CARE HOMES FOR OLDER PEOPLE
St Michaels Nursing Home St Michaels Nursing Home Elm Grove Westgate-on-Sea Kent CT8 8LH Lead Inspector
Clair Brown Announced Inspection 10:15 28 & 29 November 2005
th th 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 DS0000050429.V254818.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Michaels Nursing Home DS0000050429.V254818.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St Michaels Nursing Home Address St Michaels Nursing Home Elm Grove Westgate-on-Sea Kent CT8 8LH 01843 835709 01843 832905 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) Charing Healthcare Care Home 45 Category(ies) of Dementia - over 65 years of age (45) registration, with number of places St Michaels Nursing Home DS0000050429.V254818.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. To change category to DE(E) over a phased period with no more than two (2) admissions per week. To admit one (1) younger adult, with a mental illness, whose date of birth is 10/04/1943. 18th May 2005 Date of last inspection Brief Description of the Service: St Michaels Nursing Home is a large attractive three storey detached Home with gardens. It is situated close to the sea and is a short journey to the local amenities. The Home is registered for the provision of nursing care for older people. The Home has recently changed its registration to provide nursing care for those with Dementia. Although the Home is registered for 45 service users, currently the Home does not use all of these places. The Home employs a Manager and a team of Registered Nurses and care staff. There are waking night staff employed. There is a shaft lift to access all floors. St Michaels Nursing Home DS0000050429.V254818.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the home’s announced inspection. The inspection was conducted by one inspector and the duration of the inspection was 12 hours over two days. The 13 previously made requirements were inspected. Four of these requirements have been met fully and three have been partially met. The Homes representative was the acting manager. Additional time was spent in planning the inspection and report writing. The inspectors spent time talking to 3 service users, 4 staff and relatives to gain their views. Some staff were actively involved in the inspection. Due to the increasing number of service users with dementia observations were also made and the case-tracking of files. Two service users and three relatives completed inspection comment cards. A full tour of the premises was conducted, documents and records were examined, service users files were case tracked and medications were checked. What the service does well: What has improved since the last inspection? What they could do better:
The care plans need to contain more information about how to provide the care and to identify all of the individual needs of the service user. The home needs to provide stimulation for service users through a programme of activities
St Michaels Nursing Home DS0000050429.V254818.R01.S.doc Version 5.0 Page 6 which interests the service users. A second choice of a hot meal needs to be provided for the main meal of the day. The registered provider needs to produce and implement an action plan for completing the outstanding refurbishment of the building. Proper storage facilities need to be provided for equipment and medical aids so service users can use all of the communal space. The hot water boilers need replacing and this needs to be planned and budgeted for. Service users receiving nursing care should be provided with an adjustable bed. Infection control practices in the laundry, including the sorting of the clothing needs to be improved. The employment of adaptation student needs reviewing to reduce the frequent changes in staff and the impact of the high level of overseas staff employed with the communication problems service users encounter. The recruitment procedures of prospective staff needs to be more thorough ensuring all of the checks are conducted prior to them starting work. All staff need to complete more training, especially the mandatory courses and dementia training. 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 DS0000050429.V254818.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Michaels Nursing Home DS0000050429.V254818.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,6 The statement of purpose does not provide adequate information to enable prospective service users to make an informed decision. Prospective service users are assessed prior to admission. EVIDENCE: Pre–admission assessments are conducted and the acting manager has been confident in the findings of these to decline an admission to the home recently for a service users they believed would be an inappropriate admission. The statement of purpose has been updated to reflect the recent changes, however this document does not contain all of the required information, for example, room sizes. St Michaels Nursing Home DS0000050429.V254818.