Inspection on 05/06/07 for St Michael`s Rest Home

This inspection was carried out on 5th June 2007.

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 Rest Home 23/03/09

St Michael`s Rest Home 06/02/09

St Michael`s Rest Home 31/03/08

St Michael`s Rest Home 30/11/06

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

CARE HOMES FOR OLDER PEOPLE St Michael`s Rest Home 107 Cooden Drive Bexhill-on-sea East Sussex TN39 3AN Lead Inspector June Davies Key Unannounced Inspection 5th June 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Michael`s Rest Home DS0000067223.V337747.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 Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Michael`s Rest Home Address 107 Cooden Drive Bexhill-on-sea East Sussex TN39 3AN 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) 01424 210210 F/P 01424 210210 Balwinder Singh Khera Baljeet Kaur Khera Post Vacant Care Home 15 Category(ies) of Dementia - over 65 years of age (15) registration, with number of places St Michael`s Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That the maximum number of service users to be accommodated is fifteen (15). Service users with a dementia-type illness only to be accommodated. Service users must be older people aged 65 years or over on admission. 18th January 2007 Date of last inspection Brief Description of the Service: St Michael’s Rest Home is situated in a residential area of Bexhill-on-Sea. The home is a detached house with 12 bedrooms comprising of 9 single bedrooms and 3 double bedrooms all bedrooms are fitted with a washbasin and two rooms have en suite toilet. There is a large lounge with integral dining room. A stair lift provides access to the first floor. The front garden has been adapted for car parking, and there is a large rear garden, which is secure for the residents. Fees charged are £375.00 to £450.00 St Michael`s Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection carried out on the 5th June 2007 over a period of 6.5 hours. Information provided in this document was obtained via the Annual Quality Assurance Assessment, documents looked at during the key inspection relating to the standards inspected, discussion with two members of staff and four service users. What the service does well: What has improved since the last inspection? The statement of purpose and service user guide have been updated and contain correct and clear information relating to the service offered in the home. The pre-admission assessment now contains more detailed information in relation to prospective service users, which allows for a more detailed initial care plan to be developed. Medication has now improved following a visit from the pharmacy inspector. The home has developed detailed policies and procedures regarding the receipt, storing, and administration of medicines. The complaints policy and procedure has been reviewed and now gives clear guidelines as to how a complaint can be made and the response time. The maintenance within the building is now much better but there is still further work to be done. St Michael`s Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 6 There are no offensive odours in the home, and attention is being paid to infection control. The registered provider now carries out regulation 26 visits to the home and these are recorded. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Michael`s Rest Home DS0000067223.V337747.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 Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 Quality in this outcome area is good. The home’s service user guide now provides clear information to enable prospective service users to make a decision about moving into the home. Good pre-admission assessments ensure that the home can meet the needs of prospective service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes service user guide has been reviewed and updated this now informs prospective service users that the home is registered for dementia care, and gives clear guidelines of the complaints process. Pre-admission assessments have been reviewed and clearly show that sufficient information is obtained prior to a service user moving into the home. St Michael`s Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 9 The home is now able to better assess if it can meet the prospective service user’s needs, and has more detailed information on which to base a care plan. The home does not offer intermediate care. St Michael`s Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is adequate. Service users care needs are reflected in their individual plans and potential risks are managed, but day to day recording needs to improve to ensure the needs of the service users are met. The medication at this home is now well managed promoting good health. While staff do their best to protect the service users privacy and dignity, shared bedrooms must provide appropriate screening for the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans showed the information from pre-admission assessments had been used, together with information gained since the service user had come to live in the home, relating to their mental, physical, personal and social care needs. Risk assessments were available within each individual care plan St Michael`s Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 11 relating to mobility, together with individual risk assessments pertaining to each individual service user. There was evidence that care plans are reviewed on a regular basis. It was noted however that in daily reports personal hygiene carried out by staff was reported as full care given, and did not specify what care had been given – oral care, hair washing, tissue viability checks etc. Care plans did show that the home has a good working relationship with all health care professionals and visits are recorded. Following the last key inspection a request was made for the CSCI pharmacy inspector to visit the home following concerns regarding the administration and storage of medication, and several requirements were made. The inspector noted that all these medication requirements have been met and that the home now operates in accordance within the guidelines set out by the Royal Pharmaceutical