Inspection on 10/10/07 for St Michaels Nursing Home

This inspection was carried out on 10th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Michaels Nursing Home 07/10/08

St Michaels Nursing Home 10/04/08

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 June Davies Unannounced Inspection 10th October 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Michaels Nursing Home DS0000050429.V346822.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.V346822.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 Charing Lodge Ltd Julie Elizabeth Watson Care Home 73 Category(ies) of Dementia - over 65 years of age (0) registration, with number of places St Michaels Nursing Home DS0000050429.V346822.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 31st May 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 scale of charges at the home are £386.98 - £580.00, per week for nursing care and £377.77 - £500.00 for Residential Care Dementia. St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over a period of 8.55 hours. The inspector spoke with residents, visitors, staff and the managers of both units in the home. The pharmacy inspector was present in the afternoon to carry out an audit of medication in both units. An observational tool was used for the period of one hour, both in the a communal lounge and in the dining room over the lunch time period. The inspector also looked at all relevant documentation to the standards inspected and carried out an environmental inspection of both units. What the service does well: What has improved since the last inspection? The statement of purpose and service user guide now give clear information in relation to the home and what services it offers to prospective residents. Pre-admission assessments are clearer and there are no discrepancies between the pre-admission assessments and the plans of care. St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 6 Some of the medication procedures within the home have improved. The grounds around the dementia care unit, have been made safe and secure for the residents. Domestic staff are now employed in sufficient numbers to ensure that on the whole the home is kept clean and tidy. Most of the staff in the home have either completed all their health and safety mandatory training and there is evidence within the home that all staff should have completed this training by the end of the year. Staff spoken to confirmed that they had completed their mandatory training in Health and Safety issues. What they could do better: Care plans must be kept up to date in relation to the personal hygiene care, wound care treatment and progress and fluid charts. Where covert administration of medication is given, permissions must be recorded and advice sought from the pharmacist to ensure that the crushing of tablets does not in any impede the outcome of medication given in this manner. Where covert administration is used, the home must ensure that it does comply with the Mental Capacity Act 2005. Where medication is not used it must be placed into appropriate receptacles provided by a licensed waste disposal company, and this applies both to the nursing and dementia care units. Staff must ensure that they abide by the privacy and dignity policy and procedures, and ensure that they knock before entering resident’s bedrooms, and staff must ensure that residents are able to have visits from the General Practitioners in privacy. More staff training is required in the appropriate way to assist residents with feeding. Those residents who are able to feed themselves must be supplied with the correct aids so that they can remain independent when feeding. For those residents who prefer finger foods, this should be presented in an appetising manner and offer a variety. The complaints policy and procedure needs to be clearly made available in the home, to ensure that residents and visitors know what steps can be taken when making a complaint. The nursing unit in the home must be kept in a good state of repair, regarding redecoration, renewal and keeping small maintenance tasks up to date. None of the rooms in the home should have an offensive odour. St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 7 More care staff need to undertake NVQ training to ensure they can meet the basic care needs of the residents. Some staff still need to complete meaningful dementia care training to enable them to meet the needs of the residents in the home. The managers of the home still need to develop a robust quality assurance system to ensure that all residents receive a good standard of care in all aspects of their lives. None of the rooms in the home should be used for storage, as this can prove and health and safety and fire hazard in the home. All bedroom doors should be fitted with magnetic closure to ensure they shut properly when the fire alarm is activated, and to ensure that residents remaining in their bedrooms are safe. Repair work needs to be carried out to the front entrance step at the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 8 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.V346822.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 6 Quality in this outcome area is good. Both units of the home have an informative statement of purpose and service user guide. They provide residents and prospective residents with the information they need to make a decision about moving into the home. Pre-admissions assessments in the nursing unit contain sufficient information to show that the home can meet the needs of its nursing residents, in the dementia care unit, the pre-admission assessments need to be more comprehensive to ensure this unit can meet the prospective residents needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the nursing unit, the statement of purpose and service user guide has been updated and now gives a clear description of the services offered. St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 10 In the dementia residential care unit there is a new statement of purpose and service user guide giving a clear description of the services that the home can offer to prospective residents. Two care plans viewed for residents in the nursing unit showed that both care plans have comprehensive pre-admission assessments carried out by the Registered Manager and by Kent County Council Care Managers. There was sufficient information within these assessments on which to base a care plan. For the residential dementia care unit, the pre-admission assessments did not have sufficient information on which to base a care plan. Through discussion with the manager in this unit, it was found that while the manager gains a lot of information through pre-admission assessment this is not always recorded, she will in future ensure that future pre-admission assessments contain comprehensive information pertaining to the physical, personal and social care needs of the prospective service users. The manager of this unit does ensure that she obtains local authority pre-admission assessments from care manager prior to the prospective resident moving into the home. The home does not offer intermediate care. St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is poor. Care planning needs to improve to ensure that all the health care and personal needs of the residents are being met. 