Inspection on 10/07/09 for St Nicholas

This inspection was carried out on 10th July 2009.

CQC 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 CQC judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Nicholas 11/09/08

St Nicholas 14/03/08

St Nicholas 25/10/06

St Nicholas 26/01/06

St Nicholas 07/09/05

St Nicholas 05/01/05

St Nicholas 06/09/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE St Nicholas Harepath Hill Seaton Devon EX12 2TA Lead Inspector Michelle Oliver Unannounced Inspection 10th July 2009 07:15 DS0000022038.V376385.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Nicholas Address Harepath Hill Seaton Devon EX12 2TA 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) 01297 20814 01297 20814 Mrs Karen Roberts Mrs Karen Roberts Care Home 3 Category(ies) of Old age, not falling within any other category registration, with number (3), Physical disability over 65 years of age (3) of places St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th September 2008 Brief Description of the Service: St Nicholas is registered to provide personal care for up to 3 older people who may also have a physical disability. The property is a detached bungalow set in a third of an acre of land on the outskirts of Seaton. The accommodation consists of three bedrooms one of which is en suite. There is also a kitchen diner, separate dining room and lounge. There is parking on site and pleasant level gardens both to the front and rear of the property. The home is owned and managed by Mrs K. Roberts. The home’s statement of purpose and service user guide, which includes details about the philosophy of the home and about living at the home, is available at the home on request. A copy of the most recent inspection report is available upon request. Information received from the home indicates that the current fees are £ 330 – 525 weekly Services not included in this fee include hairdressing, chiropody, toiletries, videos, bird food, transport and some continence aids. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk/ St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that people who use this service experience poor quality outcomes. This inspection was undertaken over two days by one inspector. We spent 11 hours at the home. Prior to this inspection we sent surveys to 3 people living at the home, all of whom replied. We also received responses to surveys from 4 staff and one health care professional. Their comments and views have been included in this report and helped us to make a judgement about the service provided. To help us understand the experiences of people living at this home, we looked closely at the care planned and delivered to three people. We spoke to one person in depth to hear about their experience of living at the home during our visit. We also spoke with staff, including the manager and a carer. A tour of the premises was made and we inspected a number of records including assessments and care plans and records relating to medication, recruitment and health and safety. Prior to this inspection the Care Quality Commission had received information that a person with health needs that the service is not registered to provide care for had been admitted to the service. On the first day of this inspection we served the manager with a Notice advising them of a summary of their rights with reference to Sections 31 & 32 of the Care Standards Act 2000. We asked the manager for all records/documents relating to a person who, we had been informed by a relative, had been admitted to the Home which the service was not registered to admit. The manager was co operative and confirmed that we had been provided with all the records/documents the service held for that person. We gave the manager a record of the documents we had taken and these records were returned, by post, to the service on Monday 13/07/09 during the 2nd day of the inspection of the service. We were told that fees ranging from £330- £525 are currently charged at St Nicholas. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk . St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 6 Copies of the inspection report are available from the manager at St Nicholas and are also displayed in the entrance hall of the Home What the service does well: The home is run as a family home and people who have chosen to live there told us that they are “very happy”. They said they enjoyed the family atmosphere and the “grandchildren and animals” that “belong to the owner” They told us they are made to feel “one of the family”. They enjoy the variety of meals served at the home and the fact that they can do things when they choose and not just to fit in with staff. The environment is comfortable and people were happy with their accommodation. The home has sufficient aids and equipment to support the need of the people living there. We were told the house is always clean and comfortable. Relatives told us they were always welcome at the home and that they were informed of important issues concerning their relative. Several people described the atmosphere at the home as warm, friendly and welcoming. The home has systems in place to ensure that people have their say about the service. The staff morale at the home is high and staff feel valued in their role and have a good sense of job satisfaction. Prior to this inspection we sent questionnaires to all 3 people living at the home at that time and we received responses from all three. None of the people who responded had been able to complete the questionnaires themselves. We noted that the manager had assisted one person a friend had helped another but we were not able to tell who assisted the third person as no name had been supplied. We checked with the persons’ daughter who told us they had not been asked to help their mother, who, they felt would be unable to answer questions due to lack of understanding. Comments included “Since I have been here the quality of the care I have received is at its highest. The home always makes me feel happy, safe and secure here. All staff and carers are always willing to go out of their way to help me”. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 7 A chiropodist also returned a questionnaire and in response to “what does the service do well” they commented “personal one to one”. What has improved since the last inspection? What they could do better: 11 Requirements were made as a result of this inspection: A copy of an assessment undertaken before accommodation is provided to a service user at the Home has not been kept in the Home. Written plans as to how the service user’s needs in respect of their health and welfare are to be met are not being completed consistently. Proper provision is not always provided for the health and welfare of service users. Unnecessary risks to the health or safety of service users are not always identified and so far as possible eliminated. Arrangements have not been made for safe recording and administration of medicines received at the care home. Arrangements have not been made to ensure the care home is conducted in a manner which respects the privacy and dignity of service users. The registered person has not made arrangements, by training or other measures, to prevent people living at the home, being harmed or suffering abuse or being placed at risk of harm or abuse. