Inspection on 23/11/07 for St Paul`s Care Home

This inspection was carried out on 23rd November 2007.

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

The inspector 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 Paul`s Care Home 20/11/08

St Paul`s Care Home 28/06/06

St Paul`s Care Home 27/10/05

St Paul`s Care Home 19/07/05

St Paul`s Care Home 12/10/04

St Paul`s Care Home 13/05/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

Thorndene

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St Paul`s Care Home 65 Albany Road St Leonards On Sea East Sussex TN38 0LJ Lead Inspector Debbie Calveley Key Unannounced Inspection 23rd November 2007 09:00 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 Paul`s Care Home DS0000014047.V352752.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 Paul`s Care Home DS0000014047.V352752.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Paul`s Care Home Address 65 Albany Road St Leonards On Sea East Sussex TN38 0LJ 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) 01424-425798 01424 448170 StPauls@New-Meronden.co.uk www.newcenturycare.co.uk New Century Care (Hastings) Limited Margaret Law Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25), Physical disability (25) of places St Paul`s Care Home DS0000014047.V352752.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is twenty-five (25) Service users must be aged sixty-five (65) years or over on admission Service users with a physical disability can also be accommodated Date of last inspection 28th June 2006 Brief Description of the Service: St. Paul’s is a detached property that has been converted and adapted as a care home. It is owned by New Century Care Ltd and provides nursing and personal care for up to 25 residents of an older age, including those with physical disabilities. The accommodation is arranged over three floors, with a shaft lift providing access to all floors. There are three double bedrooms, two of which have en-suite facilities and nineteen single rooms, seven with ensuites. The home has hoists, bath hoists and an assisted shower room, for those who are less mobile. There are also grab rails and disability aids in the bathrooms and toilets. A large spacious lounge/dining room, with access to a patio area outside, provides communal space and at the front of the home, there is a parking area for several cars. The home is situated in a residential area of St. Leonards on Sea and is on the bus route for the shops at Silverhill or for the town of Hastings. The home welcomes prospective residents or their representatives to view the premises, discuss their needs with the Registered Manager and spend time with the staff and residents. Weekly fees 01/04/07, range from £470 - £700. The fees do not include hairdressing, chiropody, residents’ telephone calls and any sundries, such as newspapers: these are charged as extras. Information about the service is available on the organisation’s website (New Century Care) and from the home’s Manager. St Paul`s Care Home DS0000014047.V352752.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at St Paul’s Care Home will be referred to as ‘residents’. The information contained in this report has been compiled from an unannounced site visit undertaken over 8 hours on the 23 November 2007 plus information gathered about the home since the previous inspection. This includes discussion with stakeholders involved in resident’s care, surveys received from residents and relatives and records submitted to CSCI, which have included an Annual Quality Assurance Assessment (AQAA) and the notification of accidents and incidents. There were 18 residents living in the home, of which five were case tracked and met with. During the tour of the premises a further six residents of both sexes were also spoken with and three relatives. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including care plans, medication records, training records and recruitment files. At the time of the inspection, the refurbishment programme was still being completed and impacted on some aspects of the site visit, but not adversely on residents. In order that a balanced and thorough view of the home is obtained, this inspection report should be read in conjunction with the previous inspection reports. The Inspectors would like to thank the residents, staff and management for their assistance and hospitality during the visit. What the service does well: Residents confirmed that they were visited by the Manager prior to admission to the home and two stated they had been invited to visit the home to see if they liked it enough to live there. The menus evidence a well thought out balanced diet with a varied choice of food in line with resident’s preferences. The comments received regarding the meals included: ‘excellent food’ ‘tasty and plentiful’. Quality assurance systems are in place, which enables the service to monitor and improve their service. There is an open-house policy, which welcomes visitors at all reasonable times. St Paul`s Care Home DS0000014047.V352752.R01.S.doc Version 5.2 Page 6 Satisfactory arrangements are in place to safeguard residents’ finances. Good, effective and robust recruitment and retention practices are being followed, which provides greater