Inspection on 17/12/08 for St Michaels Nursing Home

This inspection was carried out on 17th December 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Michaels Nursing Home 23/01/08

St Michaels Nursing Home 05/07/07

St Michaels Nursing Home 25/07/06

St Michaels Nursing Home 19/12/05

St Michaels Nursing Home 26/07/05

St Michaels Nursing Home 01/10/04

St Michaels Nursing Home 13/05/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Michaels Nursing Home 19-21 Downview Road Worthing West Sussex BN11 4QN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: David Bannier     Date: 1 7 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: St Michaels Nursing Home 19-21 Downview Road Worthing West Sussex BN11 4QN 01903248691 Telephone number: Fax number: Email address: Provider web address: info@stmichaelscare.com Name of registered provider(s): Name of registered manager (if applicable) St Michaels Care Homes Limited Type of registration: Number of places registered: care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: A maximum of 37 Service Users may be accomodated at any time. A registered nurse is employed as the Registered Manager who has the knowledge, skills and experience to care for service users requiring nursing care Rooms 29-30 and 31-32 are only to be used by one (1) person. Date of last inspection Brief description of the care home St. Michaels is a care home, which is registered to provide nursing care for up to 39 residents who are 60 years or over. The conditions of registration limit the capacity of the home to a maximum of 37 residents. The home is a large detached, three-storey building situated in a residential area of Worthing. Accommodation is provided in 21 single rooms and 9 double rooms. There are large gardens attached to the property and car parking to the front. Facilities include a large lounge, smaller conservatory style lounge with a glass roof and dining area, all on the ground floor. The upper rooms of the house are serviced by a passenger lift. Fees for the home range from 550 to 675 Care Homes for Older People Page 4 of 31 0 Over 65 39 Brief description of the care home pounds sterling. Chiropody, hairdressing and incidentals such as newspapers and toiletries are not included. The registered provider is St Michaels Care Homes Ltd. The registered provider has identified Mrs R Thillainathan, who is known as Mrs Nathan, as the responsible individual and is responsible for supervising the management of the care home. The post of registered manager is currently vacant. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection has followed the Inspecting for Better Lives methodology and is called a key inspection as it assesses those standards determined by the Commission as key standards. This inspection will also determine the frequency of inspections hereafter. The registered provider returned an Annual Quality Assurance Assessment prior to the inspection. Some residents and staff were sent surveys by the Commission entitled Have Your Say. These are designed to enable residents and staff to give their opinions about how the care home is being run. The information received from these documents will be referred to in the report. A visit to the care home was made on Wednesday 17th December 2008. As this was an Care Homes for Older People Page 6 of 31 unannounced inspection we gave the manager and provider no notification of our intention to visit. We spoke to some residents and observed care practices. We also spoke to the relatives of two residents. This helped us to form an opinion of what it is like to live in this care home. We also spoke to some staff on duty in order to gain a sense of how it is like to work at the care home. We also viewed some of the accommodation and examined some records. The visit lasted approximately six and a quarter hours. Mrs Nathan and the deputy manager were present throughout our visit and kindly assisted us with our enquiries. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get Care Homes for Older People Page 8 of 31 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs have been assessed prior to admission. This care home does not provide intermediate care. Evidence: During our last inspection we found evidence that the management had assessed the needs of prospective residents before admission. We also noted that, as part of the admission process, a letter is sent before their admission confirming the persons needs could be met by the care home. During this visit we examined a selection of residents care records, and noted there was evidence that confirmed assessments had been carried out prior to admission. We were informed one resident had been admitted in an emergency the day before our visit. Mrs Nathan confirmed that an assessment and care plan for this person would be Care Homes for Older People Page 11 of 31 Evidence: place by the end of the week. Surveys returned by staff confirmed that they are always given up to date information about the needs of residents they support and care for. Information supplied in the AQAA confirmed that The pre admission assessment is always carried out by the manager or deputy manager. This includes needs related to personal care, physical wellbeing, dietary and nutritional requirements, risks, medication, life story book and activities for daily living information. We could find no evidence that this care home provides intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An individual care plan has been drawn up for each resident. However, there is still insufficient detail recorded with regard to the action staff are expected to take to ensure the identified needs of each resident have been met. Residents wellbeing have not been protected by the homes policies and procedures for dealing with medicines. Records of medication administered to residents have not been kept up to