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 8 The registered person has not maintained required records for all those living at the home. The home’s recruitment procedure is not robust. The provider/ registered manager does not carry on or manage the care home with sufficient care, competence and skill in relation to the statement of purpose and the number and needs of the service users. The manager has not undertaken training to ensure they are aware of correct procedures to follow, and alerting the appropriate authorities, if an allegation of abuse is seen by them or reported to them. 7 recommendations for good practice have been made as a result of this inspection: Up to date information relating to the Care Quality Commission should be included in contracts issued by the service to people living at the Home. A record of individuals’ interests should be maintained to ensure they are given opportunities to take part in leisure and recreational activities of their choice. All parts of the home to which people living at the home have access should be as reasonably practicable free from hazards. Laundry floors should be impermeable and these and wall finishes should be easily cleanable. The ratio of staff to people living at the home should be determined according to the assessed needs of individuals. Service users should be in safe hands at all times. This relates to staff undertaking nationally recognised qualifications. All records at the home should be stored securely. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 9 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 Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): OP 1,2,3,4 & 5. People using the service experience poor quality outcomes in this area. People considering moving to St Nicholas cannot be assured that the Home can meet their assessed needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Prior to this inspection the Care Quality Commission had received information that a person with health needs that the service is not registered to provide care for had been admitted to the service. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 11 We looked at the Homes Statement of Purpose, which states that it is registered to provide accommodation and personal care for up to three older people as does the home’s Certificate of Registration, displayed in the hall. The manager told us that she visits all people who are considering moving to St Nicholas and that people are invited to St Nicholas to look around, meet staff and others living there before they make a decision to live there themselves. We were told that when they visit prospective residents the manager gathers information about the persons’ health and social care needs and how they wish for these needs to be met. If the manager decides that individual needs can be met by the staff and environment at St Nicholas, they confirm this in writing to the person concerned, or those acting for them. Two people have been admitted to the home since the last inspection. We looked in detail at the plans of care for each of these people including pre admission assessments. We were told the manager had visited one person in hospital, gathered information about their needs and told them a little about St. Nicholas. During our conversation with this person they confirmed that the manager had visited them and told them that St Nicholas was “much more family like”. At the time of this inspection we were told by the manager that they, and a member of staff, were updating this person’s care plan file and that some of the original documentation, including the pre admission assessment, had been destroyed as it was “untidy”. [Refer to Standard 37] The manager also told us that there was “nothing much to record really as [they] look after [themselves] This person had been admitted via Social Services and the person’s social worker had completed a Care Plan, also a nursing referral letter from the hospital the person had previously been living had also been sent to the Home. We looked in detail at the care plan file for another person who had recently been admitted to the Home but at the time of this inspection was being cared for in hospital. We saw a record of a visit made by the manager [to the Care Home the person was living at prior to their moving to St. Nicholas] one month before they moved into St Nicholas. Included in the information the manager had written that the person “suffered from dementia, but not bad”. However, this person had been diagnosed with Alzheimer’s and had been living at a Home that was registered to care for people with this condition. St. Nicholas is not registered to provide care or people who have dementia. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 12 A copy of written confirmation of the Homes’ ability to meet the assessed needs of the person and an invitation for them to move to the Home on a month’s trial had also been included in the care plan file. This document was dated one day following the person actually moving into St. Nicholas. The manager also recorded a visit to St Nicholas by a member of the persons’ family 3 days after the manager had visited the perspective resident and was happy with what they saw during the visit. We saw a “Contract of Agreement”, relating to this person, the purpose of which is to inform the person of their rights and responsibilities. This document had not been signed by the person it concerned or their representatives. The manager had signed and dated it. Details of the Care Quality Commission were out of date. This means that if the person wanted to contact the Homes’ Inspector they would be unable to do so according to the information provided. The Home does not admit people who require intermediate care. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): OP 7, 8, 9 & 10. People using the service experience poor quality outcomes in this area. People living at the Home have care plans that are basic and only records simple health and personal care needs. This means that people’s needs are at risk of not being met at the home. Medication is not monitored sufficiently at the Home to protect all people living there. