Inspection on 26/07/05 for St Michaels Nursing Home

This inspection was carried out on 26th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 23/01/08

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 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 Helen Tomlinson Announced 26 July 2005, 09:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Michaels Nursing Home H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 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 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 Care Home (CRH) 39 Category(ies) of Old age, not falling within any other category registration, with number (OP), (39) of places St Michaels Nursing Home H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 A maximum of 37 Service Users may be accommodated at any time. 2 Rooms 29-30 and 31-32 are only to be used by one (1) person. 3 A registered nurse is employed as the Registered Manager who has the knowledge, skills and experience to care for service users requiring nursing care. Date of last inspection 1 October 2004 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 homeis a large detached, three storey building situated in a residential areas of Worthing. Accommodation is provided in 21 single rooms and 9 double rooms. There are large gardens attached to the property and car parking to the front. Facilities include a large lounge, smaller conservatory style lounge with a glass roof and dining area, all on the ground floor. The upper rooms of the house are serviced by a passenger lift. The person acting as manager was awaiting registration with the Commission at the time of the inspection. St Michaels Nursing Home H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection. The inspector arrived at the home at 9.30am and left at 6.15pm. There was no registered manager working at the home at the time of this inspection, but the acting manager was awaiting an interview with the Commission, which, if successful, would confirm his position as registered manager. Over the course of the inspection 16 residents, 8 visitors, 6 staff members and 2 visiting professionals were spoken with. Staff were observed giving support and assistance. Three residents files were examined in detail and other records were seen as was necessary. A tour of the premises took place. Staff files were examined. 3 comment cards from relatives/visitors were received before the inspection. These contained favourable comments about the staff and general standards of care. What the service does well: What has improved since the last inspection? Staff, visitors and residents were very complimentary about the attitude and approach of the acting manager who was awaiting interview to become the St Michaels Nursing Home H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 Page 6 registered manager of the home. They commented favourably on the changes made since his appointment and his eagerness to improve standards. They discussed that “nothing was too much trouble” and any issues brought to his attention were quickly and satisfactorily managed. All the bedrooms have been re-decorated with new carpets and curtains fitted. The radiators have been covered. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Michaels Nursing Home H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection St Michaels Nursing Home H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Residents were not admitted to the home unless an assessment of their needs had been carried out. EVIDENCE: Three resident’s files were examined. These contained assessments of need which had been completed prior to assessment. In the case of the most recently admitted resident these had been completed by the acting manager. These included both a physical and mental health assessment. Where appropriate an assessment by other professionals was on file such as social services. St Michaels Nursing Home H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 and 10 Residents benefited from a written plan of care being documented. Resident’s health care needs were met. Residents were assisted by staff who respected their privacy and dignity. EVIDENCE: Three files examined contained comprehensive plans of care. These included health assessments such as nutrition, moving and handling, risk of developing a pressure sore, physical and mental health. These plans were clear and up to date with regular reviews having taken place. The nutritional plans could not be fully reviewed due to the sit on weigh scales being broken. These should be repaired as the weight of residents is a clear indicator of malnutrition. Risk assessments for the likelihood of falls had been carried out and a general risk assessment was included in the care plan. It was discussed with the registered manager that no assessment for the risk of using bed rails had been done, though these were in place for some residents. For one of the residents it was documented that they became agitated because of the bed rails and tried to St Michaels Nursing Home H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 Page 10 climb over. The use of bed rails must be subject to a risk assessment to ensure the risks are minimised and not increased by their use. The qualified nurses working in the home had a sound knowledge of the health care needs of the residents. They communicated with other health professionals and sought advice where necessary. Residents stated that the staff treated them with respect and this was observed during interactions between them both. Staff were seen to knock on bedroom doors before entering, shut bathroom doors and address the residents in