Random inspection report
Care homes for older people
Name: Address: St Michael`s View St. Michaels Avenue North South Shields Tyne And Wear NE33 3BP zero star poor service 01/03/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Irene Bowater Date: 1 5 0 7 2 0 1 0 Information about the care home
Name of care home: Address: St Michael`s View St. Michaels Avenue North South Shields Tyne And Wear NE33 3BP 01914551215 01914551238 stmichaels@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sonia Pharoah Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ashbourne Homes Ltd care home 64 Number of places (if applicable): Under 65 Over 65 0 31 0 dementia old age, not falling within any other category physical disability Conditions of registration: 33 0 2 The maximum number of service users who can be accommodated is: 64 The registered person may provide the following category of service only: Care home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places 31 Dementia Code DE, maximum number of places 33 Physical Disability - Code PD, maximum number of places 2 Date of last inspection 1 8 0 6 2 0 1 0 Care Homes for Older People Page 2 of 13 Brief description of the care home St Michaels View Care home is owned by the Southern Cross, which was first registered in November 1994 and now accommodates 32 older people of mix gender for general nursing care and another 32 persons with mental ill health, 2 of who may also have a physical disability. The home does not provide intermediate care services. It is situated in a residential area and convenient for the town centre of South Shields. It is close to local train and bus transport. The coast, shopping outlets, local theatres and social amenities are close by. The local shops and a post office are within easy walking distance of the care home. St Michaels View is a modern single storey care home, custom designed and built to provide facilities and services in 2 distinct separate units. There are in total 4 lounges, 2 dining areas and bedrooms with en-suite facilities. There are 2 internal courtyards both with wheel-chair access. Care Homes for Older People Page 3 of 13 What we found:
We carried out this inspection to check whether the provider had complied with the requirements of one Statutory Requirement Notice (SRN). The SRN,issued on the 14 May 2010 detailed failure to ensure that all service user plans were detailed,reviewed,up to date and revised after consultation with the service user and their representative. We also checked compliance with a Warning Letter issued on the 13 May 2010 which raised serious concerns regarding health,safety and risk to service users, lack of staff supervision and lack of senior manager visits to the home under Regulation 26. Before the visit we examined information,responses and action plans from the provider and checked details of any changes in how the home was being operated.We also checked information that had been shared with us by other professionals with an interest in the service. The site visit was carried out by three compliance inspectors on the 15 July 2010. During the visit we spent time examining 10 care plans from both the Marsden and Cleadon Units,examined staff supervision records and examined reports made under Regulation 26.We checked that the environment was safe and clean and spoke to service users and staff. We also discussed our findings with the current home manager. We have reviewed our practice when making requirements,to improve national consistency.Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations,but only when it is considered that people who use services are not being put at significant risk of harm The staff had worked hard to update review and re write service users care plans. They were detailed,with up to date health care assessments in place and included excellent work from the back care adviser employed by the company. Service users health care needs were clearly recorded, including, assessing and regularly evaluating dependency levels, nutritional status using the Malnutrition Universal Scoring Tool (MUST). This also applied to falls risk,moving and assisting,pressure ulcer prevention and hydration. There was good use of fact and information sheets, for example, information about temporal lobe dementia from the Alzheimers Society, which was attached to corresponding mental health and communications care plans. Good short term care plans were in place but not always reviewed for example,sore on lip had not been up dated. However up to date information was seen in the daily progress reports. Further evidence to support this included some accidents and incidents, including a choking incident that had not been added to the care plan instructions or review. There was good information regarding the management of diabetes including a mental
Care Homes for Older People Page 4 of 13 capacity assessment regarding administration of insulin and good recording of pain management. Dementia Care Mapping had also been completed and this information was to be used to inform the care planning process so that individual care delivery could be consistently improved. Where service users required thickened fluids or specialist drinking cups this was recorded. Records showed that weights were being monitored regularly. The weights were recorded on individual care plans and the information showed that service users were maintaining or gaining weight. Other health professionals,such as dieticians,Speech and Language Therapists (SALT) Tissue Viability nurses (TVN),occupational therapists, physiotherapists,and GPs, contributed to the planning of care. There was a variety of styles used when writing the care plans, with some easier to read, with clear understandable instruction for staff that was easy to evaluate and review. Other care plans had more information about what to do if something went wrong which could detract from the relevant information needed. There was quite a lot of old documentation, such as accident reports, old care plans and diet notification forms in the plans, alongside new documents. These should be stored separately to prevent any confusion to staff delivering care. Service users appeared well cared for and they were receiving a good standard of personal care. Staff were observed to provide an appropriate level of supervision and were respectful and considerate of service user wishes. Service users were offered a cooked breakfast on both units, along with hot drinks, cereals, porridge, juices,toast and preserves. Several service users, especially on the Marsden Unit, had breakfast in bed and covered trays of food were taken to their rooms. Staff on both units assisted in a sensitive manner and staff also made sure that service users who were eating breakfast in their rooms were given appropriate support. Many service users needed a lot of support and breakfast did not finish until after 10:30 am. The mealtime experience on both units at lunchtime had improved. Tables were appropriately set and hot and cold drinks were served throughout the meal. A vast improvement was observed on the Cleadon unit with the qualified nurse taking control of the mealtime, delegating staff to assist individuals and making sure all of the service users had sufficient to eat and drink. This included making sure service users who needed specialist diets and thickened fluids were given the appropriate food and drinks. Choices were available for the meal and dessert and the food was nicely cooked and presented. Staff asked service users what their choices for meals were the day before but some
