Inspection on 17/06/10 for St Michael`s View

This inspection was carried out on 17th June 2010.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Michael`s View 15/07/10

St Michael`s View 02/06/10

St Michael`s View 13/04/10

St Michael`s View 01/03/10

St Michael`s View 13/07/09

St Michael`s View 23/07/08

St Michael`s View 31/07/07

St Michael`s View 16/06/06

St Michael`s View 15/09/05

St Michael`s View 19/05/05

St Michael`s View 20/01/05

St Michael`s View 28/07/04

St Michael`s View 26/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 04/09/2010.

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 8 0 6 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 2 3 0 4 2 0 1 0 Care Homes for Older People Page 2 of 18 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. The home is decorated and furnished to a good standard, and in keeping with the age, character and style of the building. Care Homes for Older People Page 3 of 18 What we found: We carried out this inspection to primarily check whether the provider had complied with the requirements of two Statutory Requirements Notices (SRNs). The first SRN issued on 6 May 2010 detailed failures to notify deaths of people living at the home,events which had adversely affected the wellbeing and safety of people living at the home and allegations of staff misconduct. The requirements of this SRN had been met and the new management team has been prompt and efficient in notifying the Commission as and when necessary. The second SRN issued on 14 May 2010 detailed failures to make proper provision for the care and treatment of people living at the home and fourteen specific requirements were made within this SRN. In addition we intended to check the providers compliance with five repeat requirements detailed in the inspection report dated 23 April 2010 which recorded the findings of a total of six visits. On 13 May 2010 a warning letter was also issued regarding these five requirements. We were unable to fully assess these matters at this inspection and will review them when we next visit. Before the visit we examined information, responses and action plans from the provider plus 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. Unannounced visits were made by two compliance inspectors on 17 and 18 June 2010 and in total lasted 16 hours. We spent the first visit on the Cleadon dementia care unit and the second day on the Marsden older persons unit. During the visits we spoke with all designations of staff on duty, various members of the senior management team including the acting manager, people at the home and some visitors including staff from the Local Authority and Primary Care Trust. The acting manager provided a detailed overview of the improvements which had been made to care delivery and the way the home was being operated on a daily basis. All of the permanent registered nurses, the registered manager and some carers remain under suspension from duty pending ongoing investigations. Premises: No offensive odours were apparent on either unit which was a significant improvement from previous visits. We visited most bedrooms and communal areas which were adequately clean. However housekeeping and general tidyness was lacking in some areas on Cleadon such as dining room cupboards, bedroom drawers and wardrobes and some en-suites. It appeared that there was a lack of agreement between care and domestic staff as to was responsible for what areas. There was a recurring failure to clear and sort out bedrooms when people were away in hospital with beds left unmade and personal and care items, old drinks and care records Care Homes for Older People Page 4 of 18 left in a state of disarray which could cause distress to a relative if they called to collect something. The major refurbishment work and replacement of the heating system was now complete. New low level pipework in bedrooms was yet to be boxed in and could pose an accident hazard. We were told this boxing in work was scheduled for completion in the near future. A team of decorators were working in some bedrooms on Cleadon and had left a room being used to store their equipment and paint unlocked and unattended despite previous concerns over security and access rooms. There were several minor maintenance issues on Cleadon such as a plug missing from a wash hand basin where a carer told us that wipes had to be used to block the plughole when providing hygiene care. Also some bedroom fixtures and fittings, such as towel rails and perspex wall protectors, were laid on bedroom floors and could pose a trip hazard. We were told that these were awaiting refix after decoration and we saw this work had commenced. There was a large reduction in the number of supplementary heaters in bedrooms with only one seen in an en-suite and the storage of incontinence pads in en-suites was also much reduced. There was still a problem with storage and a linen storage arrangement had been created in one communal bathroom on Cleadon together with clinical waste bins and back trolleys in another bathroom which impacted on the operational and safe use of these areas. Staffing arrangements: Occupancy on Cleadon was twenty two with some more people in hospital. Staffing levels were high with two registered nurses on duty plus regular and agency carers with support from experienced Local Authority care staff. Domestic, activities and administrative staff were also on duty. A falls assessment nurse specialist from the Primary Care Trust (PCT) was at the home advising the staff and reviewing records at each of the inspection visits. She stated that improvements had been made but progress had been hindered by continued shortfalls in record keeping and care plans. Twenty three people were resident on Marsden which was also very well staffed with a total of four dedicated