Inspection on 16/06/06 for St Michael`s Manor

This inspection was carried out on 16th June 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Michael`s Manor 16/01/08

St Michael`s Manor 21/09/07

St Michael`s Manor 23/11/06

St Michael`s Manor 24/01/06

St Michael`s Manor 12/10/05

St Michael`s Manor 08/09/04

St Michael`s Manor 08/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE St Michael`s Manor Woolton Road Woolton Liverpool Merseyside L25 7UW Lead Inspector Lynn Sharples Key Unannounced Inspection 16th June 2006 09:45 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 Manor DS0000025418.V295125.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 Manor DS0000025418.V295125.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Michael`s Manor Address Woolton Road Woolton Liverpool Merseyside L25 7UW 0151 427 9419 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) M.E.S. Pension Fund Mr Philip Sergeant Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places St Michael`s Manor DS0000025418.V295125.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 44 Nursing Care and 44 Personal Care within the overall number of 44 44 Nursing or 44 Personal Care of which 5 may be used for terminally ill (older people) (TI/E) One service user under 65 years of age requiring terminally ill care may be admitted within the overall number of 5 TI(E) 24th January 2006 Date of last inspection Brief Description of the Service: St Michaels Manor is one of two adjacent care homes situated on the same site in a quiet residential area of South Liverpool. A private company owns both homes. St Michaels Manor is registered both for residential and nursing care plus five beds for palliative care. Trees and grassed areas surround the home which gives a sense of privacy, plus the home has its own gardens, there is a car park to the front of the home. The building itself is an older Victorian dwelling, which has been modernised inside whilst keeping many of the attractive original features such as the ornate ceilings and a sweeping central staircase. Passenger lifts and stairs serve the upper floor. Accommodation for residents is provided in single rooms many of which have a toilet and hand washbasin. The home is centrally heated. There is a large central lounge dining room. The home is close to public transport, rail and bus and is near to the M62 and M57 motorways. The fees for the home range from £283.50 to £415 per week. St Michael`s Manor DS0000025418.V295125.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. At the time of the visit 44 residents were living at the home. The home did not know about the visit and took six hours. The inspector spoke with residents, relatives, a doctor, the manager of other home and staff on duty. The inspector read files and looked round the home. What the service does well: What has improved since the last inspection? What they could do better: The homes Statement of Purpose is not complete providing service users and prospective service users with limited details of the services the home provides. St Michael`s Manor DS0000025418.V295125.R02.S.doc Version 5.2 Page 6 The lack of hot water means that the comfort and well being of the residents is compromised because of lack of basic maintenance in the home. The lack of bed bumpers places residents at risk of harm. One of the two driers was broken and should be fixed as a matter of urgency. A staff team that has benefited from training would enhance the care within the home. The record of self-review by the registered provider is poor and does not provide the home with adequate quality assurance. The lack of formal supervision leaves the staff without appropriate direction. 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 Manor DS0000025418.V295125.R02.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 Manor DS0000025418.V295125.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this service. The homes Statement of Purpose is not complete providing service users and prospective service users with limited details of the services the home provides. EVIDENCE: The Statement of Purpose does not include all the relevant details, the manager agreed to amend this. Prospective residents are provided with information about the home before they decide to move in on a permanent basis. This helps them to make a more informed choice about whether they wish to stay at the home. Three residents did not have a contract on their file; therefore, they were not informed about their rights and obligations. Health care professionals known to the resident are involved in the pre admission assessment. This helps to ensure that the different aspects of care are considered for each prospective resident. St Michael`s Manor DS0000025418.V295125.R02.S.doc Version 5.2 Page 9 The home is currently registered for five Palliative care beds, however only the homes manager and two other qualified staff have had training in Palliative Care, the night staff have not had training, the manager said that more staff will be trained. To ensure that the care needs (especially pain relief) of the residents are met it is essential that all first level nurses be trained in palliative care. St Michael`s Manor DS0000025418.V295125.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. Residents’ individual health, personal and social care needs are clearly recorded. This provides care staff with the information they need to meet the residents care needs. The medication at this home is very well managed promoting good health. Personal support in the home is offered in such a way as to promote and protect the residents’ privacy, dignity and independence. EVIDENCE: All residents in the home have an individual care plan, which is formulated on admission to the home and is reviewed by the senior nurses on a monthly basis. Daily health records and risk assessments are documented for each resident, this includes any critical incidences plus any visits from GPs, specialist nurses. St Michael`s Manor DS0000025418.V295125.R02.S.doc Version 5.2 Page 11 All residents in the home can access their NHS entitlements; which includes access to dentists, opticians, and chiropody services. Care staff will accompany residents for hospital or clinic