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Inspection on 19/12/05 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 19th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

All the residents, who the Inspector spoke to on the day of inspection, spoke well of the home, and the staff members, and in particular, the food. A visitor, spoken with on the day of inspection said that she had always been made to feel "most welcome", and had no concerns at all about the care being provided by St. Michaels. A second visitor who had recently lost the person they used to visit in the home said that she found "real support" then, and now, in her loss. The Inspector saw letters of appreciation from relatives, praising the care at the home. The Manager informed the Inspector that fifty per cent of the staff members were trained to NVQ Level 2 in Care.

What has improved since the last inspection?

At the time of the inspection several windows in a state of disrepair were being replaced. In addition fire doors were also being replaced as required. The Manager informed the Inspector that there has been some repair and refurbishments to the home.

What the care home could do better:

It was noted that there are some areas of the home still in need of attention with regard to maintenance. The progress of the refurbishment of the home will be monitored at the next inspection. It was noted on the day of inspection that the scales, required to weigh the residents on a regular basis as part of their health check, were unsafe for use, and that as a result of this residents had not been weighed for some time. Not all the required paperwork was in place for the staff members who work at the home, and there were insufficient staff members on duty at the time of the inspection.

CARE HOMES FOR OLDER PEOPLE St Michaels Nursing Home 19-21 Downview Road Worthing West Sussex BN11 4QN Lead Inspector Mrs. Jennifer Wright Unannounced Inspection 19th December 2005 10.00 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 DS0000042588.V273507.R02.S.doc Version 5.0 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 DS0000042588.V273507.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Michaels Nursing Home Address 19-21 Downview Road Worthing West Sussex BN11 4QN 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) 01903 248691 St Michaels Care Homes Limited Mr Keith William Griggs Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places St Michaels Nursing Home DS0000042588.V273507.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. A maximum of 37 Service Users may be accomodated at any time. Rooms 29-30 and 31-32 are only to be used by one (1) person. A registered nurse is employed as the Registered Manager who has the knowledge, skills and experience to care for service users requiring nursing care 26th July 2005 Date of last inspection Brief Description of the Service: St. Michaels is a care home, which is registered to provide nursing care to up to 39 residents who are 65 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 areas 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. The new, recently registered Manager is Mr Griggs. St Michaels Nursing Home DS0000042588.V273507.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the second of a minimum of two statutory visits that an inspector must make to each care home during the course of a year. The first inspection, which was announced, was undertaken earlier in the year. During this inspection the Inspector looked at standards that were not looked at during the previous inspection, as well as any outstanding issues from the last report. The reader is advised to look at the reports of both inspections for a fuller picture of the home. The newly registered Manager was present during the entire inspection and very ably assisted the Inspector throughout. During this inspection the Inspector examined records of medication and care being provided to residents; as well as records of any accidents, issues, concerns or complaints, to make sure that the residents at St. Michaels were being taken care of. On the day of inspection, in addition to the Manager, the Inspector spoke to some of the residents and staff members, plus two visitors. At this inspection St. Michaels was audited against the National Minimum Standards for Older Persons. Many of the elements in each of the standards assessed were met, however there are two requirements made, which were made at the previous inspection and still outstanding, plus one recommendation, with regard to staffing numbers, recruitment practices and the weighing of residents. The Inspector would like to thank everyone who cooperated with her on the day of this inspection. What the service does well: What has improved since the last inspection? St Michaels Nursing Home DS0000042588.V273507.R02.S.doc Version 5.0 Page 6 At the time of the inspection several windows in a state of disrepair were being replaced. In addition fire doors were also being replaced as required. The Manager informed the Inspector that there has been some repair and refurbishments to the home. What they could do better: 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 DS0000042588.V273507.R02.