Society for the administration and control of medication in care homes. Eight staff have received medication training. All receiving of and administration of medication was correctly entered on the MAR charts. The home has good policies and procedures in place relating to storage, administration, and receipt of medication. The controlled drugs policy has also been reviewed and controlled drugs are properly managed within the home. While staff do respect the service users rights to privacy and dignity by knocking on service users doors and ensuring doors are shut when attending to personal hygiene, the inspector did note that in double rooms, net curtains have been provided to screen the room, but these nets are completely see through and do not provide any privacy to the service users sharing these rooms. While telephones are not available in service users bedrooms, they are able to make private calls using the office mobile phone. Three service users stated that they are able to choose and wear their own clothes, but that they rely on families to purchase new clothes for them. St Michael`s Rest Home DS0000067223.V337747.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard, 12, 13, 14 and 15 Quality in this outcome area is poor. There are not sufficient activities in the home to meet the needs of the service users. Links with the community are poor and do not enrich the service users social lives The meals in the home are good but do not take into consideration those service users who require liquidised meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the key inspection no activities were taking place in the home, the rota of activities were not clearly displayed for the service users. No outside entertainers visit the home. Three service users stated that they were bored and that there was not enough for them to do. Several service users were falling asleep and being woken up by a member of staff. The local Church of England does visit the home every four to six weeks to give communion to service users. St Michael`s Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 13 The home does not have any restrictions on visiting, and service users said that their visitors are always made welcome by the staff. The service users are able to entertain their visitors in their bedrooms or the garden if they wish to. Sometimes visitors take their service users out for lunch or a ride in the car. None of the service users are able to manage their own financial affairs due to their level of dementia. Relatives have power of attorney for the service users and where there are no relatives the services of solicitors are sought. The home has no information to inform service users or their families where they can obtain the services of an advocate. From a tour of the service users bedrooms it was obvious that service users are able to choose to bring small items of furniture, ornaments, photographs and pictures into the home when they move in. Three meals are offered in the home each day and from a four week rotating menu, there was evidence that service users are offered choice and variety of nutritious food. It was however noted that liquidised food is not offered in an appetising and attractive way to the service users. The home does cater for specialised diets as and when the need arises. Three service users spoken to said they enjoyed the food in the home. St Michael`s Rest Home DS0000067223.V337747.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. The home has a satisfactory complaints system with some evidence that service users views are listened to. Staff have a good knowledge and understanding of adult protection issues, which protects the service users from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a recently reviewed complaints policy and procedure. Since the last inspection the home has received one anonymous complaint and the registered provider, who took statements from all members of staff, investigated this. After the investigation the complaint was unfounded, no response could be made due to anonymity of the complainant. The home has a protection of vulnerable adults policy and procedure, but the acting manager said that she did not have East Sussex Social Services, Protocols and guidelines for the protection of vulnerable adults. All but one member of staff has attended POVA training. There are no adult protection issues outstanding against the home. St Michael`s Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 15 St Michael`s Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is adequate. The overall quality of furniture and fittings is good, but some decoration and external safety features for service users needs to be addressed. The home is clean and free from offensive odours. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Generally the home is well maintained and meets the needs of the service users. Furniture, fittings and decoration are domestic in character. The inspector did note that a ramp that gives access to the back garden needed attention as the rubber covering was torn and bubbled and there was no hand rail which could pose a danger to service users. Further attention needs to be St Michael`s Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 17 paid to health and safety issues in the garden to ensure the back gate is kept closed and that the hosepipe is not left lying across pathways. A corridor on the first floor needs attention where the wallpaper is hanging of the wall. During a tour of the building the inspector noted that none of the service users are able to lock their bedroom doors. The home was found to be clean and tidy and free from any offensive odours. The laundry facilities were clean and tidy and the industrial washing machine offers a sluicing and disinfecting programme. Staff are provided with plastic aprons and disposable gloves when carrying out personal hygiene for the clients. All communal toilets and bathrooms had liquid soap and paper hand towels. Clinical waste is placed in appropriate yellow sacks. St Michael`s Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is adequate. Staff are employed in sufficient numbers to meet the needs of the service users. Only limited progress has been made in addressing