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

This inspection was carried out on 5th July 2007.

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 17/12/08

St Michaels Nursing Home 23/01/08

St Michaels Nursing Home 25/07/06

St Michaels Nursing Home 19/12/05

St Michaels Nursing Home 26/07/05

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 Mrs J Aston Unannounced Inspection 09:30 5th July 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Michaels Nursing Home DS0000042588.V341052.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Michaels Nursing Home DS0000042588.V341052.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Michaels Nursing Home Address 19-21 Downview Road Worthing West Sussex BN11 4QN Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01903 248691 info@stmichaelscare.com St Michaels Care Homes Limited Post 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 DS0000042588.V341052.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. A maximum of 37 Service Users may be accommodated at any time. Rooms 29-30 and 31-32 are only to be used by one (1) person. A registered nurse is employed as the Registered Manager who has the knowledge, skills and experience to care for service users requiring nursing care 25th July 2006 Date of last inspection Brief Description of the Service: St. Michaels is a care home, which is registered to provide nursing care to up to 39 residents who are 60 years or over. The conditions of registration limit the capacity of the home to a maximum of 37 residents. The home is a large detached, three-storey building situated in a residential area of Worthing. Accommodation is provided in 21 single rooms and 9 double rooms. There are large gardens attached to the property and car parking to the front. Facilities include a large lounge, smaller conservatory style lounge with a glass roof and dining area, all on the ground floor. The upper rooms of the house are serviced by a passenger lift. Fees for the home range from £600-£650. St Michaels Nursing Home DS0000042588.V341052.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. The Inspector however for this report has referred to those living in the home as “residents”. Only the key standards determined by the Commission have been assessed during this inspection. Planning for this inspection took place prior to the visit to the home. An Annual Quality Assurance Assessment form was received prior to the inspection and information from that will be referred to in this report. The service was also asked to distribute a number of surveys to people living in the home, relatives, advocates and Health Care Professionals. Prior to the inspection eleven surveys were received in total. Nine were completed by relatives or advocates and one from a Social Care Professional. Information and comments obtained from the surveys will also be referred to in this report. An unannounced visit to the home took place on the 5th July 2007. Just over eight hours were spent in the home. During the visit the bedrooms and communal areas were looked at. Four people living in the home were spoken with; three residents, four relatives and three members of staff were spoken with privately. Further information from residents was limited due to the level of their disability however other residents were seen or observed during the visit. A sample of records relating to residents and members of staff and the safety of property was examined. A Registered Manager is not yet in post although has been appointed. The Acting Manager facilitated this inspection What the service does well: The information received from residents and relatives whilst undertaking this inspection provides evidence that St Michael’s provide a caring and friendly service. Residents and relatives spoken with during the visit to the home told the Inspector that there was always plenty of staff around, they were friendly and respectful and the Providers and Acting Manager were very approachable. Some comments that were received were “They create a very friendly homely atmosphere.” “I have been very impressed by the care and attention my mother receives.” “Very supportive, caring and compassionate staff.” “Much patience is shown, visitors are made welcome.” St Michaels Nursing Home DS0000042588.V341052.R01.S.doc Version 5.2 Page 6 All permanent members of the care team have achieved or are working towards National Vocational Qualification (NVQ) Level 2. Some have commenced NVQ Level 3 and Level 4. What has improved since the last inspection? What they could do better: From this inspection the following areas have been identified as requiring improvement and requirements have been made. In order to safeguard residents the Provider must ensure that all recruitment checks are in place before a member of staff works in the home. A requirement for the Provider to address this matter has been made at the previous three inspections and the timescales to meet the requirements have expired. There is still non-compliance. The Provider must ensure that an assessment of the needs of a prospective resident is undertaken prior to admission to the home and this is recorded. This is to ensure that the service can meet the needs of that individual and that members of staff have good information about how to support a new resident. A requirement was made at the last inspection and has not been complied with. Action must be taken to address these outstanding matters; any failure will result in the Commission considering enforcement action. The Provider must ensure that a care plan is generated from the assessment of need that describes what action the service and members of staff need to take in order to meet the needs of the service user. Other matters have been stated in the body of the report that are a reflection upon the lack of good and consistent management and have been outlined in the management section of the report. Requirements have not been made in respect of these matters. St Michaels Nursing Home DS0000042588.V341052.R01.S.doc Version 5.2 Page 7 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 DS0000042588.V341052.