Care Home: St George`s Ltd

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What the care home does well The needs of those who come to live at St Georges have their needs met by the way in which the service assesses their needs and obtains other assessments before they come to live there The health of individuals is maintained by the service People are treated in a dignified way and have their right to privacy respected People using the service are provided with a choice of meaningful activities and are able to maintain contact with their families and friends Their independence is maintained as far as possible and their nutritional needs are met The people who use the service and their families have the information they need if they wish to express any concerns about the service People are protected from abuse The people who live at St Georges live in a well maintained, pleasant and hygienic environment The people who live at St Georges are supported by staff who are sufficient in number to meet their needs are well qualified to do the job and receive training relevant to their role. The recruitment of staff protects individuals from abuse The people who live at St Georges receive care from a service managed by a qualified and experienced individual The views of individuals who receive and provide support is taken into account and the service regularly monitors its care for the benefit of individuals The health and safety of individuals in the main is promoted Comments received through surveys and discussions with people included: `Our home cares and helps the individuals their needs and well being The care staff are great and bind well as a team to make sure the residents physical and other needs are met I am happy with the way the home is being run The care manager is great really friendly and made me feel at ease and makes residents feel at ease too` `It creates a homely atmosphere and staff work well as a team It has a relaxed ethos and people talk to each other freely It is not a and them and us situation If finances allowed more staff that would mean residents would get out more often Carers could take residents out for a walk or to the shops At present this is not feasible` `There is always entertainment being organised for residents in which staff and relatives get involved to raise money I get job satisfaction when I leave my place of work at the end of each shift I know I have cared and looked after vulnerable older people` `The home s routine works well but there could be more staff at times and more support from the Manager` `I am keeping well but if I need a doctor they will get one immediately` `Meals are good and there is a choice` `Staff are pleasant` `The refurbishment of the building has not caused any problems to me` `I can visit my relation when I want` `Staff always ask me how I am` `I have been made to feel welcome and have settled in` `I get my privacy` `I receive my visitors in private` `I definitely feel safe here` `We were told about the refurbishment and when it was going to happen` `Staff will get anything I need` `The building work has not bothered me` `Staff are very friendly` `They are great` `They have been very good` `There is always something going on` `Communication from the home has been very good, they are always tell us if there is an issue` `I have been made to feel welcome` `I am more than happy with it` `When we visit, we can come and go as we please` The service`s Annual Quality Assurance Assessment considers it does the following well: `We have a reputation for providing good responsive nursing care in a friendly environment We are continually developing our active activities and events programmes which are enjoyed by most of our residents We have a very good statement of purpose and service user guide that can now be produced as either large print or in some of the main international languages due to our current computer programmes We have a robust policies and procedures manual that is both made available to staff and used as a basis for the supervision and development of staff We regularly review policies and documentation to respond to changes both from inside the organisation and regulatory We have a very good care plan policy and documentation system that is regularly audited We have achieved a Wirral Borough Council 3 star rating for the home and have applied for a three star rating, having achieved ISO 9001 certification We have a robust medications management policy that is consistently applied and have undertaken internal auditing of these practices in cooperation with the Wirral PCT Care Homes Medicines management group We have good link nurses in the areas of medicines management infection control, continence and tissue viability We have a full programme for internal audit and quality management We have a varied 4 weekly menu plan and are able to respond to the individual food likes and dislikes of our resident We have robust recruitment procedures for the employment of staff We have an effective cyclical supervision programme for all trained and care staff forming the basis of effective staff development We have clear and fair cyclical rotas and clear shift protocols for staff to work to and a very stable staff group with virtually all staff either NVQ qualified or working toward an award care domestic kitchen and administrative staff We continually strive to make improvements to our care practices and the facilities available to residents relatives and staff We have now developed and will be introducing a skills knowledge appraisal form for each grade of staff to assist I the development of an organisational training plan annually Our medications policy is used as a template for good practice by our supplying pharmacist when reviewing other homes both the manager and lead nurses for medications are involved with the Wirral PCT medicines management team Our slips trips and falls policy and other policies are used to demonstrate best practice in