CARE HOMES FOR OLDER PEOPLE
St Michaels Nursing Home 19-21 Downview Road Worthing West Sussex BN11 4QN Lead Inspector
Miss Helen Tomlinson Unannounced Inspection 25th July 2006 10.45a 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.V300189.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.V300189.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 01903 500398 info@stmichaelscare.com 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.V300189.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 19th December 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 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. . St Michaels Nursing Home DS0000042588.V300189.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspector arrived at the home at 10.30am and left at 5.30pm. A second visit on the 27th July at 1.30pm was made to view the staff files. These had been inaccessible on the first day of the inspection. The registered manager was present throughout the inspection. At the time of this inspection twenty seven residents were accommodated. Prior to the visit to the home information was gathered from previous inspections and information received regarding the service. During the inspection a full tour of the premises took place, inspectors spoke to the residents, staff and manager. Care practices were observed, care plans examined and other documents seen as necessary throughout the inspection. Three residents were accommodated who’s needs were not included in the category of registration for the home. Staff had not been trained to meet their specific needs. The manager was required to review these resident’s care, with other people involved in their support. At this inspection an issue of serious concern was raised regarding the recruitment of staff. The information gained from prospective staff members was inadequate and not all necessary checks had been completed to ensure the protection of the vulnerable adults accommodated. The manager was required to take immediate action and the matter was brought to the attention of the service providers, in writing. A requirement regarding this remained unmet from the previous two inspections. The Commission will monitor compliance with this requirement. Following the last inspection two requirements were made. One, as above remained outstanding the other was met. At this inspection six requirements were made. Good practice recommendations are within the body of the report. What the service does well:
Residents spoke highly of the staff saying they were “helpful, polite and caring.” One relative said they were sure their loved one was well cared for and the staff “treat residents like a member of their own family.” Staff said they liked working at the home and it was a good team with support from the manager. They liked the amount of training provided and said this made them feel more valued. The written care plans and health assessments were regularly reviewed and comprehensive. Medication was safely stored and administered. Care was delivered in a manner which respected the privacy and dignity of the residents. Residents could have visitors to the home at any reasonable time. Those spoken with said they were welcomed into the home and could discuss any issues or concerns with the manager or any member of staff. Residents praised the food saying it was “tasty, varied and they were served plenty.” They could have hot and cold drinks throughout the day and said staff were very helpful at mealtimes, which was a social occasion, should they wish
St Michaels Nursing Home DS0000042588.V300189.R01.S.doc Version 5.2 Page 6 to be in the dining room. For those residents who needed assistance with meals staff gave this appropriately. Staff received statutory and other training, which they appreciated and was relevant to the residents accommodated, other than those with mental health needs. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
St Michaels Nursing Home DS0000042588.V300189.R01.S.doc Version 5.2 Page 7 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.V300189.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.V300189.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Residents needs were assessed prior to them being accommodated in the home although insufficient information was recorded to evidence how the home could meet those needs. Staff had not received appropriate training to meet the needs of all residents accommodated. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service EVIDENCE: Assessments were seen on the files examined. These were not dated and the place they had been completed was not recorded. These assessments were carried out by the registered manager and recorded on a dependency scale. It was discussed that this gave no background information to the needs, health condition, or reason for a resident being accommodated, rather a scoring for daily living activities. Social services and nursing care funding assessments were present. There was no evidence the resident or their representative had been informed, in writing, that the home could meet their needs. A discussion took place regarding three residents who had been accommodated in the home, with needs which were outside of the category of registration. This meant staff had not received appropriate training or were
St Michaels Nursing Home DS0000042588.V300189.R01.S.doc Version 5.2 Page 10 employed in sufficient number to meet their needs, along with the other residents accommodated. The registered manager agreed to liaise with other services to re-assess their needs. St Michaels Nursing Home DS0000042588.V300189.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 All residents had a comprehensive plan of care documented which had been drawn up from health and risk assessments. Their physical health care needs were met, but not all mental health needs were met. Medication was safely stored and administered and records were kept. Some practices did not protect the dignity of the residents. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service EVIDENCE: All residents accommodated had a plan of care recorded. These contained detailed information regarding the resident’s needs and how these should be met. The care plans seen had been reviewed monthly, or more frequently if a change in the resident’s care had occurred. Health and risk assessments were recorded, including the risk of developing a pressure sore, moving and handling, risk of falls and nutrition. Residents had not been weighed, despite the nutritional assessment indicating a risk of weight loss. The manager reported the weigh scales had been recently purchased and this would commence the following week. Some residents were moved in wheelchairs which did not have footplates in place. This presents a risk to residents and should not occur. Moving and handling equipment was appropriately used,