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Michaels Nursing Home DS0000042588.V341052.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): Standards 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The needs of prospective residents are not always assessed prior to admission so it cannot be confirmed that the service will meet that person’s needs. The records relating to pre-admission assessments do not state clearly the reason for admission or how the service will meet that person’s needs. EVIDENCE: Information about St Michael’s is contained in a brochure and Service User Guide that made available to any prospective resident and their relatives. It was noted during the visit to the home that every resident had a copy of the brochure and Service User Guide in their rooms. The home operates an assessment and admission procedure to ensure a person’s needs would be met by the service and that the prospective resident is sure that the service can meet their needs. As part of this procedure an enquiry form is completed by the home when a referral is received. St Michaels Nursing Home DS0000042588.V341052.R01.S.doc Version 5.2 Page 10 Information is received from a Social Worker/Care Manager and a copy of their assessment is obtained, the Manager or Deputy Manager undertakes a preadmission assessment either in the persons home or in hospital and then a comprehensive assessment is undertaken on admission to the home. A sample of records relating to five residents was examined during the visit to the home. Four out of the five records examined contained a copy of an assessment undertaken by a Social Worker/Care Manager, a Continuing Health Care Assessment and an assessment undertaken by the Manager or Deputy Manager of the home. The Inspector observed the Deputy Manager making arrangements to visit a prospective resident before admission. However for a resident admitted to the home in April of this year there was no record of a pre-admission assessment or a care plan. Not all of the home’s assessment forms were dated and did not state where the assessment was undertaken. Although the assessment forms used record information about a person’s physical and mental health, their behaviour, nutritional needs, pressure areas and risks around falling and moving and handling they still do not reflect the background information to the needs, health condition, or reason for a resident being accommodated. There was no evidence the resident or their representative had been informed, in writing, that the home could meet their needs. This was referred to at the last inspection and a requirement made in order for this to be improved. Some improvements have been made. The Deputy Manager has developed a system of recording a profile for each resident that includes some background information to improve understanding about the needs of each resident. However these are not part of the pre-admission assessments and not on the care plans. Care Workers under the supervision of the Deputy Manager or an RN have started to include case presentations about residents at staff meetings to assist in communicating each residents needs and any changes to all staff. This has gone some way in meeting the requirement but improvements as above are still required. The Annual Quality Assurance form completed by the Responsible Individual recognises that improvements are still required. St Michaels Nursing Home DS0000042588.V341052.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): Standards 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information about each resident is recorded appropriately for most residents. The staff team are trained to meet the physical needs of each resident and specialist advice is sought from Health Care Professionals. There are appropriate procedures for the administration of medication. A resident’s dignity is not always respected in the way they are supported to dress and at meal times. EVIDENCE: During the visit to the home a sample of five records relating to residents was examined. Four out of the five files examined contained a care plan that provided information about the resident’s needs and how these should be met. Care plans recorded information about the residents needs in relation to the environment, eating and drinking, mobility, personal care, hygiene, psychological needs and activities. St Michaels Nursing Home DS0000042588.V341052.R01.S.doc Version 5.2 Page 12 Risk checklists had been undertaken and recorded with regard to developing a pressure area, moving and handling, risk of falls and nutrition. Care plans record the weight of a resident on admission and then a monthly record of a resident’s weight is kept within the medication file and this was found to be up to date. The care plan also gave a brief outline of how members of staff should support each resident. The information about supporting each resident has been improved with the introduction of personal profiles. Where a Social Worker/Care Manager had undertaken an assessment of the person’s needs on admission their needs and placement had been reviewed within the last year this ensures that the needs of each resident are still being met by the service. Where residents have come into the home or have developed pressure areas appropriate records