Inspection on 03/05/06 for St Michaels Nursing Home

This inspection was carried out on 3rd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 25/06/07

St Michaels Nursing Home 22/11/06

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 Susan Richards Unannounced Inspection 3rd May 2006 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.V289850.R01.S.doc Version 5.1 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.V289850.R01.S.doc Version 5.1 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.V289850.R01.S.doc Version 5.1 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. 5th January 2006 2. 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 and three physically disabled service users aged under 65 years. 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 well-kept 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. 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. Since the previous inspection a general manager has been appointed. There is no registered manager with the Commission. The range of fees charged by the home are as follows as at 18/04/06: Nursing – Derbyshire County Council assisted – from £389.90 to £482.90 Nursing – Self Funded - from £400.00 to £490.00 Personal care – DCC assisted - from £313.20 to £343.20 Personal care – Self Funded - from £315.00 to £350.00 Information is provided in writing and in the service user guide for the home. St Michaels Nursing Home DS0000059738.V289850.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. For the purposes of this inspection, this service was inspected and assessed against all of the Department of Health’s key national minimum standards for older persons. The methodology used included review of significant documentation and records kept about the home by the Commission over the last 12 months, including it service history/record of events. The provider completed a pre-inspection questionnaire providing comprehensive details about the home and its care and service provision. A site visit was also undertaken to the home during which case tracking was undertaken for three identified residents accommodated out of a total of 27. This involved discussions with service users in accordance with their given capacities about the care and services they receive and also discussions with their relatives and representatives. A tour of the building was undertaken and maintenance arrangements also discussed and assessed. Discussions were also held with the manager and staff in respect of the management of the home, its care and service provision and the arrangements for the recruitment, induction, training and supervision of staff employed. Other records were also examined in relation to services offered in the home. What the service does well: What has improved since the last inspection? Following a significant time period of management instability, a general manager has been appointed. There are clearer, more methodical management strategies in place with identified development aims and objectives in all aspects of service provision. This includes that relating to staff training, development and supervision and also arrangements for residents to engage in activities, all of which has already resulted in some significant improvements in the organisation of services in the home and its care delivery. St Michaels Nursing Home DS0000059738.V289850.R01.S.doc Version 5.1 Page 6 Various areas of the home have been redecorated over the last 12 months and there has been substantial investment in terms of structural and maintenance systems. Information about the home and its services is clearly provided for residents and their relatives in a number of key ways. Overall standards of record keeping have improved, including management reports, care records, medicines records and complaints records. 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 DS0000059738.V289850.R01.S.doc Version 5.1 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 DS0000059738.V289850.R01.S.doc Version 5.1 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 Service users and their representatives are provided with the information they need about the home and its service provision and there is a clear framework for the assessment of residents’ individual needs. Although detailed recording of individuals social interests and hobbies and lifestyle preferences would better promote person centred care delivery. The quality outcome in this area is good. This judgement has been made using the evidence available, including a visit to the home. EVIDENCE: The statement of purpose and service user guide had been revised and amended since the previous inspection. Service users and/or their representatives were familiar with key information provided in them. Notice boards had been provided at various areas around the home including the entrance hall, detailing key information for residents and relatives in relation to various aspects of the home and its service provision, including entertainment and activities. St Michaels Nursing Home DS0000059738.V289850.R01.S.doc Version 5.1 Page 9 For those residents case tracked they were provided with individual written terms and conditions with the home. The recorded needs assessment information for each residents case tracked were examined. These were reasonably well recorded, although there were variances in the consistency and accuracy of recording and they did not all provide details of individuals’ social interests, hobbies and individual lifestyle preferences. St Michaels Nursing Home DS0000059738.V289850.R01.S.doc Version 5.1 Page 10 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 Residents written plans were reflective of recognised clinical practise concerned with the care of older persons and were formulated in accordance with their risk assessed needs, however the lack of detailed care interventions in accordance with individual’s abilities and lifestyle preferences did not truly promote person centred care delivery, which potentially compromised some aspects of their care. The quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to the home. EVIDENCE: The written care plans of those residents case tracked were examined and were discussed with them/their relatives in accordance with their capacities and also staff caring for them. Core care plans were used, which included recognised clinical practise concerned with the care of older persons. They were clearly recorded within a framework of risk assessment