date. Residents have been treated with respect; their dignity and right to privacy has been maintained. Evidence: During our last visit we found evidence that each person has a plan of care which they or someone close to them has been involved in making. However, care plans and risk assessments were not setting out in detail the action which needs to be taken by care Care Homes for Older People Page 13 of 31 Evidence: staff to ensure that all aspects of the health, personal and social care needs of the person are met. This means that staff may not know what action they should take to meet needs, and in accordance with each residents personal preferences. As this directly affected the wellbeing of residents we made a requirement that action should be taken to rectify this by 30th April 2008. During this visit we looked at the care records of four residents. The registered provider showed us the changes which had been made to residents care records since our last visit. This included a seperate sheet for recording reviews of care plans, that are carried out on a monthly basis. Where possible, the resident or relative has signed the sheet to confirm they had been consulted as part of the review process. However we found instances that, whilst this document identified information to be added to the care plan, it had not been transferred over to update the care plan. We identified further instances when the information within care plans was still not sufficiently detailed to ensure all staff knew what they were expected to do to ensure individual residents needs have been met. For example, a review identified that a resident needed encouragement and assistance at mealtimes but this did not appear in the care plan. The review also identified that a hoist needs to be used to transfer the resident from their bed to a chair. However, this did not appear in the care plan, nor was there detailed instructions to staff about how this should carried out. We discussed this with the registered provider who informed us that the changes were still being introduced. The registered provider informed us that the delay in implementing the changes has been caused by the unexpected resignation of the manager. The registered provider has identified within the AQAA what they could do better as Continue to improve on care plans and sharing of information. They also identified the following as part of their plans improvement in the next 12 months, We will continue to review the content and quality of of healthcare records, care plans and policies and procedures where necessary. As there is evidence that demonstrates residents are being well cared for we will not make a requirement on this occasion. However, we will examine care records again at our next visit to determine that improvements have been made. Four surveys returned by residents confirmed they always receive the care and support they need. One survey confirmed this is usually the case. All five surveys returned by residents confirmed they always receive the medical support they need. Information provided in the AQAA confirmed that Assessment and care plans include information to ensure residents care needs are understood and delivered as required. Visits are made by healthcare professionals such as opticians, chiropodists and dentists. Care Homes for Older People Page 14 of 31 Evidence: During our last visit we found evidence that confirmed the the care home supports people who cannot manage their medicines in a safe way. On this occasion we examined a selection of records of medicines administered to residents. We noted that, in some instances, this record had not been completed by the member of staff who had administered the medication to residents. This meant that it was not clear if residents had received medication prescribed to them. We discussed this with Mrs Nathan who agreed to monitor this to ensure records are kept up to date. Information supplied in the AQAA confirmed that staff have received training in the safe administration of medication. During our last visit we found evidence which demonstrated peoples right to privacy is respected and the support they get from staff is given in a way which maintains their dignity. During this visit we observed staff interacting with residents. We noted that they treated residents with respect and ensured their dignity had been maintained when providing for their personal care needs. Residents we spoke to during our visit confirmed that they were satisfied with the way staff cared for them. They informed us they were well treated by staff and felt they were looked after in a respectful manner. We also spoke to two relatives during our visit. They also confirmed they were satisfied with the manner in which staff treated residents. One relative told us, I am very satisfied with the care provided to my relative. Thank goodness shes there! I would recommend the home to anybody. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities and social events are provided on a regular basis. Arrangements have been made to enable residents to meet spiritual needs. Residents are supported and encouraged to maintain contact with family and friends. Residents are able to exercise choice and control in their daily lives. Residents have been provided with a varied and wholesome diet which meets individual needs and preferences. Evidence: During our last inspection we found that the care home could better develop how it supports people to follow personal interests and activities. On this visit the registered provider showed us the changes they had made to residents care records. This includes finding out information about each residents life history, including social interests and hobbies. This is known as the residents Life Story Book. However, we were also informed that the care home had encountered Care Homes for Older People Page 16 of 31 Evidence: difficulties in obtaining this information for some residents, especially those residents would had lived at the care for some time. There is, therefore, still more work to be done before this has been set up for each resident. We were provided with a copy of an activity programme for the months of October, November and December. The activities which had been provided during these months included music and movement sessions, a visiting musician, Chinese dancers, church services and songs of praise. We also saw photographs of events which have taken place leading up to the Christmas period. They have included a visit by a group of Irish Dancers and also a local church choir to sing carols. One survey returned by a resident confirmed there are always activities arranged by the home that they can take part in. One survey confirmed activities are usully available. The resident told us I choose not to take part, although they are available. Three surveys confirmed that activities are sometimes available. One resident told us I prefer to use my own TV, CDs and videos and to entertain myself. I dont usually participate in the homes activities. Information that had been provided in the AQAA confirmed that Initial assessments of service users include an opportunity to ask them what their interests and preferences are for daily living. A schedule for monthly activities is prepared. Activities include a keep fit programme, music and movement, and arts and crafts. During our last inspection we learnt that people are able to keep in touch with their family and friends. During this visit were spoke to several residents and to two relatives. We were informed that residents are encouraged to keep in touch with friends and family. Visitors are made welcome by the staff and the manager. Information provided in the AQAA confirmed that Families are welcome to visit at any time and provision is made for those who wish to receive their visitors in private rather than in the communal area. Families are encouraged to join in certain social events within the home. During our last visit to the care home we found evidence that demostrated residents are as independent as they can be and have the opportunity to make the most of their abilities. All five surveys returned by relatives confirmed that staff do listen to them and act on what they say. Care Homes for Older People Page 17 of 31 Evidence: Information supplied in the AQAA confirmed that Residents are encouraged to to make their own choices with regard to rising and retiring, where they would like to spend their time, choice of food and where they would like to eat. We spoke to the cook during our visit, who informed us that the main meal on the day of our visit consisted of roast lamb with mint sauce, mashed potatoes, carrot and swede mash, cabbage and gravy followed by stewed apple and custard. We were also informed of the special diets currently being catered for. We viewed the dining room which was presented in a comfortable and homely manner. We were given copies of menus to look through. They demonstrated that the food provided is varied and wholesome. It also demonstrated that alternative meals are provided if someone does not want the meal on offer. As this has not been routinely recorded we recommended that, where a resident is provided with an alternative menu this recorded. We spoke to several residents who informed us they were satisfied with the food provided. They also confirmed they were provided with enough food for their needs and food which was to their liking. Surveys returned by four residents confirmed they usually like the meals provided at the home. One survey confirmed they sometimes like the food provided. Information provided in the AQAA confirmed that A varied menu is provided and special diets catered for. There is a weekly menu and residents have an alternative choice if required. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems have been put in place to ensure complaints will be listened to, taken seriously and, where necessary, acted upon. All staff have received appropriate training to ensure residents are protected from abuse. Evidence: We found evidence during our last inspection that, if people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. During this visit we looked through a record of complaints that the home has received since our last inspection. This provided us with evidence that demonstrated the management of St Michaels does take complaints seriously and has a system for investigating any concerns that have been raised. All five surveys returned by residents confirmed they knew how to make a complaint if it was necessary. Information supplied to us in the AQAA confirmed that, within the last 12 months they had received two complaints. Each of these had been resolved within 28 days, and Care Homes for Older People Page 19 of 31 Evidence: neither had been upheld. It was also confirmed We have a clear and concise complaint procedure which is included in the service user guide and displayed in the front reception. All complaints are investigated and acted upon promptly to ensure satisfactory resolution. During our last inspection of the home we found evidence that confirmed the care home has systems in place to protect people from abuse and neglect and takes action to follow up any allegations. We looked through staff training records. They demonstrated staff have been provided with training in how to identify different types of abuse and how any incident or allegation of abuse should be reported. We spoke to a member of staff who was on duty who was able to confirm the training received. Surveys returned by all five members of staff also confirmed they had received appropriate training regarding identifying and reporting abuse. One member of staff told us All staff have had training in safeguarding vulnerable adults. Information provided in the AQAA confirmed that, Staff training includes safeguarding vulnerable adults. Relevant adult protection policies and procedures are in place and available. