CARE HOMES FOR OLDER PEOPLE
St Michael`s Manor Woolton Road Woolton Liverpool Merseyside L25 7UW Lead Inspector
June Beaver Key Unannounced Inspection 23rd November 2006 11 am 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.V312184.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 Manor DS0000025418.V312184.R01.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.V312184.R01.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) 16th June 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 plus a top up fee of £17.50. St Michael`s Manor DS0000025418.V312184.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This site visit was unannounced and took seven and a half hours. There were forty four people living at the home at the time of the visit. The Inspector spoke with several service users, members of staff, the Manager, Administrator and some of the visitors. The visit also including looking at a selection of files and records, looking around the premises and checking how staff are recruited. What the service does well:
Service users’ individual health, personal and social care needs are well met and the medication is very well managed promoting good health. Personal support is offered in such a way as to promote and protect the residents’ privacy, dignity and independence. Service users receive a varied nutritious diet and have plenty to eat. Some of the service users spoken to on the day made comments such as “ the food is lovely here, its always well cooked” and “I can ask for something else if I don’t like what’s on the menu”. Service users are encouraged to make their own choices about how they like to spend their day such as when to get up and where they want to spend the day, whether they wish to go out with family or take part in some of the home’s activities. One service user stated that she “can stay up as late as she wants to and have a sleep in of a morning”. There is good staff morale at the home and it was noted that staff interacted positively with service users and appeared to have a good rapport with them as well as visitors to the home. Staff members spoken to during the visit stated “the atmosphere here is great, we all work well as a team and can have a laugh with the service users” and “I wouldn’t want to work anywhere else, there are times when we get very busy but we all pull together to get things done”. There has been a donation to the home from a service user’s family and it has been decided the money would be used to develop a sensory garden for the rest of the service users to enjoy. Service users have been consulted on the type of garden they want and the plans are posted on the wall in the reception area for comments. St Michael`s Manor DS0000025418.V312184.R01.S.doc Version 5.2 Page 6 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. St Michael`s Manor DS0000025418.V312184.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 Manor DS0000025418.V312184.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and service user guide contained sufficient information to enable service users and their families to make an informed choice regarding the suitability of the service. The pre-admission process is thorough and ensures that all service users’ health needs can be met prior to admission. EVIDENCE: The Statement of Purpose and Service User Guide has been updated and now includes a lot of information for prospective service users and their families to help them decide whether this home can meet their needs. It is a comprehensive document and contains a wealth of information about the home and its staff, what is included in the fee and what’s not, the management structure, staff training, details of the activities the home provides, photographs of the lounges and bedrooms, details of how to raise a concern or
St Michael`s Manor DS0000025418.V312184.R01.S.doc Version 5.2 Page 9 complaints, testimonials from satisfied customers, comments from G.P.’s and sample menus. There is a smaller brochure available for people to take away. Copies of signed contracts were available on service users files which are usually completed within a week from the date of admission. Either the service user or a member of their family and the manager signs the contract. The contract clearly states what the home will provide and gives details of terms of residency. The Manager or one of the senior members of staff visit the service user in their home or hospital prior to admission to gather information that will help staff to decide whether the home can meet the service users needs in full. This also gives the service user the opportunity to ask questions about social activities and routines at the home. The home does not offer intermediate care however they are registered for five Palliative care beds and have an additional Statement of Purpose setting out the home’s philosophy regarding palliative care to enable service users and their families decide whether to use the service if there is a bed available. St Michael`s Manor DS0000025418.V312184.