Inspection on 11/09/08 for St Nicholas

This inspection was carried out on 11th September 2008.

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

The inspector 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 Nicholas 10/07/09

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE St Nicholas Harepath Hill Seaton Devon EX12 2TA Lead Inspector Michelle Oliver Unannounced Inspection 09:15 11 September 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Nicholas DS0000022038.V366505.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 Nicholas DS0000022038.V366505.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.V366505.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th March 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 £ 322£455 weekly. Services not included in this fee include hairdressing, chiropody, toiletries, videos, 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.V366505.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 1 star. This means that people who use this service experience adequate quality outcomes. This inspection was undertaken over one day by one inspector. We spent 4 hours at the home. We spoke with people living there and staff and also spent time observing the care and attention given to people by staff. Prior to this inspection we sent surveys to 3 people living at the home, 2 of who replied and 5 staff, 3 of who replied. All questionnaires were completed and returned to us from people expressing their views about the service provided at the home. 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. Most people living at the home were seen or spoken with during the course of our visit and three people were spoken with in depth to hear about their experience of living at the home. 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. Currently the fees of between £ 322-£455 weekly are currently charged. 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 . Copies of the inspection report are available from the office. 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 St Nicholas DS0000022038.V366505.R01.S.doc Version 5.2 Page 6 need of the people living there. We were told the house is always clean and comfortable. One person has an exercise bike in their room to help “work off the meals” and told us their room was “fantastic”. An excellent admissions process ensures that the home can meet people’s needs. People were satisfied with the level of care they receive at St Nicholas and one person said their health had improved since coming to the home to live. The home works well with health care professionals, such as GPs and nurse specialists to ensure people have access to the care they need. 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. Overall, health is well managed. The staff morale at the home is high and staff feel valued in their role and have a good sense of job satisfaction. What has improved since the last inspection? The outcome of the last inspection, carried out in March 2008, rated the home as “0 star” that means that people who use this service experience poor quality outcomes Although the need for some improvements continues the outcomes of this inspection rates the home as “ 1 star” that means that people who use this service experience adequate quality outcomes The home has improved the management of medicines since the last inspection. This is now well managed and all documentation seen was accurate and up to date. Care plans have been improved to include information such as whether individuals are at risk of developing pressure sores, of falling or of poor nutrition or losing weight. Plans of actions to be taken to reduce these risks in a way that suits each person are then compiled, with the involvement of the individuals or their representatives. The preparation of meals served at the home has improved since the last inspection. The owner has undertaken extensive redecoration and replacement of carpets, throughout the home making it a pleasant, comfortable homely place to live. St Nicholas DS0000022038.V366505.R01.S.doc Version 5.2 Page 7 The manager has developed a staff rota that is displayed at the home. This means that a record of who is on duty at the home and in what capacity is maintained, which is good practice What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Nicholas DS0000022038.V366505.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 Nicholas DS0000022038.V366505.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): 1, 2, 3, 4 & 5. Quality in this outcome area is excellent. People considering making St Nicholas their home benefit from the knowledge that their health, social and welfare needs can be met at the home. The home does not admit people who need intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An assessment of individual health, social and welfare needs is undertaken before the manager confirms, in writing, that those needs can be met at the St Nicholas DS0000022038.V366505.R01.S.doc Version 5.2 Page 10 home. The manager, who will visit people in hospital or at their own homes, undertakes this assessment. Two people have been admitted to the home since the last inspection. We looked at the pre admission assessments for both of these people. The assessments were comprehensive and included some detailed personal information enabling staff to know them as people and not just their health limitations. People are invited to St Nicholas to look around, meet staff and others living there before they make a decision to live there themselves. One person had spent some time at the home before making it their home and told us that they were very happy living there. The family of another person had visited the home and decided it was the place their relative would like. The person confirmed this at the time of this visit. St Nicholas is a small home and the owner/manager told us they want to be sure that not only can each person’s needs be met but also that they will enjoy living with the other people at the home. The home does not admit people who need intermediate care. St Nicholas DS0000022038.V366505.