consistency of care for residents. The atmosphere of the home is pleasant with good interaction seen between residents and staff. The Comments received from residents and families regarding the care received included: ‘ Staff nice and polite ’ ‘ Very kind and considerate’ ‘ The staff are always chatty and pleasant’. St Paul’s Care Home provides a clean, safe and well-maintained environment, which is appreciated by the residents and their relatives. Comments regarding St Paul’s were generally positive and included: ‘I have lived here a long time and like it’ ‘ I haven’t been here long, but its fine, I am quite comfortable’. What has improved since the last inspection? What they could do better: The statement of purpose and service users guide do not give all the necessary information required for prospective residents to be assured that the home is the right home for them. The pre-admission assessments were benefit from being more detailed to ensure that the home can meet the prospective residents needs. The care documentation including individualised care plans and risk assessments need to be improved to ensure residents receive appropriate and person centred care that meets their assessed needs and to minimise any risks. There was no formal activity programme in place for viewing, and whilst it was confirmed there are visiting entertainers weekly and occasional bingo sessions, there is little evidence of other activities taking place which residents can participate in. Comments from residents included: ‘I am bored, very little happens’, ‘ I only know when the musicians come, not much else happens’ ‘I don’t think that there are any activities’. Therefore an appropriate programme of activities needs to be created that is realistic and based on the residents St Paul`s Care Home DS0000014047.V352752.R01.S.doc Version 5.2 Page 7 preferences to ensure that their social and leisure needs are met on an individual basis. It was identified from direct observation, from talking to residents and from information gained during the inspection process that it is not clear whether residents are given the opportunity and support in choosing a lifestyle they want. Poor practice regarding the moving and handling of residents was observed and did not reflect the guidance in the individual care plan. 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 Paul`s Care Home DS0000014047.V352752.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 Paul`s Care Home DS0000014047.V352752.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 and 5. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission, however the information is documented is brief thus not ensuring the home can meet the prospective residents needs. EVIDENCE: There is a range of documented information about the home and the services it provides. The home has a Statement of Purpose and Service Users Guide combined in to an ‘Information Pack’. However there are areas within these documents that need to be developed and updated. The documents do not include information regarding the category of the residents they can care for, the last inspection is not available for viewing and there is no copy of the terms and conditions of residency. St Paul`s Care Home DS0000014047.V352752.R01.S.doc Version 5.2 Page 10 Due to the on-going refurbishment of the home the notice board in the front hall is not as informative and up to date as it was found on previous inspections. Relatives and relatives spoken to were clear on the service provided by the home and costs involved. Five admissions to the home were identified and included the latest respite resident and the records relating to the admission procedures followed were reviewed. This confirmed that pre admission assessments are completed prior to admission and provide an assessment of prospective residents care needs. However the information contained in these documents was brief and needs to be more informative so as to ensure the admission to the home is appropriate, they also need to be dated and to detail who was present and involved in the assessment procedure so as to inform the admission procedures. Prospective residents’ are seen either in their home or hospital before admission and the input from relatives and other professionals is used whenever possible. As mentioned previously this approach should be more clearly recorded on the assessment documentation to demonstrate the procedure followed. Intermediate care is not provided at St Paul’s care home. St Paul`s Care Home DS0000014047.V352752.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 and 10. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although care documentation provides a framework for the delivery of care it needs to be developed to provide clear guidance to care staff on all the care needs of the residents, along with robust systems for risk assessment to ensure individual person centred care is delivered. EVIDENCE: The care documentation pertaining to five residents were reviewed as part of the inspection process and a further four were identified for viewing of specific areas of care. Care plans were found to include plans of care, nutritional assessments, personal histories and risk assessments. The care documentation demonstrated that the care was reviewed and evaluated regularly, however it was noted that not all the plans of care highlighted all the needs of residents and did not contain the guidance necessary for staff to provide a consistent and person centred approach. In particular catheter care, communication problems and diabetes. Fluid and turning charts for those that are in need of St Paul`s Care Home DS0000014047.V352752.R01.S.doc Version 5.2 Page 12 monitoring were not completed consistently and could not be found for one frail resident. It was also noted that resident’s social emotional and psychological needs were not assessed or addressed within the care records. There was evidence of consultation with the resident or their relative in the initial care plan formation, but no evidence of regular consultation that would encompass any changes in care. Records pertaining to the health needs of residents were not all accurate and some wound care records had not been completed regularly, one had no entry recorded for three weeks. It was also noted that the use of risk assessment was limited; for example the use of call bells are not documented and a resident administering own eye drops did not have a risk assessment. Those risk assessment completed for nutritional screening, falls and moving and handling need to be based on clear criteria and followed up within the care documentation. Weights and the nutritional tools are not used in a way that identifies and monitors weight loss/gain. These shortfalls were discussed in full during the feedback session at the end of the inspection with the Manager and Area Manager. Records indicated that local Doctors are called regularly and are involved in the care of residents and one General Practitioner visited the home during the time the inspection assessment was being completed. The home Manager confirmed that specialist external advice is sought as necessary and included the dietician and tissue viability nurses. The residents benefit from a named nurse and key worker system, which ensures continuity of care and builds relationships between the resident and care worker. The clinical room is compact and well organised and is kept locked at all times. There is a small fridge and temperatures of the room and fridge are recorded daily. There are policies and procedures in place for staff to refer to regarding the safe administration, storage, disposal and recording of medication. The systems for recording and checking controlled drugs were found to be thorough. Medication Administration Charts (MAR) were found to be completed with no gaps identified. However some areas of poor practice were discussed with the Manager during the inspection, these included, residents’ medication had not been counted and checked in by two persons on arrival to the home, a prescribed dosage had not been changed to reflect recent blood results and staff were therefore not giving the prescribed amount on the MAR sheet, verbal orders for antibiotics were not signed and dated by the person receiving the order. Short life prescriptions need to have the opening date documented. Staff were seen to be respectful and considerate to all residents and visitors, whilst attending to their needs. However staff were seen entering bedrooms St Paul`s Care Home DS0000014047.V352752.R01.S.doc Version 5.2 Page 13 without knocking during the inspection, and approaching residents in the lounge wearing gloves and plastic aprons. Each of the residents were addressed by their preferred term and dressed appropriately in well-laundered clothing. St Paul`s Care Home DS0000014047.V352752.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 and 15. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The lifestyle experience by residents at this time does not always match their expectations, choice or preferences. Meals remain good in respect of both quality and variety that meets the majority of residents’ tastes and choice. EVIDENCE: Care plans evidence some residents past histories and social preferences, but they are not linked constructively to a formal activity programme. From direct observation, there was no evidence of any activities during the whole day of the inspection visit. The home employs two activity co-ordinators that staff confirmed spend time with the residents on a one to one basis and include hand massages and manicures. The activity care plans were locked away in the activity cupboard and therefore were not viewed at this time. It was also confirmed by staff that the residents are encouraged to attend facilities away from the home; these include shopping trips, church services and visit to local gardening centres. It was not clear from documentation how St Paul`s Care Home DS0000014047.V352752.R01.S.doc Version 5.2 Page 15 often these take place and some residents spoken with had not been out on a trip as yet. One resident said that ‘the activities are fun, and I enjoy the bingo’, other comments included ‘ I do not go to the activities, because I prefer to stay in my room’ ‘ I get very bored and it can be lonely’. ‘ Due to my poor hearing I get embarrassed so I tend to observe rather than take part’. Relative feedback included ‘ difficult to judge as I only visit once a week’ ‘ it must be hard for the staff to find things