Inspection on 10/04/08 for St Michaels Nursing Home

This inspection was carried out on 10th April 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 Michaels Nursing Home 07/10/08

St Michaels Nursing Home 10/10/07

St Michaels Nursing Home 31/05/07

St Michaels Nursing Home 19/02/07

St Michaels Nursing Home 11/05/06

St Michaels Nursing Home 28/11/05

St Michaels Nursing Home 18/05/05

St Michaels Nursing Home 08/02/05

St Michaels Nursing Home 05/05/04

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

CARE HOMES FOR OLDER PEOPLE St Michaels Nursing Home Elm Grove Westgate-on-Sea Kent CT8 8LH Lead Inspector Sandra Crosby Unannounced Inspection 10:00 10th April 2008 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 Michaels Nursing Home DS0000050429.V361184.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 Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Michaels Nursing Home Address Elm Grove Westgate-on-Sea Kent CT8 8LH 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) 01843 835709 01843 832905 rakeshsankran@yahoo.com Charing Lodge Ltd Vacant post Care Home 73 Category(ies) of Dementia - over 65 years of age (0) registration, with number of places St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Dementia DE(E) The maximum number of service users to be accommodated is 73. Date of last inspection 10th October 2007 Brief Description of the Service: St Michaels Nursing Home is a large attractive three storey detached home with small garden areas. It is situated close to the sea and is a short journey to the local amenities. The home is registered for the provision of nursing care for people with Dementia, and has recently added a new extension to provide dementia residential care for 32 service users. Although the Home is registered for 45 nursing dementia care service users, it currently does not use all of these places. The Home employs a Manager and a team of Registered Nurses and care staff for the nursing unit and a manager and care staff for the residential dementia care unit. There are waking night staff employed for each unit. There is a shaft lift to access all floors and a call bell system; equipment is also available to ensure that service users can be moved safely. The new extension provides a shaft lift giving access to the first floor, and corridors are wide enough to cope with wheelchair users. Bathrooms in the new extension are supplied with lifting equipment, to ensure that service users can be bathed safely. The managers confirmed that the current range of fees at the home is from £396.84 - £580.00, per week. St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that people who use this service experience poor, quality outcomes. This report contains the findings of the home’s key inspection and takes account of information obtained from various sources since the last inspection of 10 April 2008, including a visit to the home. An unannounced visit took place firstly on the 10 April 2008 between 10:00 hours and 16.00 hours, and then on the 11 April 2008 between 10.00 and 16.00. The visit included talking to the group manager, the manager and deptuty of the nursing unit, the manager of the residential unit, staff on duty, two relatives and residents. An accompanied tour of some areas of the home was made, and various records were seen. The registered manager resigned at the beginning of the year and has been subsequently been managed by the deputy manager. The group manager said that this person would be applying to become the registered manager in due course. A new deputy manager has recently been appointed to assist the manager of the nursing unit. Following the inspection dated 10 October 2008 when the quality rating for the service was judged as poor, the home was required to complete and return to the Commission an improvement plan for the service. It was found at this inspection visit that of the thirteen requirements and one recommendation made, three requirements remain outstanding. However, a further nine requirements were made at this visit. The nursing managers had completed and returned the Annual Quality Assurance Assessment (AQAA) documentation. The information provided was not comprehensive and not all areas were completed to a satisfactory standard. The findings of this inspection indicate that this home is endeavouring to improve standards and provide good outcomes for the residents, but there are some areas in relation to health and personal care, dignity and privacy, staffing levels and staff training, health and safety and some management aspects that need improvement. The group manager and managers of the home are aware of what changes need to be made and are committed to making these improvements. St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 6 The findings of the inspection visit were discussed in a verbal feedback with the group manager, the two managers and deputy manager at the end of the visit clearly indicating areas where improvement were needed. A letter received at the Commission office on the 28 May 2008 from the Group Manager included an action plan to address all the issues of concern raised in this inspection report together with assurance that all issues raised will be addressed. What the service does well: What has improved since the last inspection? Staff training is ongoing and staff are working towards NVQ qualifications. Regular relative and staff meetings have been undertaken with written records maintained on the residential unit. Re-decoration and renewal of furnishings on the nursing unit is ongoing. The laundry area has been enlarged and new washing machines and a tumble dryer have been installed. St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 7 What they could do better: Care plans must be kept up to date in relation to reviews reflecting residents changing needs. Keep a comprehensive record of incidence of pressure sores and of treatment provided to the resident. Ensure that staff follows policies and procedures in relation to the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Staff must ensure that they abide by the privacy and dignity policy and procedures. Ensure sufficient staffing levels at all times to meet the needs of service users. 