Inspection on 14/03/08 for St Nicholas

This inspection was carried out on 14th March 2008.

CSCI found this care home to be providing an Poor service.

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 10/07/09

St Nicholas 11/09/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St Nicholas Harepath Hill Seaton Devon EX12 2TA Lead Inspector Michelle Oliver Unannounced Inspection 14th March 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Nicholas DS0000022038.V359732.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.V359732.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.V359732.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th October 2006 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 £400£440 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.V359732.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 the people who use this service experience poor quality outcomes. This inspection was undertaken to follow up a random inspection, which was carried out in December 2007. That inspection was carried out in response to an allegation that although registered for 3 people, a fourth person had been admitted to the home. During the inspection in December this allegation was confirmed. The manager was aware that by admitting this person they had breached their conditions of registration. As part of this key inspection the manager completed an Annual Quality Assurance Assessment (AQAA), which requested general information about the home and the people living and working there. With the information provided, CSCI surveys were sent to people living at the home, their relatives, staff and outside professionals, in order to hear their confidential views of the service, prior to our unannounced site visit. Completed surveys were received from 1 person living at the home; 5 relatives and 2 staff 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. We spent 7 hours at the home, speaking with people living there and staff. We also spent time observing the care and attention given to people by staff. To help us understand the experiences of people living at this home, we looked closely at the care planned and delivered to two people. People living at the home were spoken with during the course of our visit to hear about their experience of living at the home. We also spoke with 3 staff, including the owner/registered manager. 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. Finally the outcome of the inspection was discussed with the owner. What the service does well: The home is run as a family home and people living there were generally happy. St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 6 One relative in response to a questionnaire stated that staff “treat [my relative] like a human being and keeps us informed of any changes in [their] condition”, and “ our [relative] always seems very happy”. People feel confident that their complaints or concerns will be addressed. A good admissions process ensures that the home can meet people’s needs. People’s health care needs are well met and the home works with other 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 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. 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? What they could do better: Care plans do not include goals that have been decided with individuals living at the home or activities/ interests that they may wish to take part in or continue to enjoy. Assessment of peoples’ nutritional needs, risk of falls and use of bed rails have not been undertaken. Records are not securely stored at the home as the cupboard they are stored in has a broken lock. The management of medication at the home potentially puts people at risk. Medication is being dispensed from original containers into a weekly storage St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 7 system. The member of staff who has given medication to a person is not signing medication records. Some medications are currently being stored in an unlocked cupboard in the kitchen. A record is not kept of all medications returned to a pharmacy and some medications have not been returned to a pharmacy when no longer being used, or past an expiry date. Medication instructions are being hand written without being checked by a second person to ensure accuracy and safety. There was no evidence to suggest that a doctor or a pharmacist had been consulted before a decision has been made to “grind up” medication and put into food before giving. A record is not being maintained of prescribed ointments/creams are being applied and there is no system for ensuring that creams/ointments are not used after 28 days once opened. During this inspection and the inspection in December meals had been cooked several hours ahead of lunchtime and had been left, uncovered [in the fridge during this inspection] to be reheated later. The meals did not look appealing or appetising. Also during this inspection and the inspection in December, the kitchen was not clean. During this inspection the floor was dirty, a cat litter tray, dog food bowls and a child’s potty were in the kitchen. The number of staff on duty at some times of the day may not always be sufficient to meet peoples’ health, social and welfare needs. For a time during this inspection and the inspection in December there was insufficient staff on duty to meet people’s needs. This relates to only one member of staff being available to assist people living at the home although one person needs two staff to assist them to move or to be sat up. The staff rota did not accurately reflect the number of staff on duty at all times at the home. Staff are not up to date with current practice relating to protection of vulnerable adults and reporting poor practice. Staff addressed a person living at the home in a manner that was not considered age appropriate and another, raised their voice to a person living at the home and was asked to leave the persons’ room The home’s recruitment procedure is not robust. Two people have been employed to work at the home without the necessary checks, including police checks, being carried out. Results of surveys undertaken at the home have not been made available to interested parties or included in the home’s statement of purpose. St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 8 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.V359732.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.V359732.