Inspection on 27/01/06 for St Michael`s House

This inspection was carried out on 27th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 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 House 25/01/07

St Michael`s House 08/06/06

St Michael`s House 20/10/05

St Michael`s House 21/12/04

St Michael`s House 18/05/04

St Michael`s House 29/10/03

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Ravenhurst

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Inspirations

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

CARE HOMES FOR OLDER PEOPLE St Michael`s House Hewitt Street Chell Stoke on Trent Staffordshire ST6 6JX Lead Inspector Lorraine Mavengere Unannounced Inspection 27 January 2006 11:00 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.V280726.R01.S.doc Version 5.1 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.V280726.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Michael`s House Address Hewitt Street Chell Stoke on Trent Staffordshire ST6 6JX 01782 233435 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.V280726.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 5 Physical Disability (PD) - Minimum age 55 years on admission Date of last inspection 20th October 2005 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 was 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/reablement 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. Service users 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.V280726.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home currently has fourteen permanent residents, eight rehabilitation residents and seven assessment residents. At the time of inspection, one service user had pressure sores that they had obtained from hospital. This is being attended to by the district nurse. The home has one permanent day staff vacancy full time, one domestic vacancy full time and one temporary ten hours per fortnight vacancy. On average, the home uses agency staff once a week. The home keeps information of all agency staff including their CRB disclosure numbers and relevant work experience. The inspection was unannounced. Many of the service users and staff were spoken to during the inspection. Their comments are also used to inform the findings of this inspection. Other methods used to inform the inspection include case tracking, document and record reading, direct and indirect observation and a tour of the premises. The inspection focused on assessing the standards that had not been assessed during the last announced inspection. What the service does well: What has improved since the last inspection? The organisation has set in place a new and more detailed care plan format that includes all the individual risk assessments. The requirement that reviews must detail the changes that have taken place, how these are being dealt with and by whom is also addressed in the new care plan format. It was noted that the home is currently on a programme of renewal and decoration scheduled to last throughout the year. Fifteen beds have been shut. The building work will start in that specific wing. A new sluice will be put in place. Along each corridor, two bedrooms will be knocked through to create a lounge. The idea being that each corridor will have its own therapy room, lounge and kitchen. A wash room is also being created downstairs for the rehab and assessment programmes. This is for the residents to use. St Michael`s House DS0000032516.V280726.R01.S.doc Version 5.1 Page 6 The home has in place some new activity recording sheets that details the activities that service users have undertaken. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Michael`s House DS0000032516.V280726.R01.S.doc Version 5.1 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.V280726.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed during this inspection. EVIDENCE: St Michael`s House DS0000032516.V280726.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The home systems for the receipt, storage, administration and disposal of medicines ensure the service users’ safety, health and wellbeing. EVIDENCE: The clinical room was examined during the inspection. This is the room that houses all the medication trolleys, stock medication, medication awaiting return to the pharmacy and the medication fridge. The room was seen to be clean, tidy and well presented. A member of staff explained the home’s practices for ordering, storing, administering and disposal of medications. This was explained in a manner that evidenced good practice. Medication for permanent resident are delivered and administered from a blister pack unless otherwise specified. The local pharmacy takes care of this and does an annual medication audit for the home. The policy that was seen during the inspection had a whole section missing from it. This section covered areas such as self medication, control drugs and homely remedies. The registered manager confirmed that it is normally available to all staff but on this occasion had been separated and parts of it were not in the clinical room. The registered manager must ensure that the complete medication policy is available to all staff in the home and open for inspection. It was noted that the fridge contained some eye St Michael`s House DS0000032516.V280726.R01.S.doc Version 5.1 Page 10 drops that were not dated on the day of opening. The registered manager must ensure that all eye drops are dated on the day of opening and disposed of in the required time frame. Fridge temperatures are recorded daily. The system for storing and administering control drugs was also assessed. The system is robust and well understood by those who undertake the task. St Michael`s House DS0000032516.V280726.