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We looked at individual care files for each of the two people currently living at the home and also for a person who has recently been admitted to hospital St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 14 from the Home, in detail. Care plans are basic and only record simple health and personal care needs One file looked at included detailed information about how the person was to be assisted by staff with personal care, social activities, meals, and mobility and sleeping were recorded and showed that a person centred approach had been undertaken when they were compiled. This information is reviewed monthly by the manager and changes are made accordingly. However, the file included an assessment of the person’s needs, which was last reviewed in February 2009. The information recorded does not reflect the person’s current physical abilities. For example information indicates that the person “goes out in the garden” but daily reports state that the person is nursed in bed throughout the day. We saw no evidence that the person or their representatives are involved in the reviews that take place. We looked at the care plan for a person who had recently moved to St Nicholas from a hospital setting and were told by the manager that they, and a member of staff, were updating this person’s care file and that some of the original documentation had been destroyed as it was “untidy”. [Refer to Standard 37] We did not see any information relating to an assessment of their needs being undertaken prior to them moving to St Nicholas or how this person chose to have care delivered. We saw a document in the persons’ care plan file, designed to record information about the persons “Activities of Daily Living”. This document, if completed, is designed to provide information about activities such as personal care and physical well being, breathing, walking, sleeping and continence and should form the basis for monitoring care and abilities. This document had not been fully completed, only the section relating to personal care and physical well being had been completed. The information consisted of “finds it hard to walk, but can get [themselves] washed and dressed”. None of the relevant up to date information provided in the Nursing Referral which had been sent to St Nicholas from the hospital at the time of the persons’ discharge had been recorded. We looked at the care plan file for another person who had recently moved to the Home and had recently been admitted to hospital from the Home. The “Activities of Daily Living”, completed 20 days after their admission, included in the file had been more comprehensively completed. Also included in the file was information of how the person chose to live their life. For example, details were personalised and included information such as “we go in [to their room] quietly so we don’t make [them] jump”. This information had not been updated and did not reflect the person’s needs leading up to their recent admission to hospital. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 15 No plans of how a person’s dementia needs were to be met by staff at the Home had been recorded. The service is not registered with the Care Quality Commission to admit people who have dementia.[ please refer to Standard 31] This person had been prescribed pain relievers, which according to records of medication give, were given 4 times a day. However, there is no care plan relating to managing pain, or monitoring the effect of pain. No care plans relating to changes in the persons health had been recorded. For example the person had been prescribed medication as a result of a doctor being consulted when the person was not well. No information informing staff how the person was to be cared for during this time, or monitoring of their state of health or any changes, had been recorded. This means that this person’s health and social care needs may not be met. We saw no evidence of the person being involved in the development of their plan and it does not reflect their diverse needs, current situation or discuss any future plans Information had not been recorded about how personal goals or aims for another person would be worked towards. For instance, information provided to the Home by a social worker indicated that a person was “self caring in many respects but will need considerable support and oversight to begin to regain [their] abilities to achieve [their goal] of living independently in the community”. No plans of how this goal was going to be worked towards had been undertaken since the person had been living at St. Nicholas. This person also told us they had been given a “list of exercises2 by a physiotherapist when they were in hospital but since they had been living at St Nicholas had not been encouraged to continue with them. They also said that they were in more pain than they had been when they were in hospital. This means that people may be at risk of their goals not being met. Care plan files included information about whether individuals are at risk of developing pressure sores, of falling or of poor nutrition or losing weight. However, no plans of actions to be taken to reduce the identified risks have been recorded. For example an assessment of the risk of one person developing a pressure sore showed the person was “at risk”, an assessment of the risk of the person falling showed they were at “moderate” risk. No plan of any actions to minimise the risks had been undertaken. Another person was assessed as being at “high risk” of developing a pressure sore and at high risks of falling but no actions to minimise the risks had been undertaken. No one currently living at the home has a pressure sore and the owner/manager told us that no one has fallen or been involved in any untoward incident since the last inspection. Assessments of hazards to one person living at the Home had been undertaken by the manager. These included an assessment of the risk of a person falling St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 16 out of bed and wandering, which was undertaken 10 days after admission to the Home. The Home does not have staff on duty during the night so the manager put a baby monitor in the persons’ bedroom and in the managers private accommodation so that if the person did get up during the night the manager would be made aware of this. This procedure does not protect the persons’ privacy and dignity. An individual “daily diary” is kept for each person living at the home. This includes details of what they have eaten what activities they have taken part in and the state of their general health. We looked at the daily diary for one person in detail. Information recorded consisted of how the person had spent the night[ but no information about whether the use of a baby monitor had resulted in the manager attending to them because