Inspection on 24/05/07 for St Raphael`s Christian Care Home

This inspection was carried out on 24th May 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Raphael`s Christian Care Home 01/07/08

St Raphael`s Christian Care Home 25/07/06

St Raphael`s Christian Care Home 27/09/05

St Raphael`s Christian Care Home 07/03/05

St Raphael`s Christian Care Home 22/06/04

St Raphael`s Christian Care Home 06/11/03

St Raphael`s Christian Care Home 02/07/03

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

CARE HOMES FOR OLDER PEOPLE St Raphael`s Christian Care Home 32 Orchard Road Bromley Kent BR1 2PS Lead Inspector Wendy Owen Unannounced Inspection 09:30 24th May 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Raphael`s Christian Care Home DS0000010153.V336347.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 Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Raphael`s Christian Care Home Address 32 Orchard Road Bromley Kent BR1 2PS 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) 020 8313 1377 020 8460 1710 straphaels@schealthcare.co.uk Trinity Care Ltd ** Post Vacant *** Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (58) of places St Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Staffing Notice issued 28 July 1997 20 beds for nursing care Date of last inspection 25th July 2006 Brief Description of the Service: St Raphael’s is a large extended building situated in its own grounds with off road parking to the front of the building and within easy reach of local shops. The own is also on a bus route giving access to Bromley shopping centre and leisure facilities. St Raphael’s is part of the Southern Cross Healthcare Group, established in 1996, the company provides long term care for vulnerable people throughout the United Kingdom. The home is divided into three units, one on two levels and the other on four levels, with passenger lifts for accessibility. The home offers good communal areas accessible to all its residents. The home is dual registered with an attached purpose built nursing wing on the ground floor. All of the bedrooms in the Mellifont unit have en suite facilities as do the majority of bedrooms in the nursing unit. The older part of the building, the Orchard unit, bedrooms are provided with a wash hand basin, and toilet and bathroom facilities are within easy reach. All the bedrooms are designed for single occupancy. The home has the benefit of central heating; radiators in the resident’s bedrooms are covered in line with health and safety requirements. There are grab-rails on the stairs and in the corridors, toilets, showers and bathrooms. Specialist bathing, toilet and lifting aids are available for residents use. All bedrooms, toilets, shower rooms and bathrooms are fitted with a lock, to ensure privacy, these locks can be accessed from outside in the event of an emergency. Information on fees has shown they range from £378.51-£987.50. The Statement of Purpose states that a copy of the latest inspection report is available on request from the home. There is also a copy available in the reception area. Information is also provided to prospective residents in the form of a Service Users Guide. St Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place over the course of one day by two inspectors. The visit included a tour of the home, viewing of records, feedback from residents and relatives, discussions with staff and the manager and observations of practice. On the day of the inspection the inspectors had discussions with eight residents and three visitors. Eight relatives feedback forms were received. What the service does well: What has improved since the last inspection? St Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 6 Since the last inspection both the pre-admission practices and the care planning information have improved, providing staff with more comprehensive information on how to care for the individual resident. Medication practices have also improved with still some further improvement required in the recording of prescribed medication. The inspectors also note the improvement in the training provided since the last inspection and the way that this has been given priority. What they could do better: St Raphaels is registered to provide care for older physically frail and for those individuals who require nursing care. However, the home continues to admit people with dementia. This must be addressed, either through varying their registration and with that ensuring staff are able trained and have the knowledge and understanding of caring for individuals or they must stop admitting within this category. The pre-admission practices have improved together with care planning arrangements However, there are still some gaps in both areas which means that some information may be missed and staff would not be providing the appropriate care. Some improvements are required in the way medication is recorded to ensure there is clarity and accurate information on the medication records reducing the possibility of any health issues. Complaints procedures are in place, although the system for recording and investigating any concerns must be improved to ensure there is a clear and accurate audit trail maintained in the home. The residential unit continues to require significant improvement to ensure people are provided with a comfortable and safe environment in which to live. The Commission received overall positive comments about the standard of care provided by the staff in the home. However, the procedures relating to the supervision and formal induction of staff must be improved to ensure staff St Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 7 have the knowledge and understanding to provide good care, are monitored in their practice and staff needs are identified to ensure continued improvement. The home has been generally well managed with some improvements noted. However, the recruitment practices continue to provide concern, as does the need to address health and safety issues to ensure residents are fully protected. 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 Raphael`s Christian Care Home DS0000010153.V336347.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 Raphael`s Christian Care Home DS0000010153.V336347.