are kept on the care plan. A separate daily working file also provides a diagram of the site of the pressure area and records the required treatment. Currently three residents have pressure areas that require treatment. It was noted when walking around the home that equipment is in place to assist in the prevention of pressure areas. New pressure relieving mattresses have been purchased. It was noted from daily records that specialist information had been sought from the Community Practice Nurse and Stoma Care Nurse. Relatives spoken with confirmed that a chiropodist visits regularly and residents receive appropriate dental, optical and hearing tests as required. Qualified nurses in the home administer the medication. During the visit to the home the storage of medication and records relating to the administration of medication were examined. All medication was safely stored and the records were in good order and included a photograph or sometimes two photographs of each resident. All care staff have either achieved or are working towards the National Vocational Qualification Level 2 that provides training and assesses competence in areas of personal care, respecting privacy and dignity and moving and handling. Members of staff spoken with confirmed that they have recently received training in Dementia and moving and handling updates. Therefore the staff team have the necessary knowledge and skills to meet the physical needs of each resident. Residents and relatives spoken with during the visit to the home confirmed that members of staff are polite and have a caring attitude. Comments were also received from the surveys used as part of the inspection process. A relative said, “Staff are caring with the residents, patience is shown to them beyond my capabilities”. St Michaels Nursing Home DS0000042588.V341052.R01.S.doc Version 5.2 Page 13 Another said, “Very supportive, caring and compassionate staff. Another said, “They have some very caring staff, especially in the last six months.” However the following matters in relation to these standards have been noted and improvements should be made. There was no evidence of a care plan being in place for a resident who was admitted to the home in April of this year. Where a resident was assessed as having the capacity to take an early morning tablet and that tablet was left by his bed overnight there was no risk assessments or any other written evidence to support this decision. Where a resident’s skin is in poor condition and easily marked there was no record of any marks of a resident’s body so these can be monitored. Their were some comments received from the inspection surveys and when speaking with relatives about the laundry system in the home. A relative said, “My mother seldom wears her own clothes. There seems to be a pool of suitable clothing, it is a bit disconcerting to see her dressed in clothes that she obviously would not have chosen for herself”. This does not respect the dignity of this resident or others where this may happen. Improvements are therefore required in the laundry system and staff must be able to recognise resident’s personal clothing. The Inspector ate lunch with the residents in the dining room. It was observed that most residents were brought into the dining room in wheelchairs and remained in those wheelchairs throughout the lunch. Some wheelchairs did not have leg supports. This does not promote a resident’s independence or dignity. This was discussed with the Provider and the reason for residents remaining in wheelchairs through lunch was a matter of safety as the dining chairs did not have arm rests and some residents could fall off the chair. Also that some residents like to propel themselves in their wheelchairs and leg supports restrict this; others due to their disability could not use leg supports. It would be good practice to review the use of wheelchairs during the lunch period and to provide suitable chairs and ensure leg supports are in place where appropriate. During lunch the Inspector observed the resident sitting opposite who appeared to not require a feeding beaker and could have managed with a napkin rather than a bib like protection. This does not promote independence or dignity. This was discussed with the Provider but the explanation was insufficient to indicate why staff had adopted this practice for most residents. It would be good practice to review the needs of each resident whilst eating lunch and to only provide those items where really necessary. St Michaels Nursing Home DS0000042588.V341052.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): Standards 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some improvement has been made in the amount of activities available for residents that they have enjoyed. Relatives are made welcome and kept informed about important matters regarding their relative. EVIDENCE: Residents’ daily routines are respected as far as possible within the normal routines of the home. It was noted during the visit to the home that residents were able to get up when they chose and spend time in the lounge or their rooms or the garden. Resident’s are supported to attend religious services or to maintain adherence to religious dietary preferences. Since the last inspection more outside entertainment coming into the home has been organised and have included a ‘Sing a long’, gentle exercises to music, ‘Sinatra and Friends’ and a Summer Time Special Production has been organised for August. One of the RN’s has responsibility for organising the activity programme. The programme includes listening to music, card games, passing the ball and a church service once a month. St Michaels Nursing Home DS0000042588.V341052.R01.S.doc