the qualification and mandatory training of staff to ensure that they have sufficient knowledge to meet the assessed needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff rota showed that there were sufficient staff on duty at all times of the day and night to meet the needs of the service users. A member of staff spoken to said staffing levels were good and staff were not rushed to carry out tasks for the service users. Qualifications of staff at the present time are below the 50 minimum requirement but there are other staff that at the present time are in the process of working towards an NVQ qualification. Two staff files showed that recruitment procedures have improved, and the inspector found that staff files all contained all the relevant documentation. However staff are not given the GSCC code of conduct. St Michael`s Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 19 According to the staff-training matrix not all staff have completed health and safety related mandatory training and none of the staff have received dementia care or challenging behaviour training. St Michael`s Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 Quality in this outcome area is adequate. At the present time the home is relatively well managed but further improvements would enhance the lives of the service users. The quality assurance system needs to be further developed to ensure that service users are receiving a high quality of care. Further audits of health and safety and fires safety checks need to be carried out to ensure that service users and staff are safe in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: St Michael`s Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 21 The acting manager informed the inspector that the registered provider is in the process of recruiting a new acting manager and this should take place within the next few weeks. Staff reported that they had a good working relationship with the acting manager. The acting manager said that she receives help and support via twice weekly visits from the registered provider. While the quality assurance system in the home has improved since the last inspection further work needs to be carried out to ensure that systems used in the home are regularly monitored and recorded. The personal allowances of three service users are looked after by the manager and these were seen to be well managed, with receipts of expenditure kept, together with a separate accounting book for each resident. As reported earlier all staff must complete health and safety related training. Current maintenance certificates were seen for all appliances used in the home. There was weekly recording of fire systems and monthly hot water checks. It was noted that hot water checks showed that hot water was being delivered below 43ºC, the acting manager stated that she would get the control valves looked at. All windows have window-opening restrictors. The premises are secure with a number lock fitted to the front door and other external doors are linked to the nurse call system. There was no evidence that regular health and safety and fire check of all rooms in the building are carried out. The home does have HSE accident book and all falls are properly recorded, however these are not always entered onto the falls matrix. The home has up to date health and safety policies and procedures. St Michael`s Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 22 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 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 X X 2 St Michael`s Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 12(1) Requirement All aspects of personal care must be recorded for example oral care, hair washing, shaving, check of tissue viability etc. Service users must be weighed regularly. Timescale for action 30/07/07 2. OP8 3. OP10 14 (1)(a) (2) 17 (1)(a) Sched. (3) (3)(m) 12(4)(a)( Shared bedrooms should have b) appropriate screening to ensure privacy when personal care is being carried out or at any other time. Part of previous requirement with timescale of 08/01/06 not met 30/07/07 17/07/07 4. OP12 5. 6. OP15 OP19 14(1)(a) 15(1) 16(2)(m) (n) 12(4)(b) 16(2)(i) 23(2)(d) (o) Activities should be arranged and 30/07/07 on display, which are in keeping with the wishes and assessed needs of the service users. Liquidised food is presented to 30/07/07 service users in an attractive and appealing manner. The garden must be maintained 30/07/07 in a safe and secure condition for DS0000067223.V337747.R01.S.doc Version 5.2 Page 24 St Michael`s Rest Home 7. OP24 8. OP28 use by the service users. Decoration in all parts of the home must be maintained in a reasonable condition. 12(4)(a) Service users must be able to 13(4)(a-c) lock their bedroom doors if they 23 wish to. Locks should be provided that are suitable to the service users capabilities and accessible to staff in emergencies. 18(1)(a) A minimum ration of 50 (c) trained members of care staff Schedule2 (NVQ level 2 or equivalent) is (4) achieved this excludes the registered manager. 18(4) 18(1)(a) All staff and new members of staff must be given GSCC code of conduct. All staff must receive and update their mandatory training, receive dementia training and challenging behaviour to meet the assessed needs of the service users. Previous requirement not met dated 26/03/07 10/08/07 02/07/07 9. 10. OP29 OP30 31/07/07 31/07/07 11. OP38 13 (4)(c) The registered person shall ensure that unnecessary risks to health and safety of the service users are identified, through regular checks throughout the home to identify any health and safety or fire risks to the service users. 10/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. St Michael`s Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 25 No. 1. 2. Refer to Standard OP14 OP18 Good Practice Recommendations Information should be available on how to contact local advocacy groups. The manager obtains the East Sussex Protocols and Guidelines for the protection of vulnerable adults St Michael`s Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Michael`s Rest Home DS0000067223.V337747.R01.S.doc Version 5.2 Page 27 - 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. 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