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): 7, 8, 9 & 10. Quality in this outcome area is good. People living at the home benefit from having their personal and healthcare and welfare needs planned for. They can be confident that these will be met in a way that suits each person. Medicines are well managed and people’s privacy and dignity is promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We spoke to all three people currently living at the home. All told us they were “well looked after” and were happy living at St Nicholas. One person was aware that a plan of their care had been drawn up, to enable staff to know St Nicholas DS0000022038.V366505.R01.S.doc Version 5.2 Page 12 how the person wished their health, social and welfare needs to be met in an individual manner. The relatives of the other two are involved in the plans for two people living at the home, as they are not able to fully understand or take part in the planning. However, the manager told us that they are told about any changes to their plans, as they “may be able to understand”. We looked at the plans of care for all currently living at the home. All were comprehensive and detailed and included information such as whether individuals are at risk of developing pressure sores, of falling or of poor nutrition or losing weight. Plans of actions to be taken to reduce these risks in a way that suits each person are then compiled, with the involvement of the individuals or their representatives. 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. Information about how people chose to be assisted with personal care, social activities, meals, mobility and sleeping were well written and showed that a person centred approach had been undertaken when they were compiled. 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. None of the people living at the homes look after their own medication. The manager said that a person’s ability and wishes are assessed before moving to the home and if they wish to look after the own medicines they would be encouraged and supported by the staff. One person spoken to during this visit said they were happy that the staff were looking after their medicines and they had no wish to do so themselves. We looked at the way medicines are managed and found that the manager has worked hard since the last inspection to improve the home’s procedure. We saw medicines stored safely and securely in individuals’ rooms, in locked cupboards. Records of the administration of medicines and the use of creams/ointments were accurate and up to date. However, there was no indication of when creams/ ointments had been opened or expired. This means that people are at risk of receiving out of date preparations that may not be effective as creams/ ointments lose efficiency once opened and should be discarded when their “shelf life” has expired. People told us that they are treated with respect and that all staff at the home upholds their dignity. We spoke to staff about how they manage this and they were able to show that tell us how this is achieved. They told us that because St Nicholas DS0000022038.V366505.R01.S.doc Version 5.2 Page 13 there are only ever three people living at the home each one is seen as an individual, and that they get to know each person well and come all are treated as a member of their family. We saw the manager and a carer talking to people living at the home in a relaxed, friendly and respectful way. St Nicholas DS0000022038.V366505.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): 12, 13, 14 & 15. Quality in this outcome area is good. People living here are encouraged and supported to make choices about how they live their lives. They benefit from having a healthy, varied diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is a small domestic style home and as such does not provide “organised” activities. One person told us that they were aware of this before they decided to make St Nicholas their home. People can meet in the homes lounge, dining room or kitchen diner if they wish. At the time of this visit all people chose to spend most of their time in their rooms and generally spend their days and lives how they like. During this visit one person went out to spend the day with their family and another was St Nicholas DS0000022038.V366505.R01.S.doc Version 5.2 Page 15 enjoying watching sport on their TV in their room. 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 slept until almost 11am. Staff told us how each person likes to do things, the support they need and how they like this given. We saw details of this recorded in individual care plans also. This means that people have their care delivered in a person centred way as they choose. The home has a well-maintained, accessible garden. One person told us how much they enjoy going for a walk in the garden and down the drive. 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. Staff prepare meals in the home’s domestic and we were told by the owner that 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. 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 but are sometimes asked what they would like. They also told us that the quality of the meals served were 2 out of this world” and intimated that they had gained weight since being at St Nicholas. The manager told us that this person, after looking at the list of meals available, had said they would be happy to have any of them at any time. This information had been recorded in their individual plan of care. St Nicholas DS0000022038.V366505.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): 16 & 18. Quality in this outcome area is adequate. 