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Individual care plans and daily records have improved but still fail to identify all aspects of service users care needs. Dignity and privacy is now maintained in shared bedrooms. Medication practices have improved. EVIDENCE: There has been an improvement in the information recorded in the service users care plans, however the care plans still do not contain all of the required information to instruct care staff on how to provide the individual care. A care plan of a recent service user was seen which was written by the acting manager. This identified all of the individuals needs and provided clear step by step instructions on how to meet them. Additional time was spent explaining to the senior nurse exactly what was required of a care plan. Overall the basic medication practices have improved, medication issued directly from the blister pack was up to date and the records keeping improved. The medication room was in the process of being refurbished. The Controlled Drugs (CD) numbers corresponded with the records in the register. The controlled drug register provided evidence of an improvement in procedures and practice. St Michaels Nursing Home DS0000050429.V254818.R01.S.doc Version 5.0 Page 10 St Michaels Nursing Home DS0000050429.V254818.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 There are no activities provided within the Home. The menu does not provide a proper hot alternative to the main meal of the day. EVIDENCE: The acting manager confirmed that there is no programme of activities provided within the home. Service users were seen sitting in the lounges with nothing to do to occupy them, except watch television, with times when there was music playing at the same time. The acting manager has found a prospective activities person. There is only one hot option for the main meal of the day the alternatives consist of salad or a jacket potato. This does not promote choice or a balanced diet. St Michaels Nursing Home DS0000050429.V254818.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Relatives and service users are confident that their views and concerns will be taken seriously. EVIDENCE: There were no records within the home of complaints received prior to the acting manager starting. A family visiting their relative said they could approach the acting manager and the staff with any concerns they had and that these would be acted upon promptly. St Michaels Nursing Home DS0000050429.V254818.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 The building is not well maintained. The Home does not provide sufficient assisted baths to meet the needs of the service users. The Home does not comply with infection control procedures. EVIDENCE: The overall maintenance of the Home is limited. The planned remaining refurbishment of the Home has not been completed. One bedroom has now been locked to protect service users and the public due to it being in an unsafe state. Infection control practices in the laundry are insufficient despite a new procedure being written The registered provider has not responded to the requirement to submit an action plan in relation to the provision of assisted bathrooms, since a bathroom was turned into a store cupboard. A new dishwasher has now been purchased. St Michaels Nursing Home DS0000050429.V254818.R01.S.doc Version 5.0 Page 14 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): 27,28,29,30 The staff complement and frequent changes of staff has a detrimental impact on the care provided and causes the service users distress. Staff have not completed the training required to fulfil their roles and responsibilities. EVIDENCE: When the change to the registration to the home was approved for caring for those with dementia-nursing needs, the proposal included a commitment to all staff completing dementia training. To date the staff have not undertaken this training. The training matrix also provided evidence that staff have not completed mandatory training courses. The home runs adaptation training for overseas nurses, these staff are employed as senior carers and once they receive their nurse registration they leave the employment of the home and a new batch of adaptation student arrive. The service users expressed how unsettling they find this and that they just get used to the staff and then they leave. They also expressed their problems with understanding the overseas staff. Over ¾’s of the care staff are overseas staff. St Michaels Nursing Home DS0000050429.V254818.R01.S.doc Version 5.0 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,32,35,36,37,38 The management of the home is frequently changing causing a lack of continuity. The health & safety environmental checks are not kept up to date. EVIDENCE: There has been another change of manager of the home. There is now an acting manager in post who has managed the home previously. These changes have effected the continuity of the home and the meeting of previous requirements, however some of these