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. & 6 Quality in this outcome area is adequate. The home has developed a system, which will ensure that peoples’ needs are assessed before they make a decision to make it their home. The home does not admit people for intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In December 2007,the Commission received information that four people were being cared for at the home when it is registered to care for up to three only. A random inspection of the home was undertaken and this information was found to be correct. St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 11 During that inspection we asked to look at records for the person that had been admitted and were told that there were none. No assessment of this persons needs had been undertaken prior to their admission to the home. A requirement was made following that inspection that people must not be admitted to the home unless a comprehensive assessment of their needs had been undertaken. During this inspection the manager told us that people who are considering making St Nicholas their home will be told about the home in detail, and where possible visit, have a meal and meet people living there and staff. Two people living at the home were not able to remember details about when they moved into the home. The manager told us she would visit the person concerned at their home or in hospital to carry out an assessment of their health, social and welfare needs. This is to make sure that peoples’ individual needs can be fully met at the home. This includes making sure that staff knowledge and experience, environment and equipment are sufficient to meet the peoples’ needs. Meetings are held with family to make sure that all relevant information is gathered. The manager also said that people already living at the home are considered before a person moves in. St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 12 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 adequate. People’s health needs are well met with good multi disciplinary working, helping to protect people’s welfare. Some medication practices could place people at risk. People feel they are treated with respect and that caring staff uphold their privacy. Some approaches to people may put them at risk of not feeling they are respected as individuals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people currently living at St Nicholas have individual plans of care that have been based on the homes’ admission process. These are reviewed and updated by the manager regularly to reflect any changes in people’s needs. St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 13 We spoke to two people living at the home during this inspection. Neither of them was aware that they had an individual plan of how their care was to be carried out. Neither could remember being included in any reviews or being told of any changes to their care. However, both were happy with the care provided at the home. Care plans included information about peoples’ individual health, social and welfare needs such as mobility, personal hygiene and eating and drinking. However, they did not include any goals that people aim towards meeting. For instance things that they were able and wanted to do for themselves to retain some independence. Care plans did not include information relating to peoples’ interests or past hobbies. This means that people may not be encouraged to continue with a pastime they enjoy, as information is not available. Care plans included an assessment of peoples’ needs in relation to their mobility. This assessment includes details of a person’s weight, equipment needed and how mobile a person is, to be considered. This ensures that when being assisted to move staff are aware of individual needs and abilities. One assessment we looked at stated that the person could be assisted to sit up in a chair, if they had slipped down, by one member of staff and a hoist if the manager wasn’t available. Staff told us that the plan was not being followed as they considered that this was not safe for the person or the member of staff carrying out the task. The manager confirmed this and agreed that the plan had not been updated. This potentially puts people who need to be assisted with moving, and staff, at risk. During this inspection we saw a moving technique that it potentially harmful. [Refer to Standard 38] A care plan identified that a person has a problem with swallowing and needed their food to be pureed. Staff told us that the person could choke easily and medication was given in soft food. However, no action had been undertaken to assess the risk of this happening or what staff should do if the person were to choke. This means that peoples’ health and safety is potentially at risk, as some hazards have not been identified or actions planned to reduce them. People living at St Nicholas have access to healthcare services that meet their needs including chiropody, opticians, dentists and district nurses. During this inspection a district nurse visited the home to provide treatment for one person. The nurse told us “the home is lovely” people are well cared for at the home and the manager contacts health care professionals appropriately. This means that the home highlights changes in peoples’ general health promptly and people have access to health care professionals. St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 14 None of the people living at the home currently 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. Medication is received at the home in its original packaging from a pharmacy. We were told that when medication is received at the home it is stored in individual people’s room in locked cupboards. For eases of administration the manager dispenses medication into daily doses in a weekly medication holder for each person. This practices secondary dispensing and is unsafe practice. Medication must be dispensed to people from the original container in order to follow the prescibers directions. The manager told us that they usually administer medication and if they were not at the home would “put them in a pot” and staff would give them. The manager was not at the home when one person was given their midday medication, which was given by a member of staff. We asked the member of staff whether having given the medication they would sign the medication record and were told that they would not, that the manager would sign it on their return. The record of administration of medication was not accurate, as it is not always signed by the person who has actually given medication but by another member of staff. This puts people at risk of not receiving medication as prescribed by a doctor. The records detailing people’s medication, dosage and times to be given are