St Michaels Nursing Home DS0000042588.V300189.R01.S.doc Version 5.2 Page 12 however the dignity of the residents, when being moved in the hoist, was not protected. Assessments of the resident’s mental health had been carried out, however staff had not received training to meet some of these needs. When staff were assisting residents with personal care bedroom and bathroom doors were closed. Staff spoke to residents politely and showed them respect. Some staff were seen to enter bedrooms without knocking on the door. The qualified nurses in the home administered the medication. All medication was safely stored and administration records kept. A prescribed cream for one resident was found in the bedroom of another. A risk assessment had not been completed for one resident who stored and administered their own medication. St Michaels Nursing Home DS0000042588.V300189.R01.S.doc Version 5.2 Page 13 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): 12,13,14 and 15 Residents were not satisfied with the social aspect of life in the home. Relatives were supported and encouraged to visit residents. Choices and preferences were understood and respected. Residents praised the food served. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service EVIDENCE: Residents spoken with said some activities did take place in the afternoons. A weekly programme was on display. Activities were described as “not regular” and dependant upon the staff on duty and if they enjoyed doing them. Other residents said they were “bored” with “nothing to do.” There was no designated person to carry out the activities and this had to fit with their general caring duties. Staff spoken with said they mostly did not have time to organise activities and many residents were unable to join in. Visitors spoken with said they could visit the home at whatever time they liked and stay as long as they wished. They were complimentary about the staff and the welcome they received, saying the manager always kept them informed of their relatives condition. One visitor said staff “treat residents like a member of their own family” and they felt sure that their relative was well cared for. Residents spoken with said their choices for daily routines and personal preferences were respected. Some of these were recorded on the plans of care and the cook had food likes and dislikes recorded in the kitchen.
St Michaels Nursing Home DS0000042588.V300189.R01.S.doc Version 5.2 Page 14 Residents said they enjoyed the food, which was described as “good home cooking.” A four week menu was in operation which offered nutritious and varied meals. Alternatives were available, but not actively offered, for each meal. The menu on display did not correspond to the meal served on the day of the inspection St Michaels Nursing Home DS0000042588.V300189.R01.S.doc Version 5.2 Page 15 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 and 18 Residents were confident their complaints and concerns would be taken seriously and acted upon. Residents were protected from abuse. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: One complaint had been received, by the manager, since the last inspection. The investigation and outcome had been recorded and the complaint was resolved to the complainants satisfaction. A complaint procedure was on display. Residents and visitors spoken with said they would discuss any issues with the manager, who was described as very approachable, or any senior member of staff. They said if they had had cause to do this it had been resolved quickly. The manager said all staff had received training in the protection of vulnerable adults. No allegations of abuse had been made at the home. Staff spoken with were aware of their responsibilities to protect the vulnerable adults in their care and knew the procedures to follow should they have any concerns. St Michaels Nursing Home DS0000042588.V300189.R01.S.doc Version 5.2 Page 16 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): 19,22 and 26 The home was generally clean, tidy and free from offensive odour. The gardens were not inviting for residents. Several issues were noted which could present risks and hazards to residents. Equipment was provided suitable to meet the resident’s needs. Some toilet facilities were not suitable for residents needing assistance. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service EVIDENCE: On arrival at the home it was tidy, generally clean and free from offensive odours. Some areas, such as surfaces in resident’s bedrooms, were not clean. Residents spoken with said they liked their bedrooms and had been able to bring in personal items. Throughout the inspection fire doors, including bedrooms, laundry and communal areas, were wedged open. This presents a risk to residents and should not continue. On arrival the front door was unlocked, despite a notice to the contrary, and no-one answered the doorbell. This allowed the inspector to enter the home unchallenged. Some areas of the home had been brightened by redecoration and new chairs in the lounge were