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider has ensured residents live in a safe, well-maintained environment. The registered provider has ensured the home is clean and hygienic. Evidence: We looked at the private accommodation of several residents along with the communal areas including the dining room and the lounge of each unit. These areas were clean decorated and furnished in a comfortable manner that met the needs of the residents accommodated. Residents have been encouraged to bring personal effects and small items of furniture in order to make bedrooms as individual as possible. We spoke to some residents who told us the home was a comfortable place to live. They also confirmed they were satisfied with the accommodation provided. Four surveys completed by residents and returned to us confirmed that the home is always fresh and clean. One survey confirmed this is usually the case. Information provided in the AQAA confirmed that, We have a safe and well maintained home which meets individual and collective needs. Care Homes for Older People Page 21 of 31 Evidence: We also visited the kitchen area the laundry and several bathrooms. We noted that all areas of the premises have been maintained to a satisfactory state of cleanliness. We discussed the importance of ensuring the laundry area is kept clean and hygienic to reduce the risk of cross infection with Mrs Nathan. We noted that a system was in place to ensure dirty and clean laundry are kept separate. Information supplied in the AQAA confirmed that policies and procedures are in place for staff to follow to ensure the risk of cross infections is reduced. It also confirmed the premises has been visited by the Fire Officer and Environmental Health officer to ensure it is safe and meets requirements in terms of fire safety and health and safety regulations. Equipment such as gas installations electrical wiring and equipment have been regularly checked and maintained to ensure they are safe to use. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider has ensured that there are sufficent staff on duty with the appropriate mix of skills to meet the needs of residents accommodated. The registered provider has also ensured residents are in safe hands at all times. Residents are supported and protected by the recruitment policy and practices of the home. The registered provider has ensured staff are trained and competent to do their jobs. Evidence: We were given copies of staff rotas to look through. There is one trained nurse from 8am to 8pm each day supported by a team of five care assistants. At night there is one trained nurse and two care assistants who are awake and available to provide for residents needs. In addition to this there is a team of catering and housekeeping staff on duty each day to cook meals, carry out laundry duties and to clean the premises. After looking through a selection of residents care records we concluded that staffing levels are sufficient to meet the current needs of residents. Residents and relatives we spoke to during our visit confirmed they were satisfied with Care Homes for Older People Page 23 of 31 Evidence: the level of staffing and the care provided. Two surveys returned by residents confirmed there was always staff available when needed whilst three surveys confirmed this is usually the case. Information supplied in the AQAA confirmed that Staffing levels and skills mix are appropriate and we have a stable staff base who support each other and provide good quality care. Staffing levels are in accordance with the residential forum fomula which is used periodically to assess staffing requirements based on dependency levels. We saw the recruitment records of four members of staff who have started working at the care home since our last visit. These records demonstrated that the registered provider has obtained appropriate checks for these staff including criminal records checks and other documentation to confirm their identity. We looked at staff training records. They demonstrated that newly appointed staff undertake structured induction training. This includes providing an understanding of the principles of good care practices and covers the promoting of residents rights, independence, choice and dignity. Training records also provided evidence that confirmed staff have been provided with mandatory training such as identifying and reporting abuse, fire safety, health and safety, first aid, infection control and the safe handling of medication. Surveys returned by staff confirmed their employer had carried out appropriate checks and had obtained references before they started work at the care home. They confirmed induction training covered everything they needed to know to do the job when they started. They also confirmed they had been given training which is relevant to their role, helps them understand and meet the needs of residents and keeps them up to date with new ways of working. One member of staff told us, Ongoing training is always available at no cost to staff provided by recognised trainers of local colleges. Another member of staff informed us, Staff are offered relevent training and are at present taking training in dementia care, including myself. Information supplied to us in the AQAA confirmed that, of the 18 permanent care workers employed at the care home, 8 have completed a structured and approved induction programme. All of the staff have obtained the National Vocational Qualification in Care at Level 2 or above. This information also confirmed that what the care home does well is provide, NVQ training and mandatory training for all care staff. New staff complete induction training and are made aware of the staff