they wandered], how their person’s care needs had been attended to, what they had done during the day, what they had eaten and information relating to the continence. We had received information from a relative who was concerned about the level of care the person was receiving and these details had not been recorded in the persons’ daily diary. For example, details of the persons general health during the time they had spent out of the home with their relative and observations made by their relative on their return. A daily diary for another person included “didn’t sleep well”, “legs still in a lot of pain” and “can’t get comfy in bed or chair”. No information of how the person’s pain was to be managed or how they had been assisted to get comfortable had been recorded. We noted on the person’s medication record that a doctor had prescribed antibiotics as, according to the medication administration record, they had a chest infection. However, no details of the person’s general health leading up to the diagnosis or no information relating to a visit from a doctor had been recorded. The daily diary notes state that the person had been “fine this morning, had a good night” and “went for a walk around the garden”. The manager had compiled a separate account of actions the persons’ family had taken, including contacting their doctor, visits by the doctor and medication that had been prescribed. This document was dated 5th July, which was the day after the person was admitted to hospital following deterioration in their general health. None of this information recorded on the separate document had not been recorded in the daily diary for this person. This means that up to date information had not been recorded to enable staff to know how to deliver care or to monitor the person’s state of heath, i.e. is the medication effective, is the person recovering and does treatment need to be changed. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 17 Medication is dispensed, by a local pharmacist, into individual trays for people living at the Home to be administered at the prescribed times. The boxes are delivered to the Home weekly. The boxes are stored in a locked cupboard. We saw no other medication stored in this cupboard for any of the people living at the home at the time of this inspection. Records of administration of medication are hand written by the manager and photocopied monthly. We saw photocopied administration records in one person’s file for the following 7 months. The manager told us that they do not order medication and does not actually see prescriptions. We were told a pharmacist manages the ordering of medication from a doctor and dispenses directly to the Home. This is not good practice. We were told that none of those currently living at the home looks after their own medicines. Whilst looking at how the service manages people’s finances we noted that the manager is buying pain relievers from a supermarket for the person. We checked the medication record for this person and noted that the person had been prescribed pain relievers, by their doctor, and the person was receiving the maximum amount. We discussed this with the person concerned. They confirmed that they were being given additional pain, 3 each time when 2 were prescribed and were also being left with an “extra tablet” at night “in case” they woke in pain. They were concerned that they would not be able to continue with the amount of pain relievers they were taken as they had “so much pain”. The manager told us that they had noted that the person recently only took one of the pain relievers prescribed for them. We asked the person why they had done this and they told us they had wanted to save it for later in case they were in pain. At the time of this inspection we saw additional pain relievers in the person’s bedside table, which was not lockable. We asked the manager to remove these and to contact a doctor to make arrangements to meet the needs for this person. The manager told us they had contacted a doctor previously and an appointment had been made for the person to attend an out patient appointment next month. [There was no care plan relating to how this persons pain was to be managed] According to the receipts for the over the counter medication the person was taking an additional 32 tablets a week. None of this additional medication had been recorded as being given. We discussed this with the Manager who told us that they had spoken to the family about this as they were bringing in additional medication. The manager St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 18 confirmed that she had also bought the medication for this person and given it the person to administer as they chose. The manager promotes an open style of management at the home. The atmosphere at the home is domestic with grandchildren, dogs and friends of the manager and family visiting freely. During this inspection two people came to the home to drop off “nets” and one of these people walked into the home through the kitchen On the first day of this inspection we met a person who has open access to the care home as access to the managers’ private accommodation is through the care home. We had been by a relative that this person “looked in” on their one of the people who had been living at the home before they were admitted to hospital. We asked one of the people currently living at the home whether they saw this person during the day or night and were told that the person had come into their room once to repair a TV. This means that peoples’ privacy an dignity is at risk of not being met consistently. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): OP 12, 13, 14 & 15. People using the service experience adequate quality outcomes in this area. People living here are encouraged to make choices about how they live their lives but this process could be improved. They benefit from having a healthy, varied diet. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: St. Nicholas is a small domestic style home and as such does not provide “organised” activities. A record is maintained of activities that people take part in, and we were told by the manager, these include board games, puzzles, puzzle books, going for walks, going out in a care or wheelchair. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 20 People can spend time in the homes lounge, dining room or kitchen diner if they wish. At the time of this visit one person chose to spend most of their time in their room and another spend all their time in bed due to their current state of health. During this visit one person was watching their TV in their room another person was asked if they wished to watch TV but declined the offer. People living at the home and staff told us that there are no routines at the home, staff assist when needed at a time people choose. For example, on the day of this visit one person had spent a restless night and was awake at 7:15 am. They told us that they would stay in bed and have their breakfast later on. We noted they were given breakfast at 8:45am. Some information about individuals past hobbies and interests have been recorded in individual plans of care but there is no evidence that they have been encouraged or supported to maintain them. St Nicholas is a family orientated service and the manager’s daughters are employed as carers. The manager’s granddaughter visits the home often and we were told that people living at the Home enjoy seeing her. The manager has a dog, and one of the manager’s daughters also has a puppy that accompanies her to the home when she is on duty. We were told that people living there also enjoy seeing both dogs around the Home. The home has a well-maintained, accessible garden. One person told us how they had gone for a walk around the garden on two occasions, since they moved into the home in March 2009 and had enjoyed it. Records for another person living at the Home confirmed they also enjoyed going out in the garden, looking at the chickens and bird watching. For those who are unable to go out into the garden bird feeders have been put up so that they may enjoy watching the birds and plants. Visitors are welcome at the Home. During this inspection friends visited a person and were made welcome and offered refreshments by the manager. One person told us they frequently go out often with their family and has stayed overnight and a relative of another person told us that they often took their relative on outings and to their home. Meals are prepared in the Home’s domestic style kitchen. The manager told us they strive to provide organically home grown vegetables and locally sourced meat whenever possible. The home has an area where vegetables are grown and free-range chickens are kept for their eggs. We were also told that the manager has access to fresh seafood and one person enjoyed fresh lobster on occasion. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 21 Although the home does not have a set menu the manager has maintained a comprehensive list of main meals, puddings and snacks available. This has been compiled with the involvement of people living at the home. We asked one person whether they are told what they are going to be served at meal times. They said that they were not told but are sometimes asked what they would like. During this visit the manager told one person what was planned for lunch that day and whether that was acceptable to them. We were told by one person the manager “does her best” and that they had “put on weight since I’ve been here”. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Op 16 & 18 People using the service experience adequate quality outcomes in this area. People can be confident that they will always be listened to at the home. The lack of up to date training provided to staff, in Safeguarding Adults and procedures for reporting any allegations to the appropriate authorities, may mean that people living at the home are not fully protected from harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has a complaints procedure that is included in the home’s statement of purpose. Details of the contact details of the Care Quality Commission are not up to date. One person spoken to told us they have no complaints about the home but confirmed that if they were unhappy about anything they would feel St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 23 comfortable making a complaint. They were confident that their concerns would be taken seriously and the manager “would do something about it”. We were also told that they felt safe and protected living at the home. Forms are available in the hall, beside a visitor’s book, so that people can make suggestions or complaints anonymously if they wish. The manager told us that because St Nicholas is a small family home staff have daily contact with people and felt sure that any concerns would be dealt with before they became an actual complaint. The manager told us that no complaints have been made to the home since the last inspection. A referral has been made to Devon Adult Services Safeguarding Adults Team and is currently being investigated. Staff have not received Safeguarding Adults training since 2004. We spoke to one member of staff and the manager who said they would not hesitate to report poor practice. A recommendation was made at the last inspection that the manager undertakes training to ensure that they are of the aware of correct procedures to follow and alerting the appropriate authorities if an allegation of abuse is seen by them or reported to them. This has not been undertaken. This means that people living at the home may be at risk of allegations of abuse not being taken seriously or reported to the appropriate authorities. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): OP 19 & 26 People using the service experience good quality outcomes in this area. People live in a home which is generally clean and well cared for. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The Home provides a domestic, homely environment set in well tended gardens. St. Nicholas is a bungalow and all accommodation is on the level. The accommodation provided consists of 3 individual bedrooms, a spacious dining room, lounge, kitchen diner, cloakroom and one bathroom. Owner St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 25 accommodation is situated through a door at the end of a corridor in the Home. During this visit the home was generally clean and it was clear that the owner had worked hard to ensure the decoration of several areas had been undertaken since the last inspection. The hall, kitchen, lounge and one bathroom have been redecorated since the last inspection and a new carpet has been laid in the hall now the decoration has been completed. A shower has been removed from a former shower room and is now referred to as “the cloakroom”. Storage cupboards have been fitted in the cloakroom since the last inspection. This leaves one bathroom with a bath, for the use of people living at the home. Laundry facilities are situated outside the building in a garage where a freezer and fruit and vegetables are also stored. The laundry was not clean, mainly due to it being in a garage and the walls and floor not being easily cleanable. We were told the area is regularly cleaned but this was not reflected at the time of this inspection. A window in the bathroom and some other windows at the home, which had secondary double-glazing, have been replaced with sealed double glazed units since the last inspection. We were told that a carpet in a vacant room is due to be replaced as it is