Version 5.2 Page 15 Relatives spoken with confirmed that there is usually some form of activity going on in the afternoons. Members of staff spoken with confirmed that they do have sufficient time to sit and talk with residents. Relatives said that they could visit the home when they like but the home requests that visits take place after 11.30am. Relatives spoken during the visit to the home said they are made to feel welcome, always brought a cup of tea and sometimes invited to stay for a meal. Relatives who responded to the inspection through surveys said, “They create a very friendly homely atmosphere.” “Good communication between staff and relatives about my mother’s condition.” “Much patience is shown, visitors are made welcome.” The Inspector ate lunch with the residents. The lunch was tasty and presented well. The Inspector was made aware from relatives and residents that a lot of home cooked food is used for example cakes and soups. The Cook keeps a list of likes and dislikes or residents and caters for special diets. An alternative meal can be provided where the Cook is aware the resident doesn’t like the meal. The Inspector was informed by a resident that an alternative meal can be provided but is reliant upon a resident saying they do not like the meal when it is put in front of them. The menu is displayed but a resident said that it does not always correspond to the meal that is provided. It was noted that residents’ rooms are supplied with water jugs and juice. A relative said however these are not always refreshed daily. Improvements could be made therefore in ensuring that residents are aware of what the meal is before it is put in front of them and they are able to make a choice. St Michaels Nursing Home DS0000042588.V341052.R01.S.doc Version 5.2 Page 16 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): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives are aware of how to make a complaint and feel they are listened to and concerns or complaints responded to quickly. Members of staff have received training in recognising signs of abuse. EVIDENCE: There is a complaints policy and procedure in place and all residents and relatives have a copy of this. Relatives said they feel that they can approach the Directors, Acting Manager or other staff about any aspect of the care of their relative and they will be listened to and action taken if appropriate. A relative who responded to the inspection through surveys said, “They respond and act almost immediately we voice any concerns.” Since the last inspection four complaints have been received and responded to. The Annual Quality Assurance Assessment form provided prior to the inspection confirms that the Owner/Provider of the service checks the complaints log regularly. The Commission has not received any complaints about the service. The Annual Quality Assurance Assessment Form received prior to the inspection confirmed that a policy and procedure is in place in respect of safeguarding vulnerable adults and the prevention of abuse. In January of this year the West Sussex Social & Caring Services made the Commission aware of an allegation of abuse. St Michaels Nursing Home DS0000042588.V341052.R01.S.doc Version 5.2 Page 17 West Sussex Social & Caring Services then investigated this and a strategy meeting was held. The allegation was unsubstantiated but it was agreed with the Provider that a number of improvements in practice should be made. An action plan was sent to the Commission highlighting planned improvements. It was noted that some of these have been undertaken. Members of staff spoken with confirmed that they had received training in recognising the signs of abuse and how to report any allegations. It was noted from training records that training in safeguarding vulnerable adults had been provided in the home in January and June of this year. St Michaels Nursing Home DS0000042588.V341052.R01.S.doc Version 5.2 Page 18 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): Standards 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Where improvements have been made in the home it has enhanced the standard of accommodation for residents. Further improvements are still required in the areas of bathrooms, toilets and cleanliness to bring the home up to a good standard. EVIDENCE: During the visit to the home the Inspector looked around the home. It was noted that some improvements had been made since the last inspection. New carpets have been laid in all resident’s rooms, in the lounge and on the stairs. Bed linen and curtains were new. The carpet layers were in the building during the inspection finishing off the stairs and confirmed that they were going to renew some of the floor covering in the corridors. The dining room had been redecorated. Residents’ bedroom doors have been fitted with self-closure devices that are activated when the fire alarm sounds that means that doors can safely be left St Michaels Nursing Home DS0000042588.V341052.R01.S.doc Version 5.2 Page 19 open. All residents’ rooms looked bright, comfortable and have been personalised with resident’s belongings. At the last inspection the Inspector found that on arrival the front door was unlocked, despite a notice to the contrary, and no one answered the doorbell. This allowed the inspector to enter the home unchallenged. During this inspection the entrance to the home was secure and a member of staff met the Inspector straight away. The garden to the rear of the property looked tidy but lacked plants. There is also a terrace that residents can sit on and this is equipped with chairs and umbrellas. Records relating to the Health & Safety of the building and utilities were examined during the visit