and were up to date and regularly reviewed. However, they did not always detail care interventions in accordance with individual’s actual abilities or reflect individual’s lifestyle preferences and wishes. St Michaels Nursing Home DS0000059738.V289850.R01.S.doc Version 5.1 Page 11 One of the residents case tracked wore hearing aids to both ears and was also registered blind. There was a written care plan in respect of their communication needs, although this did not provide detail of care required in respect of their aids, both by the home or outside health care professionals. Two of the residents’ case tracked had specified pressure relieving equipment identified in their care plans by way of special mattresses and seat cushions to be used when sitting in a chair. Both of the residents were observed seated and did not have their specialist cushions. Discussions held with residents and/or their representatives about their care plans were documented by way of care reviews. There was a named nurse/key worker system in operation in terms of the organisation of personal and nursing care delivery and staff spoken with understood their roles and responsibilities in relation to this. Residents (who were able to identify) and relatives knew their named staff. Staff was also observed during the course of the inspection in terms of their approaches to residents, which were courteous and mindful of their needs. Feedback from residents and their relatives was very positive in respect of staffs’ manner with residents and their treatment of them. The arrangements for the management and administration of residents’ medicines were examined and were satisfactory, with the exception of the method of recording for the administration of food supplements prescribed. St Michaels Nursing Home DS0000059738.V289850.R01.S.doc Version 5.1 Page 12 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 were recognisable improvements in respect of the organisation of activities and entertainment in the home, although the formulation of individual social care plans for residents, based on their known lifestyle preferences would further enhance the quality of social care delivery and promote a person centred approach. Residents are provided with adequate quantities of nutritious food and the manager had begun to take positive steps to increase the choice and quality of food provided. Quality outcome in this area is good. This judgement has been made using available evidence including a visit to the home. EVIDENCE: Discussions were held with residents/relatives and the manager and staff about the organisation of activities in and outside the home, who felt that there had been improvements in this area. Details of group activities and entertainments organised were displayed in large print on residents’ notice boards around the home. On the day of the inspection entertainment was provided during the afternoon by an outside singer, who encouraged everyone to participate. Relatives and friends had also been invited. After the session, St Michaels Nursing Home DS0000059738.V289850.R01.S.doc Version 5.1 Page 13 a buffet tea was provided for everyone served with a selection of beers and wines and juices. An activities person is employed on a part time basis also. The arrangements for service users monies and financial affairs were also discussed and were satisfactory. Menus were examined and discussions held with the cook about the formulation of these and the promotion of choice for residents, given that the recorded menus were set. Discussions were also held with residents and relatives and staff about meals provided and the organisation and serving of lunch was observed. This was well organised, tables were attractively set and residents were effectively assisted by staff in accordance with their needs. St Michaels Nursing Home DS0000059738.V289850.R01.S.doc Version 5.1 Page 14 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 & 18 Residents and their representatives are able to raise concerns and to complain and the home’s policies and procedures underpin practises in the home to ensure that any complaints made are listened to and acted on and that residents are protected from abuse. Quality outcome in this area is good. This judgement has been made using available evidence including a visit to the home. EVIDENCE: Information regarding complaints received by the home was examined, and discussions were held with the manager about these. There is a written complaints procedure for the home, which is openly displayed and also provided within the service user guide. Residents and their representatives knew how to complain and felt confident that any concerns or complaints raised would be listened to and dealt with. There have been two complaints made, which were investigated on a joint agency basis, inclusive of the home via Derbyshire county council’s safeguarding adults procedures. Appropriate action has been taken by the home in respect of these. St Michaels Nursing Home DS0000059738.V289850.R01.S.doc Version 5.1 Page 15 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 Although there have been some clear improvements to the environment, with cleanliness and comfort promoted, there has been considerable slippage in the registered providers written plan for the upgrading, refurbishment and redecoration of the home. The added provision of communal soap bars for hand washing and communal flannels for face and body washing did not promote good principles of infection control and the arrangements for the storage of linen and stock supplies of incontinence pads in the home were unsatisfactory. Quality outcome in this area is adequate. This judgement has been made using available evidence, including a visit to the home. St Michaels Nursing Home DS0000059738.V289850.R01.S.doc Version 5.1 Page 16 EVIDENCE: A full tour of the premises was undertaken. All communal areas accessed by residents were inspected, including bathroom and toilet facilities and a number of bedrooms, including those of residents’ case tracked. The home was odour free, cleaned to a high standard, well lit and comfortable for residents, providing a homely atmosphere. There is an identified programme for the upgrading, refurbishment and redecoration of the home and residents and visitors to the home said they were pleased with the changes now being made in the environment. However, timescales set in the programme have slipped considerably and there are significant areas where the