Care Home: Maris Stella Wing

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What the care home does well The two main strengths of the home remain the provision and variety of food and the activity, recreational and occupational activity programme. We reported positively on these aspects of care following the last inspection. We also reported positively concerning the grounds surrounding the home which are used by residents. During this inspection, we again experienced the full co-operation of staff which enabled the inspection process to be undertaken with ease. Following the previous key inspection, we would acknowledge the positive response and commitment of the area manager in addressing the identified management shortfalls which had resulted in poor outcomes of care for residents. What has improved since the last inspection? Following the last inspection, significant day-to-day management changes and improvements had been made. These had improved the quality of care for residents. The home had appointed a new manager who with the support of the area and support manager, had reviewed and revised much of the care planing processes, staffing processes together with associated recording systems. The style of management within the home was described by management and staff as `hands on`. Staff expressed their appreciation of this to us. Residents also commented. There were management monitoring audit tools either in place or on the process of being fully implemented. This would ensure that the improved standards of care could be monitored and maintained. The day-to-day management structure within the home was more robust which had resulted in a more stable and focused workforce with residents receiving improved outcomes of personal care. What the care home could do better: The support manager and the home`s manager acknowledged the importance of maintaining the improved outcomes of care for residents. They confirmed that this would be achieved through the management audit tools in place. They also acknowledged that periodical regular reviews of practice and processes within the home would be required to further improve and develop the delivery of care within the home. Key inspection report Care homes for older people Name: Address: Maris Stella Wing 111 London Road Nazareth House Southend On Sea Essex SS1 1PP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ann Davey     Date: 1 8 0 6 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 23 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Maris Stella Wing 111 London Road Nazareth House Southend On Sea Essex SS1 1PP 01702345627 01702430352 robert.york@nazarethcare.com www.sistersofnazareth.com The Congregation of the Sisters of Nazareth Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Maris Stella is registered to provide personal care and accommodation for 32 older people. It is one of two separately registered care facilities sited at Nazareth House. The home is near the Southend town centre, the railway station, bus routes and all local amenities. The grounds include well-maintained gardens and ample car parking facilities. The premises are older in style and retain many of the characteristics including a large main hall, which is used for activities and entertainment. Accommodation is sited on three floors and there are two shaft lifts. Most bedrooms are single, some have ensuite facilities. There are three lounges, which retain a family home-style environment. Additional seating areas are available around the home. Care Homes for Older People Page 4 of 23 0 Over 65 32 Brief description of the care home Kitchenettes are available on each floor where residents and visitors can make drinks and snacks. There is a Statement of Purpose and Service Users Guide available. A copy of the last inspection report is available upon request from the home. The service manager advised that the weekly charges range from £383.18 - £650.00. The exact fee depends on the type of accommodation available or requested, assessed care needs and the source of funding i.e. private or local authority. There are additional charges for items of a personal nature. Care Homes for Older People Page 5 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection took place on 22nd March 2010. This inspection took place three months following that visit and lasted approximately 6.30 hours. Following the previous inspection, the manager left and a new manager appointed. The new manager had been in post for ten weeks at the time of this inspection. Throughout this time, the new manager had been supported by a Support Manager and the Area Manager. The Support Manager was based at the home, whilst the Area Manager had been visiting the home on a regular basis. The homes current Annual Quality Assurance Assessment (AQAA) which is required by law was dated 24th September 2009. The document provided the home with the opportunity of recording what it does well, what it could do better, what had improved in the previous twelve months and its plans for the future. We used this document as the basis for our inspections of the home during the inspections on 13th October 2009 Care Homes for Older People Page 6 of 23 and 22nd March 2010. We acknowledged that the information contained within the document may not be a fair refection of current practice due to the passage of time and events within the home. This was a key inspection and we focused on the regulatory shortfalls identified at the previous two inspections. We looked briefly at the other key standards which were assessed as satisfactory at the previous inspection but we did not undertake a full assessment. This was because the previous inspection had taken place only three months before hand. During the day we spoke with the support manager, manager, administration staff, pastoral care staff, professional health and social care professional visitors, staff and residents. We looked briefly around the home, viewed aspects of various records and observed care practices. We discussed all our findings with the manager and the support manager. We asked that the manager and the support manager took notes so that they had their own record of what was discussed and agreed. We would acknowledge that our unannounced visit co-incided with pre-arranged meetings, reviews and appointments for the manager. The managers handling of this was commendable. The co-operation of all those involved in the inspection process was appreciated. Care Homes for Older People Page 7 of 23 What the care home does well: What has improved since the last inspection? 