manual which is kept in the office. Recruitment procedures follow requirements to protect residents. Care Homes for Older People Page 24 of 31 Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the home has been well managed, people living at the care home would benefit from the appointment of a permanent registered manager. Systems are in place to ensure the home is being run in the best interests of residents. Staff are receiving supervision on a regular basis. Systems are in place to ensure the health and safety of residents and staff. Evidence: During our last visit we were informed that since the previous manager left in December 2006 the deputy manager had been appointed as acting manager. Mrs Care Homes for Older People Page 26 of 31 Evidence: Nathan also informed us at the time that she was in the process of recruiting to this post. The process proved successful and an appointment was made. Since our last visit Mrs Nathan has notified us that this person resigned after approximately four months. This person had not registered with us during this time. At this visit we were advised that the deputy manager has again been appointed as acting manager and Mrs Nathan is, again going through the process of recruiting a manager for St Michaels. We found evidence that the deputy manager is working hard to ensure residents continue to be well cared for on a daily basis. We were informed by surveys returned by residents and staff the acting manager is well regarded. Discussions we had with residents and relatives during this visit also confirmed this. However, we remain of the view that without a registered manager it will not be possible to ensure the home provides a consistently good level of care to residents. During our last visit we expressed concerns that care plans did not include sufficent information about care needs and the action staff should take to meet them. On this occasion we found evidence that Mrs Nathan, supported by the deputy manager, has made changes to the way care plans have been formatted to ensure appropriate information is recorded. However, when they were sampled shortfalls with regard to the information they contained were identified. Mrs Nathan advised us that the new system was still being introduced. She also informed us that the delay has been caused by the resignation of the last manager. At our last inspection we also identified that staff were not being regularly supervised to required levels. On this occasion we were shown supervision records. They demonstrated that staff are now receiving supervision every two months from a senior member of staff. We discussed the records we viewed with Mrs Nathan at the time of our visit. We informed her that the records indicated that supervision sessions were more like appraisals of staff competencies. Whilst this is a good starting point, we advised Mrs Nathan they need to be extended to include discussions with each member of staff about their indvidual role within the care home, the philosophy of care on which practices at St Michaels are based and the individual aspirations and training needs of each member of staff. Mrs Nathan informed us that she would be interviewing potential candidates a few days after our visit. We requested she notify us of the outcome of interviews in due course. If this round of interviews proves to be unsuccessful Mrs Nathan was asked to keep us informed with regard to the arrangements she has made to managing the care home. It is our view that, once appointed, the manager would take responsibility for ensuring care plans and staff supervisions are developed and improved as we have identified. Care Homes for Older People Page 27 of 31 Evidence: Residents and relatives we spoke to during our visit confirmed they were satisfied with the way the care is managed. We were told that staff were very caring, considerate and kind. We were also informed that the atmosphere in the care home was warm, welcoming and homely. Surveys returned by residents confirmed they knew who to speak to if they were unhappy about anything. Discussions with staff on duty confirmed they felt well supported by the management at St Michaels. Information provided in the AQAA confirmed that Although we have not had a registered manager in place, full support is provided to the deputy manager to ensure the smooth running of the home. The responsible individual visits at least once a week along with visits from other directors. The AQAA also identifies the following area for improvement over the next 12 months as, Actively seek to recruit a competent manager. During our visit we noted that several windows in bedrooms on the upper floors had had restrictors removed. We were informed that some windows had been replaced since our last visit and window restrictors may not have been refitted. Following discussion we were informed that action would be taken to replace window restrictors, where necessary. In all other repects we found evidence that the premises have been well maintained, ensuring a safe environment in which residents can live and staff can work. The registered provider has supplied information that indicates equipment such as boilers; other gas installations and electrical equipment have been regularly serviced and maintained. Residents have told us that they are satisfied with the accommodation and services provided. According to training records staff have been provided training in such subjects as fire safety training, moving and handling, food hygiene, infection control, health and safety. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Records of medication administered to residents must be kept up to date. This means that there will be clear evidence that residents have received medication as prescribed by their GP 30/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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