Inspection on 25/06/07 for St Michaels Nursing Home

This inspection was carried out on 25th June 2007.

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.

Other inspections for this house

St Michaels Nursing Home 22/11/06

St Michaels Nursing Home 03/05/06

St Michaels Nursing Home 05/01/06

St Michaels Nursing Home 08/09/05

St Michaels Nursing Home 04/03/05

St Michaels Nursing Home 29/09/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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 9 Chesterfield Road Brimington Chesterfield Derbyshire S43 1AB Lead Inspector Sue Richards Key Unannounced Inspection 25 June 2007 09:30 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 DS0000059738.V336382.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 DS0000059738.V336382.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Michaels Nursing Home Address 9 Chesterfield Road Brimington Chesterfield Derbyshire S43 1AB 01246 558828 01246 233768 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) Sun Care Homes Ltd 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 DS0000059738.V336382.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 39 service users to be accommodated, which includes x 3 service users aged under 65 years, category PD as named in the notice of proposal letter. The registration includes the accommodation of a named service user under the category DE, E - not transferable to any other service user, other than the person named. Completion of the programme of redecoration, upgrading and renewal of the fabric of the home in accordance with that detailed separately in writing - letter dated 220506, by 31 October 2006. (Completed as at key inspection of 22 November 2006). 22nd November 2006 2. 3. Date of last inspection Brief Description of the Service: St Michaels Care Home provides accommodation, nursing and personal care and support for up to 39 older persons. It is located approximately 2.5 miles north east of Chesterfield town centre on a direct bus route and within a residential area. The home provides a choice of lounge/dining space and individual accommodation comprises of 29 single bedrooms and 10 shared (two of which are currently used for single occupancy). Fifteen of the single bedrooms have an en suite. There is a pleasant enclosed rear patio and wellkept garden area providing a choice of seating, which is accessed via a conservatory. There is a choice of bathroom and toilet facilities to each floor. A passenger lift is provided and there is an emergency call system throughout the home. A variety of disability equipment is provided, both environmental and individual equipment. Individual’s care is assessed, planned and reviewed by Registered Nurses employed in the home, who are supported by a team of care and hotel services staff led by a recently appointed acting manager. The range of fees charged by the home are as follows: £393.65 to £495.50 per week. (Fees charged are dependant on individuals’ assessed needs, including whether or not they receive nursing or personal care only. This information was provided at our inspection visit). A copy of the most recent inspection report is openly displayed in the home and information is also provided about accessing this information in the home’s service guide. St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection report is based on all the information we hold about the service over the last 12 months. This includes the previous key inspection report of November 2006, information provided by the home by way of a completed annual questionnaire, six survey returns completed by or on behalf of people who live at the home and the unannounced site visit for the purposes of this inspection. During 2006, the home received two key unannounced inspections and one unannounced random inspection. Following the last inspection of this service in November 2006, we held a management review and wrote to the registered provider advising them of this, and detailing our concerns about the home and their persistent breaches of specified areas of regulation. We told the provider what we wanted them to do and why, and we asked them to provide an improvement plan telling us what they were going to do to make the improvements and to meet the requirements outlined to them. The provider submitted a written improvement plan as requested within the given timescale. During this inspection we monitored those areas where improvements are required in conjunction with our inspection of the key national minimum standards for older people. Case tracking was used as part of the methodology. This involved the random sampling of three service users whose care and service provision was examined more closely. Discussions were held with those service users (in accordance with their given capacities) and where possible their representatives and also the staff involved in their care. Individual’s care and associated records were examined and their private and communal accommodation inspected. At the time of this site/inspection visit, there were twenty-six service users accommodated, the majority of whom receive nursing care. What the service does well: People’s needs are effectively assessed in consultation with them. People live in a safe, clean and comfortable environment, which is reasonably well equipped, decorated and furnished and suits their needs. Visitors are welcomed in the home and people can see their visitors in private outside of their own rooms if they wish. Entertainments and seasonal celebrations are well promoted and organised. St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 6 People are provided with a good standard of food, which accords with their preferences and assessed needs. (This area was seen to have improved at our last key inspection and has continued to do so). What has improved since the last inspection? What they could do better: Consistently apply recognised standards of practise to the recording of medicines administration in order to reduce the potential risk to people of not receiving their medicines as prescribed. Continue to develop