hand written and are not checked by two members of staff to ensure accuracy. Also, it is possible for the person making the entry to incorrectly copy the details from either the label or the previous medication record. It is considered good practice for a second person to check and sign the entry. We noted one medication that had been written inaccurately. This potentially puts people at risk of receiving the wrong medication. People at the home had been prescribed creams/ointment that need to be applied by staff daily. Staff confirmed that creams had been applied as directed but no record had been kept of their application. Also 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 after 28 days of use. A record is kept of medication that is no longer being used and has been returned to a pharmacy. We were told that medication had recently been returned for a person but there was no record of this. St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 15 Although individual medication in kept in locked cupboards in people’s rooms, some medication is stored in a cupboard in the kitchen, which is not fitted with a lock. We saw a pack of medication with a label partly ripped off so were unable to establish the date when, or who, the medication had been prescribed for. There was no record of any person currently living at the home being prescribed this medication. We also saw a bottle of liquid medication with a label partly ripped off that was past its use by date. We also saw medication that had not been prescribed for people living at the home but was for personal use stored in this cupboard. This means that some medication is not stored safely at the home. We saw no confirmation that a doctor had been involved in a decision to give medication to one person as “grind up and add a bit of porridge to them and feed [them] the tablets”. Another persons’ medication was also being put in their food in order for them to take . It was not clear whether the people concerned were aware that they were being given medication A doctor must be consulted and agree to this procedure if it is being given in this way to disguise medication in order for people to take it against their wishes.. We were told that a doctor had but this has not been confirmed in writing. We have been told since this inspection that a doctor has been consulted and a number of medications have been changed from tablet to liquid form, which will make it easier for people to take their medication and to be able to consent to taking it. Staff told us how people’s privacy and dignity are met and promoted by the staff and manager at the home. The manager and a carer described good standards of respecting peoples’ privacy and promoting their dignity. However, we heard a person being referred to as “ a good girl” when being assisted to eat and “ you are usually good with your meals, usually eat it all up for me”. Also the carer told this person that they were “going to feed” the other person living at the home. Whilst we are sure the staff member was not being unkind this language puts people at risk of the dignity not being respected. Information received from the home before this inspection indicates that the home feels they meet people’s health and personal care needs well “by monitoring people’s needs and responding immediately to any changes in needs “The home is confident that they “provide a high quality level of care and hygiene and at present no improvements can be made”. The home feels it has improved in the last 12 months by providing “staff training to ensure current standards of care are maintained”. St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 16 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 adequate. People who live here benefit from having easy contact with their friends and family. Whilst food served at the home may be nutritious it is not always served in an appetising manner at a time when people may prefer. Adequate stimulation and interest may not be sufficient for all people currently living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A daily diary is kept of how people live their lives at the home. The reports record tasks that have been undertaken by staff, and records of meals taken, rather than what people have actually done or been involved in. The manager had recorded that one person had an interest in bird watching and enjoyed looking out at the garden. We spoke to this person who confirmed St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 17 that this is what they enjoyed. The person had a visitor during this inspection but at other times staff did not visit her room or chat to her, the person simply sat in their chair looking out of the window and looking at a clock on a table in front of them. There was no reference in the record of what this person engages with on a daily basis. Staff told us that when the weather is suitable, and if sufficient staff on are duty, they take this person out into the grounds in a wheelchair. The manager and owner told us that St Nicholas is run as a family home and people living there are treated as one of the family. People living there enjoy visits from the managers’ dog and grandchild. The home has not developed a menu offering a choice of meals, which can be given or read to people living at the home. The manager plans what the meals on a weekly basis taking peoples’ likes and dislikes into consideration. People living at the home were not given a choice of what they would like to eat or when they would like to eat it, a meal did not look appetising and was not attractively presented on the day of this inspection. When we carried out a random inspection in December 2007 we found individual plated meals had been prepared for peoples’ lunch in advance , by the manager, as she would not be on duty at the home during the lunch time. The meals had been left out, uncovered, on a worktop to be reheated at lunchtime. We were told this had been done to save the one member of staff left on duty at the home, having to prepare the lunches. We met with the owner in March 2008 to discuss our concerns in relation to the inspection in December2007. during that discussion the owner assured us that this had been a “one off” and would not be repeated. We were therefore very disappointed to find that when we arrived at 9.30 am on the day of this inspection, we saw two meals, that had been prepared and liquidised earlier that morning, uncovered in a fridge. The manager told us that they don’t usually prepare meals in advance but had an appointment that morning and had prepared the meals to help the member of staff left at the