50 of the care staff must achieve NVQ level 2 in care, to ensure they can meet the needs of residents. Management must ensure that a thorough recruitment procedure is followed and that the required references are obtained. Management must ensure that all staff receives induction training. Management must make suitable arrangements for maintaining satisfactory standards of hygiene in the care home. Management and staff must ensure that all parts of the home to which residents have access so far as reasonably practicable are free from hazards to their safety. Staff must be trained in appropriate moving and handling techniques to ensure resident safety. Management to ensure by means of fire drills and practices at suitable intervals, that the persons working at the care home are aware of the procedures to be followed in care of fire. Seek advice from the fire safety officer in relation to a safe means of holding bedroom doors open. Please contact the provider for advice of actions taken in response to this St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 8 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 Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 9 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 Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 10 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): Standard 3 and 6 were inspected at this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with the information they need to make a decision about moving into the home. Pre-admission assessments ensure that the home can meet resident’s needs. EVIDENCE: It was evidenced at the last inspection visit dated 10th October 2007 that the Statement of Purpose and Service User Guide were satisfactory in providing a clear description of the services offered. St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 11 Two of the care plans viewed for residents in the nursing unit showed that a pre-assessment had been completed together with relevant assessment information being received from care management. There was sufficient information within these assessments on which to base a care plan. The home does not offer intermediate care. St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 12 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 were inspected at this visit. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents would benefit if the home recorded fully how staff supported individuals with regard to their assessed and changing needs and personal goals. The administration of medication needs to be improved upon to ensure that medication is administered safely to the residents. The residents’ privacy and dignity must be respected. EVIDENCE: Information gathered at the last inspection visit stated that care plans are initially drawn up from the pre-admission assessments gained prior to the residents moving into the home and further information is added during the first few weeks of the residents stay. Three care plans were viewed for the nursing unit and overall contained the components as required by regulation. St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 13 Following a requirement made at the last inspection visit, it was seen that a personal hygiene checklist format had been added to the care planning documentation. It was discussed that staff are not signing this documentation and are only putting ticks in boxes. There was also no reference on this documentation to the skin integrity of the resident. The nursing manager agreed to address this issue. It was seen that care plans are reviewed monthly, however it was observed that on many occasions the review stated ‘remains the same’. Whereas other information in the care plan indicated that changes had taken place, for example one resident where it was indicated there were ongoing changes in relation to the condition of pressure areas, these changes were not reflected in the reviews. Wound care documentation was seen for three residents. It was discussed that the documentation was not clear, the different components of the wound care planning indicated conflicting information for example one body map seen showed two broken areas on the sacrum. This was discussed with the nursing manager who said that these areas were now healed. When looking through the changes of dressing records, at the top of the page it referred to the two separate areas as one and two, then further down the reports indicated that they were combined and one record stated ‘healed wound’. However, over the last two weeks it was indicated that the area had broken down again with the last entry stating ‘sore is getting worse’. There was no indication about what action was to be taken following this comment. Another wound care plan stated ‘clean with tap water’ this was discussed and the nursing manager said that this was not currently the practice and that the wound was being cleaned with normal saline. The wound care plan documentation had not been amended to reflect this