people’s written care plans to promote person centred care by ensuring that staff are familiar with people’s individual routines and lifestyle preferences, which relate to their personal care. Appoint to the dedicated activities co-ordinator post and seek to more actively promote a person centred approach to individual’s social care and lifestyle activities, which should accord with their expectations and preferences. Detail the names and contact details for the manager and registered provider in the homes complaints’ procedure alongside the stages of that procedure so as to better inform people. St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 7 Ensure that the person who manages the home submits an application for registration to the Commission as in the requirement section at the end of this report, in order to comply with the Care Standards Act 2000. Ensure that the improvements made concerned with the management and running of the home, including quality assurance and monitoring systems are sustained and continually developed in the best interests of the people who live and work there. Publish the results of satisfaction surveys and seek also to survey outside stakeholders. Produce an annual development plan for the home, which reflects aims and outcomes for people. Ensure that action is always progressed within agreed timescales to implement requirements identified in CSCI inspection reports. 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 DS0000059738.V336382.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 DS0000059738.V336382.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): NMS 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are effectively assessed in consultation with them. EVIDENCE: Case tracking was undertaken in respect of three people accommodated and their recorded needs assessment information was examined. These were reasonably well recorded. A revised needs assessment and careplanning format was in the process of being introduced into the home with the aim of promoting a more person centred approach to needs assessment and care planning. This was in place for one of the people case tracked, as recently admitted to the home. This included a daily living plan, which detailed St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 10 individual’s preferred daily routines and their likes and dislikes and detailed a more person centred approach. Copies of individual’s needs assessment and single care plan summaries were in place as provided by way of care management arrangements for the purposes of individual’s admission to the home. The Inspector was not able to hold in depth discussions with people case tracked due to their given individual capacities and illnesses. However, discussions were held with others, which indicated that people are regularly consulted about their needs and involved in their care reviews. Where this is not possible, this is done with their representatives, both family and outside health and social care. Family representatives said they well informed throughout the admission process, with plenty of opportunity to discuss matters concerning individual’s needs and care. The home does not provide for intermediate care. St Michaels Nursing Home DS0000059738.V336382.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. People’s health care needs are generally well met, although inconsistencies in the recording of medicines administration may place people at risk of not receiving medicines as prescribed. EVIDENCE: At the previous inspection of this service in November 2006 we judge that omissions of recording in respect of the health care needs of service users may potentially undermine their safety. We also made a requirement in the report of that inspection that Residents care plans must be reflective of their changing needs and always specify clear objectives and health/care interventions. (In this instance referring particularly to tissue viability/pressure ulcer prevention and access to outside St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 12 health care professionals). We also asked the home to provide us with a written improvement plan telling us what they were going to do to make improvements and meet the requirement outlined above, when they were going to do this by and who would be responsible, which they submitted to us within our given timescale. The written care plans of those people case tracked were examined and discussions were held with staff about the arrangements for individual’s care delivery. Care plans examined at this inspection were in accordance with individual’s risk assessed needs with access to outside health care professionals clearly triggered and ensured as required. They were also reflective of recognised guidance concerned with the care of older persons. A review of clinical practises in the home in respect of pressure ulcer prevention had been undertaken since the previous inspection. The care and records of one person recently admitted with a pressure ulcer was examined and discussed with staff, including documentation relevant to their wound care, which was satisfactory. See also staffing section of this report with regard to staff training in this area. Individual’s access to outside health care professionals for the purposes of specialist and routine health care screening was well accounted for. Comments made under section one regarding discussions with people case tracked apply here also in respect of the care planning process. Representatives spoken with regarding those people case tracked said that they were consulted about individual’s care and involved in their formal care reviews, which was appropriate given those people’s capacities and illnesses. However, people do not routinely sign agreement with their care plans. Out of six survey returns, five said that staff are usually available when they need them, that they usually receive the care and support they need and that staff usually listen to them. One person commented that when staff are taking their breaks there is no one to speak to. This was discussed with the