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards not assessed on this occasion. These standards assessed during the previous inspection. EVIDENCE: St Michael`s House DS0000032516.V280726.R01.S.doc Version 5.1 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17, 18 Service users legal rights are protected. The home’s policies serve to protect service users from potential or actual abuse. EVIDENCE: The registered manager confirmed that service users have their legal rights protected, are enabled to exercise their legal rights directly and participate in the civic process if they wish. Service users do postal votes. Those who wish to are supported to physically go to a voting booth to vote. The service user guide does not specify residents’ legal rights. It is recommended that service users legal rights are highlighted in the service user guide. The vulnerable adult policy remains unchanged from the previous inspection. The policy is robust and covers all areas of reporting suspected or actual abuse, it also gives a definition of abuse and signs and symptoms that may indicate abuse. The manager reported that more staff are being send onto the Protection of Vulnerable Adults Training. Although the application for the training has been completed, no dates have been arranged as yet. It is required that the manager ensures staff complete their vulnerable adult training during the induction phase. The manager also confirmed that there have been no vulnerable adult proceedings since the last inspection. Staff spoken to demonstrated an understanding of the procedure for reporting suspected or actual abuse. Records show that no vulnerable adult proceedings have taken place since the last inspection. St Michael`s House DS0000032516.V280726.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 The layout of the home is suitable for its stated purpose but ongoing work must be done to maintain safe standards. The home provides shared facilities that offer uncluttered space for service users. The number of bathrooms and toilets are adequate to meet service users stated needs. Relevant equipment is provided as per service users’ needs. All equipment is well maintained. All bedroom space meets the national minimum standard for room sizes. The home offers service users bedrooms that are safe, comfortable and have their own possessions around them. The home offers adequate heating and ventilation. The premises are kept clean, hygienic and of good domestic cleanliness. St Michael`s House DS0000032516.V280726.R01.S.doc Version 5.1 Page 14 EVIDENCE: A tour of the premises showed that there is still some ongoing decorative work. It was quite clear from discussions with the registered manager that the home holds a programme of redecoration and renewal. Many of the areas identified in the last inspection as needing some redecoration have been addressed. There are still, however, some areas that are still outstanding but are on the programme of things to do. The gardens are well maintained, safe and accessible to the service users. The registered manager confirmed that the building in the process of being adjusted to comply with the requirements of the fire service and environmental health department. On the day of inspection, the home was of good domestic cleanliness. A tour of the premises showed that the service users are provided with an adequate number of lounges, dining rooms. There is a smoking facility for the service users that smoke. Observations showed that the shared spaces offered were extensive and uncluttered. All communal areas including the garden, are accessible to wheelchair users and those with other mobility needs. The furnishing in the communal areas is suitable for its purpose and lighting is adequate. The registered manager stated that the programme for refurbishment is going to be such that along each corridor, two rooms will be knocked through to create a lounge area. The idea behind this is that each corridor will have its own lounge, kitchen and dining area. The number of toilets and bathrooms provided by the home are adequate to meet the needs of the service users. There are toilets that are prominently sited with in easy reach of the communal areas allowing for easy access. The home also provides assisted baths for those needing assistance in this area. None of the bedrooms at St Michaels have en suite facilities. It was noted during the tour of the premises that the home uses equipment such as assisted baths, hoists, wheelchairs, handrails and grab rails. The registered manager confirmed that the equipment used in the home is provided to service users in consultant with the relevant professionals such as the physiotherapist and the occupational therapist. Records seen show that the equipment is serviced as per requirement. The manager stated that service users’ need for equipment is re assessed frequently to ensure that they are provided with the appropriate equipment at all times. Service users n the rehabilitation section of the home get daily input from the Occupational Therapist who is able to keep an eye on service users’ need for equipment. Measurements for bedroom spaces were not taken on this occasion. Measurements are based on those taken by the home for their statement of purpose. Room sizes therefore meet the national minimum standard. St Michael`s House DS0000032516.V280726.R01.S.doc Version 5.1 Page 15 A tour of the premises showed the service users bedrooms to be highly personalised. Service users spoken to confirmed that they could bring in their own items of value, photographs and small pieces of furniture into the home. It was noted that in all the bedrooms, the minimum requirement for bedroom furniture was met. All service users bedroom doors are fitted with locks. The registered manager confirmed that service users are offered keys to their bedrooms. All rooms are fitted with a radiator and a window for heating and ventilation. Most of the radiators are guarded but the home has a programme of further guarding all of the radiators and pipework. This was a requirement of previous inspections and will continue to be a requirement until the work is completed. Records show that the home has emergency lighting throughout that is serviced and tested