other homes by the main agency supporting our staff through NVQ development` What has improved since the last inspection? Every person using the service now has a care plan to ensure that their needs can be met and reviewed.Staff now adhere to the medication procedure which promotes the health and well being of people using the service. The standard of the environment has now improved. The cleanliness of the flooring in people`s bedrooms has now been addressed. The service`s Annual Quality Assurance Assessment considers the following has improved: `We have reviewed and updated many of our policies and procedures and introduced new ones dining room presentation slips trips and falls clinical procedures and several general administration policies we continually seek to review and improve documentation We have put in place a St Georges Care Homes Website We have increased the number of care staff holding NVQ qualifications from around 8 to 16 with a further 2 currently working toward level 2 qualification and 11 working toward level 3 We have purchased new beds and bedroom furniture for many of our rooms Our activities coordinator 3 hours per week continues to make improvements to activities programmes and the range of activities equipment supplies available activities We have most of our auxiliary staff qualified to NVQ level 2 with some working toward a level 3 award We continue to make improvements to bedrooms and other facilities as rooms become available We have created a new nurses station upstairs to promote better monitoring and management of residents spending their in the lounge days or their own bedrooms upstairs` What the care home could do better: The service must ensure that checks are made on at least a weekly basis to the fire alarms within the building. The service must ensure that the Care Quality Commission are notified of all incidents which adversely affect the wellbeing of the people who use the service. In addition to this, a number of recommendations are raised in respect of the care provided by the service. The service`s Annual Quality Assurance Assessment considers it could improve in the following areas: `We will be continuing to refine and improve our quality management systems by the use of monthly and quarterly quality review meetings in line with Iso 9001 standards We would like to introduce a post admission questionnaire for newly admitted residents and generally improve the frequency in which we use feedback questionnaires for residents, visitors and staff We would like to introduce a system for involving residents and their families more in the planning and implementation of care for individuals Would like to train more of our nursing staff to level 4 management standards to improve their skills in staff & resource management. We would like at least one of our nurses to receive specific training to become acredited in house trainers We would like to develop roles for Senior Care Assistants to improve the supervision of carers in the provision of basic care duties We will continue to upgrade the facilities in many of our bedrooms to improve the availability and siting of nurse call points and electrical sockets. We aim to redecorate bedrooms as empty rooms facilitate such work We will look to replace older less appealing and worn out furniture, carpets, etc` Key inspection report Care homes for older people Name: Address: St George`s Ltd Croxteth Avenue Liscard Wallasey Wirral CH44 5UL     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: Paul Kenyon     Date: 0 3 0 9 2 0 0 9 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 30 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) 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 Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: St George`s Ltd Croxteth Avenue Liscard Wallasey Wirral CH44 5UL 01516306754 01516388721 colin.stgeorges@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: St George`s (Liverpool) Ltd care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 60. Date of last inspection Brief description of the care home St Georges is a two storey converted building located in the Liscard area of Wallasey and close to local amenities. The home is registered to provide nursing care for 60 older persons and 18 of the beds may accommodate clients who require personal care only. The large reception area is welcoming and the reception desk is staffed during office hours. A large lounge, a dining room and a visitors room are provided on the ground floor and a second lounge/dining room on the first floor. There are also quiet sitting areas in various parts of the building. Televisions, videos, music centres and an in house library are provided. Both single and shared accommodation is available. A Care Homes for Older People Page 4 of 30 Over 65 60 0 Brief description of the care home selection of bathrooms and toilets are provided and assisted bathing facilities are available however, en suite facilities are not available. A large lift serves both floors. There is an enclosed rear garden area, which is currently undergoing renewal. There is parking for some cars at the front of the building and a car park at the rear. Fees at St Georges range from 416 pounds to 571 pounds 574 per week dependent on the level of service required. Care Homes for Older People Page 5 of 30 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: This was a key inspection of St Georges. The visit was unannounced and took part over the morning and afternoon. As part of our visit, we looked at a number of records relating to the care provided by the service. We also sent out surveys to staff members who returned these before the visit took place. We also sent out surveys to the people who use the service and their families. These have not been returned to us at the time of writing this report yet any received will be used as part of the ongoing process of inspecting the service. In addition to this, the service completed and returned