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Inspection on 18/05/05 for St Michaels Nursing Home

Also see our care home review for St Michaels Nursing Home for more information

This inspection was carried out on 18th May 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Home provides a peaceful and happy atmosphere, where service users are content and relaxed. Service users praised the kindness and thoughtfulness of the care staff. A small group of service users enjoyed the activity that day and were smiling and happy. The service users were dressed in clean clothes.

What has improved since the last inspection?

The service users are more content and happy and the atmosphere is now peaceful and relaxed.

What the care home could do better:

The general maintenance of the building and the proposed outstanding phases of the refurbishment need to be completed. Repairs to the building need to be conducted promptly and safety issues need to be dealt with immediately. Health & safety checks must be conducted at the required intervals. The recruitment of staff needs to follow a procedure, which ensures the identity and their appropriateness for the post by conducting all of the required safety checks prior to employment starting. Care plans and daily records have improved but need to improve further to identify and record all of the care needs and the care provided.

CARE HOMES FOR OLDER PEOPLE St Michaels Nursing Home Elm Grove Westgate-on-Sea Kent CT8 8LH Lead Inspector Clair Brown Unannounced 18 May 2005 11:00 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 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 H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 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 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 Mr C Osman. Charing Healthcare Care Home 45 Category(ies) of DE (over 65) registration, with number of places St Michaels Nursing Home H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 08/02/05 Brief Description of the Service: St Michaels Nursing Home is a large attractive three storey detached Home with gardens. 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 older people. The Home has recently changed its registration to provide nursing care for those with Dementia. Although the Home is registered for 45 service users, currently the Home does not use all of these places. The Home employs a Manager and a team of Registered Nurses and care staff. There are waking night staff employed. There is a shaft lift to access all floors. St Michaels Nursing Home H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the Homes unannounced inspection, conducted by one inspector and the duration of the inspection was 6 hours and 40 minutes. There were 27 service users residing at the Home and two of these were spoken with to gain their views and aspect of living at St Michaels. The 13 previously made requirements were inspected. Two of these requirements have been met. Due to the increasing number of service users with dementia observations were also made and the case-tracking of files and talking to staff, to gather the required information. What the service does well: What has improved since the last inspection? What they could do better: The general maintenance of the building and the proposed outstanding phases of the refurbishment need to be completed. Repairs to the building need to be conducted promptly and safety issues need to be dealt with immediately. Health & safety checks must be conducted at the required intervals. The recruitment of staff needs to follow a procedure, which ensures the identity and their appropriateness for the post by conducting all of the required safety checks prior to employment starting. Care plans and daily records have improved but need to improve further to identify and record all of the care needs and the care provided. St Michaels Nursing Home H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 Page 6 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. St Michaels Nursing Home H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection St Michaels Nursing Home H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These outcomes were not inspected but will be assessed at future inspections. EVIDENCE: St Michaels Nursing Home H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Individual care plans and daily records have improved but still fail to identify all aspects of service users care needs. Health care assessment tools have not been completed accurately and give a misleading picture of needs. Some of the medication practices have improved but there remain unsafe practices. Privacy and dignity is not maintained in some of the shared bedrooms. EVIDENCE: There has been an improvement in the information recorded in the service users care plans, however the care plans still do not contain all of the required information to instruct care staff on how to provide the individual care. One care plan did not identify the fact the service user used a zimmer frame when standing and a wheelchair for mobility. Not all service users files contained a nutritional assessment, as required. Those that did contain nutritional assessments were found to be inaccurate and gave an incorrect score in relation to the individuals actual needs. Overall the basic medication practices have improved, but there remains poor practices by some staff. Medication issued directed from the blister pack was up to date and the records keeping