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. Care Homes for Older People Page 8 of 23 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 using the service can expect that their needs will be assessed or identified to ensure that their admission would be appropriate. Evidence: Since the last inspection there had been one admission. The pre-admission process had been undertaken by the previous manager. We did not assess the information obtained at that time as part of that pre-admission process. This was because since that admission, the pre-admission process had been reviewed and changed. The current manager showed us the amended pre-admission format document which would now be used for any future assessments. We were advised that any future preadmission assessments in the foreseeable future would be undertaken jointly by the manager and the support manager.This would be to ensure that assessments were robust. There were copies of the current Statement of Purpose and Service Users Guide Care Homes for Older People Page 10 of 23 Evidence: available. We noted that the information had been updated regarding the changes in the management structure. This ensures that people reading the documents would have current information about the provision. Care Homes for Older People Page 11 of 23 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 using the service can expect to have their health and social care needs recorded in a way that would promote a safe and competent delivery of care. Evidence: The manager advised us that since their appointment, the content of all care plans and risk assessments had been reviewed and the information within them was current. We looked at the care plans and the risk assessment documentation belonging to three residents. We also looked at their health care related documentation records. All social and health care records are held on a computer system. The system was password protected and there was a built in facility to prevent entries being deleted or changed inappropriately. We noted that there were paper copies of care plans which had be endorsed by the respective resident. Entries on the care plan system were current and reflected the care required by the respective resident. We noted that care plans had review dates in place. There were current risk assessments and health care records available. Staff we spoke with confirmed that they had access to the care Care Homes for Older People Page 12 of 23 Evidence: planning records. Residents we spoke with confirmed that they had been consulted about their care. We noted that on the care plans we viewed entries had been made about residents end of life wishes. Staff we spoke with were knowledgeable about individual residents care needs. We spoke with two visiting professionals who acknowledged the improvements made since the last inspection. We spoke with three visitors who confirmed the improvements in the delivery of care had been beneficial to their respective family members who lived in the home. All the residents we spoke with were satisfied with the care they had received. We spoke with staff, visitors, residents and visiting provisionals about the availability, accessibility and accuracy of health and social care information held within the home. Nobody raised any concerns and the majority were complimentary about the improved standard of recording within the home. We noted that the manager had introduced a number of management monitoring tools. For example, there were staff work allocation sheets and weekly audit tools to monitor the safety of bed rails. We noted that these records were current. Following the last inspection, a new room had been set up to store all medicines and related records. The room was in the process of being refurbished and decorated. Staff told us that the new facility was much bigger and enabled them to be more efficient when undertaking medicine administration duties. We sampled the MAR (medicine administration records) and noted that there were no anomalies in the recording process. The medicine trolley was clean and orderly. We looked at the storage facility and records of controlled medicines held by the home. These were in good order. We noted that there was a small fridge to store medicines requiring refrigeration. This was locked and we noted that the temperature of the fridge had been monitored on a daily basis and the findings recorded. The senior carer (agency staff) who assisted us with this aspect of the inspection demonstrated knowledge and competence. On the records we saw there were appropriate records relating to the medical or clinical care that residents required and had received. The manager told us that the home had a good working relationship with all health and social care agencies. During the day we observed a number of different members of staff providing personal care and support to residents. These activities were undertaken with due care, sensitivity and dignity. We noted that staff knocked on bedroom doors or called out to the occupant before entering the room. We noted that residents being cared for in bed had access to call bells. We observed that the rapport between residents and staff was good humoured, pleasant and friendly. Residents were positive about staff on duty. Care Homes for Older People Page 13 of 23 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 benefit from a varied , balanced diet and are able to participate in a wide range of social activities. Evidence: The key standards of this section of the report were assessed in full at the previous inspection and recorded in the subsequent report as having good outcomes for residents. We did not assess these standards at this inspection again in any depth. We noted that the menu for the day was available and residents remained very complimentary about the provision of food with the home. Residents also remained very positive about the range and variety of social, recreational and occupational activities available. The three relatives we spoke with were positive about the improvements in the day to day management of the home and remarked that the outcome of this had been beneficial to residents. They felt the respective relatives care was being better managed. Care Homes for Older People Page 14 of 23 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 can be confident that their concerns will be dealt with appropriately and their care provided in a safe way. Evidence: The homes complaints procedure was displayed in the home and also detailed in the Statement of Purpose and Service Users Guide. Residents we spoke with knew that they could raise a concern at any time and intimated that they would feel confident in speaking with a member of staff about any issue. One resident told us about an issue they had raised and was encouraged and pleased about the way it had been managed and resolved. The three visitors and one of the professional visitors we spoke with were confident that any concerns they had would be managed appropriately. The manager advised us that since the last inspection the home had received a concern from a relative. We noted that the matters were being dealt with by the interim service manager in an appropriate manner. We spoke with