Inspection on 23/01/08 for St Michaels Nursing Home

This inspection was carried out on 23rd January 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Michaels Nursing Home 17/12/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St Michaels Nursing Home 19-21 Downview Road Worthing West Sussex BN11 4QN Lead Inspector Ed McLeod Key Unannounced Inspection 23rd January 2008 09:15 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.V358343.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 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 info@stmichaelscare.com St Michaels Care Homes Limited Post Vacant 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.V358343.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. A maximum of 37 Service Users may be accommodated 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 5th July 2007 Date of last inspection Brief Description of the Service: 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 £650. St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this is service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection visit was arranged to follow up requirements made in the previous inspection report, and to update assessments of the key standards from the national minimum standards for care homes for older people. The visit was carried out by one inspector who was on the premises for six hours and twenty five minutes. In preparation for the visit we looked at the previous report, and obtained updated information on the service from their annual CSCI questionnaire audit (the AQAA) – which was completed by the acting manager - and information received on the service from the provider and other agencies. Our preparation also included gathering and assessing views on the service from CSCI survey forms. Seven survey forms completed by relatives or advocates for people living in the home were returned to us, and five survey forms completed by staff working in the home were returned to us. During our visit we spoke to three people living in the home, two visiting relatives, three members of staff, the acting manager and the registered provider. These interviews have also helped inform this report. During our visit we sampled four sets of admission records, care plans and risk assessments. We also sampled four sets of staff recruitment and training records. We visited ten bedrooms, all communal areas, and kitchen and laundry areas in the home. We observed some interactions between staff and people living in the home. During our visit we also sampled records including some referring to health and safety practice in the home, complaints records, and an activities plan. What the service does well: In the absence of a permanent manager, the acting manager has helped ensure a consistent level of care is being provided in the home. St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 6 People’s right to privacy is respected and the support they get from staff is given in a way which maintains their dignity. Survey forms we received included comments such as “the staff are ably led” and “the staff are very caring and always treat residents with dignity”. People are able to keep in touch with family, friends and representatives. All five staff who completed CSCI surveys said they were well supported and have access to training to give them the skills to care for people in the home. There is a good atmosphere in the home. What has improved since the last inspection? What they could do better: St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 7 Care plans and risk assessments are not setting out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the person are met. The management of the home must ensure that good care plans are in place, and that staff are receiving the required levels of supervision. The care home could better develop how it supports people to follow personal interests and activities. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. EVIDENCE: It was found at the previous inspection visit that the needs of prospective residents were not always assessed prior to admission. At the previous visit we required that an assessment of need that includes consultation with and confirmation to the resident or relative, must be carried out and recorded prior to any resident being accommodated. St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 10 At this visit we sampled the pre-admission assessments for four people admitted to the home since our previous inspection. We found that pre-admission information had been obtained and that the home had assessed the needs of people before admission. A letter to the prospective resident or their relative had been sent to confirm the person’s needs could be met in the home before their admission. This previous requirement was found to have been met. We asked the responsible individual Mrs Nathan if trial stays can be offered before someone makes a decision to move in or not. Mrs Nathan said she asked the manager to mention this when people visit. St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each person has a plan of care which they or someone close to them has been involved in making. Care plans and risk assessments however are not setting out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the person are met. The care home supports people who cannot manage their medicines in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way which maintains their dignity. EVIDENCE: St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 12 At the previous visit a requirement was made that the individual plan of care be generated from assessments of need and compiled in consultation with the service user or relative on admission to the home. At this visit we looked at four sets of care records, and found that an individual plan of care was in place for each of the four people. Care records seen included information that had been gathered on the individual interests of the person, but this was not being followed up in the care plan by advice to staff on how the person’s individual interests and social needs should be supported. For one person it was noted in the individual plan of care that they needed “encouragement to socialise” but it was not set out in the individual plan of care how this should be