home. A person living at the home called out at 12.15 that they were hungry and wanted their lunch. Staff told us that it was usual for this person to do this but lunch was not served until 1pm when the afternoon member of staff came on duty. We asked the person whether they were hungry and wanted lunch and were told that they had misread the clock but “didn’t want to get left out”. The member of staff told us that the person had recently moved to the home from a larger one and thought they may be forgotten. At 1.15pm an afternoon member of staff had not arrived and we asked the member of staff on duty whether they could heat the meal for this person. This was done. When being assisted with their lunch the person asked what it was that they were being given. The member of staff replied that they didn’t know, as the manager had not told them. The person said the meal looked “ strange” and that it had “never looked like that before”. The person was assured it always looked this St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 18 way. The person then asked the staff member whether they would eat a meal like this and were told it looked all the same colour because gravy had been poured over it or it would have been too dry. When the afternoon staff member came on duty they took over assisting the person with lunch and told them what it was. The member of staff stood throughout the time taken to assist the person, and took about 5 minutes to complete the task. We spoke to the manager about this who said that this is the way staff were asked to assist as if the person being assisted saw the food they would be put off by the amount, whereas this way they ate a good meal and received the appropriate amount of nutrition. We saw recorded in two care plans that one person had “ a tin of soup” and another “a tin of rice” for tea. Nothing was recorded in the daily notes of what people actually ate for at evening mealtime. There was no evidence of people being offered a choice or having a sweet at this time. A nutritional assessment undertaken for one person highlighted that the person was at high risk of poor nutrition but no strategies to prevent this had been developed. The home stated, in a self-assessment of the service they provided before this inspection, that they “provide a varied and stimulating environment to ensure that daily lives are as interesting as possible”. St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 19 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. The home has a satisfactory complaints process. Staff have a limited knowledge and understanding of the forms of abuse and would benefit from receiving training to ensure they are aware of up to date guidance. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaints have been made to the home since the last inspection. The Commission received information in December 2007 that four people were being cared for at the home when it is registered to care for up to three only. We carried out an unannounced inspection and found that a person had been admitted to the home and the dining room had been made into a bedroom for them. A number of requirements were made at the time of the inspection and we have met with the owner and discussed this breach of the Care Standards Regulations with them. They are aware of the seriousness of their actions and will be producing an improvement plan as to how the requirements will be met. St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 20 Two people who responded to questionnaires stated that they always know how to make a complaint and always know who to speak to and that staff always listen and act upon what they say. At the time of this visit one person living at the home and a relative said that if they had any concerns they would feel comfortable speaking to any of the staff at the home. The manager told us staff have good relationships with people living at the home, and spend a lot of time talking to them, making sure that if they have any complaints or concerns they can be dealt with. We spoke to one member of staff who was not able to Staff working at the home have limited understanding around restraint issues. A person living at the home has rails attached to their bed to prevent them from falling as the manager has assessed that they are at risk of doing so. There are no written risk assessments to support this decision or in relation to risks that the bed rails can present. For instance are the rails being used compatible with the bed, are they well maintained, could the person cause themselves an injury by trying to climb over them or between the rails or could some part of their body become trapped in the rails. Guidance to enable staff to make the person comfortable at night has been written in the persons’ care plan. Included in this information is “once finished push up the big armchair up against the cot-bed sides just for extra safety because in the past [they] have put [their] legs through the bars”. Once again no assessment of the risks presented by this have been recorded. We asked the manager whether the person had been involved in the decision for the rails to be used and were told that they had but we saw no evidence to suggest the person concerned had been involved in the decision. We spoke to the person who said they had not been asked before they were put up, that they “hated” them but had been told they were for their safety. During this conversation a member of staff was frustrated, because they said the person had been asked, and raised their voice and referred to being annoyed by “people like you old people” related to “changing their minds”. We had to ask the member of staff to leave the room at this time as their outburst upset the person concerned. We were told that staff had received training in the protection of vulnerable adults from the manager. During this visit we asked staff to discuss different forms of abuse but the knowledge demonstrated was limited. The home’s self assessment for what they do well in relation to dealing with complaints and protecting people who live at the home includes that they St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 21 “have set care standards and monitoring procedures for both staff and residents welfare”. St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 22 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 & 26. Quality in this outcome area is adequate. People live in a comfortable environment but would benefit from an improvement to general cleanliness, hygiene and décor at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: St. Nicholas provides