qualified nurses together with four regular and agency carers. Again a senior carer had been identified and staff appeared supportive of each other on this unit. Staff handover arrangements had been amended and care was delivered via a mix of task orientated and team work approaches. Agency staff worked alongside regular carers to ensure supervision and consistency when giving care and approaching people who were mostly confused. A key worker and named nurse system had not yet been implemented. The nurse in charge on Cleadon took no part in the hands on delivery of care and spent their time either writing records in the office or administering medicines. The delegation of care and management of what was happening on the unit was left to a newly Care Homes for Older People Page 5 of 18 promoted senior carer who was efficient and well aware of peoples individual care needs. However this recent change had led to unrest amongst the care team who were not working in harmony with each other which impacted on the overall approach to the residents and atmosphere within the unit. The care staff told us that working conditions had improved and that they felt more involved. However they commented on the lack of help from the nurses and a continuing lack of involvement in care planning and records. Also, an ongoing lack of knowledge about peoples medical conditions and subsequent care needs. Staff knew that care plans were being rewritten and were hopeful that this would lead to an increased awareness and input once this work was complete. Care delivery: The majority of people were up and seated in the communal areas rather than in their beds or alone in their rooms as seen during the April visits. These changes were largely due to the improved provision of specialist chairs and equipment, which had been supported and led by the PCT. People were clearly enjoying being up and involved in the units activities. The SRN requirement to ensure that everyone had access to call bells unless individual risk assessment indicated otherwise had been met. Several people on Cleadon were attending a painting class in the garden, others were enjoying the world cup football. A Wii games console had been purchased and was in use in the main lounge for exercise and games after lunch. The weather was warm and sunny and replacement of the heating system was complete. We found that the SRN requirement to keep people warm and comfortable had been met during this inspection. We saw people, who had previously never left their rooms, who were really enjoying the sunshine in the garden and who were smiling and holding conversations with the staff. We observed that the catering team were now fully involved and informed about peoples individual catering needs and preferences and were seen taking a proactive and positive role in the content and delivery of meals which was an improvement from the April inspection. We found that the SRN requirement to ensure that accurate records of food and drink provision had been met and new, individual food records were in use which assisted staff to fully describe what and how much people had eaten. The care staff made sure that people had access to drinks and snacks in between meals which included smoothies, cake and fruit. The lunchtime meal on Cleadon lacked leadership and supervision on 17 June 2010 despite the presence of both nurses in the dining room. It appeared that too many staff were milling around and observed concerns included the approach to thickening fluids, drinks not served until halfway through the meal, absence of salt even when asked for, inadequate use of aids such as plate guards, failure to replace uneaten meals or offer Care Homes for Older People Page 6 of 18 alternatives and lack of prompts and assistance for people who were struggling with their food and thickened drinks where a spoon was required. Away from the dining room things were better with some excellent one to one support for people in armchairs in the main lounge and people being fed in their bedrooms. Food on both units looked and smelled appetising and was well presented and served. However some people in their bedrooms on both units were left with meals which they could not manage or who had fallen asleep while their food went cold. Others with gammon gave up altogether when they could not cut it. It was apparent that a significant number of people on both units require assistance to eat. We observed the breakfast meal on Marsden on 18 June 2010 which did not finish until 11am. Staff told us they were late because the night staff had not got anyone up. However staff were sensitive to peoples needs and conducted the meal in an unhurried and attentive manner making sure everyone got what they wanted and the assistance they needed. The lunchtime meal was equally well organised and supervised. We found that the lunchtime meal on Cleadon was better organised and a calmer event on 18 June when carers on duty told us they had been told off after the inspector feedback. However the SRN requirement to ensure that staff adequately support and assist individuals identified as needing assistance with their food intake so that they receive a nutritious diet that is suitable to their needs had not been met during the first day of the inspection. Care staff on both units again told us that they remained unaware of peoples medical conditions and some current care needs for example the care of a pressure sore and the suspected cause of a facial bruise. This feedback indicated that the SRN requirement to ensure that all staff are provided with appropriate handover information about the conditions and care needs of residents in their care at the start of each shift, had not been met and posed a potential risk to peoples wellbeing. We met with most of the residents and looked in some detail at the