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection St Michaels Nursing Home DS0000042588.V273507.R02.S.doc Version 5.0 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 the following standard(s): 1, 2 and 6 Prospective residents and their relatives have the information they need to make an informed choice about where to live, and each resident has a written contract/ statement of terms and conditions with the home. EVIDENCE: The Inspector was told of a new Statement of Purpose and Service Users Guide that contained information about the home, including the change of Manager. All residents and their representatives are given a copy prior to their coming into the home. The Manager assured the Inspector that all residents, and their representatives receive a statement of the home’s terms and conditions, which contain all the requirements of the National Minimum Standards. Copies of these are kept on file. St. Michaels does not offer intermediate care. St Michaels Nursing Home DS0000042588.V273507.R02.S.doc Version 5.0 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 the following standard(s): 8, 9 and 11 Resident’s health care needs are fully met, and where appropriate, residents are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Residents and their representatives are assured that at the time of their death, staff members will treat all residents and their family, with care, sensitivity and respect. EVIDENCE: The Manager assured the Inspector that all residents are informed of all services available under the National Health Service, and that specialist equipment is provided where necessary. It was noted on the day of inspection however, that the scales, needed, to weigh the residents on a regular basis as part of their health check, were unsafe for use, and that as a result of this residents had not been weighed for some time. A recommendation is made in this report that this matter be addressed. Policies and procedures for the receipt, storage, administration and disposal of drugs were available for inspection. Records of drug administration demonstrated that these were being adhered to. All staff members who administer medication are trained nurses, and the Inspector was assured that any resident electing to administer their own medication was only able to do so following a risk assessment. This would be recorded on the resident’s file, and monitored regularly. The St Michaels Nursing Home DS0000042588.V273507.R02.S.doc Version 5.0 Page 10 Inspector was informed that family or friends are offered a spare bedroom, if available, or a comfortable chair in the residents room, at the end of their life. It would appear that St. Michaels treat residents who are dying, and their family and friends with respect, care and sensitivity. St Michaels Nursing Home DS0000042588.V273507.R02.S.doc Version 5.0 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 the following standard(s): 12, 13 and 14 People living at St. Michaels are able to make day-to-day decisions about how they want to live their lives. There are activities for those who wish to participate, and residents are encouraged to maintain contact with all their old friends and family, wherever possible. The food is home cooked, and offers a choice of menu, with people able to eat either with other residents in the dining room, or in their own room should they prefer. EVIDENCE: One visitor spoken to on the day of inspection told the Inspector that they visited the home regularly, and that the person they visit was very happy at the home. The Manager informed the Inspector that the home offers a choice of menu, with people able to eat either with other residents in the dining room, or in their own room, should they prefer. On the day of the inspection, the Inspector shared a meal with the residents, who told the Inspector that the food was very tasty, there was plenty of it, and confirmed that there was a always a choice. There was a good atmosphere between the residents and staff members throughout the meal. From direct observation, the Inspector noted that the mealtime appeared to be unhurried, with all residents being afforded sufficient time to eat their meal. Where it was necessary staff members were seen to help residents in a sensitive and unobtrusive manner. St Michaels Nursing Home DS0000042588.V273507.R02.S.doc Version 5.0 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 the following standard(s): 16,17 and 18 Resident’s legal rights are protected. Training sessions for staff, plus policies and procedures regarding abuse, ensure that, as far as is possible, the people who live at St. Michaels are protected from bad practice. EVIDENCE: Complaints are recorded in the complaint’s book, there was one complaint recorded since the last inspection. Residents told the Inspector that should they have any concerns at all, they would have no hesitation in going to the Manager and know that they would be listened to. The Manager confirmed that the home operates an “open door policy, and residents and visitors are aware that they can always come to him whenever they want to.” The Manager informed the Inspector that postal votes are obtained for residents, however, if a resident prefers transport can be arranged for them to go to the local polling booth. Since the last inspection all staff members have had training in adult abuse. St Michaels Nursing Home DS0000042588.V273507.R02.S.doc Version 5.0 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 Residents live in a safe, reasonably well-maintained environment and have access to safe and comfortable indoor and outdoor communal facilities. Residents have sufficient and suitable lavatories and washing facilities, and access to the specialist equipment they require to maximise their independence. Resident’s’ rooms suit their needs and are safe, clean and comfortable. EVIDENCE: During the course of the inspection all of the rooms were visited to ensure that the environment was safe and comfortable for people who live there. It was noted that many residents had brought personal possessions into the home, including small items of furniture, ornaments and photographs. Records were available to show that the home is maintained to a satisfactory standard. On the day of inspection, St. Michaels was seen to be clean, and free from offensive odours. There were Christmas decoration and fairy lights throughout the home, and in the centre of the home is a light airy conservatory which residents and their visitors can sit in and share a coffee or a meal