Inspection on 21/07/06 for St Michael`s Mount

This inspection was carried out on 21st July 2006.

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 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 Mount 12/09/07

St Michael`s Mount 24/01/06

St Michael`s Mount 12/10/05

St Michael`s Mount 07/09/04

St Michael`s Mount 07/06/04

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 Mount Woolton Road Liverpool Merseyside L25 7UW Lead Inspector Lynn Sharples Key Unannounced Inspection 21st July 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 Mount DS0000025184.V295417.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 Mount DS0000025184.V295417.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Michael`s Mount Address Woolton Road Liverpool Merseyside L25 7UW 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) 0151 427 9419 Mr Michael Hanlon Mr James Mutch Elma Draper Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places St Michael`s Mount DS0000025184.V295417.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 45 Nursing Care and 45 Personal Care in the overall number of 45 Date of last inspection 24th January 2006 Brief Description of the Service: St Michaels Mount is one of two adjacent care homes situated in a quiet residential area of South Liverpool. Both homes are owned by a private company. St Michaels Mount is registered both for residential and nursing 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 side of the home. The building is purpose built and consists of two floors. The upper floor is served by passenger lifts and stairs. Accommodation for residents is provided in single rooms many of which have a toilet and hand wash basin. The home is centrally heated. There is a large central lounge, a separate dining room with conservatory. 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 Mount DS0000025184.V295417.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home did not know about the visit and took six hours. The inspector spoke with residents, relatives, the manager of the 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? The home now employs two full time and one part time domestic, this ensures that the home is kept and tidy. The garden area has been improved the patio slabs have been replaced and cleaned, some of the garden bushes have been cut back, the lawn has been mowed. This provides a pleasant area for the residents to use. 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. St Michael`s Mount DS0000025184.V295417.R01.S.doc Version 5.2 Page 6 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 Mount DS0000025184.V295417.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 Mount DS0000025184.V295417.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): 1,2,3,4,5,6 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 complete providing service users and prospective service users with details of the services the home provides. EVIDENCE: The home’s Statement of Purpose and Service User Guide are up to date to ensure that prospective residents have some knowledge of the home before they decide to move in on a permanent basis. Each resident has a contract and a copy of the statement of the terms and conditions of the home and this makes sure that they are informed about their rights and obligations The residents’ pre-admission assessment documentation is comprehensive; and must be completed before residents are admitted to the home to ensure that the skill mix of the workforce in the home can meet the residents identified care needs. St Michael`s Mount DS0000025184.V295417.R01.S.doc Version 5.2 Page 9 The homes senior nurses undertake a nursing pre admission assessment on residents before they are admitted to the home, to ensure care needs are Identified and can be met. Other health care professionals known to the resident are also involved in the assessment. The home currently has one resident, who is inappropriately placed due to their medical condition, the home is therefore in breach of their conditions and should apply to the CSCI to vary the conditions of the home. Prior to admission residents can visit and usually relatives visit before making a decision to stay. The residents have a six week trial period to ascertain if they wish to stay longer. The home does not provide intermediate care. St Michael`s Mount DS0000025184.V295417.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): 7,8,9,10 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 the care staff with the information they need to meet the residents care needs. The medication at this home is 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: The residents at 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. Residents and family also contribute the formulation of the plan. Daily health records are documented daily for each resident, this includes any critical incidences plus any visits from GPs, specialist nurses. St Michael`s Mount DS0000025184.V295417.R01.S.doc Version 5.2 Page 11 No resident in the home self medicates and the nurses in the home administer all medications for residents. The protocols for the receipt, storage, disposal, and documentation of medications in the home are safe. The wooden cabinet in the treatment room is not secure to the wall and could be opened easily. Most of the care staff has undertaken training on tissue viability. The Primary Care Trust (PCT) tissue viability nurse will visit the home at any time if needs arise. Photographic and skin mapping evidence for pressure sores is recorded in the resident’s personal file. This allows for the appropriate monitoring and treatment. All residents in the home can and do access their NHS entitlements, which includes dentistry, opticians and chiropody services. The staff were observed knocking on residents room before entering and treated the residents with respect. The residents said that the staff were helpful and polite. St Michael`s Mount DS0000025184.V295417.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): 12,13,14,15 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. Residents have some opportunity to exercise their choice in relation to leisure and social activities. The meals at the home are good and ensure that residents receive a wholesome appealing balanced diet. EVIDENCE: On admission to the home the resident with help from a family member completes a Social Assessment questionnaire, which is a “Work life History” of the resident, and includes schooling, work, hobbies, food likes and dislikes and preferred daily and weekly routines. This information is used to facilitate organised activities for the resident. The home does not employ an activities coordinator, carers undertake to organise the social activities. When residents participate in social activities, it is recorded in their daily health record sheet, how they participated in the activity. This is to ensure that there is recorded evidence of how the resident responded in the activity, and to their mood, emotions, physical dexterity. The recordings of the resident activities helps to complete a record of the residents’ progress, or even identify developing care needs. St Michael`s Mount DS0000025184.V295417.R01.S.doc Version 5.2 Page 13 The residents said that they would like to go out on trips and that this has been promised but has not happened. The residents meetings record this issue from March this year. The home should either have trips out or inform the residents why this cannot take place. Visitors are allowed in the home at any reasonable time of day and residents may entertain their visitors in the communal lounges, or in their own bedroom. Residents said that they enjoyed the food in the home. The residents had a choice of two hot meals or sandwiches at lunch time. Some of the residents prefer to take their meals in their own room rather than go to the dining room. The cook said that they provide two hot meals at lunchtime and other options if necessary. Menus for each day are printed in large print in the resident’s dining room. Therapeutic diets can be catered for in the home for residents with a medical condition. St Michael`s Mount DS0000025184.V295417.