to the home and found to be up to date and in good order. There is current Public Liability Insurance for the home and a current fire certificate. A comprehensive fire risk assessment was undertaken in June of this year. There has been some refurbishment in the home and this has made a good improvement for the residents however further improvements are still required. Bathrooms and toilets were found to be in very great need of refurbishment. The Provider confirmed that an improvement plan is in place and further improvements that will concentrate on bathrooms and toilets in the home would be starting on the 9th July 2007. During the visit to the home it was noted that some areas of the home, like the conservatory, that is used as the designated smoking area was in need of cleaning. Windows in some of the resident’s bedrooms and surfaces, such as bedside tables also required cleaning. A relative who responded to the inspection through surveys when asked what the home could do better said, “more cleaning staff, afternoons one of the care staff has to go in the kitchen to provide suppers. The room is in need of a bit more cleaning; the bedside table needs throwing away. I am the one that fills the water jug each day.” This is a large building that would benefit from increased dedicated domestic hours to ensure that the home raised its standards of cleanliness. From examining records relating to the Health & Safety of the home a number of call bells had been taken away for repair after an inspection and service in June of this year. The Provider confirmed that as the home was not fully occupied all residents had call bells to use. Whilst walking around the home the Inspector noted that some residents did not have the call bell within their reach so could not call for assistance. The Inspector also found that one resident who had a call bell extension could not call for help as the call bell button had broken. The Inspector tested the call alarm on the wall and a member of staff attended very quickly. It was noted from examining the complaints log that a relative St Michaels Nursing Home DS0000042588.V341052.R01.S.doc Version 5.2 Page 20 had complained within the last couple of weeks that the call bells were turned down during the night. These matters were raised with the Provider and the Deputy and an explanation was given. It is essential however that a review is undertaken of the capacity of each resident to use a call bell and where they lack capacity this is recorded on their care plan. There should also be a regular check undertaken of the call bells to ensure that they are all working and are not turned down. As previously stated in this report in Health & Personal Care the laundry system needs improvement and members of staff must ensure that resident’s wear clothes that belong to them. St Michaels Nursing Home DS0000042588.V341052.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): Standards 27, 28, 29, and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The recruitment procedures followed do not protect the residents living in the home and there has been non-compliance with previous requirements. The staff team have sufficient time and training in order for them to do their work. EVIDENCE: The home has had a fairly stable staff team and the use of agency staff is very low. The Annual Quality Assurance Assessment form recorded that no agency staff have worked in the home within the last three months. Within the staff team there is a mix of female and male staff, a mix of ages, different nationalities and levels of experience. The staffing levels in the home on the day of the visit were appropriate to meet the needs of the currently twenty-six residents accommodated. There are sufficient Registered Nurses to ensure that a qualified nurse is on duty twenty-four hours a day. Members of staff spoken with confirmed that there were sufficient numbers of staff on any shift that allowed them time to carry out their work well. They also felt that they had time to talk with residents. A requirement regarding the safe recruitment of staff has been made at the last three inspections and not met. It was found at each inspection that there were some members of staff that had started to work in the home without all of the necessary checks being in place. St Michaels Nursing Home DS0000042588.V341052.R01.S.doc Version 5.2 Page 22 A check against the Protection of Vulnerable Adult Register (POVA first check) had not been received until after the person had started to work in the home. The Commission sent a letter of serious concern to the Provider on the 1st August 2006 to address this matter. During this inspection the records relating to five members of staff was examined. The sample included those who had been recruited since the last inspection. It was found that out of the five records examined two members of staff who had been recruited at the end of last year had dates of employment on their records that were before references, criminal record checks or a POVA first check. This was discussed with the Provider during the inspection. The Provider explained that the date of employment was not the date of the first working day for the member of staff and they would perhaps be on induction training and if working in the home would be under supervision. In exceptional circumstances where the Provider needs to start a person working in the home prior to recruitment checks being in place a check against the Protection of Vulnerable Adults Register (POVA first check) must be in place before they receive induction training and they must be under supervision at all times and recorded evidence of this is kept. The Provider could not provide records to support this and therefore the requirement is still unmet. The Annual Quality Assurance Assessment form confirmed that all permanent care staff are trained to National Vocational Qualification (NVQ) Level 2. Members of staff spoken with confirmed that the management of the home have supported them well through their NVQ training and encourage and assist them to take higher levels. Members of staff spoken with confirmed other training that had been provided for example, moving and handling, infection control, dementia, food hygiene, and fire and recognising signs of abuse. St Michaels Nursing Home DS0000042588.V341052.