manager who advised that since coming into post, she had recently reviewed staffs’ routines and practises in relation to their breaks in order to prevent this. One relative, who has been visiting the home daily for a significant time period said that, given the difficulties experienced over the last year, that there has been significant improvement and positive recently with regard to the care and support the home provides. People also said that, although there had been some recent issues regarding the attitude of a particular staff member towards individual residents (see St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 13 complaints section of this report). That staff were respectful in their approaches to them and felt they treated them with respect. Individual’s preferred term of address was clearly recorded within their needs assessment and care planning records and staff were observed to approach them accordingly. Our pharmacist inspector also visited the home on the day of this inspection and examined the systems and arrangements in place for the management and administration of medicines in home. This included looking at the medicines arrangements for those people case tracked. Individual’s care plans and daily records contained good detail in respect of their medicines. However, individual’s medication administration records were not all accurately recorded, including some inconsistencies in the recording. Staff responsible was observed to administer people’s medicines to them with care and courtesy and there is a clear record of receipt and disposal of medicines, providing a complete audit trail. Medicines policies were comprehensive and the home has regular advice and training visits, from the local supplying community pharmacist. Medication is appropriately and securely stored, although there was some overstocking for some items and an oxygen cylinder prescribed for one person, case tracked, kept in their own room was not stored securely in a suitable stand. Eye drops in use, were not dated when opened and so may have been used after the recommended timescale. As there was no stock available in the home to replace these with, we told the home in writing during the inspection, the immediate action they must take to rectify this. St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 14 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): NMS 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although some activities are organised for people, the more active promotion of a person centred approach to individual’s social care and lifestyle activities may better ensure that individual’s interests and needs are met in accordance with their expectations and preferences. People are provided with a good standard of food, which accords with their assessed needs. EVIDENCE: Discussions were held with some service users and their representatives regarding the arrangements for social contacts and activities. All said they were able to receive visitors when they chose and that visiting to the open is open. St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 15 They said that seasonal celebrations were always arranged, including birthdays that visits from outside entertainers were periodically arranged, although the activities co-ordinator post remains vacant. Crafts and board games are provided, and there are regular arrangements for religious expression and worship within the home. A monthly newsletter is also now issued for people who live at the home and their relatives and representatives. The May edition was seen. This provides general information about the home, diary dates, which include residents’ birthdays, church services, open appointment days with the registered provider, details of forth coming entertainment events details of access to a local day centre, puzzles and a ‘writers corner, which people are encouraged to contribute to. Completed surveys were returned to us from six people or their representatives regarding activities in the home. The majority indicated that activities were usually organised and that service users engaged in these in accordance with their choices and/or individual capacities. However one person said they sometimes were. Many felt that access would be improved with the re-establishment of an activities co-ordinator. The manager stated that they were attempting to recruit to this post. During discussions with people, some felt that staff knowledge and understanding of individual’s preferred daily living routines could be improved, in order that these may be upheld. Some aspects of these were recorded within individual’s care records, although not consistently. This was discussed with the manager and staff who felt that once all care plans were transferred onto the new format, that this would promote more consistency of approach. The revised needs assessment and care planning format being introduced, which was in place for one person case tracked, included some information in respect of their assessed social care needs and life history and there was also a recorded social care plan for that person. A life story book was in place for this person, which the home are seeking to introduce for all people who consent as part of implementing the ‘Dignity Challenge’ strategy, aiming to better promote people’s dignity. However, care-planning information was brief and there was little recorded in terms of individual’s choices made and their actual engagement and participation in social and recreational activities. During the inspection a small group of people engaged in a game of bingo in the lounge area. The Inspector was advised that there were no service users accommodated at the time of the inspection who had chosen to handle their own finances, all having representative who did this on their behalf, either by way of relatives or social services. All residents spoken with said they were able to bring their St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 16 own personal possessions into the home with them and the bedrooms, which were inspected of those residents case tracked reflected