achieved. Care plans seen did not refer to when and how a person usually liked to get up or go to bed. When we asked about this, the responsible individual for the service, Mrs Nathan, advised that night staff and morning staff have a list of people who usually like to get up and their time. In the four care needs assessments we looked at, it was recorded for one person there was a need to ensure “enough fluids” were being taken, for another person that they needed “prompts to eat/drink”, with a third person that staff needed to “ensure drink often/enough”, and for the fourth person that there was a need to “encourage fluids”. The care plans and risk assessments seen did not however set out how the individual was to be encouraged to drink, and how the home would be measuring if enough fluids were being taken. We asked the acting manager about this, and asked how fluid intake was being recorded for the four people referred to above. The acting manager showed fluid charts that could be used, but could not confirm that fluid charts were being recorded for the four people mentioned. We noted during our visit that jugs of water and juice drinks were being provided in people’s bedrooms and in communal areas including the dining room. We also noted during breakfast and lunch that staff were assisting people who needed assistance and encouragement with drinking. It may be that people are being supported appropriately to take the amount of fluids they need to ensure their good health and wellbeing, but there is not sufficient evidence in the care records and guidance to staff in care plans to support this view. St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 13 If, for example, on admission to hospital a person was found to be dehydrated, the service would not have adequate evidence on which to properly advise what fluids had been taken. This was discussed with the deputy manager and Mrs Nathan. The deputy manager expressed the view that it would create too much work to monitor the fluid intake of every person in the home, but acknowledged that the individual’s needs assessment could be used to indicate if the person’s fluid intake did need to more closely monitored. We noted that in two of the care plans there was a printed daily hygiene routine which was word for word the same for each person, although it was clear from the needs assessments their hygiene needs were very different. We discussed this with the acting manager and Mrs Nathan, and put forward the view that the person’s wishes about how they wanted their personal care and hygiene to be provided needed to be ascertained and recorded in the individual plan of care. This would help ensure that staff are providing the person’s care in the way the person wishes. At this visit, a relative who said he had had concerns at the time of our previous visit about his mother not always wearing her own clothes said that now when he visited his mother was always wearing her own clothes and therefore he was satisfied that the home had resolved this issue. In the previous inspection report we advised that it would be good practice to review the use of wheelchairs during the lunch period and to provide suitable chairs and ensure foot supports are in place where appropriate. At this visit, we noted that a number of people were seated in wheelchairs at breakfast and lunch, and that one person in a wheelchair did not have the comfort and safety of foot supports on their wheelchair. We discussed this matter with the acting manager, who confirmed that some people were routinely being seated at the table in their wheelchair, and that one person who strongly resisted having foot supports on their wheelchair was not having foot supports put on their wheelchair. We asked if risk assessments were in place which supported these practices, and if care plans had been agreed with the person and their relatives concerning this. We found no evidence that such risk assessments were in place although there is a risk of discomfort (for example prolonged sitting in a wheelchair not designed for the person’s comfort) or injury (for example a leg not supported by a foot rest becoming stuck under the moving wheelchair). Another practice observed during lunch at our previous visit was people who didn’t need a feeding beaker or aprons being given these. We advised in our St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 14 previous report that it would be good practice to review the needs of each resident whilst eating lunch and to only provide those items where really necessary. At this visit Mrs Nathan told us that people were now offered the choice of using a napkin, and that new napkins had been purchased. We found during our visit that some people who needed more support were using aprons, and other people were using napkins. In this and some other ways (such as the recording of people’s interests and social needs) there was indication at this visit that people’s individuality and dignity is being more respected in the home. We talked to four people living in the home, two of whom could only engage with us in a limited way due to memory loss. One person living in the home we talked to said she didn’t wish to take part in many of the social activities in the home, and said this wish was respected by staff. We looked at the administration of medicines in the home. The acting manager advised us that only registered nurses in the home were administering medicines. We sampled arrangements for the storage, recording and disposal of medicines in the home, and were advised that the acting manager does regular checks on medication records and signs these where this has been done. St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care home could better develop how it 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 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. EVIDENCE: The acting manager told us that more activities are being provided for people living in the home, such as music and exercise and a singer. Photographs of entertainments that took place over Christmas were displayed on the wall, St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 16 such as the Christmas party, Irish dancers, Father Christmas and an Elvis Presley tribute. There is a weekly events schedule which sets