St Michaels Nursing Home DS0000042588.V300189.R01.S.doc Version 5.2 Page 17 appreciated by the residents. The large gardens were not well maintained, flowers and plants being sparse, with no suitable furniture or umbrellas for shade. Some residents said they would like to sit outside, when it was a bit cooler as the day was very hot. There were ramps providing access to the garden, from the lounge, which were worn and had a gap between them and the door frame, which could present a hazard. The two toilets nearest the lounge, which were well used by residents, could not be accessed fully with any moving and handling equipment, resulting in screens being used in the corridors. These do not protect the privacy or dignity of the residents and an agreement to develop a suitable toilet had not been fulfilled. One bathroom was being used to store items of equipment, which were filling the room, but it remained accessible to residents. Not all residents who were in their bedrooms had their call bells within reach. All staff had completed infection control training and were seen to wear protective clothing appropriately. St Michaels Nursing Home DS0000042588.V300189.R01.S.doc Version 5.2 Page 18 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): 27,28,29 and 30 A sufficient number of staff were working in the home who had received training to meet the majority of needs of the residents accommodated. The recruitment of staff did not protect the vulnerable adults in their care. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The staff rota was examined. This showed a sufficient number of qualified and care staff on duty to meet the needs of the residents accommodated. Since the last inspection the manager had additional supernumerary hours to complete necessary managerial duties. Staff spoken with said a sufficient number of staff were on duty to carry out the work they were doing. A recognised tool to assess the staff needed to meet the dependency of the residents was used by the proprietor. This was not reviewed with a change in needs of the residents accommodated. Seventy five per cent of care staff had completed NVQ level two or above. This exceeds the number reccommended. Other training had been carried out which staff said was helpful in their day to day work. This included the statutory training and additional training on specific clinical areas and meeting these care needs. Some staff had received training in the care of people with dementia or other mental health problems. It was observed that this did not adequately equip staff to meet the mental health needs of all residents accommodated. Three staff files were examined. These did not contain the information necessary to ensure the protection of the vulnerable adults they cared for. Two members of staff were working at the home without a check having been carried out on the Protection of Vulnerable
St Michaels Nursing Home DS0000042588.V300189.R01.S.doc Version 5.2 Page 19 Adults Register. The manager stated they would not work again until satisfactory checks had been obtained. For one staff member there was no identification and the references supplied had not been verified. A requirement regarding the safe recruitment of staff remains unmet from the last inspection. A letter of serious concern regarding this was sent to the provider, following the inspection. St Michaels Nursing Home DS0000042588.V300189.R01.S.doc Version 5.2 Page 20 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): 31,33,35 and 38 The home was run by an experienced and qualified manager. A formal system of reviewing the quality of care in the home was not in place. Resident’s personal finances were not managed by the home. Several issues of health and safety were noted. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service EVIDENCE: The registered manager has been in this position at St. Michaels for over one year. Prior to this he had managed other care and nursing homes for older people. He is a level one qualified nurse and holds the registered manager’s award. He has many years experience in working with older people. There was no formal quality review system in place at the home. A questionnaire had been sent to relatives. No audits took place. There was no evidence of a quality review system, which incorporates a continual improvement of the service. The manager stated no residents personal finances were managed by
St Michaels Nursing Home DS0000042588.V300189.R01.S.doc Version 5.2 Page 21 the home. This was done by their themselves or a relative or other representative. Records of accidents were in place. Several issues of health and safety regarding the environment were noted. These included lack of security, poor fire safety and hazards through unsafe storage. St Michaels Nursing Home DS0000042588.V300189.R01.S.doc Version 5.2 Page 22 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 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 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 2 X 2 2 X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 St Michaels Nursing Home DS0000042588.V300189.R01.S.doc Version 5.2 Page 23 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 OP3 Regulation 14 Requirement An assessment of need, which includes consultation with and confirmation to the resident or relative, must be carried out and recorded prior to any resident being accommodated. Only residents whose needs can be met by staff at the home, should be accommodated. The home should be conducted in a manner which protects the privacy and dignity of the residents. The use of screens to block doorways when residents are using a toilet must cease and appropriate facilities be provided. A programme of activities which meets the needs of the residents must be provided and take place. All fire doors must be kept closed, unless held open by a device which meets the guidance of the fire authority. All staff must be recruited so as to ensure they are fit to work with vulnerable adults. This requirement remains
DS0000042588.V300189.R01.S.doc Timescale for action 31/08/06 2 OP10 12(4)(a) 30/09/06 3 OP12 16(2)(n) 31/08/06 4 OP19 13(4)(a) 31/08/06 5 OP29 19 and Schedule 2 25/07/06 St Michaels Nursing Home Version 5.2 Page 24 6 OP33 24 unmet since the inspections of 26/07/05 and 19/12/05 . The timescale given of 31/12/05 has expired A system of reviewing and improving the quality of service provided must be in place. 30/09/06 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.V300189.R01.S.doc Version 5.2 Page 25 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
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