together. St Michaels Nursing Home DS0000042588.V273507.R02.S.doc Version 5.0 Page 14 This room contains many green plants and a waterfall, and residents told the Inspector that it was “like being outdoors, but indoors”. Items of equipment that were judged as in need of attention, at the previous inspection, had either been repaired or disposed of, however although some work had been done, the home is still in need of redecoration and refurbishment. The Manager informed the Inspector that this would be addressed shortly as part of St. Michaels’s maintenance plan. Progress of the work on the home will be monitored at the next, and subsequent, inspections. Several windows and fire doors were being replaced, where necessary, on the day of inspection. St. Michaels provides sufficient communal space for the residents, which consists of separate lounge and dining areas. There are enough washing facilities available in the home, with accessible toilets close to the communal sitting areas and the dining room. On the day of inspection several doors were seen to be wedged open, the Manager was made aware of the safety implications with regard to this. St Michaels Nursing Home DS0000042588.V273507.R02.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 29 St. Michaels was not adequately staffed on the day of inspection. National Vocational Qualification is on going and further development training is expected. All training is recorded on staff member’s files. Residents are not supported and protected by the home’s recruitment policy and practices. EVIDENCE: On the day of inspection the staff rota indicated that there were insufficient staff members on duty to meet the National Minimum Standards, despite there being a requirement for this matter to be addressed at the previous inspection. The Manager informed the Inspector that there were unusual circumstances as to why the home was short staffed. A further requirement is made in this report for the home to ensure that there are sufficient numbers of staff on duty at all times for the safety of the residents. Ongoing monitoring of the staffing levels at the home will be undertaken by the Commission for Social Care Inspection. The Manager informed the Inspector that over 50 of the care workers at St. Michaels are in receipt of their NVQ Level 2 or above. At the previous inspection a requirement was made that all staff members be in receipt of the necessary paperwork prior to their commencing work at the home. At this inspection it was noted that this had not been complied with, and a further requirement is made for this matter to be addressed immediately. The Manager informed the Inspector that all those staff members awaiting the necessary paperwork are never left to work in the home unsupervised. St Michaels Nursing Home DS0000042588.V273507.R02.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 37 and 38 Residents live in a home, which is run and managed by a person who is fit to be in charge, and they benefit from the ethos, leadership and management approach of the home, which is run in their best interests. Residents are safeguarded by the home’s record keeping and policies and procedures, including financial. The health, safety and welfare of residents are promoted and protected in the main. EVIDENCE: The recently appointed Manager is a Registered Nurse, has obtained his NVQ Level 4 and Registered Managers Award, and is very experienced in working with older people. The Manager told the Inspector that he operates an “open door policy” and “works the floor” to ensure he is aware of what goes on at the home. The Manager is to introduce a new quality assurance questionnaire in the new year, in order that he can, where possible give the people who live at St. Michaels what they want. The inspector saw that insurance cover is in place to meet the National Minimum Standards. There is a business and St Michaels Nursing Home DS0000042588.V273507.R02.S.doc Version 5.0 Page 17 financial plan for the home, which would be available to the Commission for Social Care Inspection upon request. Residents are encouraged to manage their own affairs with the help of relatives or advocates if necessary. St. Michaels offers formal bi-monthly supervision to all care staff. Non-care staff and volunteers are also offered supervision. The Manager informed the Inspector that risk assessments are completed for both the home and individual residents, and that all staff members have received induction training together with fire safety, manual handling and infection control. Records of accidents, injuries and untoward incidents are recorded and reported appropriately, however not all the necessary paperwork with regard to new staff members was in place. All records are kept in a secure manner. St Michaels Nursing Home DS0000042588.V273507.R02.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 2 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 X X 3 2 St Michaels Nursing Home DS0000042588.V273507.R02.S.doc Version 5.0 Page 19 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 OP27 Regulation 18(1a) Requirement At all times suitably qualified, competent and experienced staff are employed in the care home in such numbers as are appropriate for the health and welfare of the residents. All staff must be recruited so as to ensure they are fit to work with vulnerable adults. Timescale for action 31/12/05 5. OP29 19 and Schedule 2 31/12/05 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 OP8 Good Practice Recommendations That residents be weighed on a regular basis. St Michaels Nursing Home DS0000042588.V273507.R02.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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 DS0000042588.V273507.R02.S.doc Version 5.0 Page 21 - 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. 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