have not been responded to by the registered provider. There remains a lack of clarity around service users finances that are handled by the home. A high proportion of the service users are local authority funded and therefore would be entitled to allowances, but the manager is unclear who receives this. The acting manager confirmed that she plans to restart formal supervision for staff. St Michaels Nursing Home DS0000050429.V254818.R01.S.doc Version 5.0 Page 16 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 1 1 2 3 2 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 X X 2 1 2 2 St Michaels Nursing Home DS0000050429.V254818.R01.S.doc Version 5.0 Page 17 yes 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 OP1 OP4 Regulation 4,5 sch 1 12,13,14, 18,15,16 12,13,14, 18,15,16 Requirement The statement of purpose must contain all of the required information. An application for a variation to the homes registration for those service users with mental health needs. Required to produce individual Service User care plans that accurately detail individual assessed needs and ensure that these needs are met. That reviews are conducted monthly or sooner if changes are noted, for changes/ deterioration to be recorded and appropriate action to be taken. (Previous timescale 31.07.04,31.07.05) Nursing needs must be clearly identified in the care plan and recorded as provided in daily reports. Records of medication sent for disposal/destruction must be kept. An activities programme which reflects the interests and needs of the service users must be
DS0000050429.V254818.R01.S.doc Timescale for action 31/03/06 31/01/06 3 OP8OP7 31/03/06 4 5 OP9 OP12 12,13,14, 16 12,14,15, 16,23 31/01/06 31/03/06 St Michaels Nursing Home Version 5.0 Page 18 6 OP15 12,13,14, 15,16,sch 4 12,13,23, 14,16 7 OP24OP23 OP20OP19 8 OP21 23 9 OP25OP19 12,13,16, 23 10 OP22OP20 OP19 12,13,23, 14,16 11 12 OP24 OP26 16 12,13,16, 23 13 OP27 18 provided. A second choice of a hot meal must be provided every day. Records of meals provided must be kept for every service user. To provide the CSCI with a written action plan that includes timescales for the ongoing refurbishment both internally and externally of the Home. (Previous timescales 31.08.04, 31.05.05 & 31.07.05) To provide the CSCI with an action plan with timescales regarding the Home bathrooms/service user ratio. (Previous timescale 31.08.04, 31.07.05 The registered provider must submit an action plan to the CSCI for the renewal of the boilers for the provision of hot water and heating. The home must identify and provide sufficient storage for the items needed to meet service users needs (such as feeds, continence aids, movement & handling equipment) and not use communal space/rooms for this purpose. Adjustable beds must be provided for those service users receiving nursing care. Infection control procedures must be adhered to by all staff, including the handling and washing of the laundry. Foot operated pedal bins must be provided for clinical waste bins. The large clinical waste containers must be locked and kept secure. The registered person must review the high numbers of adaptation students working within the home and to reduce
DS0000050429.V254818.R01.S.doc 31/01/06 31/03/06 31/03/06 31/03/06 31/07/06 31/07/06 31/03/06 31/03/06 St Michaels Nursing Home Version 5.0 Page 19 14 15 OP28 OP29 16 OP29 17 OP30 18 OP35 19 OP36 20 OP38 the frequent turn over of staff. 50 of the care staff must achieve NVQ level 2 in care. Previous requirement. 7,8, To ensure that prospective staff 18,19,sch are recruited ensuring the 2 protection of Service Users and that staff files are audited to ensure they contain the required forms of documentation. (Previous timescale 31.08.04,31.07.05) 7,8,18,19, The Manager must confirm sch 2 directly with the Home Office about the named work place on work permits. 12,13,18 All staff must complete the mandatory training. All staff must complete Dementia training – senior staff should attend an in depth/advanced course, junior staff (including ancillary staff) should complete at least a basic introduction to dementia course. 12,17,20, Records of service users financial 23, sch 4 transactions must have a twosignature procedure. The manager must confirm with the local authority who is entitled to pocket money allowances and the method of payment. 18,19 All staff must receive formal supervision six times a year. (Previous timescales 31.12.04, 31.07.05) 13 The manager must ensure that all health & safety environmental checks (including gas & fire checks) are conducted at the correct times and by appropriate persons. Evidence to be submitted to the Commission. (Previous timescale 31.08.04, 31.07.05) 18 30/09/06 31/01/06 31/01/06 31/07/06 31/03/06 31/07/06 31/03/06 St Michaels Nursing Home DS0000050429.V254818.R01.S.doc Version 5.0 Page 20 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 DS0000050429.V254818.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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