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 at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans are initially drawn up from the pre-admission assessments gained prior to the residents moving into the home further information is added during the first few weeks of the residents stay. Two care plans viewed for the St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 12 nursing unit followed a short observational inspection, which took place in one of the communal lounges and the dining room. These care plans had been signed by the resident’s relatives/representatives. It was noted however that personal hygiene care is not recorded in detail in either of the two care plans viewed. Risk assessments were in place and care plans are reviewed on a monthly basis. While it was observed that one resident had a dressing applied there was no evidence within the care plan of wound care charts, further investigation showed that wound care charts are not kept in detail in any of the care plans, personal hygiene is described as ‘all care given’ which is not helpful or adequate. This was also true of fluid intake charts, for those residents who need to have their fluid intake recorded. Care plans in the dementia care wing, were informative and well written but again personal hygiene tasks were not recorded in detail. Those residents in the nursing unit that are susceptible to pressure areas occurring are provided with pressure relieving mattresses and cushions. There was evidence from both units that any concerns regarding the psychological health of residents are referred via the doctor to the psychiatric consultant and/or the community psychiatric nurse. The home employs two part-time activities co-ordinators. One of these coordinators does do gently armchair exercises with the residents. All care plans in both units have weight charts, and nutritional screening is undertaken on a monthly basis. 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 as and when required. The pharmacy inspector carried out an audit of medication in both units of the home and found medication was stored securely and at the correct temperature. Staff had accurately recorded receipt and administration of medicines. An exception to this was staff giving a laxative, prescribed to be taken as directed, without recording the dose given. The quantities of controlled drugs corresponded to the recorded balances in the controlled drugs register. At night controlled drugs are given by a trained nurse and witnessed by a carer. A letter signed by a GP in 2005 authorising crushing of tablets, for any patients of this surgery was with the medication records. More recently similar letters had been signed by the GP for individuals. There was evidence that one relative had also given consent two years ago. There was no evidence that pharmaceutical advice had been sought about crushing any medicine. St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 13 Staff had dated eye drops on opening and those in use had been open for less than 28 days. It was discussed that the corporate medication policies and procedures in each unit had different dates and that the most recent version should be available to all staff. A waste disposal company collected unwanted medicines from the nursing unit but the residential unit returned unwanted medicines to the supplying pharmacy. To comply with waste disposal legislation, all unwanted medicines must be collected by a licensed waste disposal company. One resident spoken to said “Staff generally respect her privacy and dignity.” But during a tour of the home the inspector observed two members of staff entering a resident’s bedroom without knocking on the door prior to entry During an observation in the dining room at lunchtime a Doctor visited one of the residents, the Dr. spoke over the residents head to one of the staff, in front of all other residents and other members of staff. Residents in both units are able to have visitors both personal and professional in the privacy of their own bedrooms. Care plans in both units clearly state the residents preferred term of address. The inspector spoke with three members of staff all were aware of the homes privacy and dignity policy and procedure. St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 14 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. Quality in this outcome area is adequate. Activities throughout the whole home are well managed and meet the needs of the residents. Links with the community are good and this helps to enrich the residents’ social lives. Staff need greater understanding of feeding residents, to ensure that residents’ dignity is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A short observational inspection took place in one of the lounges and the dining in the nursing unit just prior to and during a lunch time period. The inspector observed on the activities co-ordinators working on a one to one basis with some of the residents in the lounge. The interaction between this member of staff and the residents in the lounge was good. St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 15 The home employs two part time activity co-ordinators, one spends much of their time working one to one with the residents, and the other activity coordinator arranges group sessions for the residents. 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. Both co-ordinators keeps records of residents who have joined in activities. 