appointments. A GP visits the home twice a week. The GP was present on the day and said that the palliative care was good and that the nurses work well together. The staff were observed interacting appropriately with residents and appeared to have a good rapport with them. None of the current residents in the home self medicate. Nurses or senior carers in the home administer all medications for residents. The protocols for the receipt, storage, disposal, and documentation of medications in the home are in accordance with the National Minimum Standards (NMS). Residents and relatives spoken with said that the staff in the home were courteous, respectful, and strove to maintain their privacy and dignity when assisting residents with personal care. The staff spoken with demonstrated an awareness of equality and diversity issues. St Michael`s Manor DS0000025418.V295125.R02.S.doc Version 5.2 Page 12 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): 12,13,14,15 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to exercise choice and to have flexibility how they spend their day in the home. They also pursue leisure activities according to their choice and preferences. This allows independence and individuality for each resident. Residents receive a varied nutritious diet that is in accordance with their preferences. EVIDENCE: On admission residents in the home are asked, about their lifestyle, choice of foods, and choices and preferences of the social activities they would like to participate in. The resident with help from a family member completes a social questionnaire, which is a “Work life History” of the resident and includes schooling, work, hobbies, food likes and dislikes etc. This information is used to facilitate organised activities for the resident; when residents participate in social activities, it is recorded in their daily health record sheet. St Michael`s Manor DS0000025418.V295125.R02.S.doc Version 5.2 Page 13 Visitors are allowed in the home at any reasonable time of the day and residents may entertain their visitors in the communal lounges, or in their own bedroom. On the day of the inspection there were people visiting relatives. Residents’ bedrooms are furnished with personal belongings. None of the residents had an advocate and this was discussed with a senior member of staff, who said that they would contact a local group. Some residents said that they enjoyed the variety of food in the home, but sometimes the food was cold especially for those who choose to eat in the bedrooms. Some of the residents prefer to take their meals in their own room rather than go to the dining room therefore the registered manager must remain mindful that the meals in these circumstances are served hot. At lunchtime the meals served were either fish and chips or sandwiches; the meal was well prepared and well presented. This helps to ensure that mealtimes are a meaningful social occasion. Therapeutic diets can be catered for in the home for residents with a medical condition. The menus indicated that residents receive a varied and nutritious diet. St Michael`s Manor DS0000025418.V295125.R02.S.doc Version 5.2 Page 14 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): 16,18 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this service. The homes policy and training programmes for POVA, and Whistle Blowing, ensure that the homes residents are protected from any potential abuse. EVIDENCE: The home had received two complaints from residents, however, after speaking with some relatives they had made a formal complaint and this was not documented, this was discussed with the manager. The Commission for Social Care Inspection (CSCI) had received one concern. The care home has up to date information on the Protection of Vulnerable Adults (POVA) this information is communicated to new employees on their induction course. There was evidence that many of the staff in the home had undertaken training on POVA protocols, and the Whistle Blowing Policy. The staff spoken with indicated a good knowledge of adult protection issues. St Michael`s Manor DS0000025418.V295125.R02.S.doc Version 5.2 Page 15 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): 19,20,22,24,25,26 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to this service. The lack of hot water means that the comfort and well being of the residents is compromised because of lack of basic maintenance in the home. The lack of bed bumpers places residents at risk of harm. EVIDENCE: The grounds were tidy and a patio area at the back of the home was well maintained. The home was clean and free from odour, the home employs three domestic staff, one has just left. Residents’ hand washbasins in bedrooms on the ground floor had no hot water; neither did the communal washbasins in the bathrooms. The registered person should consider installing a modern water system that can heat water for 45 residents and other services in the home. This was a requirement from the last two inspections. St Michael`s Manor DS0000025418.V295125.R02.S.doc Version 5.2 Page 16 The home provides grab rails in the corridors, bathrooms and toilets. Two bedrooms that have bed rails did not have bed bumpers in the room. It is vital that all bed rails have bed bumpers attached and should be kept in the residents bedrooms at all times and this should be included in the risk assessment. Each bedroom was individually furnished with the resident’s personal belongings, adjustable beds are provided for service users receiving nursing care. The home’s washing machines in the laundry have had an OTEX system fitted to them; this enables soiled washing to be cleaned at lower temperature, using Ozone, less electricity, soap and water. The washing is ionised and aerated to allow widening of the cloth fibres so soaps can penetrate the fibres and kill more bacteria, including MRSA, Hepatitis B and C. A radiator has been installed to ensure that staff work in an ambient working temperature laid down by the Health and Safety Executive. St Michael`s Manor DS0000025418.V295125.R02.S.doc Version 5.2 Page 17 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): 27,28,29,30 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to this service. The standard of