care of five people on Cleadon where we found that most people were receiving an improved standard of care and enjoying a better quality of life. However we found a variance in the level of personal care delivery and pressure sore prevention. When we questioned this we received differing feedback from care staff and senior management as to why this had occurred. We identified through care records, regular observation of staff interactions and discussions with staff on the 17 June 2010 that one highly dependent gentleman, at high risk of pressure sores, had no positional changes, pressure area or continence checks after 8am and before 3.25pm when the inspectors had to prompt care delivery. This persons personal hygiene record indicated that he had only received one shower so far in June 2010. This was confirmed by a carer who added that staff could experience Care Homes for Older People Page 7 of 18 difficulties with this persons resistive behaviour. In order to further assess this persons care delivery we referred to care plans and identified confusion over the location of short term care plans which were being held with the medication records. Also a wound care plan for a pressure sore had last been evaluated on 20 May 2010. We were told this problem was now resolved and staff did not know why this plan was still in place. We saw that the care plan of a lady, who was doubly incontinent, stated that she preferred two showers per week. However, hygiene records indicated that, apart from one day, full body washes had been given so far in June and that she had received only two showers in seventeen days. Staff on both units told us that the washing of people in their rooms was done with the use of cloths with water from the wash hand basins, which in many cases were situated in en-suites. They told us that individual washing bowls, which could be taken to people for them to wash themselves or dips their hands into etc were not available for use. The acting manager told us that new wash bowls had been purchased and could not understand why the staff did not know this. Two ladies on Cleadon, who refused all attempts at personal care and who refused their meals posed significant challenges to the staff. One was extremely vocal and her incessant shouting did upset other residents. The care staff remained patient and coped with these challenges despite the fact that they received minimal support or guidance from the registered nurses. A gentleman who had previously spent all his time in his room was now able to spend time in the main lounge and we saw that he looked well and was clean shaven and smartly dressed. A carer told us that the gentleman was much better and now chatted and laughed with the staff. We examined the care delivery for six people on Marsden and found that most were receiving a better standard of care delivery. Once again peoples mood and interactions with staff and each other was notably improved. One lady who had never been out of her room was now using a specialist chair and a revised feeding regime which meant she could get up during the day and go out into the garden and communal areas. Care staff were relaxed although some told us they felt under pressure with workload and again lacked support and hands on input from the nurses. One told us we have been playing catch up, only one nurse has helped us and the other only helped because she was told to. Nurses do not help with personal care. An agency nurse who had worked regularly at the home told us that she had seen improvements in care however some basic care delivery was missing and that the nurses did not assist the carers. She wondered how the nurses were able to rewrite and complete peoples care plans when they had not been involved in actual care delivery. We found a variance in the level of personal care delivery and pressure sore prevention on Marsden where we received differing feedback from care staff and senior management as to why this had occurred. We met with a highly dependent lady whose care we had examined In April 2010. We made reference to her care plans and care records and discussed our observations with Care Homes for Older People Page 8 of 18 the care and nursing staff involved with delivering her care. New and well presented mental capacity and manual handling risk assessments were in place although old and out of use information had not been removed from the care file. We identified concerns and confusion over this ladys pressure area care and wound management, the delivery of personal hygiene care, the accuracy of records, bowel care and the use of bed rail equipment. All of this was aggravated by the fact that old and out of date care plans were still in use. Other concerns involved a lack of clarity and evidence over diabetic management and the continence care and management of a gentleman who had previously had a urinary catheter. It was apparent that these shortfalls were again aggravated by inadequate record keeping which placed people at risk of incorrect care delivery especially when so many agency staff were involved in care provision. These findings indicated that the SRN requirement to make adequate, proper and prompt provision for the general care and treatment of residents had not been met in all cases. We found that some of the varying standards of hygiene and personal care were due to peoples reluctance to cooperate and again staff appeared to be struggling with a lack of support and input from the nurses. Other people were receiving good standards of personal care and their appearance and mood was much improved from the April 2010 inspection visits. However our findings in relation to several people indicated that the SRN requirements to ensure that individuals personal hygiene needs were met and implement any necessary changes to ensure that pressure