Care Home: Abbeyfield St George`s House

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What the care home does well The home is well managed and the new manager has implemented many improvements since the last inspection was carried out. Resident’s views are obtained and acted upon so that their experience of living in the home is as they expect. Before a person is offered a place in the home the manager carries out a detailed assessment of their health and personal care needs so as to determine that the home will be suited to them. People looking for a care home are given written information about the home and the services provided to help them decide if it will be right for them. Each resident has a plan of care, which describes their needs and how they would like to be cared for and supported. Staff receive training and support to enable them to care for residents properly. Risks to resident’s health and safety are assessed and minimised. Staff are recruited robustly and are employed in sufficient numbers to support residents for their assessed needs. Staff are trained to safeguard residents, recognise signs of abuse and to report any suspicions appropriately. Complaints are received, investigated and responded to in line with the homes complaints policy and people feel that their concerns are taken seriously. Dedicated staff are employed to ensure that the home is well maintained, clean and safe. All equipment, furniture and installations necessary for the running of the home are maintained in good working order, serviced and replaced as needed. What has improved since the last inspection? The new manager has made many improvements to the service since the last inspection was carried out. Complaints are recorded and investigated better and people feel that their concerns are taken seriously. Residents and their families have more opportunity to be involved and to make comments and suggestions about how the home is managed. Staff are recruited more robustly and all of the checks including references from previous employers, Criminal Records Bureau disclosures and PoVA First Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 checks are carried out so as to help ensure that only people who are suitable are employed to work in the home. What the care home could do better: More opportunities for activities and entertainment could be provided for residents. Staff must ensure that they keep accurate records when they administer medicines so as to ensure that residents receive the medicines, which are prescribed for them. Key inspection report CARE HOMES FOR OLDER PEOPLE Abbeyfield St George`s House Park Terrace Westcliff On Sea Essex SS0 7PH Lead Inspector Carolyn Delaney Key Unannounced Inspection 18th September 2009 12:00 DS0000015412.V376563.R01.S.do c Version 5.2 Page 1 DS0000015412.V376563.R01.S.do c Version 5.2 Page 2 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 3 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Name of service Abbeyfield St George`s House Address Park Terrace Westcliff On Sea Essex SS0 7PH 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) 01702 331512 01702 342893 The Abbeyfield Southend Society Limited Manager post vacant Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 5 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st July 2008 Brief Description of the Service: Abbeyfield St George’s care home provides care for twenty-five older people who do not fall within any other registration category. The home is decorated, furnished and maintained to a high standard. All personal accommodation is offered on a single occupancy basis. Twenty-five bedrooms have en-suite facilities. Each room has access to telephone and television points. The gardens are well maintained and attractive. There is parking available to the side of the building that can accommodate six cars. The home is situated in close proximity to Southend-on-Sea town centre, local community amenities and facilities. There is close access to local buses and the mainline train station to London. All prospective residents are provided with a Statement of Purpose and Service User Guide that supplies them with up to date information on the home. The cost of a place in the home is £546.85 per week and there are additional charges for hairdressing, chiropodist, newspapers, telephone, toiletries and transport. Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a routine unannounced inspection, which included a visit made to the home between the hours of 12.30 and 17.30 on 31st July 2009. The last inspection was carried out on 31st July 2008. As part of the inspection process we reviewed information we had received about the service over the last twelve months including notifications sent to us by the manager of any event in the home, which affects residents such as injuries, deaths and any outbreak of infectious diseases. We also looked at the information the manager provided us with in the homes Annual Quality Assurance Assessment. This document is a self-assessment, which the registered provider or owner is required by law to complete and tell us what they do well, how they evidence this and the improvements made within the previous twelve months. We also looked at the improvement plan that we asked the manager to send us following the last inspection. This plan described how the manager was to address the issues as identified at the last inspection. We sent surveys each to the home to distribute to residents and staff and to complete and tell us what they think about the home. At the time of writing this report we had received surveys from three residents living in the home. We received seven surveys from staff members and six surveys from residents’ relatives. During the inspection we spoke with three residents, two relatives, two members of staff and the manager. When we visited the home we looked at residents care plans and information available to staff to help them support residents. We looked at how staff were recruited to work in the home and how they were trained to support residents. We looked at how the home was managed and how residents were involved in this. We also observed how staff interacted with residents when supporting them with activities such as meals and providing recreation and stimulation. A brief tour of the premises was carried out and communal areas including lounge and bathrooms were viewed. Information obtained was triangulated and reviewed against the Commissions Key Lines for Regulatory Activity. This helps us to use the information to make judgements about outcomes for people who use social care services in a consistent and fair way. Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 7 What the service does well: The home is well managed and the new manager has implemented many improvements since the last inspection was carried out. Resident’s views are obtained and acted upon so that their experience of living in the home is as they expect. Before a person is offered a place in the home the manager carries out a detailed assessment of their health and personal care needs so as to determine that the home will be suited to them. People looking for a care home are given written information about the home and the services provided to help them decide if it will be right for them. Each resident has a plan of care, which describes their needs and how they would like to be cared for and supported. Staff receive training and support to enable them to care for residents properly. Risks to resident’s health and safety are assessed and minimised. Staff are recruited robustly and are employed in sufficient numbers to support residents for their assessed needs. Staff are trained to safeguard residents, recognise signs of abuse and to report any suspicions appropriately. Complaints are received, investigated and responded to in line with the homes complaints policy and people feel that their concerns are taken seriously. Dedicated staff are employed to ensure that the home is well maintained, clean and safe. All equipment, furniture and installations necessary for the running of the home are maintained in good working order, serviced and replaced as needed. What has improved since the last inspection? The new manager has made many improvements to the service since the last inspection was carried out. Complaints are recorded and investigated better and people feel that their concerns are taken seriously. Residents and their families have more opportunity to be involved and to make comments and suggestions about how the home is managed. Staff are recruited more robustly and all of the checks including references from previous employers, Criminal Records Bureau disclosures and PoVA First Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 8 checks are carried out so as to help ensure that only people who are suitable are employed to work in the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Abbeyfield St George`s House DS0000015412.V376563.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 Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know when they move into the home that their assessed needs will be met. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that before a person was offered a place in the home, a detailed assessment of their needs would be carried out. They told us that the assessment was preferably undertaken at the applicants existing residence, where they would be familiar with their surroundings, thus reducing potential stress and its adverse effects. Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 11 They told us that specialist equipment including hoists, stand-aids and profile beds were provided for residentss needs. They told us that every applicant was provided with a Statement of Purpose and Service User Guide. Since the last inspection the home had stared to provide short (respite) stay, without any obligation as to a long-term contractual arrangement. A separate respite Contract had been drawn up for this purpose. Each of the three residents who completed surveys told us that they had received enough information about the home to help them decide if it was the right place for them. They also told us that they had been given written information about the home’s terms and conditions (a contract). Six relatives completed surveys. Four told us that they felt the home always met the needs of their relative, one said they usually do and one indicated that they sometimes do. When we visited the home we looked at the arrangements in place for assessing the needs of people before they were offered a place at the home. We looked at the assessments carried out for two people who had recently moved into the home. We saw that the manager has visited each person in their place of residence to carry out an assessment of their health and personal care needs. Both assessments were detailed and described each person’s needs for carrying out personal care tasks and what if any support they needed to do this. There was information recorded about any medical conditions the person had and how these were treated. There was information about both people’s general health, mobility, hearing, sight and communication etc. From this information the manager determined that the home would be suited to the individual’s needs. Abbeyfield St George`s House DS0000015412.V376563.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are well cared for and their assessed health and personal care needs are met in the way that they choose. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that care plans were person-centred and allowed each key-worker to develop a clear assessment of the resident, identify changes in health and recognise the appropriate changes in personal care needed to accommodate these. They told us that the home had a reliable company which undertakes vision and hearing tests for all residents and that a similar arrangement with a chiropodist ensured that this aspect of personal health is also professionally catered for. They told us that security of medication and medication procedures were stringently adhered to with a policy of non-disturbance for the Senior Care staff when they are administering medication. Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 13 Each of the three residents who completed surveys told us that they received the support and medical attention they needed. Staff told us that they were given up to date information about the needs of the people they cared for. Residents relatives told us that they felt that staff had the right skills and experience to care for residents. When we visited the home we looked at how care was planned for residents to support them with their health and personal care needs. We looked at the care plans for three people. We saw that the manager had introduced new care plans and assessment documents so as to assist staff to record information more effectively. Care plans were person centred and identified each person’s strenghts and areas where they needed assistance. Information was recorded about how residents preferred to be supported for their perosnal care needs. There was information as to how (bath or shower) and when residents wished to carry out personal care and whether they had any preference for the gender of their carer. There was detailed information about each person’s medical conditions and how staff were to support them. There was evidence that staff sought the advice of health care professionals such as dieticians and tissue viability nurses and this was incorporated into the individual’s care plan. Staff reviewed plans regulary and amended them where there had been changes to the person’s assessed needs. Staff who were responsible for administering medicines received training and there was information within each person’s care plan about the medicines they were prescribed and the reason for its use. Two people were capable of and suported to retain control of and administer their own medicines at the time of this inspection. We looked at medication administration records and these were well maintained by staff. There were procedures in place for a second member of staff to check and countersign records where prescriptions were handwritten. This helped to minimise errors in recording. The majority of medicines are supplied to the home by Boots chemist in blsiter multi dosage systems. On occasions when a person is prescribed medicines for ‘as required usage’ or a short course of medicines such as antibiotics these are sent in boxes or bottles. We carried out a check on medicines for one person who was prescribed Furosemide 40mg to be taken once each day. A box containing 28 tablets had been received on 1st of the month and records indicated that seventeen tablets had ben administered. When we checked the remaining tablets there were sixteen not eleven as records would indicate. The manager told us that the resident was periodically prescribed this medication and that there may have been some carried over from the last time they were prescribed, however they were unable to evience this. Abbeyfield St George`s House DS0000015412.V376563.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported to live their lives as they choose. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that residents were encouraged to develop their own routine which was then documented as a guide to staff. They told us that changes could be made to this as and when residents chose and these changes were recorded in the daily notes and amendments made to the daily routine guide. They told us that there were a variety of activities that residents could undertake (books / tapes etc) The manager said that new care plans had ensured greater communiaction between key workers and their named residents thus allowing greater discussion and prompt acknowledgement of choices made by residents. They said that less frequent but larger entertainment events have been held with an emphasis on encouraging attendacne of family / sponsors. They told us that residents were encouraged and supported in maintaining independence and making their own choices. Residents meetings were held, Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 15 where there was an opportunity to raise issued about daily routines, social activities and other matters. An entertainment log was maintained to monitor events held and for reviewing their success and planning future events. We saw that as part of the care planning each person’s preferences for daily routines and how they wished spend their time was recorded. Staff supported residents to spend their time as they chose. We spoke with two residents and they told us that they liked spending time on their own watching television and reading. Each of the three residents who completed surveys told us that there were sometimes activities in the home, which they could participate in. Relatives and staff who completed surveys said that more entertainment could be provided. We discussed these issues with the manager during the inspection. They told us that it was difficult to find activities, which residents wished to participate in and that options were discussed during residents meetings. They agreed that more opportunities could be provided and told us that activities were provided on ‘an ad hoc’ basis as residents regularly changed their minds at the last minute. They showed us a plan of activities provided. This included keep fit sessions, which had been recently introduced and residents appeared to enjoy these. There were regular visits from church representatives, volunteers and relatives. There were games such as bingo, quizzes and cards. There were some crafts sessions provided. We looked at records, which staff kept in respect of activities provided and which residents participated in. From these we saw that the majority of activities were around bingo, television and watching television. There was little recorded about outings or opportunities for residents going out for coffee, shopping etc. The manager told us that when staff returned from maternity leave that this would allow for one member of staff to coordinate activities and support residents who wished to go out. The home employs a full time catering manager and staff to prepare and cook meals. Each of the three residents who completed surveys told us that they enjoyed the meals provided by the home. When we visited the home we saw that there was a four week menu displayed and that residents had the option of three choices of meal at lunch and teatime. The menus indicated that there was a good variety of foods made available. The catering manager met with residents to see if there were any particular meals that residents would like to see or not see on the menu and these choices were incorporated into the menu. Residents have the opportunity to discuss meals with the manager or staff at any time or at resident’s meetings. Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are treated well and know that their complaints and concerns will be taken seriously and resolved. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that the complaints policy was included in the Statement of Purpose and Service User Guide. They told us that it was thorough and comprehensive and copies were displayed throughout the home. They told us that criticism of a constructive nature was viewed positively as a tool for evaluating quality of care and making improvements to service delivery. The manager said that all complaints were acted upon promptly and actions taken in accordance with the societys complaints policy & procedure in order to ensure that individuals rights are maintained.They told us that a suggestion box was available for use by residents, families, sponsors and staff. The manager said that a log of formal complaints was maintained at head office and a summarised copy kept in the home. They told us that Criminal Records Bureau disclosures had been renewed for all existing staff. Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 17 Each of the three residents who completed surveys told us that they knew who to speak with if they were unhappy and how to make a formal complaint. Six relatives told us that they knew who how to complain and that the home responded appropriately when concerns were raised. When we visited the home we looked at how complaints were received and responded to appropriately and the arrangements for safeguarding people from harm. We looked at records of complaints made within the past twelve months. We saw that one complaint had been received. This was about lack of hot water and intermittent problems with the hot water systems. We saw that this had been dealt with and that the manager had communicated with the complainant at all stages while the issues were being resolved. We spoke three residents and the relatives of two residents. They told us that they knew who to speak with if they were unhappy. All but one of the people we spoke with told us that they had no complaints about the home. The other person told us that the manager was approachable and dealt with any issues, which arose. We looked at the arrangements for safeguarding people who live in the home from abuse or harm. We saw that all staff had undertaken safeguarding training and that there were refresher sessions provided annually. All staff had been provided with copies of the local safeguarding team handbook with guidance and information around how to recognise signs of abuse and how to act and report any concerns. We looked at the home’s policy and procedure for safeguarding. This document told staff that all incidents should be referred to the society’s head office for consideration. This conflicts with safeguarding procedures. The manager assured us that they would follow the correct procedure and refer any allegations of abuse to the local safeguarding team. There had been one safeguarding referral made about the home since the last inspection. This had been dealt with appropriately and action taken so as to protect people living at the home. We saw that there was a comprehensive system for assessing and minimising risks to the health and welfare of people living in the home. We looked at how staff were recruited to work in the home. We saw that all of the required checks including references from previous employers and Criminal Records Bureau disclosures were obtained before a person commenced work at the home. These checks help to ensure that only people who are suitable are employed to work in the home. Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home enjoy a clean, safe comfortable and well maintained environment, which suits their individual and collective needs. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that the home was purpose-built and had been continuously upgraded so as to ensure an environment which is safe, comfortable, clean, relaxing and which meets the needs of residents. They told us that during the year the kitchen had been completely redesigned and refurbished. Communal areas had been redecorated and refurbished. They said cleaning procedures and maintenance by directly employed staff ensure that these functions were delivered effectively and ensuite facilities were provided in every bedroom. They said that residents were Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 19 positively encouraged to bring their own furniture and personal possessions into the home. She told us that all equipment in the home including electrical equipment and Residents personal items were annually inspected for Health & Safety purposes. Each of the three residents who completed surveys told us that the home was always fresh and clean. When we visited the home we looked at the arrangements for maintaining the home’s environment and equipment so that they were suited to the needs of residents. We saw certificates and other documents, which evidenced that regular checks were carried out on all equipment and installations such as heating and hot water systems, lifting equipment, gas, electric and fire detecting and lighting equipment. We saw that communal areas had been redecorated and new furniture purchased. The manager told us that residents had been involved in choosing the furniture and colours etc for the redecoration. Residents and relatives who we spoke with during the inspection commented positively about the changes to the environment. One person said ‘The home is much brighter and welcoming now’. Another person said ‘It’s more homely and cosy’. During the inspection we were invited by three residents to view their bedrooms. We saw that residents were encouraged to bring in items of furniture to help personalise their bedrooms and make them their own. The home employed dedicated cleaning staff and all areas of the home we saw were clean and free from odours. Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are well cared for by a team of staff who are recruited thoroughly and trained to understand their needs EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that the required ratio of care staff to Residents was maintained by active recruitment. They told us that dependency levels of residents were used to determine the staffing levels required. They said that recruitment interviewing was undertaken by a panel experienced in this area of work and always included a mix of trustees and staff. They told us that staff were not appointed until all necessary checks and documentation were in place and a six month probationary period accompanied the initial appointment of new staff and the right to extend this existed should this be necessary. The manager said that there was a specific budget for staff training and that 70 of all care staff were qualified to NVQ Level 2 or above. Each of the three residents who completed surveys told us that staff were available when they needed them. Relatives told us that they felt that staff working in the home usually had the right skills and experience to care for Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 21 residents. We spoke with residents and relatives during the inspection visit and they were generally very complimentary about the staff. One relative said ‘They are kindness itself. I cannot fault them’. One resident told us ‘Staff are wonderful they give me all the help I need’. When we visited the home we looked at how staff were recruited, trained and deployed in the home to meet the assessed needs of residents. We looked at the arrangements for recruiting staff. We looked at the files for three people who had been employed to work in the home since the last inspection. We saw that checks had been made around each person’s previous employment and that satisfactory references, PoVA First checks and references had been obtained before a person was employed. We saw that candidates were interviewed by a panel of trustees and the manager so as to help determine the person’s suitability to work in the home. Each person was employed subject to a six month probationary period during which they undertook an induction to help familiarise themselves with the needs of residents and the homes policies and procedures. We saw that the manager regularly met with staff to discuss how they were working and to give support. We looked at the arrangements for training staff so that they cared for residents properly. Each of the seven staff who completed surveys told us that their employer had carried out all of the checks such as Criminal Records Bureau disclosures and references before they started work. They told us that their induction covered everything they needed to know about the job when they started. Staff told us that they received training, which was relevant to their roles, helped them understand the individual needs of residents and kept them up to date with new ways of working. We looked at the arrangements for training staff so that they cared for residents properly. All staff undertook training including Health and safety (including fire safety), safe moving and handling, safeguarding people, mental capacity and deprivation of liberty. In addition some staff had received training in medication administration, pressure area care, catheter care, oral health and caring for people who have Parkinson’s disease. We looked at how residents were supported by staffing levels in the home. The manager told us that generally staffing levels were one member of staff to five residents during the day and three staff at night. They told us that these were based upon the dependency levels of residents, which were reviewed regularly. We looked at staff rotas and saw that these levels were maintained without the use of temporary agency staff. We saw that all staff had appropriate time of work and time allocated to training. Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the interests of the people who live there. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that there was a system of business, policy and strategic planning in place at Board level with decisions being taken for the benefit and development of the home. They said that the societys board of trustees had a wide range of skills and experience with members being drawn from a variety of professional backgrounds. They told us that there was a professional team of paid staff at Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 23 the societys regsitered office, which provided full admin support for the registered manager - eg payroll recruitment, Health & Safety etc. The manager, who was recently employed at the time of the last inspection had recently completed their registration with The Care Quality Commision and was due to comment their Leadership and Management course. We saw that there have been a lot of improvements made by the manager within the previous twelve months including better care planning, risk management and overall better communication between staff, residents and relatives. When we sent surveys to residents, their relatives and staff to complete and asked them what the home did well and where they felt improvements could be made. One person told us that ‘Staff are always friendly and courteous, ceating a happy atmosphere’. Others said that ‘staff really seem to care’ and that they were ‘very kind and caring’ and that ‘residents are given choices’. Some people told us that improvements could be made to the overall environment and this had been implemented at the time of the inspection. Others commented that ‘more entertainment and activities could be provided for residents’. We saw that the manager was looking at ways to provide more opportunities for entertainment and activities and told us that when staff returned from maternity leave that this would enable one person each day to coordinate activities and support residents to go out should they choose. We saw that residents were provided with surveys each year to make comments about how the home was managed and to make suggestions for changes. Residents and relatives had access to staff and the manager where they could discuss any issues on a more informal basis. Regular staff and residents meetings were held to pass information more effectively and to discuss where improvements could be made. There was also a sugestion box where people could make suggestions anonymously should they choose to do so. We saw that the home was well maintained and that all equipment necessary to meet the needs of residents was kept in good working order and records were kept up to date and available for inspection. Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 3 X 3 Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 25 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 OP9 Regulation 13 (2) Requirement Staff must administer, handle and store medicines in the home in accordance with the homes policy and procedure so as to safeguard residents and reduce the risk of mishandling of medicines. Timescale for action 30/10/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Abbeyfield St George`s House DS0000015412.V376563.R01.S.doc Version 5.2 Page 26 Care Quality Commission Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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