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): 2,3,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been improvements in the way the manager obtains information prior to admitting residents into the home to ensure staff have the information they require to care for the individual. However, the home continues to admit residents with dementia which is not in their registration category nor are staff trained to provide this care. EVIDENCE: Residents, relatives and friends were spoken to about the admission process. One resident had been admitted to the home only four weeks previously. Her friend stated that she had been an emergency admission to the home with Social Services involved in the pre-admission procedures. The inspector was told that a Care Manager completed an assessment to determine the care required and a referral made to the home to ascertain whether they had a St Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 10 suitable vacancy. An assessment of need was completed by the home and an offer of a placement was made. As it was an emergency admission the assessment was completed after the resident had moved into the home. The sister and her friend were involved in choosing St Raphael’s, and visited the home prior to the admission. They were also involved in providing information about the resident as part of the assessment and made sure that the home was aware of their specific personal, health and social care needs. This was evidenced by the assessment documentation and the care plan being signed by the sister of the resident. The friend also stated that they had been shown around the home and were able to choose the room. Viewing of the information provided shows the home continues to admit residents outside of its registration category. The diagnosis for one resident, recorded in the assessment documentation, stated that this residents’ dementia had advanced, that there was a decline in her physical and mental health and risk of disorientation and wandering. This resident was spoken to and appeared, at first, able to be able to converse but when asked a question did not respond appropriately. On checking the care plan and assessment information, it appears this individual requires a care home with a dementia category. Within the information supplied prior to the inspection, the manager recorded that there were 25 residents with mental health or dementia. A recent complaint highlighted how caring for people with dementia needs staff who are trained and have the knowledge and understanding of this client group. As stated previously the manager needs to ensure admits people within the category or apply for a variation to the registration where the dementia is the primary diagnosis. To continue to admit residents outside of the registration category is a breach of the Care Standards Act 2000. A separate letter has been sent to the Providers. In total five peoples records were viewed to determine the pre-admission information. This was generally of a good standard, although there is a need to ensure the information is completed in full, dates and signatures are recorded when gathering the information. It is also beneficial to make clear certain phrases ie all care required-what does this mean? (See requirement) Other information such as a draft care plan had also been completed in some cases and a record of property brought into the home was also in place. Of the five files viewed there was evidence of contracts for privately funded residents, although some did not have fees recorded, others were not signed by family or resident. Where the Local Authority made the placement there was no evidence of the agreement between the Authority and resident, although there were agreements between the home and the resident. However, details of the fees were not evidenced due to the delay with the authority. (See requirement) St Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9& 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been significant improvement in the way the home develops care plans for the individual needs of the residents and with further improvement the home will ensure staff have full information on the way in which residents wish to be cared for. EVIDENCE: The inspector was told by one resident “I feel comfortable in the home.” In conversation with another resident it was evident that she felt that the home was able to meet her personal, health and social care needs. She said that the staff were very kind and caring and understood how much support and the individual residents needed encouragement. A visitor to the home was sitting in the garden with his sister, who had been resident in the home for a number of years said he felt his sister was well cared for, the food was good and that the entertainment was varied and the staff were kind and caring; his St Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 12 sister stated that she was happy in the home and quite enjoyed living there, the manager and the staff at the home were kind and appeared to understand the needs of the residents. Five care plans with associated assessment information were viewed. These had improved since the last inspection with clearer information detailing the identified needs of the individuals. There were gaps still evident, particularly around information on personal care and how many staff required to assist? In one case the care plan did not reflect the current situation. For instance it stated that the individual was nursed in bed and supported to sit in a recliner for two hours daily. However, the person in question was sat in the lounge throughout the day and according to staff no longer cared for in bed. There was no risk assessment regarding the person’s behaviour when hoisted, or whether MRSA was still present. All contained supporting documentation around the healthcare needs of the individual. Risk assessments in relation to moving and handling, falls, pressure care and nutritional needs had been developed with corresponding care plans detailing the action to be taken where risks had been identified. However few, if any, care plans contained information on the cognitive needs of individuals particularly those with dementia. (See requirement) There was some evidence of the care plans being reviewed and that the resident or the relative had been involved in the development of