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. In the dementia care unit, the inspector noted a very good atmosphere, many of the residents in the lounge, had visitors and all were enjoying talking to one another, laughing and joking, this room was very lively. Both residents and visitors in this lounge said that the atmosphere is always like this. Visitors said they visited on most days. This unit also has outside entertainers and 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. On the day of the inspection a local vicar visited the home in the morning to ask the manager if he could hold a harvest festival service in the afternoon. Relatives take their residents out into the community. The home has a visiting policy, and visitors are welcome at any time. The manager in the nursing unit often arranges fund raising days and relatives and friends are always invited to join in. Where it is possible residents are encourage 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. During the observation inspection the inspector noted that the lunch was well presented and that food was served up in an attractive and appetising manner. One resident said, “the food was not always very good, and that the higher management were doing their best to cut back on the food bill in the home.” An example given was that residents used to like ‘Horlicks’ which was no longer available and they used to be offered a variety of fruit drinks, the one she liked (black currant) was no longer purchased, and she did not like the orange juice, the manager has now arranged for her choice of fruit juice to be purchased again. This resident also stated “When there was stew on the St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 16 menu, which was quite often, there was never enough meat on the dish, just one or two bits and everything swimming in gravy.” Residents are offered three full meals per day. All liquefied food was well presented on the day of the inspection. One member of staff said that the cook does not have a heated trolley in which to keep meals hot and has to keep the plated meals hot in the oven, this was later verified by the cook. 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. The manager of the dementia care unit said that she generally found the food was good; it was all cooked in the one kitchen of the home. Relatives and residents stated that the food was good in this unit. The inspector did note in the nursing unit, that not all staff understand good feeding techniques, and it was observed that three members of staff were standing over residents to feed them, one member of staff was observed blowing on each spoon of food before placing it into the residents mouth. Two members of staff were having a conversation between themselves, while feeding residents. There were six residents that needed feeding, and with the exception of one resident the staff interaction between the remaining five residents was not good or non-existent. A senior carer who was feeding a resident the interaction was good – carer was explaining what food the resident had on his plate, and asking him what he would like on his spoon, the interaction was ongoing the resident was smiling and was able to take his time while eating his dinner. For another resident she was offered sandwiches and spent most the dinner hour just looking at the sandwiches, none of the staff interacted with her or encouraged her to eat her sandwiches. At the end of the lunch, this resident was asked if she wanted anymore to eat and she declined there was no attempt by the staff member to sit with this resident and encourage her to eat. The inspector also observed that another resident while being given assistance by a member of staff to eat at the beginning of the lunch time, the member of staff then left the table, and this resident continued to try and feed himself. It was obvious that had this resident been given specialised cutlery and a plate collar he would have been quite capable of feeding himself with his meal. He was having difficulty in turning his fork and his knife into his mouth and eventually resorted to using his fingers. St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is adequate. 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints policy and procedure has been reviewed, but the inspector noted that an up to date copy had not been placed in the frame, which is exhibited in the main hallway of the home. There is also an issue that where the complaints policy is situated in the main hallway it is very difficult for anyone to read especially the residents as it is placed so high up on the wall, and is presented in small print. In the nursing unit of the home there have been five complaints since the last inspection. One resident said, ‘Yes I do know how to complain, and I have done so when it has become necessary. The manager has listened to my complaints and responded fairly.’ A visitor said that they had made a complaint and stated, “It was accepted by the manager and her response was appropriate.” St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 18 In the dementia care unit, they have received five complaints since opening nine weeks ago. The manager of this unit has responded appropriately to four of the complaints, but one is ongoing. The home has up to date policies and procedures relating to the protection of vulnerable adults and whistle blowing. According to the staff-training matrix in the nursing unit and conversation with members of staff, the majority of staff have now completed POVA training. There have been no adult protection issues in the home since the last inspection. In the dementia care unit, none of the staff have undertaken POVA training, but the inspector was shown evidence by the manager that this had been booked to take place in the near future. 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.V346822.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. Quality in this outcome area is adequate. Improvements to some parts of the home will enhance the lives of the residents. Offensive odours must be dealt with to ensure that residents live in a pleasant environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is suitable for its stated purpose; it has recently been extended to provide a dementia care unit for 32 residents in a care home setting. The original building provides nursing care for 41 residents with dementia. Since the last inspection the new dementia care unit has opened, and the external gardens around the home have been secured, but could be dangerous to the St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 20 residents due to the amount of fallen leaves on the pathways around the garden. In the nursing unit, the communal areas on the ground floor have been refurbished, but there is still work to do in redecoration and refurbishment of bedrooms in this unit. There are