a polite manner. When giving assistance to the residents the staff protected their dignity by being discreet. During use of the hoist they ensured the resident’s clothing kept them appropriately covered, or used a blanket. St Michaels Nursing Home H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 The food was nutritious with a choice offered which suited the residents and served in a pleasant environment. EVIDENCE: At lunch time a choice of meals was served and the residents said they had enjoyed the food. They said the meals were always good and the chef knew their individual likes and dislikes well. Staff assisted residents to eat and drink in a discreet manner. The liquidised food was mixed together and did not look appealing for the residents. The foods should be liquidised separately and served in a more appealing manner. Some residents ate in their own bedrooms if this was their choice. Most ate in the dining room which was nicely set and a pleasant environment to eat. Throughout the day staff assisted residents with hot and cold drinks. At morning coffee time there was a lack of staff in the main lounge which meant some residents were given hot drinks and not assisted to have them until 15 or 20 minutes later which meant they had gone cold. Other residents were left for this length of time with no staff supervision. There should be timely assistance for residents to have their drinks hot and they should not be left unsupervised for this length of time. St Michaels Nursing Home H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Any concerns or issues raised would be taken seriously and appropriate action would be taken. The procedures for reporting allegations of abuse did not adequately protect residents. EVIDENCE: A record of complaints made to the home was kept. These included the action taken to resolve the issues and ensure there was no re-occurrence. One visitor spoken with said that should they have to raise any issues with the manager then they were dealt with quickly and satisfactorily. Residents and visitors spoken with said they felt very comfortable at approaching the manager to discuss any concerns and felt confident he would “try his best.” A copy of the complaints procedure was in the service user guide on the table in the entrance hall. The manager was aware of the correct procedure to take should an allegation of abuse be made at the home. Not all other staff who may be in charge of the home were aware of the correct procedure to follow. The written procedure was correct and in line with the West Sussex guidelines. It was discussed with the manager that all staff who may potentially have an allegation of abuse made to them must be aware of the correct procedure to follow. Care staff had received training regarding the protection of vulnerable adults and understood their responsibility in this regard. St Michaels Nursing Home H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 Some equipment was not well maintained. The fire safety precautions where inadequate to protect residents and staff. The home was generally clean but some areas had an offensive odour present. Some spread of infection risks were present. EVIDENCE: The general decoration of the home was suitable for the residents living there. Day to day maintenance was carried out. Some areas of the home were showing signs of wear and tear and were in need of maintenance. The skirting boards on some corridors were badly marked and some bedrooms were in need of redecoration. Some equipment was in need of repair or replacement. There was a broken footstool in the lounge, several wardrobes and drawers in resident’s bedrooms had broken handles, one commode had a broken backrest and one small window on a corridor had a hole in it. These issues were brought to the attention of the manager and an audit of the equipment, St Michaels Nursing Home H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 Page 14 furniture and fabric of the building should be carried out. All equipment and furniture must be safe for use at all times. Many fire doors were wedged open at the bottom with wooden wedges. Fire doors to cupboards containing combustible material were left open. All fire doors must be closed at all times unless held open by a device approved by the fire service. The fire doors leading from the main lounge had bolts and chains attached. The manager said these were for security reasons, however staff were seen having difficulty opening these doors due to not knowing where the bolts were located. These must be removed and these doors not obstructed at any time. There were no call bells available for the residents in the lounge. Since they were without staff supervision for long periods of time this is not safe for the residents as assistance could not be called in an emergency. The home was generally clean and the residents said they were happy with the level of cleanliness of their bedrooms and communal areas. Some issues of cleanliness and potential hazard for the spread of infection were discussed. Some individual bedrooms had an offensive odour which was discussed with the manager. This should be eliminated. The small tables for general use in the lounge were rusty and not able to be cleaned adequately. Some were not clean at the time of the inspection with dried on food present. These should be cleaned or replaced. The bathroom which had been in use that morning had not been adequately cleaned following use. All areas of the home must be kept clean at all times. Staff were seen to wear protective clothing when appropriate. St Michaels Nursing Home H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30 