homely and comfortable accommodation including a comfortable lounge and a spacious dining room. All staff undertake general cleaning duties throughout the day and a domestic is employed at the home for 2 hours a week. The manager told us the home has a contract with professional cleaners who ensure that carpets throughout the home are cleaned regularly. St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 23 We carried out a random inspection in 2007 and found the kitchen to be dirty at that time. At the time of this inspection some parts of the home was generally clean and fresh, however, the kitchen was not. The floor was dirty; there were dog food bowls, a cat litter tray and a child’s potty in the room where food for people living at the home is prepared. According to the rota a cleaner was due to come to the home for two hours on the day of this inspection. However, the person was unable to come on that day. We saw a member of staff sweeping the kitchen floor when they came on duty during the afternoon. Several carpets throughout the home, including the lounge, dining room and one bedroom, were badly stained and skirting boards in the dining room were dirty. We were told that the manager had already arranged for outside cleaners to visit the home to clean some carpets. The general décor of the home was looking tired and in need of redecoration. The home’s laundry facilities are in a separate outside building. At the time of this inspection the floor was dirty, an open clinical waste bag containing some incontinence items and an open bag of potatoes were stored in the room together with two freezers. We were told that a member of staff is responsible for cleaning the room. People living at the home were happy with their accommodation. The rooms we saw were comfortable and had been personalised to make people feel more at home. 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.V359732.R01.S.doc Version 5.2 Page 24 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. Staffing levels at the home are usually sufficient to ensure peoples’ needs are met in a timely and proper way but are at risk of their needs not being met when only one person is on duty. People living at the home are not protected by the homes’ recruitment procedure, which is not robust. This judgement has been made using available 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 another member of staff was due at the home at 10am to carry out some cleaning duties; this person did not arrive due to sickness. The manager is usually on duty between 9am-5pm and there is always a carer on duty throughout the day. The manager lives at the home and undertakes sleeping night duty. Arrangements are in place for people to call during the St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 25 night if they need assistance and one was able to confirm this at the time of this visit. We looked at the staff rota to establish the number of staff on duty at any one time. The rota was not accurate. The manager was due to leave the home at 11.30 but this was not reflected on the rota. The other member of staff on duty was not the person indicated on the rota. After looking at the needs identified in people’s care plan it was evident that one person required two people to assist them to move. This could not be carried out if only one person was on duty. During this inspection one person wanted to go to bed but was told they couldn’t because there was only one person available. The manager told us she or one of her daughters is at the home almost all the time but there are times when they may not be. The manager always leaves contact telephone numbers so that staff may contact her in the case of an emergency. We saw a several telephone numbers written on the duty rota. This puts people at risk of their needs not being met by the number of staff on duty at the home. A relative commented in a questionnaire returned before this inspection that possibly an increase in staff at certain times” was one way the service could improve. People told us they received the care and attention they needed. Relatives responding to questionnaires felt that the home gave the support required and could meet the different needs of people living there. Staff morale at the home is high and staff felt valued; some people described satisfaction they get from working at the home. Comments from staff included, “I have worked at many homes and this is the best one I have worked in”. 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 the “Mental Capacity Act” in 2007, however when asked one was unable to discuss what the training involved. No staff had attended a basic food hygiene course although they are involved with serving food. We discussed with the manager the need for staff to receive mandatory training in moving and handling annually We were told that staff receive a period of induction training when the are employed at the home. The home has only 3 people living there and most of the induction is provided verbally. We did not see any records of this training. St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 26 Past records and staff files show the home does not have a high staff turnover and do not employ agency staff. One member of staff has achieved a nationally recognised qualification [NVQ] at level 2. The manager has achieved a NVQ at level 4 and has attained a Registered Managers Award. We were told in information received from the home before this inspection that they train their “staff to a high standard, retain good quality mature staff and provide good working conditions”. The home feels that this is evident by “looking at staff training records”. The home’s plans for improvement in the following 12 months are to “continue to ensure that staff needs, financial, physically and spiritually are reviewed and met, where possible, to ensure they are motivated to provide the best level of care to people living at the home”. We looked at the recruitment files for all staff employed at the home, two of which have been employed since the last inspection. There was no record or file for one person and we were told that no police check, references or application form had been completed for this person. There was a file for another member of staff but once again no police check, references or application form had been completed. We saw an application form for another member of staff but no references or police check had been completed. This puts 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.V359732.R01.S.doc Version 5.2 Page 27 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): 31,33,35 & 38. Quality in this outcome area is poor. 