stained and we saw the replacement carpet in the room in preparation. We noted the lounge carpet was stained. The manager told us carpets are cleaned regularly by outside contractors and they were due to be cleaned within the next few days. An area of flooring in the kitchen/diner was worn in one area and created a trip hazard. The manager told us this is due to be repaired. We asked the manager to make temporary repairs to the area immediately to minimise the risks of falls, which they agreed to undertake. No people living at the home currently go into the kitchen. We saw equipment and aids to assist people living at St. Nicholas. These included a portable hoist, which was serviced on the 2nd day of this inspection, bath grips, pressure relieving cushions and mattress and a bath aid. The manager has employed a cleaner for 9 hours a week. During this inspection the cleaner was on holiday. We were told that the manager and staff undertake the cleaners’ duties when they are not available. We looked at all people’s rooms during this visit, with their consent. All were personalised and comfortable. At the last inspection we were concerned that a rug had been placed in one room making the door to the room very difficult to open. We discussed the risks that this presented to staff when carrying out care tasks, especially in relation to maintaining adequate infection control St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 26 procedures but also in the event of fire. The door has been adjusted to allow clearance of the rug. The manager told us how good standards of hygiene are maintained at the home although no training has been provided. The owner/manager described how soiled linen is dealt with, as this is taken through the kitchen to the garage, and this complies with good practice. Information relating to what the home feels it does well in relation to the environment and cleanliness provided for people at the home included that the home “produces about 40 of their own food on site”. The home aims to “use local and recycled products reducing food miles and waste”. The home feels they show they do this well by “livestock and poultry being registered with Defra and also quality assurance surveys from peoples’ relatives”. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): OP 27, 28, 29 & 30 People using the service experience poor quality outcomes in this area. People living receive support from a small staff group. Staffing levels at the home are usually sufficient to ensure peoples’ needs are met in a timely and proper way but continue to be at risk of their needs not being met when only one person is on duty. The Home’s recruitment procedure is not robust and does not fully protect people living at the Home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: At the time of this inspection two people were living at the home and the manager and one member of staff were on duty. We were told that there are always at least two carers on duty in this home. During the night, there is no waking night staff but the owner is available if needed. People that we spoke to St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 28 confirmed that they have a call system that can be used at night, but has not needed assistance. We looked at the homes staff rota showing the number of staff and the times they are on duty at the home. We noted that the owner/manager is on duty from 6:15am –12midnight, when they are then available for people to call upon if needed, 7 days a week. We arrived at St Nicholas at 7:15 am on the first day of this inspection. We were told by a person leaving the Home when we arrived that they would show us in as the Manager “wasn’t up yet”. The person told the manager we had arrived and she later met us in the kitchen diner. The manager’s daughter and young granddaughter live in a cottage attached to the Home and we were told the manager had been up for most of the previous night with their young granddaughter. We were concerned that this meant that then manager was not actually at the Home. The manager told us their daughter had brought the baby to the managers’ accommodation. On arrival at the Home, when waiting for the manager, we looked in the rooms of the two people currently living there. One person was asleep; another was awake and complaining of pain. We asked them how long they had been awake and we were told “about a couple of hours”. We asked if they had seen a member of staff and were told they had not. We were told that they usually stayed in bed until about 9-9:30 when they were given breakfast in bed. [Shortly after arriving at the Home at 08:45 a member of staff prepared breakfast for the two people currently living at the Home.] On the day of this visit a member of staff had come on duty at 8:45am to assist the manager and was scheduled to be on duty until 4pm. This then left only the manager on duty until midnight. This potentially put people at risk of their needs not being met. One person, according to a “lifting assessment” reviewed on 30/06/09, requires “2 nurses to transfer for all”. We were told that the current staffing level is sufficient to meet peoples’ needs and if an emergency situation arose there are people who can be called to the home. We were told that these people had previously been employed at the Home, had undergone appropriate training and recruitment procedures. The manager provided us with written information about the number of staff employed at the Home; 2 permanent members of staff and 3 staff “when needed” [bank staff] is employed at the home according to this information. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 29 Prior to this inspection the manager sent us copies of training records for staff working at the home. The manager and one member of permanent care staff have completed training related to safe handling and food safety. The manager has also completed training in the safe handling of medicines. One member of bank staff has completed training in dementia and communication and food safety. There are no training records for the other member of permanent staff. One bank staff has undertaken Safeguarding Adults training but permanent staff, including the manager, have not. The Home had admitted a person to the Home with a diagnosis of dementia, a category for which the Home is not registered with the CQC to provide care for. None of the permanent staff had undertaken dementia training although we were told one staff member had experience in caring for people with dementia and communication difficulties. The manager has successfully completed a Registered Managers’ Award and one member of bank staff has completed an NVQ at level 3. Neither of the other 2 members of permanent staff have undertaken NVQ training. We were told 1 wants to undertake NVQ level 4 and