change. Care plans have weight charts, and nutritional screening is undertaken on a monthly basis. It was however observed that for one resident where it showed a continued weight loss in the region of ten kilos from October 2007 to March 2008, the GP record showed that this issue was not discussed with the GP until the 26 February 2008. There was evidence on all care plans viewed, and from discussion with some residents and visitors to the home that residents have access to all specialist care from opticians, chiropodists, dentists, hospitals and community health services mainly as and when required. Previous requirements have been made in relation to Standard 7 – 30/07/04, 31/07/05, 31/03/06, 11/05/06, 28/02/07, 31/05/07, 10/10/07 and not met. The medication records were seen for the Nursing Unit. Gaps in recording were seen, and it was difficult to ascertain if the medication had been St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 14 administered and not signed or not given. The medication storage cupboards in the medication room were not locked and the medication fridge was not locked. Re-sheathed needles were seen in the sharps box. On the residential unit a carer administering the lunchtime medications left the medication trolley open and unattended by the dining area. It was seen that instructions for a controlled drug medication were not strictly followed when practice was observed. The nursing managers both agreed to address these issues. The inspector was told that currently only one resident is receiving medication that is covertly administered, and instructions from the pharmacist were seen in relation to this. The home has a contract with a licensed waste disposal company for the collection of unwanted medicines from both the nursing and residential units. The returns documentation was seen for the nursing unit, and it was discussed with the nursing manager that this information needed to be comprehensively recorded as it was seen that for a small number of the returned medicines that no quantity had been entered. The lists seen are currently written on blank paper and a proper formatted form for the return of medications may assist the staff to record all necessary information. In relation to treating residents with dignity, it was observed that a trolley set up in the Dining Room of the nursing unit was noticeably very dirty, the plastic feeder mugs were badly stained, and the two sugar and coffee containers seen were dirty on the outside, and the coffee was seen to be congealed at the bottom of the coffee contained. The group manager, who was present at this time, requested that this issue be addressed immediately. During the accompanied tour of some areas of the home it was seen that one resident had been left a feeder mug of tea and biscuit. These had been left out of reach of the resident, and there was no member of staff present at the time to provide assistance. Also during the accompanied tour of some areas of the home it was seen that one resident in a lounge area was not appropriately supported by pillows/cushions in order for them to be seated comfortably. A resident was also seen in their bed that needed support from pillows/cushions in order that their face was not against the bed rails. The nursing manager did provide support for this person when it had been pointed out. Residents in both units are able to have visitors both personal and professional in the privacy of their own bedrooms. Care plans clearly state the residents preferred term of address. The inspector spoke with two members of staff on St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 15 the residential unit and they were aware of the homes privacy and dignity policy and procedures. St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 16 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): Standards 12,13,14 and 15 were inspected at this visit. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can mainly be confident they will have satisfactory opportunities regarding lifestyle choices however, staffing levels at times may restrict choices. EVIDENCE: The AQAA documentation states that there are three activity co-ordinators for the two units and residents have individual diaries recording activities undertaken. The inspector was able to speak with one of the activity coordinators who was providing activities on the first day of the visit. A game of soft skittles was being played and the interaction observed between this member of staff and the residents in the lounge was good. There was a birthday party that afternoon that included a singalong. Other activities undertaken include for example catchball, big dominoes, use of a light stimulation machine, memory games, quizzes and planting in the garden weather permitting. St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 17 In most cases activities are arranged around the wishes of the residents, rather than adhering to a strict rota. It was nice to see that residents are given the opportunity for meaningful interaction on a one to one basis. Links with the community are good and this helps to enrich the residents’ social lives. Some residents are able to go out with their families at weekends. One resident told the inspector that she always enjoys the musical entertainment that is brought into the home. This resident also stated that she has relatives and friends who visit her and she is never lonely. Relatives said that atmosphere is good in the residential unit. The unit also has outside entertainers at which times relatives and friends are invited to join in. Links with the