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a comprehensive complaints procedure that is included in the home’s statement of purpose. Details of the contact details of the Commission are not up to date. People spoken to tell us they have no complaints about the home and have ‘never had one’ but confirmed that if they were unhappy about anything they would feel comfortable making a complaint. They were confident that their concerns would be taken seriously and the manager “would do something about it” St Nicholas DS0000022038.V366505.R01.S.doc Version 5.2 Page 17 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. We were also told that they felt safe and protected living at the home. The manager told us that no complaints have been made to the home since the last inspection and none have been made to the Commission. A requirement was made at the last inspection for the manager to make arrangements to ensure that staff are aware of up to date information relating to the prevention of adult abuse and alerting procedures in the event of an allegation being made. We spoke to one member of staff who had been employed at the home in June 2008. They had received training in Safeguarding Adults in 2006 when working at another service; we saw no evidence of other staff at the home receiving training. We were shown a training video “ No Secrets” dealing with Safeguarding Adults but saw no evidence that staff had watched it. No other arrangements have been made to up date staff in Safeguarding Adults. The manager was unclear what actions must be taken in the event of an allegation of abuse being made to them, both at this and the last inspection. 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. There was no evidence to suggest that people living at the home are anything but well cared for at the time of this visit. St Nicholas DS0000022038.V366505.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): 19, 20, 21, 22, 23, 24, 25 & 26. Quality in this outcome area is good. People live in a home which is suited to their individual needs and which is clean and well cared for. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked around the home during this visit and noted an improvement in the environment and general cleanliness of the home since the last inspection. As a result of the last inspection an environmental health officer visited this home in April 2008. No actions for improvement were needed. St Nicholas DS0000022038.V366505.R01.S.doc Version 5.2 Page 19 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 lounge. We were told that now the decoration ahs been completed the hall carpet will be replaced. A shower room is currently not being used as the shower is being refitted. This leaves one bathroom for the use of people living at the home. We noted that a window in the shower room needed replacing. The manager told us that this has been organised and some other windows, which have secondary double-glazing will be replaced with sealed double glazed units. We were told that all staff undertakes cleaning tasks as part of their role. During this visit we saw a carer undertaking various chores in the home between caring for people living there. We looked at all people’s rooms during this visit, with their consent. All were personalised and comfortable. 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 presents to staff when carrying out care tasks, especially in relation to maintaining adequate infection control procedures but also in the event of fire. The manager agreed that the door be adjusted to allow clearance of the rug. A member of staff told us how they maintain good standards of hygiene at the home although no training has been provided. The owner/manager described how soiled linen is dealt with and this complies with good practice. However, when we arrived at the home a pile of clothes that needed washing had been left on a worktop in the kitchen, which does not comply with good practice. We were told that the clothes were not soiled and they had been dropped there “in a rush” St Nicholas DS0000022038.V366505.R01.S.doc Version 5.2 Page 20 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): 27, 28, 29 & 30 Quality in this outcome area is adequate. People living here benefit from receiving support from a small committed 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. Although the home’s recruitment procedure has improved since the last inspection people are not fully protected, as it is not robust. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection three 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.V366505.R01.S.doc Version 5.2 Page 21 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. On the day of this visit a member of staff had come on duty at 9am to assist the manager and was due to leave at 11am. This then left only the manager on duty until 1:15. A member of staff came on duty at 1:15 until 4:15pm after which the manager was the only member of staff on duty. We were told that a family member who is usually at the home throughout the day supports the manager. This person is employed at the home but does not appear on the rota. We were told that the current staffing level is sufficient to meet peoples’ needs. If an emergency situation arose there are people who can be called to come to the home. All the care staff hold a National Vocational Qualification (NVQ) in care but have not received additional training as needed. We looked at training records for staff working at the home. Staff had undertaken first aid training in 2004, manual handling in 2006 and the most recent fire training in October 2007. The manager and one member of staff attended a training session on dementia recently. We looked at the records of induction training provided for people employed since the last inspection. This took the form of a series of questions and answers, which we were told, were completed after staff had read policies and procedures undertaken at the home and read individuals care plans. A member of staff said that they had been told what to do in the event of fire and other emergency situations. No staff training has been provided since the last inspection when a requirement was made that suitable arrangements must be made to provide a safe system for moving and handling people. This related to staff not having annual training in moving and handling and inappropriate moving and handling techniques being used at the home. [Refer to standard 38.] St Nicholas DS0000022038.V366505.R01.S.doc Version 5.2 Page 22 The manager told us they have recently become