the other does not “want to do anything”. People living at the home described the staff as ‘friendly and caring’ and during this inspection the manager and carer spoke kindly and respectfully to those living at and visiting the home. During this inspection we looked at 2 staff recruitment files, including that for a recently recruited member of staff. The manager has completed a recruitment file for a member of staff who has been employed at the Home since 1998, but at the last inspection no recruitment procedure had been completed. The file included all the required documentation but no references. We were told that the references had been received but the member of staff had been asked to produce references for a reason other than employment and the references had been removed from the file. The recruitment file for a recently recruited staff member did not include the required police check, although we were told that it had been applied for, there was no proof of the person’s identity and only one reference had been obtained. The homes recruitment procedures continue to put people living at the home at risk of being cared for by people who have been employed without following a robust recruitment procedure. No care staff have been recruited at the home since the last inspection and therefore no induction training had been undertaken at the home. These were inspected during the last inspection. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 30 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): OP 31, 33, 35, 37 & 38. People using the service experience poor quality outcomes in this area. People living and working at the home benefit from an open system of management. However, to ensure standards of care continue to improve, awareness of management responsibilities and current legislation in relation to the Care Standards Act and National Minimum Standards and Regulations continues to be needed. The home continues to carry out some practices that do not fully promote good health, safety and welfare for people living at the home or staff. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 31 We have made this judgement using a range of evidence, including a visit to this service. People living and working at the home benefit from an open system of management. However, to ensure standards of care continue to improve, awareness of management responsibilities and current legislation in relation to the Care Standards Act and National Minimum Standards and Regulations continues to be needed. The home continues to carry out some practices that do not fully promote good health, safety and welfare for people living at the home or staff. EVIDENCE: The manager/owner has attained a National Vocational Qualification, [NVQ] level 4 in care and has completed a Registered Manager’s award. We would expect anyone with these qualifications to be aware of their responsibilities under current legislation and to ensure the care home is managed safely for the benefit of people who live there. However, we have had concerns of issues relating to breaches of regulations. In May 2009 we were contacted by the daughter of a person who had recently been admitted to St Nicholas. They were concerned because after an assessment of their mothers’ health and social care needs had been undertaken by the manager of St Nicholas, the manager had assured them that the assessed needs could be met by the staff and environment at St Nicholas. The daughter and family were not aware that the service was not registered with the CQC to provide for people who suffered from dementia. We were told that their relative had been transferred to St Nicholas from a service that was registered to provide for people with dementia. During this inspection it was unclear as to whether the owner was aware that they had breached the conditions of their registration by admitting this person. A number of requirements were made as a result of the inspection. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 32 Several issues relating to allegations of poor care were also made by this person. Adult Services Safeguarding Adults team are currently investigating these allegations and we will also be involved. The manager promotes an open style of management at the home. The atmosphere at the home is domestic with grandchildren, dogs and friends of the manager and family visiting freely. On the first day of this inspection we met a person who has open access to the care home as access to the managers’ private accommodation is through the care home. We had been by a relative that this person “looked in” on their one of the people who had been living at the home before they were admitted to hospital. We asked one of the people currently living at the home whether they saw this person during the day or night and were told that the person had come into their room once to repair a TV. We asked the manager whether required checks had been undertaken for this person to ensure that people living at the home are protected and kept safe. The manager told us that no checks had been carried out, but that she had mentioned this to them only recently and they intended to apply for a police check to be carried out and kept on record. Recruitment practices are poor, which means that staff may be unsuitable to work at the home, and potentially places people at risk. The home does not look after finances for any of the people who currently live at the home. Accounts for any items not covered in the weekly fee are calculated monthly and sent to the person or their representative. During this inspection we saw an account that had been sent to one person. The account showed that the manager had bought pain relievers for the person. The items were highlighted on a long receipt from a local supermarket. The receipt included a large amount of provisions bought for the Home. The person concerned was confused and was worried that they had to “pay for all this food”, they thought that “food was provided”. We assured the person that they were only being charged for the items that had been highlighted. We discussed this with the manager and suggested that the account be explained to people concerned. People’s individual records would be made available to them, or their representative, if they wished. Records were not securely stored. At the time of this inspection records were stored in a cupboard in the kitchen that, although fitted with a lock, was not locked. We were told that the manager had destroyed some records for a person living at the home, including a pre admission assessment. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 33 The manager said that people are consulted on all aspects of their life at St Nicholas on a daily basis when she chats with them. A quality audit has been undertaken since the last inspection to gather people’s views relating to the running of, and the quality of life experienced at the home. Questions asked were “how are you treated, by staff”,” how do staff speak to you” and “are you consulted in matters relating to your own care and matters that concern you” and “any other comments”. We saw the results of the survey showed that people living at the home are happy with care they receive. A basic summary of the last satisfaction surveys has not yet been collated for people to see. Records show that staff have received recent moving and handling training, which means that people living at the Home will be assisted to move and transfer by staff who are aware of safe techniques. Information received before this inspection showed maintenance or servicing of gas and electrical systems was up-to-date and that a hoist was serviced regularly. Prior to this inspection the provider/manager was asked to complete an annual quality assurance assessment (AQAA). This is a self-assessment that is filled in by the owner and is one of the main ways that we will get information about how they are meeting outcomes for people using their service. The AQAA completed and returned by the provider was not the correct version for the service, the information provided was brief and did not consistently provide us with relevant information in relation to how the home is working to meet, and improve, National Minimum Standards. It is disappointing to note that the Home’s recruitment procedure continues not to be robust. The outcome of a police check has not been received, no proof of identity and only one reference had been obtained for a person employed at the Home. The manager told us that due to the size of the home people are consulted on all aspects of their life at St Nicholas on a daily basis when staffs chat with them. A quality audit has been undertaken since the last inspection to gather people’s views relating to the running of, and the quality of life experienced at the home. The results of the survey showed that people living at the home continue to be happy with the care they receive. A basic summary of the last satisfaction surveys has not yet been collated for people to see. Information received before this inspection showed maintenance or servicing of gas and electrical systems was up-to-date. Also that other equipment, such as hoists was serviced regularly. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 34 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 1 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 x x x x x x 3 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 3 x 3 x 1 1 St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 35 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. Standard OP1 Regulation 14[1] Schedule 3 [1a] 15[1] Requirement A copy of an assessment undertaken before accommodation is provided to a service user at the Home must be kept in the Home. The registered person must prepare a written plan as to how the service user’s needs in respect of their health and welfare are to be met. The registered person must ensure that proper provision is provided for the health and welfare of service users. The registered person must ensure that unnecessary risks to the health or safety of service users are unidentified and so far as possible eliminated. Timescale for action 20/08/09 2. OP7 20/08/09 3 OP8 12[1] 20/08/09 4 OP8 13[b] 13/07/09 5 OP9 13[2] This relates to a person being assisted to exceed the prescribed amount of pain relievers to be taken in 24 hours. The registered person must 13/07/09 make arrangements for safe recording and administration of medicines received at the care home. DS0000022038.V376385.R01.S.doc Version 5.2 Page 36 St Nicholas 6 OP10 12[4][a] The registered person must make suitable arrangements to ensure the care home is conducted in a manner which respects the privacy and dignity of service users. This relates to the use of a baby monitor in a persons room. Also, friends and family of the manager and staff visiting the home freely, which potentially compromises peoples’ privacy, dignity and safety. 20/08/09 7 OP18 13[6] 8 OP37 17[1][a] The registered person must make arrangements, by training or other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The registered person must maintain in respect of each service user records as specified in Schedule 3. 20/08/09 30/07/09 9 OP38 19[1][b] This relates to pre admission assessments and some care plans for a person currently living at the service being burned by the registered person. The registered person must not 20/08/09 employ a person to work at the care home unless they have obtained information and documents specified in paragraphs 1-7 of schedule 2. This relates to police checks, proof of identity and references. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 37 10 OP38 10[1] 11 OP38 10[3] The provider and registered manager shall, according to the size of the care home and the statement of purpose and the number and needs of the service users, carry on or manage the care home with sufficient care, competence and skill. The manager must undertake training that is appropriate to ensure they have the experience and skills necessary for managing a care home. This relates to having knowledge of the correct procedures to follow and alerting the appropriate authorities if an allegation of abuse is seen by them or reported to them. 20/08/09 20/08/09 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. Refer to Standard OP2 Good Practice Recommendations Information relating to the Care Quality Commission should be included in contracts issued by the service to people living at the Home. A record of individuals’ interests should be maintained to ensure they are given opportunities to take part in leisure and recreational activities of their choice. All parts of the home to which people living at the home have access should be as reasonably practicable free from hazards. This relates to an area of flooring in the kitchen that presents a trip hazard. St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 38 2. OP12 3. OP19 4. OP26 Laundry floors should be impermeable and these and wall finishes should be easily cleanable. 5. OP27 The ratio of staff to people living at the home should be determined according to the assessed needs of individuals. This relates to some times during the day when there is only one member of staff on duty at the home. Service users should be in safe hands at all times. This relates to staff undertaking nationally recognised qualifications. All records at the home should be stored securely. 6. OP28 7. OP37 St Nicholas DS0000022038.V376385.R01.S.doc Version 5.2 Page 39 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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