the care plan. The manager should try and promote this involvement further. Wound care records were in place to ensure pressure sores treated. There was evidence that pressure sores had improved and feedback from the PCT confirmed that the home seeks the advice of the tissue viability nurse at appropriate times. The home also records various health professional visits since admission, as well as ensuring residents are weighed regularly and according to any assessments developed. There was evidence of a referral to a physiotherapist and a record of subsequent visits in one file viewed. The manager and Area Manager undertakes a medication audit regularly with the last one viewed by the inspector being May 2007. A number of areas were identified for improvements. At this inspection the inspector observed parts of the medication round on the units and medication administration records. This was generally satisfactory, although there were areas to be addressed in relation to the recording. There were few gaps in the records. However, two signatures are required for hand transcriptions, photos must be in place for all residents where medication is administered and allergies recorded or none known. In one record tramadol was to e given “as required”. The records must show not only dosage and time but in what circumstances should the medication be administered. The training matrix details that 60 of staff have been provided with medication training. (See requirement) St Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 13 St Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the routines on the residential unit provide residents with activities and mealtime which are enjoyable and stimulating, the routines on the nursing unit do not ensure that the residents have their nutritional needs met or that they are provided with a stimulating environment. EVIDENCE: The residents were observed in the Orchard lounge and during this time the activities co-ordinator had been supervising a music and movement programme. The ladies and gentlemen were either taking part or watching and all seemed to be enjoying themselves and some of the residents were looking forward to the church service later that morning. There was to be a bingo session that afternoon where the residents could win prizes. There appeared to be good social interaction between the residents with an established rapport with the activities co-ordinator. On chatting with the residents they all said how much they enjoyed their sessions in the lounge and the variety of St Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 15 activities that were on offer. Five of the residents had recently taken up basket weaving and there was a weekly painting class. One resident said, “There is a lot going on and I am well looked after.” She stated that the activities were very good and that she enjoyed the quizzes and was looking forward to the summer fayre on the 23/06/07. The home provides a variety of entertainment for the residents and also arranges short outings to local attractions, including the nearby shopping centre and garden centre. During the morning residents were offered tea and biscuits and squash was available. As it was a warm day, the lounge opens out on to the patio area of the garden and some of the residents said it was lovely to sit outside and have their tea on a nice day. Staff were on hand in the lounge to assist residents if they needed any assistance and it was noted that the staff treated the residents with respect and assistance was given in an unobtrusive manner. There was less evidence of activities on nursing unit was mixed. The manager has discussed this with activity co-ordinator and an action plan developed to improve this area. (See recommendation) The lunchtime service was observed in the Orchard dining room. The dining room is well decorated and the furniture and soft furnishings are of a good quality. The tables are for either 3,4 or 6 residents; they were set with tablecloths, serviettes, cutlery, drinking glasses and condiments. This dining room was for the more able residents, however there was one resident who needed help to eat and a couple who needed some encouragement and support. The cook served the food from a hot trolley by the cook and the food was plated and served to the residents by the two staff on duty assisted by the deputy manager. The menu has two choices of main course and two choices of dessert with residents choosing their food the day before. They are offered alternatives if they do not like the choices. The food served was well cooked and presented and the residents commented how good the food was, how much they enjoyed it and said there was always a choice on offer. There was a calm and peaceful atmosphere in the dining room with residents unhurried and offered drinks throughout the meal. The staff assisted the residents where needed in a respectful manner. On the ground floor there is another dining room, this is for the residents of the Mellifont unit. This dining room is in need of some redecoration and some new furniture. The team leader of the residential unit and one member of staff supervised the dining arrangements in this area. The observations of the lunchtime routine on the nursing unit, was much different to that on the residential unit. The inspector noted that there were no menus evident for residents to view (the menu of the day was in the reception area) A higher number of residents required staff support or assistance. Staff were required to serve the meal and deliver to the residents and it was evident that a number of residents had food served with a delay in staff assistance. Food gradually became cooler and less appetising. The inspector had the view that staff were more hurried and therefore the meal St Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 16 time was less relaxing. There is the potential that some residents may not get the full support required and therefore may not have their nutritional needs met. Those spoken to felt improvements could be made if routines were changed. The inspector observed drinks being served during the morning at intervals and on request by residents. Of the eight relatives who provided written feedback- two stated that food could be improved with more greens and choices of vegetables. (See recommendation and requirement) It is positive to note that the manager has arranged meetings with residents and relatives and holds a weekly “surgery” where she is available to discuss any concerns or issues. From observations made the residents have choices on how they wish to spend their day. Some residents spend time in their rooms or the communal units and have their meals where they prefer. Two residents spoken to preferred their own rooms to the communal areas and were able to make the decisions to have meals in their rooms. St Raphael`s Christian Care Home DS0000010153.V336347.