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality in this outcome area is good. This judgement has been made using all available evidence including a visit to the service. The health and social care needs of service users are met in a satisfactory manner and service users are treated with dignity and respect. EVIDENCE: Three service users care files were case tracked and found to contain a good deal of information on service users health and social care needs. All service users have an individual care plans which are drawn up on admission to the home and reviewed by the senior nurses on a monthly basis to ensure they are still appropriate. Daily health records and risk assessments are also kept for each service user which include any specific issues such as accidents or incidents and any visits from GPs or specialist nurses. These records help staff to make sure all aspects of service users health and welfare are looked after. St Michael`s Manor DS0000025418.V312184.R01.S.doc Version 5.2 Page 11 Service users health needs are met by a variety of professionals visiting the home such as specialist nurses doctors, chiropodists, opticians and physiotherapists. The small palliative care unit is managed by senior nurses with support from G.P.’s specialising in this branch of care. The doctors visit at least twice a week and are “on call” if needed. The medication practices at the home are very good. Nurses or senior carers in the home administer all medications to those service users who do not wish to self medicate. One service user commented that she had been asked but after discussing the matter with her family decided not to. The protocols for the receipt, storage, disposal, and documentation of medications in the home are sound. Service users and relatives spoken with said that the staff in the home were courteous, respectful, and very friendly. A service user commented that “staff were more than helpful, you only have to ask and they will help you”. A visitor commented that “staff always greet you when you come in and offer you a cup of tea”. Another service user stated that “she was very anxious about moving in but now feels so at home she doesn’t want to leave”. St Michael`s Manor DS0000025418.V312184.R01.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, and 15 Quality in this outcome area is good. This judgement has been made using all available evidence and by visiting this service. The range and number of activities within the home is good, providing service users with a fair amount of stimulation and social interaction on an individual basis or in a larger group. Service users receive a nutritious varied diet. EVIDENCE: On admission service users are asked about their lifestyle, choice of foods and preferences of the social activities they would like to take part in. The service user with help from a family member or staff completes a social questionnaire, which includes schooling, work, hobbies, food likes and dislikes and television and radio preferences. This information is used to form an activities plan. Comments from service users and visitors on the day of the visit indicated that activities are not well promoted at the home and there was not enough to do. This information was given to the Manager who has stated he will look into the matter with a view to making improvements. There was some evidence to support the fact that the home can cater for service users with diverse needs as they can provide alternative diets if required and will respect all spiritual, cultural and holy days. The home has a
St Michael`s Manor DS0000025418.V312184.R01.S.doc Version 5.2 Page 13 equality and diversity recruitment policy and employs both male and female workers. Visitors are welcome at the home at any reasonable time. Visits can take place in the main lounge or in the service users own room. Staff spoken to on the day of the visit confirmed this. Visits are usually recorded in the service users care file including visits from clergy and health professionals. Sample menus were sent with the pre-inspection material which indicated that a wide and varied diet was provided by the home this was confirmed through discussion with service users who stated “the food is lovely here, always nice and hot and the staff will get you something else if you don’t want what’s on the menu”. One service user commented that she often had a sandwich when she didn’t want a meal and “it was no bother to the staff”. Two meals were observed on the day of the site visit, both meals appeared to be enjoyed and contained potatoes, meat and vegetables followed by a sweet. Staff were observed to assist those service users who needed help in a discreet way by sitting down with them and taking time. Service users can choose whether to eat in the dining room, the lounge or in their own bedroom if they wish. St Michael`s Manor DS0000025418.V312184.R01.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 and 18 Quality in this outcome area is good. This judgement has been reached using all available evidence including a visit to the service. There is a satisfactory complaints/concerns policy and procedure and service users can be reassured that their concerns will be listened to. EVIDENCE: Complaints documentation was reviewed and evidence was provided that concerns and complaints were treated seriously by the home and resolved by either a face to face meeting or in writing. The home has received one complaint since the last visit which was dealt with internally. 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.V312184.R01.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): 19,20,21,23,24 and 26. Quality in this area outcome is adequate. This judgement has been reached using all available evidence including a site visit to the service. The comfort and wellbeing of the service users is put at risk due to the lack of hot water in some areas of the building. 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 on all three floors. The hand washbasins in bedrooms on the ground floor had no hot water; neither did the communal washbasins in the bathrooms. The registered person needs to address this as a matter of urgency to make sure that service users have access to a decent supply of hot water throughout the day. This was a requirement from the last two inspections. The water supply to the other two floors was satisfactory.