out the entertainments and activities which will be taking place. On the day of the visit, a member of staff was doing some singing with people. As evidenced in the “Health and personal care” section of this report, care plans are not recording what support is to be provided for people to maintain their personal interests. One person we talked to said the home was supportive in helping her keep contact and receive visits from a friend, and was assisting her to have a phone line in her bedroom. Most of the seven relatives who responded to our CSCI survey said the home always helps people living in the home keep in touch with their relatives and that relatives are kept informed about important issues. We talked to two relatives on the day of our visit, and they said they felt welcomed when they visited and that staff were friendly. On the day of the visit the main course at lunch was meat pie, vegetables and potatoes, which was presented well. One person we talked to said it was “great”, and the meal was generally being well enjoyed. No alternative main course was being offered. The cook told us alternatives which can be offered for example are salads and omelettes. The cook said one person didn’t eat pork (for religious reasons) and one person who didn’t eat fish were always given alternatives which they liked. We asked the cook about specialist diets, and were advised that people with diabetes are served desserts made with sweetener rather than sugar, and liquidised diets (seen during our visit) were provided for people needing a soft diet. The cook told us that fresh fruit is always available and that a bowl of fresh fruit is put out. We noted during the lunch sitting that people who needed assistance with eating and drinking were receiving this. St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 17 St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. EVIDENCE: We looked at the complaints record for the home and found no complaints have been recorded since the previous inspection. Mrs Nathan told us that staff are encouraged to record complaints, and that this was raised at a recent staff meeting. A relative we talked to during our visit said the acting manager “always sorts out any niggles”. St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 19 At this visit, a relative who said he had complained about his mother not always wearing her own clothes said that now when he visited his mother was always wearing her own clothes and therefore he was satisfied that the home had resolved this issue. A member of care staff we talked to said she felt she could take any concerns she had to Mrs Nathan. Staff working in the home are receiving training in the safeguarding of vulnerable adults. The home has a copy of the updated procedures for safeguarding referrals in West Sussex, and the acting manager told us she had attended a briefing meeting on changes made to these local procedures. There has been a safeguarding alert raised, and an investigation into this is being undertaken by the local West Sussex County Council adult services team. The management of the home have been cooperating with this investigation. St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. The home has enough space and facilities for people to live the life they choose and meet their needs. Their room feels like their own, it is comfortable and they feel safe when they use it. EVIDENCE: St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 21 We looked at maintenance records for the home, and visited all communal areas and ten bedrooms. Generally the home is being well maintained, and where bedrooms have been recently decorated they had a brighter and fresher appearance than bedrooms which had not been recently decorated. Mrs Nathan advised that rooms are being redecorated when they are vacant, and some redecoration in bedrooms was planned accordingly within the next few weeks. The garden and external areas of the home are being well maintained. At our previous visit we found bathrooms and toilets in need of refurbishment, and some areas of the home such as the conservatory and bedrooms were in need of cleaning. Since the previous inspection, improvements to the environment have included the provision of two new shower rooms equipped to meet the needs of people in the home and refurbishment of one of the bathrooms. During our visit we noted that this work had been carried out to a good standard. Staff we talked to said the new shower rooms make it much easier for people to be assisted with washing, making it a more pleasant experience for them. The acting manager said that there had been improvements to cleaning routines in the home. We found that all parts of the home visited were clean. Bedrooms visited had been personalised with pictures and furniture by the people living in them, and were arranged to make assistance with transfers and handling easier. Risk assessments seen advised where a person was at risk of pressure areas, and the type of mattress to be used was recorded. Where an air mattress is being used, the acting manager advised us that the proper assessment of the setting for the mattress is carried out. Safety features in bedrooms include safety catches on all windows, and electronic door stops which are triggered when there is a fire alarm. As some people living in the home suffer from incontinence, arrangements are in place for the regular washing of carpets. Our visit to the laundry room indicated that suitable arrangements are in place for the handling of incontinence laundry. St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have safe and appropriate support as there are enough competent staff on duty at all times. They can 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. EVIDENCE: Mrs Nathan advised us that the home has been using the residential forum tool for calculating numbers of care staff required. Mrs Nathan said that staff numbers are varied according to the levels and care needs and numbers of people accommodated in the home. St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 23 Care staff advised us that four care staff are covering the morning shift, and they work in pairs as many people need two people to assist them with their personal care, mobilising and transfers. The acting manager advised