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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents feel that they are able to raise any concerns in a variety of ways and that these concerns will be listened to. More robust practices for recording complaints would further improve the way in which complaints are managed. Adult Protection procedures are in place to protect vulnerable residents from harm, although the recruitment procedures. However the checks required for the recruitment of staff must be more robust to ensure residents are fully protected. EVIDENCE: St Raphaels has an organisational complaints procedure which is on display in the reception area. The also manager invites individuals to raise concerns or issues during the weekly “surgery” or during residents/relatives meetings. Over the last twelve months there have been two complaints. One involved the action the home took regarding a resident and another anonymous complaint regarding the way the home is being managed. The inspector has received investigation reports on both complaints from the Provider. The complaints were partially substantiated with actions required by the home to improve the service. There is a need to have clear audit trail of the complaint, St Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 18 including nature of complaint, outcome, investigation route etc (See requirement) One resident spoken to said that she had attended meetings in the home and was able to voice her views and if she had any concerns she would speak to the home manager who she found approachable and understanding. Written feedback confirmed this view. There is also evidence of residents and relatives meetings with discussions on how the service could be improved. Adult protection procedures and Whistle-Blowing procedures are all in place with the manager qualified to train staff in adult protection. This is good practice. The training matrix stated that 60 of staff have received adult abuse training to date. There have been no allegations in last twelve months. The inspector still recommends that Local authority inter-agency guidelines from the placing authorities are obtained. (See recommendation) Please see comments on recruitment in the staffing outcome group. St Raphael`s Christian Care Home DS0000010153.V336347.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): 19,20,21,23,24,25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of accommodation is mixed with some residents provided with a comfortable, homely and well furnished environment whilst others continue to have a poor standard of accommodation that needs redecoration and refurbishment. EVIDENCE: A tour of the home showed that the Orchard Residential unit in the home is in need of updating as far as redecoration and furniture is concerned. The communal bathrooms and toilets are in need of refurbishment, however they do have grab rails and raised toilet seats. Generally the unit is clean and tidy but, in the inspectors view, is dull and dingy with some bathroom floors sticky. Two wheelchairs and a commode was stored in one of the bathrooms and St Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 20 there was an exposed wooden surface and tiles missing. The kitchen units need replacing and the fridge needed cleaning. It was noted that the fridge temperatures were recorded and documented correctly; the radiator in the kitchen was not covered and the window did not have a restrictor fitted, allowing possible access by strangers if not locked securely. The door adjacent to the chapel was wide open and there was an old medication trolley, toilet seat and walking aids left outside. This presented a health and safety hazard. Four residents bedrooms were inspected and all had locks fitted to the doors that could be accessed from both sides. There was no lockable drawer space in some of the rooms and many of the rooms were in need of decorating and new furniture and furnishings. Some of the beds still have metal frames that are potentially hazardous to residents. The bedrooms seen had been personalised to a degree and there was evidence that residents could have their own telephones and TV’s. The rooms did not have cabinets above the hand basin and therefore there was nowhere to store toiletries and they were left on a shelf. It was noted that none of the residents on the Orchard unit held their own keys, yet there were no risk assessments relating to keys in the care plans and it seemed that only staff had access to the individual room keys and the master key. Mellifont dining room also requires redecoration although the nursing unit generally well maintained, clean and fresh. (See requirements and recommendations) The laundry is still located in the basement area wit no changes no change still hazardous to carry laundry. One relative wrote of issues with the laundry particularly the poor returning of clothes. St Raphael`s Christian Care Home DS0000010153.V336347.