area care was delivered and ensure that all staff were aware of individual peoples skin conditions with particular regard to pressure damage had not been met in all cases. We found that staff were unsure and records were unclear in relation to the SRN requirement to promote and monitor peoples bowel actions. The fact that inspectors had to prompt changes and alert staff to shortfalls in care delivery was a poor reflection on the leadership and management of daily operations by the nurses and senior staff. However we did find that SRN requirements in relation to the use of oral and nasophayngeal suction and the need to follow the guidance and instruction of multidisciplinary professionals such as dieticiens had been met. Further SRN requirements to take professional advice prior to adding medicines to meals and drinks and to ensure that all staff were aware of peoples individual nutritional needs had also been met. What the care home does well: The home was clean and free of offensive odours. Care Homes for Older People Page 9 of 18 A lot of improvements have been made to the premises which has enhanced the living arrangements for residents and working conditions for the staff. The activities staff provide and coordinate a varied programme of entertainment and recreation which the care staff readily give support to by getting involved. The quality and presentation of meals has remained good. 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 10 of 18 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 7 15 Ensure that all service users 02/07/2010 plans clearly identify how each individual service users health and welfare needs are to be met. Put in place effective arrangements to ensure that all service users care plans are reviewed at least monthly or sooner as dictated by changes in individual service users needs. Put in place effective arrangements to ensure that where appropriate, service user care plans are revised to reflect individual service users changing health and welfare needs after consultation with the service user or a representative of his. This is to make sure that staff plan and review how they work with people so that everyone works in the same way to ensure peoples needs are being met. 2 7 15 The care plans must be up to 26/04/2010 date,detailed,reviewed at least monthly,be person Page 11 of 18 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 centred and reflect how current and changing needs will be met. This is to make sure that staff plan and review peoples care so that people receive a good quality care. 3 8 12 Ensure that staff adequately 24/05/2010 support and assist individual service users identified as needing assistance with their food intake so that service users receive a nutritious diet that is appropriate to their individual needs. This is to make adequate,proper and prompt provision for the care and treatment of service users generally and in accordance with specific requirements. 4 8 13 Ensure that individual service 02/07/2010 user risk assessments are reviewed and updated to reflect their changing health needs. This is to ensure service users are protected from risks of harm. 5 8 12 Make arrangements to 24/05/2010 promote and monitor individual service user bowel actions and take prompt remedial action where problems are identified. Ensure that all staff are provided with appropriate Care Homes for Older People Page 12 of 18 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 handover information about the conditions and care needs of service users in their care at the start of each shift. Ensure that the personal hygiene needs of individual service users are met. Undertake a review of the pressure area care provided to each individual service user and implement any necessary changes in order to ensure that pressure area care is provided to all service users according to their individual needs paying particular attention to those service users who remain in bed. This review should involve consultation with each service user and their representative. Put in place effective arrangements to ensure all staff are made aware of individual service users skin conditions having particular regard to pressure damage. This is to make adequate, proper and prompt provision for the care and treatment of service users generally and in accordance with specific requirements. Care Homes for Older People Page 13 of 18 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 6 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 7 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 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 Care Homes for Older People Page 14 of 18 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 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 staff receive training appropriate to their work in order to meet the health and welfare needs of the service users accommodated at the home. 8 36 18 Ensure that the staff receive formal and appropriate supervision. This will ensure that staff are appropriately supervised and supported in their work. 31/07/2010 Care Homes for Older People Page 15 of 18 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 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 2 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. 3 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 16 of 18 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 19 All staff should contribute to the overall tidyness and housekeeping standards at the home with additional attention to unoccupied bedrooms. General maintenance issues should be promptly identified and addressed 2 19 Care Homes for Older People Page 17 of 18 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 18 of 18 - 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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