carpets throughout the unit that need replacing, and one lounge and one recently vacated bedroom in particular had an offensive odour. During a tour of the building the inspector noticed areas of the home, which are being used as storage areas, in front anti rooms (which can be seen on approaching the nursing unit), also in the ground floor bathroom and in two vacant bedrooms. One of the communal lounges had a hairdryer stored in it. There were several light bulbs throughout the home, which were in need of replacing. Pull cords on some over bed lights, where too short to be turned off, without the resident getting out of bed. One bedroom did not have any curtains at the windows The registered provider must produce a programme of maintenance and refurbishment for the nursing unit. It is understood that the home does not have a regular maintenance employee, but a mobile maintenance man who covers several of Charing Healthcare homes, and will visit the home once a week to carry out maintenance tasks and check fire call points and hot water delivery. To ensure the nursing unit is kept in a safe and usable condition the provider must ensure that there is sufficient maintenance time provided. The dementia care unit has only been opened for nine weeks and was very well presented and was seen to be homely and comfortable. The home meets the requirements of the local fire service and environmental health officer. The home does not use CCTV cameras. Generally both units were clean and tidy, but two rooms in the nursing unit did have offensive odours. The laundry room, which serves both unites in the home, is fitted with an industrial washing machine and tumble drier. The industrial washing machine has a sluicing and disinfecting facility and red alginate bags are used for soiled linen. The laundry room was fairly clean, but there was some evidence of grimed in dirt, the floor surface is impervious to water. 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. 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.V346822.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. Quality in this outcome area is adequate. Staff are presently employed in sufficient numbers to meet the needs of the residents in the home. 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: According to the rotas and the numbers of staff on duty on the nursing unit on the day of the inspection there are sufficient staff on duty to meet the assessed needs of the residents. At the present time the nursing unit is not full, when more rooms are occupied the registered manager must ensure that the staffing levels are reviewed to meet the needs of the residents. The nursing home also employs adaptation nurses, who work supervised and supernumerary to other RGN’s employed in the home. St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 22 At the present time there are only 11 residents in the dementia care unit, and the staffing levels meet these residents needs. As more residents come to live in this unit the manager must review staffing levels and employ sufficient numbers of staff to meet the needs of the residents. In the nursing unit only 27.3 of care staff have an NVQ level 3 qualification, with a further three staff due to sign on to a NVQ course. In the dementia unit none of the care staff have NVQ at the present time. The inspector looked at staff files for four carers in both units of the home and found that all four staff have completed application forms giving a full employment history, all had received CRB checks prior to starting their employment with the home, there were two forms of identification, 2 references with exception of one file which only had one reference. All new staff are given the GSCC code of conduct booklet at the start of their employment with the home. Charing Healthcare has now 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. From the training matrix in the nursing unit nearly all staff have completed the mandatory training, with the exception of the newest recruits and their training is being provided over the next few months. In the dementia care unit, none of the staff have completed mandatory training, but this unit has only been open for nine weeks, and training will be provided within the next few months. With most members of staff completing their mandatory training prior to December. Not all staff have received dementia care training and this must be arranged to ensure that staff have the skills and knowledge to deal with the residents in the home. All staff undertake an introductory induction, and the induction booklets were available for inspection, once they have completed this induction they start on a Skills for Care Induction Pack. St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 Quality in this outcome area is poor. The managers have a good understanding of the areas in which the home needs to improve. Residents’ views are sought, but the both units need to develop its quality assurance system to include the views of stakeholders and to ensure that service users receive a high standard of care. Resident’s personal allowances are well managed to ensure that they are kept safely at all times. Attention to health and safety issues are not always satisfactory and do not ensure the service users and staff live and work in a safe environment. This judgement has been made using available evidence including a visit to this service. St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 24 EVIDENCE: The registered manager of the nursing unit has many years experience at management level, she is a qualified nurse and has gained many other qualifications to widen her knowledge. She is well respected by the staff, many of whom say that she is fair but firm. As a manager she is aware of the improvements she would like to see in the home and works hard with the higher management of Charing Healthcare to achieve these improvements. The manager of the dementia care unit has several years experience and 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. Through discussion with the inspector it was obvious that this manager is aware that she needs to regularly update her mandatory training. The quality assurance system in the home still requires further development. Resident/visitor questionnaires have been sent out, but the home still needs to develop a questionnaire for all external stakeholders who visit the home on a regular basis. The managers must ensure that they 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. Together with Fire Safety and Health and Safety checks which have been carried out and should be done at least twice a year, this should form the basis of a good quality assurance system, the findings should be published on an annual basis and made available to residents and relatives and other interested parties. 