regularly. Records show that all staff have completed infection control training, this includes all domestic staff. A tour of the premises showed the home to be clean and tidy on the day of inspection. The laundry facility is sited in an appropriate location, far away from the kitchen and eating areas. The home provides two industrial washing machines and two industrial dryers. No service users access the laundry room. The registered manager confirmed that in the home’s programme for refurbishment, the home is to create another laundry room for the rehabilitation wing in order to allow service users to maintain their skills in this area. The laundry room itself, while suited for its stated purpose, has some huge cracks in the wall. The registered manager must ensure that these are investigated and rendered accordingly. Records show that the home has policies and procedures for infection control. Observed practice showed that the practices are in line with the policy. St Michael`s House DS0000032516.V280726.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 Service users are in safe hands at all times. The home’s policies on recruitment ensure that service users are safe guarded but practices are not as stringent as required by the policies. EVIDENCE: Records seen show that of the 20 care staff at St Michaels, twelve of them are qualified to NVQ2 or above. This shows that the home is ahead of the 50 target. The registered manager also confirmed that a further six care staff are currently doing their NVQ2 and the home are aiming to have all their staff through the NVQ programme by the end of this year. The home must be commended on its efforts to ensure that all staff are suitably qualified. A sample of staff files was seen during the inspection. The files showed that on the whole staff are provided with a statement of terms and conditions, and each member of staff has two references and a police check. This was not the case for all the files. The registered manager must ensure that all files have the relevant recruitment information on them. St Michael`s House DS0000032516.V280726.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 St Michaels has a manager who is fit, qualifies and competent to run the home. The home has in place some effective quality monitoring systems with room to further develop these. Service users’ financial interests are safeguarded and the home encourages service users where possible to manage their own finances. EVIDENCE: Records show that the home has in place some questionnaires designed for service users, relatives and stakeholders. The questionnaires cover all relevant areas of the home and allow space for participants to give their opinion on the service. Some feedback from doctors, district nurses and social workers were seen during the inspection. All the comments were very positive. The questionnaires are send out to the relevant parties every year. The home’s St Michael`s House DS0000032516.V280726.R01.S.doc Version 5.1 Page 18 annual and business plan not available on this occasion so inspector was not able to ascertain whether or not outcomes from the surveys were incorporated into the annual plan for improvement. The registered manager must ensure that the home’s annual development plan is available and open for inspection. Records also confirmed that service users opinions are sought through Rehabilitation meetings (for those residing in this section of the home) where they can give their opinions on service provided and contribute to the menus. They also agree on activities that they would like to do. Monthly regulation 26 visits are routinely sent to the Commission for Social Care Inspection. The manager stated that all service users have a Financial Assessment as part of their care plans when they are first admitted into the home. The service users who are not able to manage their own finances have a plan in place by which either social services or their relatives manage their finances. The systems for depositing and withdrawing money are comprehensive and easy to trail. Records indicate clearly the service users who are on Guardianship or power of attorney. Where relatives are in charge of service users monies, cheques are always made out in the service users name so that it can be deposited in their bank or post office account. The home uses the purse system. This is audited monthly. The home also has a financial monitoring system in place. Receipts and financial sheets are kept for seven years after the resident is deceased. St Michael`s House DS0000032516.V280726.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 2 2 3 3 3 3 3 2 3 STAFFING Standard No Score 27 X 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X x St Michael`s House DS0000032516.V280726.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The registered manager must ensure that all eye drops are dated on the day of opening and disposed of in the required time frame. It is required that the manager ensures staff complete their vulnerable adult training during the induction phase. The registered manager must ensure that decorative work is completed within the required timescale. The registered manager must ensure that each member of staff has two references on file. The registered manager must ensure that the home’s annual development plan is available and open for inspection. The registered manager must ensure that all radiators and pipework are guarded in accordance with assessed risk. Timescale for action 27/01/06 2. OP18 13(6) 31/05/06 3. OP19 23(2) 31/07/06 4. 5. OP29 OP33 Schedule 2 24 28/02/06 31/05/06 6. OP25 13(4) 31/07/06 St Michael`s House DS0000032516.V280726.R01.S.doc Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP17 Good Practice Recommendations It is recommended that service users legal rights are highlighted in the service user guide. St Michael`s House DS0000032516.V280726.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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