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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents feel well care for by the staff in the home. Training has improved and continues to improve to ensure staff are able to care for and support individual needs. However, recruitment practices continue to lack the robustness needed to protect residents fully. EVIDENCE: It is positive to note that the Providers have taken on board the need to ensure supernummary management in the home when the manager is absent. On the day of the inspection the deputy manager was providing management duties and there was an RGN leading in the nursing unit with a team leader on residential. Staffing levels on the residential unit were satisfactory with six carers, including the team leader and a RGN and four care staff on the nursing unit. The feedback received provided positive comments about the care provided by staff in the home. However, it is also evident that there are still some concerns about the use of bank or agency staff with relatives feeling that recruiting permanent staff to fill vacancies would further improve the standard St Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 22 of care. One relative wrote it “Would be nice to employ more permanent staff so relatives could get to know them.” The staffing levels appeared to meet the needs of the residents during the major part of the day. However, during the busy mealtime periods the inspector noted that, staff on the nursing unit were unable to deliver a consistent standard of care. This was due to a high number of residents requiring assistance and support with staff having to serve and assist with eating and drinking or encourage residents. Staff were obviously stressed during this time and with some reorganising of the routines this problem may be resolved without increasing the staffing level. (See requirement) The inspectors had discussions with seven staff on the residential and nursing units. All stated that they had received core training and that the manager actively promoted training for staff. One staff member had a less favourable view, stating that their clinical training, support and supervision had been limited. There was mixed feedback about the provision of formal supervision. some staff stated that they had received formal supervision, this was not the case on the nursing unit. Staff spoken to also stated that they felt they worked as a team with residential and nursing staff working together and the manager and deputy manager supporting the staff team. Staff also told the inspector that there had been regular staff meetings held by the manager. There was evidence of this from the minutes of staff meetings. (See requirement) Four of the staff spoken to had qualified to NVQ level 2 or above, whilst another was hoping to register soon. Staff stated that it was beneficial having the manager who is an NVQ assessor to support them with this qualification. Induction training takes place with two staff spoken to stating they had received four-day induction when they first started. However, when three records were viewed for other new staff members, there was evidence, in one case only, of induction taking place. The manager needs to ensure there are clear records of induction. (See requirement) Many of the staff spoken to said that they felt that the management had improved over the last year with more opportunities provided for training and a manager who provided a supportive and encouraging role. The training matrix produced for 05/07 identifies core and specific training taking place and where there is a need to provide further training or updates. The matrix shows that improvements are required in the core areas. With high number of residents with dementia or are confused- only 26 of staff have been trained in dementia and there is a need to improve in this as well as challenging behaviour. It is positive to see a high number of staff trained in care planning and food hygiene. Over 50 of staff have received moving and St Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 23 handling, pressure care, health and safety, COSHH and safe handling of medication. There is a need to ensure these percentages are improved and it is a concern that only 15 have received training in nutritional needs. The matrix identifies clinical and ancillary staff and shows a high number of clinical staff receiving training with improvements required in the core training for ancillary staff. However, there is evidence that the manager is being proactive in this and therefore a requirement will not be made on this occasion but will be monitored closely at the next. The manager has developed a competency schedule for residential and nursing staff. This has not been implemented yet but should make a useful tool for assessing individual competency. Recruitment procedures were also audited with four files viewed. Two carers who work on the residential unit said that had been through the company’s recruitment procedure and had completed application forms, had an interview, were required to provide documentation for a CRB check and proof of identification and of training and skills in the field of caring. They had completed an induction process and received mandatory training. The records of three staff members showed that there are still gaps in the information required. In two of the three, references could not be located. There was also difficulty in locating CRBS and POVA checks. Some of these had been provided after employment commenced. The manager was made aware of the need to ensure that recruitment practices are more robust. It was evident from the information sent regarding the staffing that there were gaps in the information held by the home and therefore this should have triggered further examination by the manager. For example the records show, for some, no evidence of CRBs or photographs (See requirement) St Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is being well managed, although issues around health and safety issues are potentially hazardous to residents safety and well-being. EVIDENCE: The Acting Manager has been in post since last few months of 2006. With the resolution of the issues with the registered manager there is a need for the manager to apply for registration without delay. The Commission has received overall positive feedback regarding the current management of the home with one relative saying, “it is the best yet”. Those St Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 25 spoken to including residents felt that the manager was open and approachable. There is evidence of Providers receiving feedback about the quality of care provided being obtained from residents and relatives through surveys and regular meetings. There are also regular audits taken place with evidence of these together with the shortfalls. However, the more formal review of the service had still not taken place or results of surveys have not been collated to determine things they do well or things that need to improve about the service. Any review and subsequent