us that there is a registered nurse on duty 24 hours a day, supplemented by the acting manager who is also a registered nurse. Care staff told us that there is usually one carer during a shift who is based in the lounge. All people we saw appeared clean, comfortable and well cared for. During the lunch sitting, which was unhurried and relaxed, there were enough staff to ensure people who needed assistance with eating or cutting food were receiving this. Training records seen indicated that staff are being supported to undertake qualification training. At the previous inspection we found that the recruitment procedures were not protecting people living in the home as some staff were commencing employment before references, criminal record checks or a POVA first check had been obtained. We looked at four sets of staff recruitment records and found that checks and references were in place before the staff had commenced work in the home. The previous requirement concerning this was assessed as met. All five staff who completed CSCI surveys said they were well supported and have access to training to give them the skills to care for people in the home. One carer said that staff had regular staff meetings and that she was “happy professionally”. She added that when new staff start they work side by side with more experienced staff to learn the job. A registered nurse on duty said she had recently undertaken safe handling of medicines training as part of Registered Mental Nurse training she was undertaking. She said her recent training included Dementia and MRSA. St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home would benefit from management arrangements which ensure staff are receiving supervision, and by the provision of care plans which set out in detail the individual’s care needs and how staff will meet these needs. The environment is safe for people and staff because appropriate health and safety practices are carried out. EVIDENCE: St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 25 The acting manager said she had been managing the service in a temporary capacity since the previous manager had left in December 2006. Mrs Nathan advised us that a number of candidates for the post had been interviewed during the past year, and interviews were continuing. The management of the home is however not ensuring that good care plans are in place, or that staff are receiving the required levels of supervision. In other areas it is our view that, in the absence of a permanent manager, the acting manager has helped ensure a consistent level of care is being provided in the home. Survey forms and interviews with staff and relatives lets us know that the acting manager is well regarded by staff and residents. We found that all three requirements made at the previous inspection have been met. People living in the home, their relatives, and staff we spoke to said there was a good atmosphere in the home. Survey forms we received also included comments such as “the staff are ably led” and “the staff are very caring and always treat residents with dignity”. A carer we spoke to said that Mrs Nathan has an open door policy, and staff can discuss any problem or issue with her. We found the atmosphere in the home to be good, and this view was supported by the comments of staff, relatives and people living in the home on the day of our visit. We looked at the results of a quality assurance survey carried out by the home in October and November 2007, which included seeking the views of people living in the home and their relatives or advocates. Comments were received such as “a very homely atmosphere with caring staff”. We asked Mrs Nathan if any improvements to the service had been made as a result of listening to the views expressed. Mrs Nathan advised that there were no suggestions for improvement made that the service thought they could take up. At the previous visit we found no record of individual supervision for new members of staff. St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 26 At this visit there was a lack of evidence that sit down supervision for staff is taking place. We were advised by managers and staff that staff have been taking part in annual appraisals. This consists of staff filling out a self-appraisals form which they then discuss with a manager. Mrs Nathan advised us that recorded supervision for staff has not been taking place due to the lack of a permanent manager. She advised us that staff supervision would commence again when a new manager was in place. For the management of a home to improve the service provided, the Commission believes that good staff supervision must be in place, as staff need to be able to contribute to how a home improves and receive proper professional guidance and support in doing their job. A requirement has been made concerning staff supervision. We sampled some of the health and safety records in the home, such as periodic environmental risk assessments and fire training records. Training arranged for staff between January 2008 and March 2008 included fire training, infection control, and manual handling. The cook advised us of the arrangements in place for kitchen cleaning and hygiene, which includes use of the Safer Food recording system. Door guards have been fitted to all bed rooms which helps ensure better safety for people in the home in the event of a fire. St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 X 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X X 1 x 3 St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 28 no 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 OP7 Regulation 15 Requirement For the good care and wellbeing of people living in the home, care plans must set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the person are met. Timescale for action 30/04/08 2. OP36 18.2 For the safety and wellbeing of 30/04/08 people living in the home, care staff must receive formal supervision at least 6 times a year. Supervision must cover all aspects of practice, philosophy of care in the home, and career development needs. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 29 St Michaels Nursing Home DS0000042588.V358343.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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