy portfolio that has been implemented, to achieve a high standard of set aims and objectives. She has worked at every level in the care sector, mainly at St Michaels, for over 20 years, four as Care Manager. St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 24 The inspector was impressed by the openness and confidence in the observed interactions of staff, relatives and service users. The relationships were seen to be of mutual trust and respect. Appropriate risk assessments are in place for service users, through care planning and recording, staff selection and the general environment, these are up to date and accurate. The Registered Provider with the care manager, have developed a formal approach to monitoring quality across a wide range of activities. This includes a care plan review process that is recorded at least once a month, a staff training programme, and a quality development programme, including the setting of objectives, and target dates to aim for. Social Workers’ review meetings are regarded as a vehicle for assessing quality. The home has an open door policy and a commitment to equal opportunities. Service users and their families are encouraged to look after their own financial affairs, however if the service user requires some assistance this could be offered and the procedure for dealing with monies would be operated. As previously mentioned there is a willingness to create a training environment, and a staff supervision policy and procedure is in place in the home. An examination of administrative, monitoring, planning and care records showed an organised and professional attitude to effective record keeping. In general they were found to be well maintained, accurate and up to date, ensuring that the service users’ rights and best interests are safeguarded. Records inspected included, fire prevention tests on equipment, six monthly fire training and procedures, Health and Safety checks on equipment servicing and planned preventative maintenance and risk assessments. Water temperature logbook, the record of testing and servicing of wheelchairs and hoists. The manager offered evidence of safe working policies, procedures and practices including: - fire safety training, first aid training, and the handling of abuse. There was no procedure for the prevention and management of pressure sores, to which the care manager agreed to arrange with the Provider. The health and safety of service users and staff are promoted with safe storage of hazardous substances, regular electrical PAT testing, and servicing of gas appliances and regulation of the water system. Gas and water certificates were evidenced. The accident book was seen and found to be in order for staff, service users and reporting arrangements to Riddor. The administration and management of the home is efficient, uncomplicated and sensitive to the needs of service users. St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 2 2 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 3 3 St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 OP19 Regulation 39 (h) Requirement That the Registration of the Home reflects the change of use and provision of services. Timescale for action 01/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 4 6 Refer to Standard OP19 OP29 OP38 OP7 OP21 Good Practice Recommendations The management provide the CSCI a refurbishment/development plan for period 2007/08. That all staff are supplied with a copy of the General Social Care Council code of conduct and practice. That COSHH posters be secured in areas of chemical usage and storage. Ensure the daily report is kept up to date. Early address to maintenance and repair to fabric and furnishings. - Parker Bath St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 27 7 8 OP30 OP33 9 Provide a staff training programme for 2007/08 Provide a suitable procedure for the prevention and management of pressure sores. St Michael`s House DS0000032516.V328407.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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