all the residents enjoy’. Activities should be an important part of life to the residents living in St Paul’s, as there are some very able people living there and therefore it is identified as an area that requires development to meet all the residents’ social needs and their expectations. It was discussed in full with the Manager during the inspection. Resident’s rooms were found to be individual and personalised and each resident has their preferred term of address recorded in their care documentation and this preference was respected. It was found from talking to residents that during the refurbishment of bedrooms residents were not consulted on the their preference regarding the colour of their room, and some were not totally happy with the colour scheme chosen, it would benefit the residents if they had been consulted on the changes to their room. From direct observation it was noted that residents could not help themselves to a drink of cordial or water whilst in the lounge area, the drinks and glasses are placed out of reach thus restricting residents’ choice and impacts on their independence as they either have to ask or wait for a drink. From talking to residents they felt that they could choose their daily structure in most areas, but negative comments included, ‘ I used to love my bath, but I don’t get one any more’ ‘ I would like to lie in some mornings, but they get me up first’. Visitors spoken to were all happy with the visiting arrangements and how staff who were said to be ‘very welcoming’ received them. There are no restrictions on visiting times as long as consideration is shown to all the residents. Mealtimes at St Paul’s are enjoyed by the residents, they are able to choose their preference for breakfast and the chef confirmed that they can have whatever they fancy, either cooked or cold. The chef visits each resident in the morning and takes their order for their midday meal and supper. There are no menus displayed in the home at this time and staff thought this was due to the current refurbishment programme and they had not yet been re displayed. The kitchen and storage areas were seen to be organised and well managed and the chef was knowledgeable regarding the residents’ tastes and dietary needs. A recent visit by the environmental health team had not raised any concerns. St Paul`s Care Home DS0000014047.V352752.R01.S.doc Version 5.2 Page 16 From discussion with the Manager and staff, it was found that records are not kept on what food is eaten by each resident and this needs to be introduced to enable staff to identify appetite trends at the earliest point. All feedback about the food was complimentary and comments included ‘good food’ ‘I have choices in the meals and the meals are good’ ‘ tasty and plenty of it’ ‘lovely food, always of good quality’. St Paul`s Care Home DS0000014047.V352752.R01.S.doc Version 5.2 Page 17 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 and 18. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a formal complaints system with evidence that residents feel that their views are listened to and acted upon. Staff receive training to protect residents from abuse. EVIDENCE: The complaint policy and procedure is clear and uncomplicated and a copy of this is readily available in the home and the Service Users Guide. The policy and procedure states the timescales and also gives alternative organisations as who they can raise concerns with. The home introduced a ‘Comments and Suggestions’ Book during the site visit, in line with the organisation’s current policy. The residents spoken with confirmed that they would talk to the senior nurse on duty if they had a problem or a concern. Adult Protection policies and procedures are in place and Criminal Record Bureau (CRB) Disclosures are applied for as part of the recruitment process. The Manager stated that all staff have been trained or updated in ‘Adult Abuse’. A copy of the East Sussex multi agency guidelines is available in the home and the home works to the organisations policies for the management of adult abuse and for whistle blowing. St Paul`s Care Home DS0000014047.V352752.R01.S.doc Version 5.2 Page 18 St Paul`s Care Home DS0000014047.V352752.R01.S.doc Version 5.2 Page 19 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 and 26. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. St Paul’s provides a comfortable, clean and safe environment for those living there and visiting. Residents and their families are enabled and encouraged to personalise their room, and rooms are homely and reflect the resident’s personalities and interests. EVIDENCE: The home continues to follow an improvement and refurbishment programme that has benefited the residents and visitors to the home and provides a welcoming and comfortable environment. The tour of the home evidenced that there is still work ongoing and does not impact negatively on the everyday lives of the residents. The lounge and dining room area is combined and is spacious and plenty of natural light. It is pleasantly decorated and well furnished. The majority of the furniture in the home is of good quality. St Paul`s Care Home DS0000014047.V352752.R01.S.doc Version 5.2 Page 20 Residents who expressed an opinion spoke positively about the home, many