Care Homes for Older People Page 5 of 13 could not remember what they had ordered or had changed their minds.The ordering of meals could be reviewed so that service users can choose what they want to eat at the point of service. A tour of the home found continual improvements being made to the communal areas and bedrooms. Medication storage on the Cleadon Unit had been re located from the nurses office, however the carpet in this room was dirty and stained and needs to be replaced. Also on the Cleadon unit there was an odour in the corridor near to the dining room. However the manager ensured the area was cleaned and there after no odours were noted throughout the visit. Work was continuing to box in piping following the central heating system and also work was in progress to replace damaged vanity units in bedrooms. It was unclear whether the units were to be repaired or fully replaced and a plan of ongoing refurbishment was to be provided. One person had been admitted to hospital on the previous Saturday and although the bedroom door was locked, it was disappointing to see that the bed remained unmade and stale fruit and chocolate had not been removed from the room. Bedrooms which were being used as storage areas were kept locked. The bathroom opposite room 25 on the Cleadon Unit has a grey plastic three tier unit which contained various items including unnamed toiletries, underwear and assorted named slippers. One bathroom on the Marsden Unit also had a storage unit and toiletries and an empty container were given to the manager for disposal.The tap at the wash handbasin was not working. Storage within the home had improved with the relocation of clean linen from a communal bathroom. Sluices were kept locked and were clean,tidy and had no odours. There was real mix of approach and entries seen in huge supervision file which would benefit from a break down into staff categories.It was acknowledged that attempts had been made to complete supervisions and the current manager knew that this area needed detailed attention to include formal staff mentorship and training support for the supervisors, so that they would know and understand what they were meant to be doing. Current records were a mix of handover information to staff ,such as media and police input and updates, individual disciplinary actions, and training aids such as how to write a care plan or use mobility equipment. It was agreed that evidence was needed to show that staff have been listened to, given a voice to encourage them to open up, contribute and feel part of the improvements at the home. Senior staff from the Company were regularly in the home and were completing
Care Homes for Older People Page 6 of 13 Regulation 26 visits. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 18 18 All grades of staff must complete safeguarding training which links into the Local Authority Procedural Framework. This will ensure people living in the home are protected from harm. 07/05/2010 2 22 23 Review and improve the storage arrangements throughout the home. This will free up resident areas and space and assist staff with prompt and efficient delivery of care. 31/08/2010 3 27 18 Ensure that, at all times, 31/07/2010 suitable and competent nurses are taking charge and providing effective leadership of each unit. This will help to ensure that peoples needs are met and that staff performance is monitored. 4 30 18 Undertake a comprehensive 31/07/2010 review of the training provided to current staff at the home and produce an accurate record of all training provided to individual members of staff. Produce an
Page 8 of 13 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action assessment of training needs for each member of staff to identify the training needed to enable each member of staff to meet service users health and welfare needs. Ensure that as a minimum each member of staff receives training in Understanding Dementia,Managing challenging behaviour,Safeguarding Adults, Mental Capacity Act and Deprivation of Liberties. Ensure that all nurses with responsibility for administering medication are trained to do so. Put in place effective arrangements to ensure that all newly employed and current staff receive structured induction training that as a minimum includes, Moving and Handling training, Fire safety training, Safeguarding adults, Health and safety training and Food Hygiene. Ensure there are sufficient staff employed at the home that are trained in first aid so that there is at all times a minimum of one person on duty who has received first aid training. This is to ensure that the
Care Homes for Older People Page 9 of 13 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action staff receive training appropriate to their work in order to meet the health and welfare needs of the service users accommodated at the home. 5 38 13 Put in place effective 31/07/2010 arrangements to ensure that all staff and contractors are diligent in securing areas which are not suitable for service user access. This will ensure the safety and well being of people who may be confused or vulnerable to injury. Care Homes for Older People Page 10 of 13 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 19 23 Replace the dirty worn carpet 03/09/2010 in the Cleadon Unit nurses station. This is to make sure all areas are clean and easy to be kept clean. 2 24 23 Provide a refurbishment plan 31/08/2010 with timescales to shown when the vanity units in bedrooms will be replaced or repaired. This is to make sure service users have a safe, comfortable environment. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 8 Recommend early removal of out of date information in care plans to aid staff and avoid confusion. Also recommend that information details the frequency of corresponding assessments such as urinary and MUST nutrition scoring. Care Homes for Older People Page 11 of 13 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 2 3 4 15 19 21 Recommend a review of how meals are ordered so that service users can choose food at the point of service. All staff should contribute to the housekeeping standards especially when service users are admitted to hospital. It is recommended that service users personal items be returned to their rooms immediately after bathing or showering. The development of staff supervisions should continue. 5 36 Care Homes for Older People Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 13 of 13 - 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!