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): 16,18 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. The home has a documented complaints procedure to ensure residents’ views are listened to and acted upon. Systems are in place to ensure residents are safeguarded from abuse and harm. EVIDENCE: The home has one record of a complaint that has been investigated and upheld. The CSCI has received one concern regarding the home. Residents spoken with were aware of how to complain. An adult procedure and the Wirral “No Secrets” adult protection protocol are kept at the home. Staff demonstrated an awareness of how to ensure service users were protected from abuse, the staff have received training in adult protection. St Michael`s Mount DS0000025184.V295417.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): 19,20,21,24,26 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. Recent investment has improved the appearance of the home creating more comfortable environment for those living there and visiting. The overall quality of the furnishings and fittings is good. EVIDENCE: The home has employed two further domestic assistants since the last visit, and the work has started to improve the gardens. The garden area near the dining room is now accessible, the patio slabs have been cleaned and fixed so that they are safe. Some of the bushes have been cut back, to assist with the residents accessing the gardens, more work is planned to continue this improvement. St Michael`s Mount DS0000025184.V295417.R01.S.doc Version 5.2 Page 16 There is one large dining room and one large lounge; there is also a conservatory, which is used as a quiet area. These were clean and domestic in character. All of the bedrooms in the home are single occupancy, and most of the residents have personalised their bedrooms with pictures and memorabilia. The home’s washing machines in the laundry have had an Eco system fitted to them (OTEX). This enables soiled washing to be cleaned at lower temperature, using 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, and Hepatitis B and C. Monitoring of the room is essential in case of an Ozone leak from the system. The home has an infection control policy includes the prevention and spread of Methicillin Resistant Staphylococcus Aureus and Hepatitis B and C. The home was clean and free from malodour on the day of the visit. St Michael`s Mount DS0000025184.V295417.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): 27,28,29,30 Quality in this outcome is adequate. 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. The lack of staff who can communicate effectively with residents 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 rota indicated that there were sufficient staff on duty. From speaking with residents and relatives, there were concerns raised about the some staff being impatient with residents and some of the staff difficult to understand as English was not 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. The residents and relatives said that the staff were caring and did spend time with the residents. An examination of a sample of staff records indicated that all staff had two references, enhanced CRB checks, statements of terms and conditions on their personnel file. St Michael`s Mount DS0000025184.V295417.R01.S.doc Version 5.2 Page 18 Mandatory and specialist training for all staff is ongoing in the home; this is evidenced in the personal files of the staff. The home has residents who have diabetes, epilepsy and learning disabilities, the staff would benefit from training in these areas. St Michael`s Mount DS0000025184.V295417.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): 31,33,35,36,38 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this service. Staff morale is high in the care home, resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life and the turnover of care staff is low. 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. Not all the staff in the home has documented supervision six times per year, this ensures that all staff have the opportunity to discuss with the manager, and other senior nurses, any issues, which can effect or improve the care for St Michael`s Mount DS0000025184.V295417.R01.S.doc Version 5.2 Page 20 the residents. Documented supervision of all staff gives the staff and manager’s opportunities to discuss their own/or identified training needs. The home has documented residents meetings and there was evidence of issues raised by residents sometimes being dealt with. Where possible residents look after their own financial affairs, the home does not hold any bank accounts for individual residents. The homes certificates of insurance and worthiness for machines, gas, electricity, fire equipments, lift, hoists were in date and valid. The Employers Liability Insurance certificate is displayed in the main hall of the home and is valid and in date. Personal files of both staff and residents are kept secured in accordance with the Data Protection Act 1998, thus maintaining confidentiality. St Michael`s Mount DS0000025184.V295417.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 2 3 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 3 17 X 18 3 3 3 3 X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 St Michael`s Mount DS0000025184.V295417.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP4 Regulation Care Standards 2000. 12 Requirement The registered person must ensure that they apply to the CSCI to vary their conditions of registration. The registered person must ensure that all staff are able to effectively communicate with residents to ensure that their needs are met. The registered person must ensure that staff receive training appropriate to the work they perform. The registered person must ensure that all care staff employed in the home receive appropriate formal documented supervision. Timescale for action 31/07/06 2 OP27 21/08/06 3 OP30 18 21/08/06 3 OP36 19 21/08/06 St Michael`s Mount DS0000025184.V295417.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 1 Refer to Standard OP9 OP30 Good Practice Recommendations It is recommended that a lockable metal cupboard is purchased to ensure safe storage of medication. It is recommended that the staff receive training in diabetes, epilepsy and learning disabilities. St Michael`s Mount DS0000025184.V295417.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 © 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 St Michael`s Mount DS0000025184.V295417.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!