The number of staff on duty was not adequate to fully meet the resident’s needs at all times of the day. The recruitment procedures were not adequate to ensure protection for the vulnerable adults in the home. Residents benefited from being cared for by staff who had received appropriate training. EVIDENCE: The number of staff on duty was one qualified nurse and four care staff from 8am to 8pm and one qualified nurse and two care staff at night. During the morning of the inspection this number was inadequate due to the majority of residents needing two care staff for assistance to get up. This left those residents who were up sat in the lounge without supervision or assistance being available. The qualified nurse was managing the medication and carrying out dressings and other nursing tasks. The potential risk to residents of being unsupervised was discussed with the manager. Residents reported to the inspector that at times, particularly in the mornings, if they use their call bells they are not answered quickly and they could wait quite some time. The number of staff on duty must be reviewed and must be adequate to meet the needs of the residents at all times. Two staff files were examined for the most recently recruited staff. These did not contain all the information required to ensure adequate checks had been St Michaels Nursing Home H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 Page 16 carried out to verify the suitability of the person to work with vulnerable adults. The relevant up to date police and Protection of Vulnerable Adult checks had not been completed prior to them starting work at the home. There was no full employment history, no photograph and no self declaration of offences on the file. One staff member had only one reference on file. It was discussed with the manager that no staff member must work in the home without all relevant checks having been carried out satisfactorily. These staff members must work under the supervision of an adequately experienced member of staff until the checks are received. All relevant information must be obtained for any new member of staff prior to them working in the care home. Training records were kept in the home. These indicated that all staff had the opportunity to undertake appropriate training for the work they were to perform. Two staff members had recently completed training in the care of people with dementia and infection control. They intended to pass this to other staff in the home. Statutory training was completed such as moving and handling and fire safety. There was a commitment to offer NVQ training for staff and some had completed theirs. Staff said they were pleased with the training opportunities and the emphasis on training had increased with the introduction of the present manager. St Michaels Nursing Home H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35,36 and 38 Resident’s financial interests are safeguarded. Staff received appropriate supervision. Some risks to the health and safety of residents were present. EVIDENCE: The manager stated he did not manage the finances of any resident. All resident’s monies were held by them or managed by the relatives. Staff received one to one supervision from the manager. This included all aspects of their work and was seen as an opportunity to identify training needs. Staff stated they thought the process was useful for their work. St Michaels Nursing Home H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 Page 18 As discussed in standard 19 the fire safety at the home was not adequate and must be reviewed. Some staff were seen to move residents in an inappropriate manner which had the potential to put themselves and the resident at risk. Staff were seen to use the hoist appropriately. As discussed in standard 19 the broken equipment and furniture could present a risk to residents. Accidents were appropriately recorded. St Michaels Nursing Home H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x 3 3 x 2 St Michaels Nursing Home H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 Page 20 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. 2. Standard 8 19 Regulation 13(4)(c ) 23(4) Requirement All potential risks to residents must be identified and reduced. All residents must be adequately protected from the risk of fire. All fire precautions should be in place. Suitable arrangements to prevent the spread of infection in the care home must be taken. At all times suitably qualified, competent and experienced staff are employed in the care home in such numbers as are appropriate for the health and welfare of the residents. All staff must be recruited so as to ensure they are fit to work with vulnerable adults. Timescale for action 31/8/05 31/8/05 3. 4. 26 27 13(3) 18(1)(a) 31/8/05 31/8/05 5. 29 19 and schedule 2 31/8/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 15 18 Good Practice Recommendations All foods should be liquidised seperately and presented to the residents in an appealing manner. All staff who may be in charge of the home should be H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 Page 21 St Michaels Nursing Home 3. 26 aware of the correct procedure to follow should an allegation of abuse be made. All parts of the care home should be free from offensive odours. St Michaels Nursing Home H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 2nd Floor, Ridgeworth House, Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Michaels Nursing Home H60-H11 S42588 St Michaels Nursing Home V230671 260705 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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