improved. Medication administered from its original packaging was found not to be administered for three service users. Some medications are being accepted with instructions that say “give as directed”, including insulin. Staff are not recording the dose of insulin being St Michaels Nursing Home H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 Page 10 administered. The medication room was less cluttered and was clean, however there was three over filled sharps boxes that had not been disposed of. The Controlled Drugs (CD) numbers corresponded with the records in the register. The controlled drug register provided evidence of poor procedures and practice. These included single signature for administration and receipt of CDs’ and evidence that staff are signing that medication has been given prior to it being administered. Qualified staff spoken stated that medication procedures in this country are very different to those they had used in their country of origin / training. However, it was noted that there had been some improvement with the CD procedures in the last month. St Michaels Nursing Home H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These outcomes were not inspected but will be assessed at future inspections. EVIDENCE: St Michaels Nursing Home H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 No new complaints have been recorded to enable this standard to be inspected. The adult protection policy does not provide sufficient guidance to staff. EVIDENCE: The complaints records showed that no complaints have been received since the last inspection. It was agreed with the manager that the requirement relating to this standard will remain active on this report and will be assessed at future inspections. The company adult protection policy has been amended but still does not provide staff with clear guidance on the procedures to follow. However the manager has produced an additional file specifically on this subject. St Michaels Nursing Home H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 24, 25, 26. The building is not well maintained and the safety of service users, staff and visitor is compromised. The Home does not provide sufficient baths to meet the needs of the service users. The Home does not comply with infection control procedures. The Home is clean and free from offensive odours, except for the area near the smoking room. EVIDENCE: The overall maintenance of the Home is restricted by the hours available to the maintenance person and the procedures in place for the approval of work. The manager was unable to use the homes own maintenance person to replace two missing door handles on the lounge (due to requiring approval from head office before the work could be carried out), which caused the inspector to be shut in the room and unable to get out, without placing themselves in danger; the inspector was advised by staff that the method of opening the door was to kneel on the floor and put your hand underneath to pull the door open. A bedroom deemed as unfit for occupation at the inspection in February 2005 has been vacated but the repairs have not been carried out. The planned St Michaels Nursing Home H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 Page 14 remaining refurbishment of the Home is now the responsibility of the part time maintenance person who has only been able to decorate two bedrooms so far this year. A bedroom window that had been restored was painted and sealed closed and the frame has been broken to enable the window to be opened, but has not been repaired. The manager has requested a new dishwasher for the kitchen (documentary evidence was seen to support this), the current machine has been out of order since September 2004. Infection control procedures in the laundry are insufficient, there is no waste bin and staff make hot drinks in this area. The registered provider has not responded to the requirement to submit an action plan in relation to the provision of assisted bathrooms, since a bathroom was turned into a store cupboard. The Home was clean and the only area with an offensive odour was the areas close to the smoking room. The registered provider has previously invested in the first phase of refurbishment. St Michaels Nursing Home H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28, 29 Insufficient numbers of the care staff have achieved the NVQ training. The recruitment procedures implemented do not ensure the safety and welfare of the service users. EVIDENCE: The Home employs 19 care staff as well as the qualified nurses. Of the 19 care staff only 2 have achieved the NVQ level 2 in Care qualification. The Home is required to have 50 of the care staff with the NVQ training. A further 6 carers have enrolled on the training course. A prospective member of staff had been offered a position, which was confirmed in writing. The prospective carers file did not contain any proof of identity, the CRB had not been applied for, there was no interview record and the references were not from the most recent employer. Other recently recruited staff files seen, revealed the same findings. A member of staff left and returned a few months later, no checks or new paper work was completed. St Michaels Nursing Home H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 37, 38 The monitoring and assessments of the quality of service and care provided is not being conducted by the registered provider or by an appointed person. The health, safety and welfare of staff and service