local community are good for the residents, with different religious denominations visiting the home. Relatives take their residents out into the community. The home has a visiting policy, and visitors are welcome at any time. It was stated in the last inspection report that where it is possible residents are encouraged to make decisions in regard to their daily lives and financial affairs. Due to the level of dementia all of the relatives have power of attorney for the residents financial affairs. If requested residents can have access to their own care plan or can request that their relatives are given access. Many of the rooms viewed throughout the home showed that residents are given the opportunity to bring personal possessions into the home with them. Menus were seen to offer residents a variety of varied and nutritious food. Residents are offered three full meals per day. Soft diets are also catered for. It was seen that the cook now has a heated trolley for keeping food hot. In the nursing unit of the home approximately 15 residents eat in the dining room, and all other residents have their meals in their bedroom, the residents in dining room have their meals first, and then bedroom meals going out one by one, with staff assisting those residents in their bedrooms to eat. This practice was not observed at this inspection visit. The inspector observed the lunchtime meal on the second day of the inspection visit on the residential unit. It was seen that the position of the table and St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 18 chairs made it difficult for staff to work with ease in this area. The procedure of going through the double doors of the unit down the short corridor and having to use a key pad to gain entry into the kitchen to come back with a tray carrying two meals showed that the delivery of the meals to residents took a long time, and on a number of occasions there were no staff in the dining room area. It was also seen that some care staff did not speak and provide assistance to residents at the resident’s level and overall there was little interaction about the meal. A carer came into the dining room and proceeded to offer orange squash to all residents. There was no offer of a choice of drinks. These issues were discussed with the manager of the unit. Staff spoken with when working long days were able to have meals at the home and they commented that the food was good. Two relatives spoken with confirmed that the food at the home was good. St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 19 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 were inspected at this visit. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and visitors know their complaints will be listened to and acted upon. Some staff have good knowledge and understanding of adult protection issues, which protects the residents from abuse. EVIDENCE: It was reported at the last inspection visit that the complaints policy and procedure had been reviewed. Action has now been taken to provide a copy of the complaints procedure in the reception area of the home. This was seen on the first day of the inspection visit, it was seen to be in a normal print size and information in relation to telephone numbers was incorrect. Action was taken by management to address this issue and a further complaints notice was seen on the second day of the inspection visit. The information had been amended, however the print text size remained the same and may provide difficult for a person with sight impairment to read. St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 20 The AQAA information completed by the nursing managers, states that there have been 22 complaints made in the last twelve months, and that 100 percent of complaints have been resolved within 28 days. Information was not completed in relation to how many of these complaints were upheld. It was reported that there has been one safe guarding adults investigation during the last twelve months. The staff-training matrix for both units and conversation with members of staff, indicates that the majority of staff have now undertaken POVA training. Action needs to be taken to ensure that all staff undertakes this training. The last inspection report stated that where restraint is used this is appropriately risk assessed and permissions are sought and available on the relevant residents care plans. The home has up to date policies and procedures in relation to staff receiving gifts from the residents. St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 21 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 were inspected at this visit. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a mainly clean and comfortable home but cannot be sure that the environment is safe. EVIDENCE: The home is suitable for its stated purpose; it has recently been extended to provide a residential dementia care unit for 32 residents in a care home setting. The original building provides nursing care for 41 residents with dementia. In the nursing unit, the communal areas on the ground floor have been refurbished, and work is ongoing in relation to redecoration and refurbishment of bedrooms in this unit. It was seen that hallway and stairs carpets have been renewed. St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 22 During the accompanied tour of some areas of the home it was seen on the nursing unit that potential hazards to health and safety had been left around the building for example and area where a TV, a lamp, several pictures and other articles had been left in a corridor, laundry bags containing