St Michael`s Manor DS0000025418.V312184.R01.S.doc Version 5.2 Page 16 The carpet in the main corridor on the ground floor was very badly stained and worn and the paintwork in this area was marked and scuffed. This area is a well-used part of the building by service users, visitors and staff and the poor décor detracts from the overall impression of the premises. This needs to be addressed by the registered owner to improve and enhance the area for the service users benefit. The home provides grab rails in the corridors, bathrooms and toilets which help service users who have problems with mobility. There are also different types of hoists which help staff to transfer/move service users safely. Service users bedrooms were individually furnished with their personal belongings, and some service users commented that their rooms were “lovely” and “very nice”. Adjustable beds are provided for service users receiving nursing care. Bed rails and bumpers are provided if necessary after a risk assessment has been carried out. A monthly safety check is carried out on the bed rails and bumpers and records were kept for review. St Michael`s Manor DS0000025418.V312184.R01.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 and 30. Quality in this outcome area is good. This judgement has been made using all available evidence including a visit to the service Staffing levels are appropriate for the current group of residents. Service users are protected through a good recruitment procedure and the employment of a competent staff team. EVIDENCE: Rotas confirmed that there are sufficient trained nurses, senior care staff and health care workers on duty throughout the day and night. There are separate domestic and kitchen staff and the home employs a handyman. Issues regarding staff communication skills highlighted at the last inspection visit have been explored with service users and their families at a Residents meeting. The Manager of the home stated that improvements have also been introduced to the recruitment procedure to ensure communication skills are adequate prior to employment. The home operates a satisfactory recruitment procedure which helps ensure service users are protected from potential harm or abuse. Three staff files were reviewed and all contained a completed application form, two written references, Criminal Records Bureau (CRB) clearance, induction record, photographic identification, interview notes and visa information where necessary. The Personal Identification Numbers (PINS) of all the registered
St Michael`s Manor DS0000025418.V312184.R01.S.doc Version 5.2 Page 18 nurses in the home was documented on Nursing Midwifery Council (NMC) stationery. The home is not currently assisting any overseas nurses to do an adaptation course. Staff training has improved since the last visit and there was evidence that all levels of staff have access to in-house and outside training courses. Certificates of attendance at study days and training were available on staff files. Recent training included first aid, moving and handling, basic food hygiene, dental hygiene and health and safety training. The home provided evidence that it can access training for trained staff at one of the local universities these courses include tissue viability, care of the dying, dementia training and mentorship. There are now four members of staff who have completed the Palliative Care course and two further members of staff have enrolled on the course that begins in January 2007. The number of staff who have completed NVQ level 2 training has not changed since the last site visit and this matter needs improving. It is recommended that a minimum of fifty percent of the workforce completes an NVQ level II course in care. St Michael`s Manor DS0000025418.V312184.R01.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 and 38. Quality in this outcome area is good. This judgement has been made using all available evidence including a visit to the service The home is managed efficiently however the welfare of service users is compromised due to the lack of hot water in some areas of the building. EVIDENCE: An experienced first level nurse manages the home who provided evidence that he has registered on an NVQ level 4 care management course since the last site visit. This will enhance and develop his management skills for the benefit of the service users and staff. The registered provider now documents his monthly visits to the home and provides the Commission for Social Care with a copy, this helps provide evidence that the registered person is available at least once a month for the
St Michael`s Manor DS0000025418.V312184.R01.S.doc Version 5.2 Page 20 service users and staff and gives the Manager the opportunity of raising any concerns that may need his attention. Where possible residents are encouraged to look after their own financial affairs, as the home does not hold any bank accounts for individual service users. Formal staff supervision has commenced and records kept of all of these one to one meetings. Both supervisor and supervisee sign the records evaluating the outcome and benefit of the session. It is anticipated that formal supervision will take place at least six times a year. The homes certificates of insurance and worthiness for machines, gas, electricity, fire equipments, lift, hoists were in date and valid which helps protect the health and safety of service users, visitors and staff. All service users in the home have individual fire evacuation details in their personal files, this is good practice and helps to ensure the safety of the residents and staff. However staff training records for fire safety and fire drill training need to be reviewed especially for the night staff as it was difficult to track if any member of staff’s training was not up to date. 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.V312184.R01.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 3 3 X X X 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X 2 2 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 X 2 St Michael`s Manor DS0000025418.V312184.R01.S.doc Version 5.2 Page 22 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 OP12 Regulation 16.2 Requirement The registered person must ensure that the home organises suitable activities to meet service users expectations The registered person must ensure there is a sufficient hot water supply to service users bedrooms, bathrooms and toilets on the ground floor. This requirement remains outstanding from 24/1/06 and 16/6/06 The registered person must ensure that all staff receive regular fire training including drills. The registered person must ensure that the staff receive training appropriate to the work they perform of at least NVQ level 2 standard. The registered person must ensure that the worn and dirty carpet fitted to the ground floor corridor is replaced Timescale for action 31/12/06 2. OP21 23 31/12/06 3. OP30 18 31/12/06 4. OP30 18 31/03/07 5 OP19 23 31/01/07 St Michael`s Manor DS0000025418.V312184.R01.S.doc Version 5.2 Page 23 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 OP19 Good Practice Recommendations It is recommended that the home produces a rolling programme of re-decoration and refurbishment as some of the décor looks faded and the furnishings look worn. St Michael`s Manor DS0000025418.V312184.R01.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
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