this. Written information was provided regarding access to advocacy in the entrance area of the home. Discussions were held with service users and their representatives about meals provided in the home. Satisfaction with food provided was variable from being always satisfied to usually satisfied. All people surveyed said they usually liked the meals at the home and comments were received that the quality of meals had improved following the recent employment of a new chef. Drinks were provided for service users at regular intervals throughout the inspection. Residents spoken with said they were offered plenty of drinks. There were no persons accommodated with diverse religious or cultural requirements in respect of their diet, although the manager advised that these would be provided in accordance with any prospective persons assessed or expressed. Copies of menus were provided. These detailed a balanced nutritious diet. Lunches served during the inspection were suitably prepared in accordance with people’s assessed needs and presented in an unhurried and calm manner and service users received the support they needed. St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 17 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): NMS 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management and handling of complaints by the home is substantially improved, thereby increasing people’s confidence in the home’s ability to listen, take seriously and act upon any complaints or concerns, which may be made. EVIDENCE: There is a clear written complaints procedure in the home, which is openly displayed and also details are provided within the home’s service user guide (or brochure). However, this does not provide names and contact details of the manager and registered provider. Service users and their representatives spoken with during the inspection said they knew how to complain. Out of the six survey returns all said that they knew how to complain. One of those indicated that they had raised a complaint, however, this related to an outside health care professional and not directly concerned with the home Over the preceding 12 months until January 2007 there have been eight complaints about the home. Five of these were made directly to the Commission, with four of these directly related to the management of the St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 18 home and one regarding the alleged poor standards of food provided. All of these were passed to the provider to investigate and all were also monitored by us by way of a random inspection to the home in July 2006 (following the key inspection of May 2006) and a further key inspection of the home in November 2006. All of these complaints were substantially upheld. We also met with the registered provider to discuss our concerns about the complaints and their management and handling of these. At the last key inspection, we also made a requirement that the home must take seriously and properly investigate any complaint made to them. They have taken suitable action in respect of these. The sixth complaint was made directly to the home regarding an alleged lack of health care in respect of a named individual. We are advised that this is unresolved and is currently with the Ombudsman. The final two complaints were investigated via local authority safeguarding adults’ procedures. One made in June 2006 alleged neglect and poor care of a named resident. Satisfactory action was taken by the home as agreed via those procedures, which are now closed. Since January 2007 the home has received a complaint regarding missing items of clothing. This is recorded in the home’s complaints record as resolved to the satisfaction of the complainant. The other concerned an allegation made directly to the home in March 2007 of physical and psychological abuse of a resident by a care staff member. The home acted immediately and reported this to relevant authorities, including local authority safeguarding adults’ procedures. During and following the investigation, the home took appropriate and satisfactory action to ensure the safety of people living at the home. The allegation was upheld. Records of complaints were not being properly made at the random inspection for this service in July 2006. Records were examined during the key inspection in November and at this key inspection and were satisfactory. There is relevant key policy guidance in place for staff with regard to recognising and preventing abuse and safeguarding adults’ procedures. Staff is provided with training in respect of these, together with regular updates and are familiar with their responsibilities in relation to these. St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 19 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): NMS 19, 23 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a safe, clean and comfortable environment, which is reasonably well equipped and suits their needs. EVIDENCE: The private and communal accommodation for people case tracked as inspected, together with a small number of other bedrooms, which were randomly chosen for inspection. These were clean and odour free, comfortable and reasonably well furnished and decorated. All areas were suitably equipped in relation to the assessed care needs of those people case tracked, including specialist beds and mattresses and including the laundry. All bedroom doors have suitable locks, St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 20 which can be accessed by staff in the event of an emergency and lockable storage space. Bedrooms were personalised and people spoken with said they were satisfied with their environment. Of the six survey returns five said the home was always fresh and clean and one said it usually was. A few bedrooms had wall lights, which were not working. However, the manager had completed an environmental audit since coming into post, which included areas of maintenance and had begun to put together a written programme for the ongoing maintenance, repair and upgrading of the home. This included a review of beds and bedding