soiled laundry were seen on the floor in corridors, and a call bell wire was seen trailing across a bedroom floor. It was also noticed that two windows had broken sash cords one of which was in a communal area and held open with a CD case that when removed the window quickly fell shut. It was observed on the nursing unit in the ground floor sluice room, that a urinal and a roll of yellow bags were seen situated in the sink, and indicated that staff were not using the sink for the purpose of washing their hands before leaving this area thereby not following infection control procedures that may compromise residents and staff safety. In the sluice room on the first floor the one and only mechanical sluice machine was not working and the manager said that it had not been working for sometime. The group manager Janet Rayfield who was then informed took action and arranged for a contractor to come to the home the following Monday to address this issue. On the residential unit it was observed that some of the bedside lamps that are touched to put the light on were not working. It was also seen that the bathroom and toilet doors did not have appropriate locks thereby comprising the dignity of residents. Management should review the number of hours currently worked by the maintenance man at the home, in order to ensure a safe environment for residents and staff. The home does not use CCTV cameras. The laundry room, which serves both units in the home, has been extended, and two new washing machines and one new tumble dryer are in place. The industrial washing machine has a sluicing and disinfecting facility and red alginate bags are used for soiled linen. It was discussed that the current layout of the room means that clean laundry has to be taken through the dirty laundry area and is not good practice in relation to infection control. The group manager said that action would be taken to address this issue. It was also seen that a latex glove had been put over the smoke detector in the laundry area, the nursing manager said that this would be removed when it was pointed out to him. Staff in both units, are provided with protective clothing in the form of plastic aprons and disposable gloves for use when dealing with personal hygiene tasks and bodily fluids. On two occasions it was seen that a member of staff was St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 23 walking down the corridor with still wearing gloves and an apron. Management need to ensure that staff are aware of best practice when using protective clothing, in order that residents and staff are not put at risk of infection. The home has a contract with a clinical waste disposal company, and clinical waste within the home is managed appropriately. St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 24 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 were inspected at this visit. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. An effective staff team, in sufficient numbers to meet their needs, may not always be available to support residents. Staff training needs to be further developed to ensure that all care staff have the skills and knowledge to meet the needs of the residents. The managers must ensure that all staff employed are properly vetted to protect the residents. EVIDENCE: At the present time the nursing unit is not full, when more rooms are occupied the Registered Providers must ensure that the staffing levels are reviewed to meet the needs of the residents. The staff rota for the nursing unit was seen and indicated that there may not always be sufficient staff on duty to meet the needs of residents. The staff rota indicates that there are five carers to work the am shift. There were five care staff on the rota to work the am shift on the first day of the inspection visit. However, one of these carers should have been a supernumerary member of staff as they had only just started employment at the home. St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 25 On the second day of the inspection visit the staff rota was seen for the residential unit. The staff rota indicates that there are five carers working the am shift. It was indicated that on Saturday 05 April 2008 there were three care staff on the long day shift for thirty-one residents. The residential manager checked the signing in sheet and this also indicated that there was three care staff on duty on that day. When talking with one of the carers later in the day they confirmed that they had worked the long day on this Saturday and that there were in total three care staff on duty for the am and pm shifts. It was reported in the last inspection report that the nursing home also employs adaptation nurses, who work supervised and supernumerary to other RGN’s employed in the home. It was indicated on the staff-training matrix that of the 31 carers currently employed six have obtained NVQ Level 2 or above. Both managers, nursing and residential, said that carers were currently undertaking NVQ Level 2. Previous requirements have been made in relation to Standard 28 - 28/11/06, 30/09/06, 31/05/07, 10/10/07 and not met. The inspector looked at three staff files on the residential unit and four staff files on the nursing unit. Although it was seen that components required by regulation were in place gaps were seen for example contract signed and not dated, application form signed and not dated, no references, no photo and no induction documentation. CRB and POVA checks are undertaken. The AQAA documentation completed by the managers did not provide any information in relation to recruitment practice. Previous