report would identify what the service does well and how they could continually improve to meet the needs of those people living there. (See requirement) The Providers undertake the monitoring visits required by Regulation 26, identifying good care provided and where there are shortfalls. The comments made in the previous outcome group identifies the need for more regular formal supervision to take place with those responsible for supervising staff provided with appropriate training. (See requirement and recommendation) A number of areas were inspected relating to the health and safety of the home. There was good evidence of equipment and services used being regularly checked to ensure continued safety, including lifting equipment, nurse call system, legionella, environmental health and checking of the hot water temperatures. However, the gas service certificate was viewed and this showed that the annual servicing was imminent. The inspector has highlighted that core training is taking place with the manager identifying where there are gaps. This is to be monitored further at the next inspection. The manager provided the inspectors with a copy of the fire risk assessment dated 06/06. This contained comprehensive information and evacuation procedures for residents. There was evidence of the fire alarm service and fire drills. During a tour of the home the inspector noted in one room on the nursing unit that the call bell was not in place. It appeared that it may have been pulled off the wall and no action taken to address this. This was addressed by the Nurse in Charge. The certificate of registration and appropriate insurance certificate is in place (although the certificate on the day showed the insurance had expired there is evidence that this has been addressed). St Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 2 X 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 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 2 17 X 18 3 2 3 2 x 2 2 2 2 STAFFING Standard No Score 27 x 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 2 3 2 x 2 St Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5 Requirement The Registered Provider must ensure that all residents have details about the fees, including a breakdown of who is responsible for payment. The Registered Provider must ensure that assessments must be completed in full and are signed and dated The Registered Provider must ensure care plans are reflective of identified needs including the needs of those with dementia or other cognitive impairment. The needs of the individual must be regularly reviewed in consultation with the resident and/or their representative The Registered Provider must ensure where medication is hand transcribed there are two signatures in place confirming the transcription; photos are in place for all residents; allergies are recorded and where medication is to be administered as required further guidance provided as to the circumstances DS0000010153.V336347.R01.S.doc Timescale for action 01/09/07 2 OP3 17 01/09/07 3 OP7 15 01/09/07 4 OP9 13 01/08/07 St Raphael`s Christian Care Home Version 5.2 Page 28 5 OP15 16 6 OP16 22 7 OP21 23 the medication is to be given. The Registered Provider must 01/07/07 ensure that a review of the mealtime routines on the nursing unit takes place to ensure the residents are provided with a hot, nutritious meal with the support they require. The Registered Provider must 01/09/07 ensure that full information is maintained in the home on any complaints made including the nature of the complaints, investigation route, outcome and action to be taken by the home. The Registered Person must 01/09/07 ensure that toilet, washing and bathing facilities are provided to meet the needs of the residents. An action plan must be provided to include redecoration, refurbishment and/or deep cleaning. This is a repeated requirement timescale 31/05/06, 01/12/06 and 01/06/07 expired. 8 OP19 23 9 OP24 23 10 11 12 OP19 OP30 OP29 23 18 17 The Registered Provider must provide an action plan for the redecoration of the residential units to include the “mellifont” dining room and individual bedrooms. The Registered Provider must provide the Commission with an action plan for the removal of metal frame beds still used in the home. The Registered Provider must ensure a restrictor is fitted on the ground floor kitchen area. The Registered Provider must ensure induction training is recorded. The Registered Provider must ensure that recruitment checks DS0000010153.V336347.R01.S.doc 01/09/07 01/08/07 01/07/07 01/09/07 01/07/07 Page 29 St Raphael`s Christian Care Home Version 5.2 13 OP33 24 are carried out in line with Schedule 2 of the Care Homes Regulations (as amended) 2004 The Registered Person must 01/08/07 ensure that there is an annual quality survey and that the CSCI is advised of the outcome. This is a repeated requirement outcome 31/5/06,1/10/06 and 01/06/07 expired. The Registered Provider must ensure formal supervision takes place regularly for all care staff. 01/09/07 14 OP36 18 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 OP12 Good Practice Recommendations Residents in the nursing unit should be provided with the opportunity to participate in activities and stimulation witin the nursing unit. Residents should have more involvement in the choosing of the menus. The cook should consider including more vegetables. Menus should be available in each unit each day for residents have some idea of choices for the day. Bedrooms should be fitted with storage for toiletries and lockable drawer space Residents should sign receipts for monies handed over to hairdressers etc, where appropriate. Risk assessment should be developed where keys cannot be held by residents. The manager should obtain the Adult Protection procedures from local authorities placing service users in the home. DS0000010153.V336347.R01.S.doc Version 5.2 Page 30 2 OP15 3 4. OP24 OP35 5. 6. OP7 OP18 St Raphael`s Christian Care Home 7 OP36 Staff responsible for supervising others should be provided with supervision and appraisal training. St Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Raphael`s Christian Care Home DS0000010153.V336347.R01.S.doc Version 5.2 Page 32 - 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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