a member of Devon Care Training and will be accessing training courses for staff. Their aim is that all staff will undertake appropriate training. People living at the home described the staff as ‘friendly and caring’. We saw a member of care staff and the manager speaking kindly and respectfully to them showing that staff promote relaxed and respectful relationships. It was required at the last inspection that people must not be employed to work at the home unless information and documents meeting current good standards are obtained. We looked at the records of the home’s recruitment procedure, which included details of checks undertaken prior to a member of staff being employed. The home has recruited two members of care staff and a gardener since the last inspection. Checks for care staff included police checks and references. However, only one reference had been obtained for one member of staff and this was not from their most recent employment. Records did not include proof of the person’s identity or any documentary evidence of relevant qualifications for the person. No records were available for a person employed as gardener. The manager said no checks had been carried out for this person, as they do not come into contact with people living at the home. 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. St Nicholas DS0000022038.V366505.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): 31, 32, 33, 35, & 38. Quality in this outcome area is adequate. 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. This judgement has been made using available evidence including a visit to this service. St Nicholas DS0000022038.V366505.R01.S.doc Version 5.2 Page 24 EVIDENCE: The manager of the home is also the owner. She has long experience of working with older people and has attained a National Vocational Qualification, [NVQ] level 4 in care holds the Registered Managers Award. However, they are not keeping themselves up to date with training and developments. We discussed this with the manager and were told that they spend all their time at the home but were aware that they needed to update in some areas of practice. They had recently recruited staff to work at the home, which will enable them to access and attend appropriate training. This means that ensure people living, and working at the home will benefit from it being managed by a person who continues to develop their skills and qualifications to manage the home. Although the manager has improved the homes’ recruitment procedure since the last inspection it is disappointing to note that the procedure is not robust. Only one reference was sought for a member of staff. We saw no evidence of records of previous training or qualifications or proof of identity. We were told that the member of staff concerned had contacted the service they had previously been employed by requesting training certificates be forwarded to them, but this was two years ago. The manager of St Nicholas had not contacted the person’s previous employer for a reference. 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. Records kept at the home are stored securely in locked cupboards. We were told that people’s individual records would be made available to them, or their representative, if they wished. 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. Staff have not received up to date first aid, food hygiene or moving and handling training. A member of staff told us they had not had manual-handling training for at least 2 years but had been given an update by the manager when they were first employed at St Nicholas. The manager is not a Manual Handling trainer and has not had any updates since 2006. We asked a staff member to describe how they would assist a person to stand from a sitting St Nicholas DS0000022038.V366505.R01.S.doc Version 5.2 Page 25 position. An outdated, potentially unsafe method was described. We were told by the manager during the last inspection that they were aware staff needed to be updated and were planning a training session with another home. This training has not been undertaken since the last inspection despite a requirement, that it be undertaken, being made. The manager has informed us since this inspection that training in Manual Handling has been planned to take place in 2 weeks time and Fire Training and Basic Food Hygiene training has been arranged to take place in October. 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. Prior to this inspection the owner 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. St Nicholas DS0000022038.V366505.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 3 3 4 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 1 St Nicholas DS0000022038.V366505.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 OP30 Regulation 18 [1] [c] Requirement Staff must receive training appropriate to the work they undertake. This is to ensure that people using the service are in safe hands at all times. Suitable arrangements must be made to provide a safe system for moving and handling people. This relates to staff not having annual training in moving and handling and an inappropriate moving and handling techniques being used at the home. This requirement was made at the previous inspection and the timescale [30/04/08] set at that time has not been met. Timescale for action 30/10/08 2. OP38 135 09/10/08 St Nicholas DS0000022038.V366505.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. 1 Refer to Standard OP27 Good Practice Recommendations 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. 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. 3 OP38 The registered person should ensure that the recruitment procedure at the home is robust. This relates to obtaining at least 2 references for people who are employed at the home. 2 OP38 St Nicholas DS0000022038.V366505.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. Extracts may not be used or reproduced without the express permission of CSCI St Nicholas DS0000022038.V366505.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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