and some bedroom and en suite floor coverings, replacement of some comfortable chairs and the provision of a kitchenette area to be accessible to people accommodated, together with ongoing areas of routine redecoration. Funding was also recently secured for the upgrading of bathrooms in the home. Commodes were replaced with new since our previous inspection and there were suitable waste bins in accordance with requirements made in the previous inspection report in November 2006. Some orientation signing was provided, together with a large faced clock in the dining room to assist those people who may have sight difficulties. St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 21 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): NMs 27, 28 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are being effectively recruited, inducted, trained and deployed, which is in the best interests of people accommodated. EVIDENCE: At the previous inspection of this service we judged that people’s needs were not always met by the numbers and skill mix of staff who were not all sufficiently trained, which may place them at risk. We made a requirement in the report of that inspection that there must be suitably qualified, competent and experienced persons working at the care home in such numbers as are appropriate to the health and welfare of residents. And that staff must undertake training appropriate to the work they are to perform. We also asked the home to provide us with a written improvement plan telling us what they were going to do to make improvements and meet the requirements outlined above, when they were going to do this by and who would be responsible, which they submitted to us within our given timescale. St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 22 During this inspection we examined the arrangements for the recruitment, induction, training and deployment of staff. We did this by discussing these with staff, examining related records, observations, discussions with people who use the service. We also obtained written feedback about staffing arrangements from six returned survey questionnaire from people who use the service. At this inspection there were 26 people accommodated, mostly in receipt of nursing care. The arrangements for staff deployment had improved considerably and feedback was positive from people accommodated and from staff regarding the improvements made and the positive impact this has had on the care and support people receive. Staff said that morale was much improved and that they had ‘time to care for people.’ Staff also said that there were effective training arrangements and they received good support from the manager and the rest of the team. The care team consists of people from a variety of cultures, although is predominantly British white. Equal opportunities monitoring is undertaken as part of the staff recruitment process and the home operates and equal opportunities policy. Staff training needs analysis and a training plan and planned programme is in place for 2007. This included all key core areas to ensure staff safe working practises and also training in positive approaches to dealing with aggression, nutrition, tissue viability and infection control and dementia care. Good progress is made with the programme. Eighty four percent of staff have achieved at least NVQ level 2 with a further eight who have registered to do either NVQ level 2 (new staff starters) or NVQ level 3 (existing staff). The personal records of four staff were examined. These contained all satisfactory information as is required for the purposes of their recruitment, together with their training records. A comprehensive induction programme had been reinstated for new staff starters, the format of which was provided and is satisfactory. However, copies of completed induction records were not kept with the personal files of new staff starters. Staff spoken with confirmed the induction process, which included supervised practise and the records they kept as retained by them. We discussed the need for the home to retain a copy of completed induction records for each staff member. Staff deployment arrangements observed on the day of the inspection are appropriate to the needs of people accommodated. St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 23 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): NMS 31, 33, 35, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The clear and positive improvements made concerned with the management and running of the home, if sustained and developed, should continue to promote the best interests of people and their health, safety and welfare. EVIDENCE: At the previous inspection of this service in November 2006 we judged that the home was not being effectively run in the best interests of people and that their health, safety and welfare (including that of staff) was not always best promoted, which may place people at risk. St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 24 We held a management review and wrote to the registered provider advising them of this and about our concerns regarding persistent breaches of regulation. We told the provider what we wanted them to do and why and we asked them to provide an improvement plan telling us what they were going to do to make the improvements and to meet with the requirements outlined. The provider submitted a written improvement plan as requested within the given timescale. The home has been without a registered manager for the most part of two and a half years, with a series of acting management arrangements during this period, with the exception of a registered manager appointed during the summer of 2005, who left her employment in January 2006. Since we held our management review about the home, the registered provider has secured management consultancy for the home and appointed a new manager. The manager commenced their employment at the end of February 2007. She has to date not submitted an application for registration with the Commission. This was discussed with her during our inspection. People