three members of staff about their understanding of safeguarding residents from harm and what they would do should an incident come to their attention. All provided us with appropriate responses. Care Homes for Older People Page 15 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 live in a comfortable and safe environment. Evidence: The key standards of this section of the report were assessed in full at the previous inspection and reported in the subsequent report as having good outcomes for residents. We did not assess these standards again in any depth at this inspection. At this inspection we noted that the medicine storage facility had improved. A room adjacent to the office was in the process of being refurbished and decorated for this purpose. Another room had been refurbished and decorated and was being used for hairdressing. The office (unit office) was also in the process of being refurbished and decorated. We received no concerns or negative comments from residents about the environment. One relative told us that the bed in their respective relatives bedroom had been re-sited. The outcome for the resident was that this had proved to be positive and beneficial for their wellbeing. We noted that the maintenance book was current and matters requiring attention had been addressed promptly. Care Homes for Older People Page 16 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 looked after by appropriately recruited, trained and supervised staff. Evidence: The new manager had been in post for ten weeks prior to this inspection. There was evidence at this inspection to support that the day to day management of the home had improved significantly. The outcome of this was that the day-to-day delivery of care to residents was better managed and consistent. The current staff rota was displayed and reflected the staff on duty. The managers hours had not been recorded but this was addressed before the end of the inspection. The manager told us that were are no less that six carers on duty in the morning , four carers on duty in the afternoon and evening and three staff on duty at night. Care staff are supported by a team of ancillary staff. At the time of the inspection twenty five residents were being accommodated. The home was registered to accommodate thirty two residents. The manager told us that they were aware that whilst the current level of staff may be adequate to meet the needs of existing residents, the number of staff on duty would need to be reviewed once new admissions were considered. It was positive to note that since the last inspection, the total reliance on agency staff to maintain staffing levels had ceased. At this inspection there was one agency member of staff on duty. The manager advised us that there were four new members Care Homes for Older People Page 17 of 23 Evidence: of care staff starting their induction programme the following week which would bring the homes own staff to a full complement. Staff were very positive about the changes in management and told us that they were happier in their work. We received comments such as things are so much better now...(the manager)rolls their sleeves up and mops up like the rest of us...I know what Im supposed to do now...its nice working here now. One member of staff told us that the support manager had helped me make the beds this morning, thats good isnt it?. Two residents also commented on how much happier staff seemed to be in the past couple of weeks. The manager told us that there had been a full review of records and documentation relating to staff recruitment, training, induction and supervision. We spent time with the homes administrator who had responsibility for this aspect of work. We did not view all aspects of these records but the aspects we saw were current. We noted that there were audit tools in place to ensure that these records are being maintained appropriately. There were records to support that staff meetings had taken place. Staff confirmed that their training programme had been reviewed and some had attended additional training since the last inspection. Care Homes for Older People Page 18 of 23 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 developing management processes and systems in the home ensure a positive delivery of care to residents. Evidence: There was evidence to support that significant improvements had been made to the day-to-day management of care within the home. The new manager had been in post for ten weeks prior to the inspection. Since that time and with the support of other senior managers, the manager had reviewed all the various aspects of the homes care planning system and other processes pertinent to the wellbeing of residents. We noted that a number of processes such as the care planning system, medicines and day-to-day recording systems had already been updated and were working well. Other systems such as the staff supervision were still in the process of being fully implemented. We noted that there were robust management monitoring tools in place to ensure that good standards were being maintained. We spoke to the manager about their intention to make an application to become the Care Homes for Older People Page 19 of 23 Evidence: registered manager of the home. They advised us that they would speak with their senior managers about the situation. Staff were positive about the new management processes and felt much happier in their work. They told us that they had appreciated and valued the principle of the manager working along side with them on a daily basis. They told us that whilst they thought the manager was very friendly, they had respect for the managers authority and position. The manager was working closely with senior managers to ensure that all the various elements of the homes management structure were subject to review and robust systems set up with management monitoring tools put in place. The senior managers and the manager told us that there was a good working relationship between all parties. At the previous inspection we assessed some of the general maintenance and service agreements, together with other general environmental related records. These were in good order at that time and we did not view them again on this occasion. It was positive to note that residents now have full access to their personal monies. Care Homes for Older People Page 20 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 23 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 31 The home does not have a registered manager. Consideration should be given to an application being made to the Commission as soon as possible. We have not made this a statutory requirement at this stage due to the relatively short period of time the current manager has been in post. Care Homes for Older People Page 22 of 23 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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