have brought in their own possessions, pictures and ornaments. The gardens are accessible and attractive. There are adequate communal bathrooms and shower rooms in the home with specialist equipment, which enables frail residents and those with a physical disability to enjoy the facilities available. Specialised equipment to encourage independence is provided e.g. handrails in bathrooms, hoists, wheelchairs and lifts to all areas of the home. There is a call bell system that includes the use of a pendant so that residents can move around and still call for assistance if required. The lighting in the home is of domestic quality and there are above bed lights as well as the main ceiling lights. Water temperatures are controlled and monitored monthly and a record kept. Random temperatures were taken and were of the recommended level. It was confirmed in the Annual Quality Assurance Assessment (AQAA) that there are systems in place for monitoring safety issues such as fire checks, fire drills, PAT testing, electrical tests and gas and boiler checks and all the rooms are routinely checked for safety and maintenance issues. Records therefore were not checked at the site visit. Polices and procedures for infection control are in place and are updated regularly. The home was clean despite the on going refurbishment, however offensive odours were identified on the ground floor on the day of the inspection. The Manager confirmed she would investigate the cause. The appropriate use of aprons and gloves was discussed during the inspection and staff are to receive a refresher in the homes policies and procedures. At present the ground floor sluice is not fit for purpose due to building work, and staff need to ensure that safe practices are followed during this time, the laundry room was seen to be functioning well and the residents confirmed their clothes were well looked after. Residents were appropriately dressed in clean clothes. St Paul`s Care Home DS0000014047.V352752.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are robust recruitment procedures are in place to protect residents, and the staff training ensures staff are able to provide the support and care the resident’s need. However the staffing levels need to be regularly reviewed to ensure the resident’s needs are met. EVIDENCE: The staffing rota was viewed and it was felt by staff that staffing levels were sufficient to meet the dependency needs of the residents at this time, however there was delays noted in answering call bells at key times of the day, residents were seen to be left unsupervised for long periods and the meal service was slightly delayed as residents were still being attended to. It would benefit the residents if the staffing levels were reviewed regularly and respond to resident’s dependency. A selection of staff recruitment files were viewed and demonstrate that a robust recruitment process has been maintained to protect residents and contained all the relevant information required. There was evidence of health questionnaires, Criminal Record Bureau checks, two references, a resume of previous employment and work permits where necessary. All the paperwork is kept within a locked room. St Paul`s Care Home DS0000014047.V352752.R01.S.doc Version 5.2 Page 22 There is an induction programme in place for all staff. Files seen confirmed this. Staff spoken with said that training opportunities at the home are good and that they are well supported by the senior staff and the Manager. The Manager confirmed that compulsory training such as manual handling, adult protection, first aid and fire safety have been undertaken, and the files are in the process of being updated. Many of the care staff have a National Vocational Qualification and others are currently enrolled on a course. St Paul`s Care Home DS0000014047.V352752.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, 33, 35, 36, 37 and 38. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is managed in an open and friendly manner with suitable quality monitoring systems. The health, safety and welfare of residents and staff are not being fully promoted and protected at this time. EVIDENCE: The Manager is a first level registered nurse with ten years experience in caring for the elderly and has attained her Registered Manager’s Award (RMA). The Manager is supported by a deputy manager in leading a team of carers and ancillary staff. An Area Manager for the organisation visits the home once a week and completes a monthly Regulation 26 visit pro forma. St Paul`s Care Home DS0000014047.V352752.R01.S.doc Version 5.2 Page 24 The home continues to undertake annual service user surveys and questionnaires for stakeholders as part of its quality assurance systems. These are audited and then actioned if appropriate and the results published within the home for the residents’ information. There is an Annual Development Plan for the home and this is reviewed during the year and changed if required dependant on the feedback from the audits. There are some residents that manage their own financial affairs but in the main relatives or solicitors act on the residents’ behalf. The Head Office for the organisation holds individual accounts for some residents and their personal allowance is then sent out