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 is needed. Although people are generally well cared for at the home some practices do not promote good health, safety and welfare for them and staff. This judgement has been made using available evidence including a visit to this service. St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 28 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 over a number of issues relating to breaches of regulations. In December 2007 a random inspection of the home was carried out following information received that four people were being cared for at the home when it is registered to care for up to three only. During the inspection we found the information to be correct and no information was available about the fourth person. 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. Recruitment practices are poor , which means that staff may be unsuitable to work at the home, and 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. 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 lockable. The manager said that people are consulted on all aspects of their life at St Nicholas on a daily basis when she chats 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 regular training in the prevention of fire, however they have not received up to date first aid, food hygiene or moving and handling training. During this inspection we saw a person being helped to sit up by a member of staff pulling them up under their armpits. This is not recommended practice and could cause injury to the person being assisted. We asked a staff member to describe how they would assist this person when only one of them was available and this unsafe method was described. We were St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 29 told by the owner that they were aware staff needed to be updated and were planning a training session with another home. Information received before this inspection showed maintenance or servicing of gas and electrical systems was up-to-date. Also that other equipment, such as the lift and hoists were 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. Information included in the AQAA returned by the owner 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. We discussed this with the manager who told us that they had not actually completed the AQAA but had provided their legal advisor with the relevant documents who then completed the form. St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 2 2 St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 31 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 OP7 Regulation 4c Requirement Unnecessary risks to the health and safety of people living at the home must be identified and as far as possible eliminated. This relates to no risk assessments being undertaken of people’s nutrition, risk of falls and use of bed rails. 2. OP9 132 Arrangements must be made for the recording, handling, safe keeping, safe administration and disposal of medicines received into the home. This relates to medication being dispensed by the manager from original containers. [Secondary dispensing] Medication records not being signed by the person who has given medication to a person. Insecure storage of medication [in the kitchen] Records not kept of St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 32 Timescale for action 30/04/08 30/04/08 multidisciplinary decisions made to give medication in food. Records not kept of all medication returned to a pharmacy. Medication not being returned when no longer being used, or past an expiry date. A record not being kept of the application of prescribed creams/ ointments. Hand written prescriptions not being checked and signed by two to ensure accuracy and safety. 3 OP15 16[2][c] [I] People must be provided with nutritious, wholesome food, which is properly prepared. This relates to 2 meals cooked in advance, and left in a fridge uncovered, to be re heated at lunchtime. 4 OP26 23[d] All parts of the home must be kept clean and reasonably decorated. [This relates to the kitchen and the laundry not being clean at the time of this visit] Staff must be employed in sufficient numbers at the care home to meet the health and welfare needs of the people living there. Recorded staff rotas, showing which staff are on duty any time during the day and night, and in what capacity, should be kept. This relates to the manager not St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 33 30/04/08 30/04/08 5 OP27 18[1][a] 30/04/08 6 OP27 Schedule 4 [7] 30/04/08 7 OP29 19[4][b] Paragraph 1-7 Schedule 2. recording the times they are on duty and inaccuracies in relation to staff on duty.. People must not be employed to work at the home unless information and documents specified in Schedule, paragraphs 1-7 has been obtained. The manager must undertake training that is appropriate to ensure they have the experience and skills necessary for managing a care home. 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. 30/04/08 8 OP38 10[3] 30/06/08 9. OP38 13[5] 30/04/08 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 OP7 Good Practice Recommendations Care plans should include goals that have been decided with individuals living at the home and also activities/ interests that they may wish to take part in or continue to enjoy. A system for ensuring that creams/ointments are not used after 28 days once opened, should be established. Staff should use appropriate language/terms when speaking to people living at the home. The interests of people living at the home should be DS0000022038.V359732.R01.S.doc Version 5.2 Page 34 2 3 4 OP9 OP10 OP12 St Nicholas recorded. People should be given the opportunity for stimulation through leisure and recreational activities in and outside the home, which suits their needs and capabilities. 5 OP15 Food, including liquidised meals, should be presented in an attractive manner. A menu offering a choice of meals should be provided and given or read to people living at the home. 5 OP18 Arrangements should be made to ensure that staff are aware of the prevention of adult abuse. This relates to a member of staff being unsure of what would constitute abuse, and an outburst by another when a person denied being asked about the use of bed rails before they were used. 6 OP37 All records at the home should be stored securely. St Nicholas DS0000022038.V359732.R01.S.doc Version 5.2 Page 35 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.V359732.R01.S.doc Version 5.2 Page 36 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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