vetting and recruitment practices has improved with the appropriate checks being carried out on all new staff. This ensures that the residents are not put at risk. A staff team that has benefited from training would enhance the care within the home. The lack of night staff that can communicate effectively with resident’s places them at risk of harm and their care needs may be missed. EVIDENCE: There is always a first level nurse on duty that is assisted by care staff and ancillary staff. The rotas indicated that sufficient staff are on duty at any time during the day and night. Residents and relatives said that there appeared to be enough staff on duty. From speaking with residents and relatives, there were concerns raised about the night staff being impatient with residents and the majority of staff difficult to understand as English was not their first language. There were also concerns raised about night staff leaving soiled bed linen on the floor outside rooms. This was raised with the manager and the rotas examined that St Michael`s Manor DS0000025418.V295125.R02.S.doc Version 5.2 Page 18 indicated that the majority of night staff did not have English as their first language. Residents are at risk of harm as their care needs may be missed and it would be difficult to build a personal relationship between the residents and staff. Of the thirty care staff nine have the NVQ level 2, this is below the standard of a minimum of 50 trained members care staff. The staff files include the completed application form, two written references, Criminal Records Bureau (CRB) clearance, induction record, and Visa information. The Personal Identification Numbers (PINS) of all the registered nurses in the home was documented on Nursing Midwifery Council (NMC) stationery. The home has two overseas nurses working in the home who are undertaking an Adaptation Course to prepare them for registration on the Nursing Midwifery Council (NMC) as First level Nurses. All files that were read had an induction record and included safe working practices. The manager said that not all the staff team have received three paid training days per year. St Michael`s Manor DS0000025418.V295125.R02.S.doc Version 5.2 Page 19 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): 31,33,35,36,38 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to this service. Staff morale in the care home is good, resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. The record of self-review by the registered provider is poor and does not provide the home with adequate quality assurance. The lack of formal supervision leaves the staff without appropriate direction. EVIDENCE: An experienced first level nurse manages the home; currently the manager has not registered on an NVQ Level 4 care programme. This was discussed with the manager who agreed to look into this. St Michael`s Manor DS0000025418.V295125.R02.S.doc Version 5.2 Page 20 The registered provider does not record their monthly visits to the home. The home has documented residents meetings and there was evidence of issues raised by residents being actioned. Where possible residents are encouraged to look after their own financial affairs, as the home does not hold any bank accounts for individual residents. Formal staff supervision was introduced in May this year; this was a requirement in the last inspection in January and only started in May. There was a discussion about the staff having at least formal supervision six times a year. The homes certificates of insurance and worthiness for machines, gas, electricity, fire equipments, lift, hoists were in date and valid. All residents in the home have individual fire evacuation details in their personal files, this good practice and helps to ensure the safety of the residents and staff. The Employer’s Liability Insurance certificate is displayed in the main hall of the home and is valid and in date. St Michael`s Manor DS0000025418.V295125.R02.S.doc Version 5.2 Page 21 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 3 2 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 X 2 X 3 2 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 St Michael`s Manor DS0000025418.V295125.R02.S.doc Version 5.2 Page 22 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 2 Standard OP2 OP4 Regulation 5 18 Requirement The registered person must ensure that all residents have a contract. The registered person must ensure that First Level nurses undertake training in Palliative Care to ensure the assessed and changing needs of the residents are met. (This requirement remains outstanding 24/01/06). The registered person must ensure that a record is kept of all complaints made and includes details of investigation and any action taken. The registered person must ensure that bed bumpers are provided with bed rails. The registered person must ensure there is hot water in residents bedrooms and communal bathrooms. (This requirement remains outstanding 24/01/06). The registered person must ensure that all staff are able to effectively communicate with residents to ensure that their DS0000025418.V295125.R02.S.doc Timescale for action 14/07/06 28/07/06 3 OP16 22 30/06/06 4 5 OP22 OP25 13 23 30/06/06 28/07/06 6 OP27 12 28/07/06 St Michael`s Manor Version 5.2 Page 23 7 OP30 18 8 OP31 9 9 10 OP33 OP36 26 19 needs are met. The registered person must ensure that the staff receive training appropriate to the work they perform. The registered person must ensure that the manager undertake a management training course. The registered person must visit the home at least once a month and prepare a written report. The registered person must ensure that all care staff employed in the home receives formal documentation six times per year. (This requirement remains outstanding 24/01/06). 31/08/06 28/07/06 30/06/06 28/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP30 OP27 Good Practice Recommendations It is recommended that all staff receive at least three days paid training per year. It is recommended that all staff complete the NVQ level St Michael`s Manor DS0000025418.V295125.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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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