users are not protected in all areas. EVIDENCE: The last regulation 26 report received at the CSCI was dated 01.02.05, duration 2 hours. No visits have occurred since then. The appointed person for conducting these visits has changed. The report was lacking information and any evidence of an in-depth visit. The report consists of one sentence in each of the 5 boxes. The company adult protection policy has been amended by the Company but continues to fail to provide staff with clear instructions about the procedures to follow. The Manager does have her own additional adult protection information file available in the office for staff to refer to. The fire log book provided evidence that the fire safety checks were not being conducted as required, weekly checks were being conducted less frequently, St Michaels Nursing Home H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 Page 17 and the specialist engineer has not serviced the fire alarm and emergency lighting since 01.04. The fire extinguishers had been inspected and serviced this year. The electrical certificate was in date but the gas certificate could not be found. The hot water temperature records were locked in the maintenance persons’ room therefore inaccessible. A large piece of equipment continued to be stored on landing area blocking access to the toilet. See section for standard 26. St Michaels Nursing Home H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 2 1 1 x x 2 2 2 STAFFING Standard No Score 27 x 28 2 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x x 1 x x x 2 1 St Michaels Nursing Home H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 Page 19 yes Are there any outstanding requirements from the last inspection? 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 4,7,8 Regulation Requirement Timescale for action 31.07.05 (Previous timescale 31.07.04 2. 9 3. 10 12, 13,14, Required to produce individual 18,15, 16, Service User care plans that accurately detail individual assessed needs and ensure that these needs are met. That reviews are conducted monthly or sooner if changes are noted, for changes/ deterioration to be recorded and appropriate action to be taken. Individual care, such as mouthcare must be provided and recorded. 12, 13, The Home and staff must comply 14, 16 with safe medication procedures to ensure that it is recorded, handled and administered using safe practices. 16 Effective and appropriate screening must be provided in all shared bedrooms. 17, 22 schedule 4 The manager must adhere to the Homes complaint procedure and record all stages of the investigation with outcomes and action plans and records of communication with the complainant. All complaints should be recorded. To provide the CSCI with a 31.07.05 4. 16 31.07.05 (Previous timescale 30.09.04) 31.07.05 5. 19, 20, 23, 13, 2312, 31.07.05 Page 20 St Michaels Nursing Home H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 24 14, 16, 6. 21 23 7. 26 12,13,16 23 8. 28 18 9. 29 7, 8, 18,19, schedule2 10. 36 18, 19 written action plan that includes timescales for the ongoing refurbishment both internally and externally of the Home. To provide the CSCI with an action plan with timescales regarding the Home bathrooms/service user ratio and the replacement of the condemned Parker bath. Hand-washing facilities in the laundry area must not be obstructed and staff adhered to infection control procedures. A procedure / protocol for the handling of linen in the laundry room should be written to prevent cross infection from dirty to clean laundry. For 50 of care staff to have NVQ level 2 in care, taking into account all of the care staff working at the Home including the adaptation students. To ensure that prospective staff are recruited ensuring the protection of Service Users and that staff files are audited to ensure they contain the required forms of documentation. All staff must receive formal supervision six times a year. The manager must ensure that all health & safety environmental checks (including gas & fire checks) are conducted at the correct times and by appropriate persons. Evidence to be submitted tot the Commission. That all hot water provided where service users have access is delivered at the required temperature and is monitored and recorded. Appropriate action must be taken when it is found to be too hot & too cold. (Previous timescales 31.08.04 & 31.05.05) 31.07.05 (Previous timescale 31.08.04 31.07.05 30.12.05 31.07.05 (Previous timescale 31.08.04) 31.07.05 (Previous timescale 31.12.04) 31.07.05 (Previous timescale 31.08.04 11. 25, 38 13 St Michaels Nursing Home H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 Page 21 12. 26, 38 12,13,16, 23 13. 33 26 The registered provider must 30.06.05 provide appropraite dishwashing provisions / equipement in the kitchen, taking into consideration health & safety and infection control procedures. regulation 26 visits must be 31.07.05 completed monthly and conducted by an appropriately appointed person and produce a detailed and accurate report of the findings. A copy of the report to be sent to the CSCI. 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 Good Practice Recommendations St Michaels Nursing Home H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent. TN23 1HU National Enquiry Line: 0845 015 0120 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 H56-HO5 S50429 St Michaels N H V226328 180505 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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