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): Standards 31, 33, 35 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Appropriate management support is in place however; deficiencies in the management systems and practices in the home compromise the quality of the service for residents. EVIDENCE: The home has been without a full time Registered Manager since October 2006. A further Manager was appointed earlier in the year however the Provider’s terminated the contract as it was felt to be an unsuitable appointment. The Inspector was made aware that a new manager has been appointed but references and criminal record checks have still not been received. St Michaels Nursing Home DS0000042588.V341052.R01.S.doc Version 5.2 Page 24 The Deputy Manager therefore has been acting up as the Manager and has put great effort into managing the home with the support of the Provider. Members of staff spoken with said they felt well supported by the Deputy Manager and Providers and that they always has someone who they could call upon. Members of staff spoken with confirmed that they have received individual supervision on a regular basis and an annual appraisal however there was no record of individual supervision for new members of staff. There was evidence that staff meetings have been held in September 06, January and May 07. A quality assurance system is in operation and consists of asking residents and relatives to complete a questionnaire. This has recently been undertaken and the Provider provided evidence to the Commission that there was a very positive outcome with very positive feedback. There was evidence that the Providers visit the home regularly to undertake monthly inspections and reports of these visits are kept in the home. It is the home’s policy not to manage a resident’s financial affairs. Where a resident lack capacity a relative, advocate or Solicitor takes responsibility for financial matters. Where a resident requires money for hairdressing etc the relatives are asked to reimburse the home. The records relating to the Health & Safety of the building were examined and found to be in good order. There was evidence to demonstrate that inspections and safety checks for hoists, the lift, fire alarms, water temperatures and electrical items have been undertaken. The Annual Quality Assurance Assessment form confirmed that the requirements made from the last Environmental Health Officer’s visit in January of this year have been complied with. Members of staff spoken with confirmed that they are up to date with their fire training, moving and handling and infection control. A training plan for the rest of the year indicated that other training in fire; risk management, food hygiene, moving and handling and first aid will be provided. Evidence that has been recorded previously in this report that demonstrates that the home lacks a good standard of management is as follows: • • • • • Recruitment practices do not safeguard residents. Lack of supervision for new staff. Not all areas of the home are being kept clean. Residents’ do not always wear their own clothes. There was no evidence that a resident admitted in April of this year had an assessment undertaken prior to admission and there was no evidence of a care plan. St Michaels Nursing Home DS0000042588.V341052.R01.S.doc Version 5.2 Page 25 • • • • Risk assessment had not been undertaken where medication was left by a resident’s bedside. No record of any markings on residents’ skin where it is identified that their skin is in poor condition. Residents not being left with the call bell within reach. Lack of dignity for residents through practices adopted by care staff. . St Michaels Nursing Home DS0000042588.V341052.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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 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 3 X 2 3 3 3 3 2 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 3 St Michaels Nursing Home DS0000042588.V341052.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 OP29 Regulation 19 and Schedule 2 Requirement All staff must be recruited so as to ensure they are fit to work with vulnerable adults by undertaking all checks to determine their suitability before working in the home. Previous timescales of 31/8/05, 31/12/05, 25/7/06 have not been met. 2. OP3 14 An assessment of need that includes consultation with and confirmation to the resident or relative, must be carried out and recorded prior to any resident being accommodated. Previous timescale of 31/08/06 has expired. This requirement remains unmet. A care plan must be generated from assessments of need and compiled in consultation with the service user or relative on admission to the home. 06/08/07 Timescale for action 06/08/07 3 OP7 15 06/08/07 St Michaels Nursing Home DS0000042588.V341052.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Michaels Nursing Home DS0000042588.V341052.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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. 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