décor and furnishings, including carpets in the home are tired and worn. The manager advised that work would be completed over the next 6 months. The Inspector observed staff assisting residents to dining tables for lunch. Many residents were seated at the table in their wheelchairs due to dining chairs provided being unsuitable to accommodate residents’ mobility needs. The manager advised that dining tables and chairs were to be replaced. Discussions were held with the manager in relation to some aspects of infection control practises in the home and also the storage of linen, bedding and stock supplies of incontinence pads. St Michaels Nursing Home DS0000059738.V289850.R01.S.doc Version 5.1 Page 17 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 induction and training needs analysis undertaken by the manager was comprehensive and the training plan increases the potential for greater staff competency, although residents are not protected by the home’s recruitment practises. The quality outcome in this area was poor. This judgement has been made using available evidence including a visit to the home. EVIDENCE: Arrangements for the staffing of the home and the recruitment, induction, training and supervision of staff were examined. This included assessing information provided by way of the pre-inspection questionnaire, discussions with the manager and staff and examination of relevant records kept in the home in relation to each of these areas. Staff practises were also observed. Serious concerns were raised with the registered provider during the inspection both verbally and in writing in relation to recruitment practises, which were not in accordance with legal requirements and recognised practise. St Michaels Nursing Home DS0000059738.V289850.R01.S.doc Version 5.1 Page 18 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, 33 & 35 & 38 There were positive improvements in the management of the home to the benefit of residents and staff and clear strategies identified by the manager to promote all aspects of their health, safety and welfare. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to the home. EVIDENCE: An acting manager has been appointed to the home since the previous inspection. She has not yet made an application to the Commission as registered manager for the home. Feedback in discussions with staff, residents and relatives/representatives was positive in terms of the management systems she has introduced to date, St Michaels Nursing Home DS0000059738.V289850.R01.S.doc Version 5.1 Page 19 including strategies for communication and the organisation and delivery of care. The development plan for the home was discussed. There has been formal operational auditing of the home and its care and service provision in accordance with the audit system in place since March 2004. A comments and suggestions book had been introduced by the manager, located in the main entrance. Residents and their relatives were aware of this and a number of comments had been made therein, which were all positive feedback about noted changes in the home. A newsletter had also been devised which was openly promoted in the home. The systems and arrangements for the management and handling monies for those residents case tracked were examined and discussed and were satisfactory. A number of records, which are required to be kept in the home, were examined as part of the inspection process, including residents care records. Comments are made under the relevant sections of this report. Comments have also been made under the staffing section of this report regarding the arrangements for staff training, including core health and safety training. Details of the maintenance of equipment in the home were provided by way of the pre-inspection questionnaire, and records were sampled during the inspection. The arrangements for the reporting and recording of accidents were examined and were satisfactory. St Michaels Nursing Home DS0000059738.V289850.R01.S.doc Version 5.1 Page 20 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 3 3 2 X X X 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 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 2 3 2 3 2 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 2 3 2 St Michaels Nursing Home DS0000059738.V289850.R01.S.doc Version 5.1 Page 21 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 OP19 Regulation 23 Requirement The written programme for the upgrading, repair and renewal of the building must be fully completed. Previous timescale – 31/03/06 Timescale for action 31/10/06 2. OP8 23 Residents must be provided 01/06/06 with the equipment they need in accordance with their assessed needs. In this instance pressure relieving cushions. Medicines administration records must be kept in accordance with recognised guidance. In this instance staff must always sign for medicines (including creams and supplements) on the medicines administration record (MAR) sheet and not use ticks to indicate whether a preparation has been given. The registered person must ensure that suitable arrangements are made to promote good infection control and to prevent the spread of DS0000059738.V289850.R01.S.doc 3. OP9 13 & 17 01/06/06 4. OP26 13 01/06/06 St Michaels Nursing Home Version 5.1 Page 22 5. OP22 23 6. OP29 19 infection in the home – in this instance communal bars of soap must not be used in shared bathrooms and toilets and a suitable system identified for the use of flannels. Suitable storage areas must be provided for the storage of linen and stock supplies of incontinence pads in the home. The registered person(s) must ensure that staff is not commencing employment in the home without satisfactory confirmation of their POVA/CRB checks in accordance with recognised guidance. 31/07/06 03/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP3 OP3 Good Practice Recommendations Individual’s recorded needs assessment information should include details of their social interests & hobbies. Daily living plans should be provided for each service user in accordance with their agreed/known lifestyle preferences, wishes, feelings and needs. Individual’s written care plans, including social care plans, should aim to detail care interventions, which accord with individual’s abilities and lifestyle preferences and promote their independence. 3 OP3 St Michaels Nursing Home DS0000059738.V289850.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. 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