requirements have been made in relation to Standard 29 - and not met It was stated in the last inspection report that Charing Healthcare have employed a company to provide mandatory training to all staff. This company has set up a rota of mandatory training, which will be repeated at the home over several periods in the year. The staff-training matrix indicates that staff still require training in for example First Aid, Infection Control, Adult Protection, Fire training, Moving and Handling and Dementia training. There were training dates on the notice board for dementia training, and a copy of planned training over the coming months was provided to show that training is ongoing at the home. The last inspection report stated that all staff undertake an introductory induction, and the induction booklets were available for inspection at that time. St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 26 Once they have completed this induction they start on a Skills for Care Induction Pack. The completed AQAA documentation states that ‘induction training in place’. At the time of this visit the newly appointed deputy manager stated that she had not undertaken any induction training. The group manager said that this issue would be addressed. Whilst observing the serving of the lunchtime meal on the residential unit and moving and handling transfer was seen undertaken by staff that was inappropriately carried out. The dining chair was placed incorrectly for the transfer and the brakes were not put on the wheelchair before the transfer took place. This issue was discussed with the manager of the residential unit in relation to staff training. St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 27 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 were inspected at this visit. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents cannot always be confident that their home is well run. Health and safety issues are not always attended to and do not ensure the residents and staff live and work in a safe environment. EVIDENCE: St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 28 The registered manager of the nursing unit resigned, and the then deputy manager took over as manager, he is a qualified nurse. The group manager said that this person would be applying to become the registered manager. A new deputy manager for the nursing unit has recently taken up post and both the manager and deputy manager have worked very hard to address the issues raised in the last inspection report. It was reported in the last inspection report that the manager of the residential unit has several years experience at management level, she has NVQ level 4, and BETEC national diploma in care with distinction, at the present time she is in the process of completing her registered managers award. Evidence gathered from this and previous inspections can conclude that the management of this service were re-active to developing issues rather than pro-actively. The monthly Regulation 26 notices were requested and copies were later provided for October 2007, November 2007 and January 2008. The group manager said that she had undertaken the visits for February 2008 and March 2008 but was unable to provide this information as she said that they were not yet in a format available for inspection. These reports may have provided evidence that the service had identified those areas highlighted in this report and enabled them to produce an action plan on how they were proposing to tackle those difficulties to improve outcomes for the residents of the home. The manager of the nursing unit when asked said that he had not received regular supervision with written records maintained from the group manager. The group manager said that this was to be started. The manager of the residential unit confirmed that she had received supervision two monthly. The group manager said that the quality assurance system in the home is still being improved. She said that questionnaires had been developed for external stakeholders and that currently these were in the process of being sent out. The Registered Providers need to develop a good quality recorded monitoring system to ensure that, care plans, medication, cleaning, food delivery, hygiene standards, policies and procedures and training competency are monitored on a regular monthly basis. Some evidence was seen to show that these audits were starting to be put into place. The manager of the residential unit has started to have regular relative meetings and staff meetings with written records maintained. These were St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 29 informative and the group manager asked that the nursing unit manager set up a similar system for the nursing unit. It was reported at the last inspection visit that where service users personal allowances are handled by the home they were well managed with clear accounts being used for each service user and receipts kept for all expenditure. Each resident has their own account sheet, where monies coming in and going out are recorded; all receipts are kept of expenditure. Monies are kept in individual envelopes and retained in a place of safekeeping. These records were not seen at this visit. The inspector viewed maintenance certificates for the equipment used in the home at the last inspection visit and found them all to be in date. The AQAA documentation completed by the managers, states that equipment has been checked but no dates were provided. The fire logbook was seen and on the whole it was evidenced that the necessary weekly and monthly checks are undertaken