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. The registered manager checks monies on a monthly basis, and signs each residents finance sheet to show that she has monitored. Staff training relating to health and safety mandatory training has been addressed under OP30. The inspector viewed maintenance certificates for the equipment used in the home and found them all to be in date. St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 25 The weekly check of fire systems is generally good, but there were some gaps in weekly checks. The premises is secure and all external doors are number locked or connected to call system. All windows are fitted with window restrictors. Relevant health and safety notices were available in staff areas. Policies and procedures were in place for maintaining a safe working environment but in need of review they were last reviewed in February 2005. A fire risk and health and safety assessment has been carried out for the whole home and this was done in October 2007. Two bedrooms and small annexes to the front of the building are being used as storage areas for unwanted furniture, cardboard boxes and mobility aids, this is a potential health and safety and fire hazard. Some bedroom doors have magnetic closures that will close bedroom doors automatically when the fire alarm is activated, but many of the bedroom doors in the nursing unit have not got these fitted. There was an incident that occurred at the time of the inspection, where a visitor lost her footing on some broken tiles on the front entrance steps and sustained a heavy fall onto the shingle driveway of the home. Evidence was available to show that all accidents are recorded appropriately in HSE accident book, and that these records once completed are kept in accordance with Data Protection Act 1998 St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 X X X X X X 2 STAFFING Standard No Score 27 3 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 X X 1 St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 27 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 Requirement The registered manager must ensure that personal hygiene is recorded in detail and that wound care and fluid intake charts are placed into residents care plans. Previous requirements have been made under this standard: 31/07/04, 31/07/05,31/03/06, 11/05/06, 28/02/07 2. OP9 13(2) The registered managers must ensure for the protection of residents, decisions on covert administration must be reviewed, taking into consideration the Mental Capacity Act 2005. Pharmaceutical advice must be sought when it is intended to crush any medicine. Training in medication must meet the needs of the residents. The registered person ensures that all unwanted medicines are collected from the home by a licensed waste disposal DS0000050429.V346822.R01.S.doc Timescale for action 30/11/07 06/11/07 3. OP9 13(2) 06/11/07 St Michaels Nursing Home Version 5.2 Page 28 4. OP10 12(4)(a) 5. OP15 12(1) company, to comply with current legislation. The registered manager must ensure that staff respect the privacy and dignity of the residents at all times, by ensuring they knock on bedrooms doors before entering and that residents see their G.P. in private. The registered manager must ensure that staff are instructed how to assist residents when feeding in a discreet and sensitive manner. The registered manager must ensure that residents are assessed for specialised eating aids to enable them to feed independently if they wish to. The registered manager must ensure that residents requiring finger food are offered a variety in an appetising manner and encouraged to eat by members of staff. The registered manager must ensure that residents and visitors have access to a clear and up to date complaints policy and procedure and that it is clearly displayed in the home. The registered provider must ensure that the nursing unit of the home is maintained in a good decorative order, with replacement of carpets and furniture, and that small maintenance jobs are carried out regularly. The registered manager of the nursing unit must ensure the home is kept free from any offensive odours. 50 of the care staff must achieve NVQ level 2 in care DS0000050429.V346822.R01.S.doc 06/11/07 30/11/07 6. OP16 22(7)(a) (b) 30/11/07 7. OP19 23(2)(d) (5) 16 (2)(j) 30/11/07 8. OP26 16(2)(k) 30/11/07 9. OP28 18 21/12/07 Page 29 St Michaels Nursing Home Version 5.2 Previous requirement The current timescale was given at the inspection visit dated 28/11/06, 30/09/06 and 30/09/07. 10. OP29 19(4)(c) Sched. 2(5) The manager of the dementia care unit must ensure that she receives two written references prior to a prospective member of staff starting employment in the home. The registered managers in both units must ensure that staff receive in depth dementia care training to meet the assessed needs of the residents. The quality assurance system must be developed further to obtain the views of external stakeholders. Previous requirement and timescale of the 27/08/07 was not met. 13 OP38 13(4)(6) 30/11/07 The registered manager must ensure that rooms around the home including vacant bedrooms, small rooms to the front of the home and bathrooms are not used as storage areas for unwanted/unused items of furniture, cardboard boxes and mobility aids, as these could prove a health and safety and fire risk to the residents. The registered provider must ensure that all bedroom doors are fitted with magnetic door closures, that will ensure bedroom doors close automatically when the fire alarm is activated. The registered provider must St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 30 30/11/07 11. OP30 12(1)(a) (b) 18(1)(a) (c) 12(1)(a)2 4(1)(a)(b) (2)(3) 30/11/07 12. OP33 30/11/07 ensure that the steps at the front entrance to the nursing home have the tiles replaced to prevent them being a hazard to residents and visitors to the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP30 Good Practice Recommendations The manager of the dementia care unit develops a training matrix of employed staff and continues to develop this matrix as more staff join the team. St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Michaels Nursing Home DS0000050429.V346822.R01.S.doc Version 5.2 Page 32 - 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!