from that account, to the home. A balance of their account is held on a computer. This allows a resident to control how their money is spent. Some residents have money brought into the home by relatives: residents can then either keep it in their room in a locked facility or it is held in the office safe, in individual wallets. There are individual records of expenditure maintained by the home and receipts are kept for any items purchased. The Inspector did not view the records on this visit. The Annual Quality Assurance Assessment (AQAA) was completed by the Manager prior to the inspection visit. Staff supervision was discussed and it was confirmed that staff supervision has been commenced and there was evidence that staff receive regular appraisals. It was stated in the AQAA that all the maintenance checks are in place, the maintenance person was unavailable, however the fire equipment and lifting equipment evidenced regular checks. The Accident book for the home was viewed, the Manager confirmed she audits the occurrence of slips, trips and falls and then investigates the causes and then plans the plan of prevention. Some areas of poor practice were discussed with the Manager regarding promoting the health and safety of the residents, these included: residents being wheeled in wheelchairs without using the appropriate foot rests, and no risk assessment in place as to the reasoning, poor moving techniques were observed and the care plans not being followed. Two doors were seen during the tour of the building wedged open with pieces of furniture. This matter was brought to the attention of the manager who resolved the matter immediately. St Paul`s Care Home DS0000014047.V352752.R01.S.doc Version 5.2 Page 25 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 2 3 2 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 2 St Paul`s Care Home DS0000014047.V352752.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 (1) (c) Requirement That the Registered Person ensures that the Statement of Purpose includes all the necessary information and is up to date, in order to enable prospective service users and their representatives to make an informed choice as to whether to utilise the services of the care home, in accordance with the Regulation and Schedule 1 of the National Minimum Standards. Timescale for action 27/01/08 2. OP3 3. OP7 4. OP8 That the Service User Guide is reviewed and be specific to St Paul’s Care Home. 14 (1) That the Registered person ensures that the pre-admission assessment has sufficient detail to ensure the home has the necessary facilities and skills to meet the prospective needs. 15(1)(2) That the Registered Person 12(1)(a)( ensures that care plans b) accurately reflect the specific needs of the service users. 14(1a)(a) That the Registered Person (b) 13(1b) ensures that all risk assessments are updated regularly, are DS0000014047.V352752.R01.S.doc 01/01/08 01/01/08 01/01/08 St Paul`s Care Home Version 5.2 Page 27 accurate and include an action plan for staff to follow. That accurate records pertaining to nutrition, wound care, continence and communication are further developed and accurately reflect the service users changing needs. That the Registered Person ensures that safe medication practices are followed by staff: Verbal orders need to be signed and dated. • Changes to prescribed dosages need to be signed and dated with clear instructions for staff to follow. • That medication brought into the home by service users are counted and signed by two persons. That the Registered Person ensures that activities are provided to suit service users expectations, preferences and capabilities. That service users are supported and enabled to attend activities. That a programme of activities is more formally devised based on residents choices. 01/01/08 That the Registered Person ensures that all staff follow the homes policies and procedures in the: • Standard of infection control measures. • In the appropriate use of gloves and aprons. • That unpleasant odours are investigated and action taken to eradicate the odours. DS0000014047.V352752.R01.S.doc Version 5.2 Page 28 5. OP9 13 01/01/08 • 6. OP12 16 (2) (m) (n) 27/01/08 7. OP26 13 (3) 16 (2) St Paul`s Care Home 8. OP27 18 (1) 9. OP38 13 (5) That the Registered Provider ensures that there are sufficient staff on duty to meet the needs of the service users at all times, that staffing levels are reviewed regularly. That the Registered Person ensures that safe moving and handling techniques are used. 01/01/08 01/01/08 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. 2. Refer to Standard OP9 OP15 Good Practice Recommendations Medication for disposal should be checked and signed for by two nurses. Residents should be made aware in advance, of the menu and any alternatives that are available should be included on it, enabling them to have time to make a choice. That the Registered Person ensures that service users have the opportunity to exercise their personal choice in relation to their everyday life. 3. OP14 St Paul`s Care Home DS0000014047.V352752.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Paul`s Care Home DS0000014047.V352752.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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