and records maintained. However it was discussed that there was no record of a practice fire drill having been undertaken in the home for the last fourteen months. The manager of the nursing unit was unable to say when the last fire practice drill was undertaken. Since the inspection visit the manager of the nursing unit has sent a letter to the Commission stating that documentation that was misfiled provides evidence that a fire drill practice was undertaken on the 17 July 2007, and in the letter he stated that a fire practice drill was undertaken on the 15 April 2008. The Registered Providers are advised to seek advice from fire officer in relation to a safe way of holding doors open as it was seen that a chair was propping the bedroom door open for one resident. All windows are fitted with window restrictors, however it was seen that on two windows the sash cords were broken and this requires immediate attention. The premises are secure and all external doors are number locked or connected to call system. The broken tiles on the front entrance steps seen at the time of the last inspection visit have been replaced/repaired. St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 30 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 1 St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 31 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 OP7 Regulation 15(1)(b) 17(1)(a) Sch 3(n) Timescale for action The registered person shall 28/05/08 ensure that the assessment of the service user’s needs is (a) kept under review A record of incidence of pressure sores and of treatment provided to the service user 2. OP8 12(1)(a) The registered person shall 28/05/08 ensure that the care home is conducted so as (a) to promote and make proper provision for the health and welfare of service users Ensure that professional advice is appropriately sought when a continued weight loss is recorded 3. OP9 13(2) The registered person shall make 28/05/08 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home Ensure that MARS sheets are appropriately signed when medication is administered St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 32 Requirement Ensure that medicines to be disposed of are appropriately recorded 4. OP10 12(4)(a) The registered person shall make 28/05/08 suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users The registered person shall 28/05/08 having regard to the number and needs of the service users ensure that equipment provided at the care home for use of service users or persons who work at the care home is maintained in good working order after consultation with the environmental health authority, make suitable arrangements for maintaining satisfactory standards of hygiene in the care home; 6. OP27 18(1)(a) The registered person shall 28/05/08 having regard to the size of the care home, the statement of purpose and the number and needs of service users (a) ensure that at all times suitably qualified, competent and experienced persons working at the care home in such numbers as are appropriate for the health and welfare of service users The registered person shall 31/12/08 having regard to the size of the care home, the statement of purpose and the number and needs of service users (a) ensure that at all times suitably qualified, competent and experienced persons working at DS0000050429.V361184.R01.S.doc Version 5.2 Page 33 5. OP26 23(2)(c) 16(2)(j) 7. OP28 18(1)(a) St Michaels Nursing Home the care home in such numbers as are appropriate for the health and welfare of service users Staff to receive training in Fire Safety, Moving and Handling, Health and Safety, Infection Control 8. OP29 19(1)(b) Sch 2(3) The registered person shall not 28/05/08 employ a person to work at the care home unless (3) Two written references including, where applicable a reference relating to the persons last period of employment which involved work with children or vulnerable adults of not less than three months duration The registered person shall 28/05/08 having regard to the size of the care home, the statement of purpose and the number and needs of service users (c) ensure that the persons employed by the registered person to work at the care home receive (i) training appropriate to the work they are to perform including structured induction training The registered person shall 28/05/08 ensure that (a) all parts of the home to which service users have access so far as reasonably practicable free from hazards to their safety The registered person shall 28/05/08 ensure that the care home is conducted so as (a) to promote and make proper provision for the health and welfare of service users Appropriate moving and handling techniques only to be used St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 34 9. OP30 18(1)(c) (i) 10. OP38 13(4)(a) 11. OP38 12(1)(a) 12. OP38 23(4)(e) 17(2) Sch 4(14) (14) A record of every fire 28/05/08 practice, drill or test of fire equipment (including fire alarm equipment) conducted in the care home and of any action taken to remedy defects in the fire equipment (e) to ensure by means of fire drills and practices at suitable intervals, that the persons working at the care home and so far as practicable service users are aware of the procedures to be followed in care of fire, including the procedure for saving life RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Maidstone 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 Michaels Nursing Home DS0000050429.V361184.R01.S.doc Version 5.2 Page 36 - 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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