accommodated, their representatives and staff made many positive comments about the management changes in the home since the recruitment of the manager and staff said they were better supported and felt organisation and leadership to have improved considerably. At the previous inspection of this service we made a requirement to maintain an efficient and competent system for reviewing at appropriate intervals and improving the quality of care and service provided by the home, including nursing care. The manager had recently distributed satisfaction surveys to all people accommodated (or their representatives) about the home. A number of returns were received, with other awaited. Open days are advertised, which are held each month giving people formal opportunity to speak with the registered provider and external management to discuss any matters they choose. There has been reasonable uptake with this group meetings are reestablished. A formal quality assurance monitoring system was being re-introduced, commenced by way of formal internal auditing of the home and its services. To date, an environment audit has taken place and an action plan was being put together. Staffing systems and care files were also being audited and monthly health and social care audit was in place. A monthly management report and action plan is in place and the registered provider also provides written reports of their monthly visits to the home, which consider the quality of care and services the home provides. St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 25 A formal system of individual staff supervision was being rolled out and records are kept regarding these. The arrangements for the management and handling of people’s monies by the home were examined for two people case tracked, for whom the home handles and safe keeps monies on their behalf. These were satisfactory. The arrangements for safe working practises were discussed with the manager and staff and observed during the course of the inspection. Related records were also examined in respect of staff training and also the system for the reporting and recording of accidents and untoward incidents. These were satisfactory. Details of the arrangements for the maintenance of equipment in the home were provided in the AQAA pre-inspection questionnaire and are satisfactory. Suitable arrangements were also made regarding the review of the home’s recorded fire risk assessment, which was a requirement made at the previous inspection of this service. St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 26 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 X X X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 2 X 3 St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 27 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 OP9 Regulation 13(2) Requirement All medicines with a shortened expiry date must be dated when opened and discarded after the recommended timescale to ensure that they are not used when they have become contaminated or lost potency. Medicines administration records must be accurately recorded and kept up to date in respect of any medicines administered to ensure that medicines are being given as prescribed and that residents’ healthcare needs are met. Oxygen must be safely and securely stored to prevent accidents to people in the home. The substantial improvements made to the organisation and provision of staff training must be continued and sustained to ensure that people consistently benefit from their needs being effectively met. The manager must submit an application for registration with the Commission if they are to continue to manage the home, DS0000059738.V336382.R01.S.doc Timescale for action 27/06/07 2. OP9 13(2) 31/07/07 3. 4. OP9 OP30 13(2) 18(1)(c) 31/07/07 30/09/07 5. OP31 Section 3, CSA 2000 26/08/07 St Michaels Nursing Home Version 5.2 Page 28 6. OP33 24 as it is an offence to carry on or manage a care home without being registered to do so. The home’s formal quality assurance and monitoring systems must continue to be developed to ensure that there are consistent and ongoing mechanisms in place to measure success in meeting the aims and objectives and statement of purpose of the home. (The establishment of such a system was a requirement in the previous report – as this is partially complied with we have agreed to extend this timescale). 30/09/07 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. 2. Refer to Standard OP7 OP7 Good Practice Recommendations Care plans should be agreed and signed by the resident whenever capable, or their representative (if any). NMS 12 also applies here. The home should continue to develop care plans in order to better promote the philosophy of person centred care by ensuring that staff are familiar with people’s individual routines and lifestyle preferences, which relate to their personal care. The home should seek to appoint to the activities coordinator post and continue to develop social care and activities for people, in order to improve the promotion of a lifestyle in the home, which matches their individual expectations, interests and needs. The complaints procedure should detail the names and contact details for the manager and registered provider alongside the stages of the procedures, in order to better inform people. The results of satisfaction surveys should be collated and published and outside stakeholders should also be periodically surveyed as a mechanism for obtaining DS0000059738.V336382.R01.S.doc Version 5.2 Page 29 3. OP12 4. OP16 5. OP33 St Michaels Nursing Home 6. OP33 feedback from people who use and access the service. There should be a written annual development plan for the home, based on a systematic cycle of planning – action – review, reflecting aims and outcomes for people. St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. Extracts may not be used or reproduced without the express permission of CSCI St Michaels Nursing Home DS0000059738.V336382.R01.S.doc Version 5.2 Page 31 - 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. 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