an Annual Quality Assurance Assessment (AQAA) when we asked and this has been used as part of our assessment of the service. We toured the building and interviewed staff about their experiences of working at the service. We also interviewed four people who live at St Georges and five relatives who were visiting their relation during the visit. Any comments made are included within this report. Care Homes for Older People Page 6 of 30 Care Homes for Older People Page 7 of 30 What the care home does well: The needs of those who come to live at St Georges have their needs met by the way in which the service assesses their needs and obtains other assessments before they come to live there The health of individuals is maintained by the service People are treated in a dignified way and have their right to privacy respected People using the service are provided with a choice of meaningful activities and are able to maintain contact with their families and friends Their independence is maintained as far as possible and their nutritional needs are met The people who use the service and their families have the information they need if they wish to express any concerns about the service People are protected from abuse The people who live at St Georges live in a well maintained, pleasant and hygienic environment The people who live at St Georges are supported by staff who are sufficient in number to meet their needs are well qualified to do the job and receive training relevant to their role. The recruitment of staff protects individuals from abuse The people who live at St Georges receive care from a service managed by a qualified and experienced individual The views of individuals who receive and provide support is taken into account and the service regularly monitors its care for the benefit of individuals The health and safety of individuals in the main is promoted Comments received through surveys and discussions with people included: Our home cares and helps the individuals their needs and well being The care staff are great and bind well as a team to make sure the residents physical and other needs are met I am happy with the way the home is being run The care manager is great really friendly and made me feel at ease and makes residents feel at ease too It creates a homely atmosphere and staff work well as a team It has a relaxed ethos and people talk to each other freely It is not a and them and us situation If finances allowed more staff that would mean residents would get out more often Carers could take residents out for a walk or to the shops At present this is not feasible There is always entertainment being organised for residents in which staff and relatives get involved to raise money I get job satisfaction when I leave my place of work at the end of each shift I know I have cared and looked after vulnerable older people The home s routine works well but there could be more staff at times and more support from the Manager I am keeping well but if I need a doctor they will get one immediately Meals are good and there is a choice Staff are pleasant The refurbishment of the building has not Care Homes for Older People Page 8 of 30 caused any problems to me I can visit my relation when I want Staff always ask me how I am I have been made to feel welcome and have settled in I get my privacy I receive my visitors in private I definitely feel safe here We were told about the refurbishment and when it was going to happen Staff will get anything I need The building work has not bothered me Staff are very friendly They are great They have been very good There is always something going on Communication from the home has been very good, they are always tell us if there is an issue I have been made to feel welcome I am more than happy with it When we visit, we can come and go as we please The services Annual Quality Assurance Assessment considers it does the following well: We have a reputation for providing good responsive nursing care in a friendly environment We are continually developing our active activities and events programmes which are enjoyed by most of our residents We have a very good statement of purpose and service user guide that can now be produced as either large print or in some of the main international languages due to our current computer programmes We have a robust policies and procedures manual that is both made available to staff and used as a basis for the supervision and development of staff We regularly review policies and documentation to respond to changes both from inside the organisation and regulatory We have a very good care plan policy and documentation system that is regularly audited We have achieved a Wirral Borough Council 3 star rating for the home and have applied for a three star rating, having achieved ISO 9001 certification We have a robust medications management policy that is consistently applied and have undertaken internal auditing of these practices in cooperation with the Wirral PCT Care Homes Medicines management group We have good link nurses in the areas of medicines management infection control, continence and tissue viability We have a full programme for internal audit and quality management We have a varied 4 weekly menu plan and are able to respond to the individual food likes and dislikes of our resident We have robust recruitment procedures for the employment of staff We have an effective cyclical supervision programme for all trained and care staff forming the basis of effective staff development We have clear and fair cyclical rotas and clear shift protocols for staff to work to and a very stable staff group with virtually all staff either NVQ qualified or working toward an award care domestic kitchen and administrative staff We continually strive to make improvements to our care practices and the facilities available to residents relatives and staff We have now developed and will be introducing a skills knowledge appraisal form for each grade of staff to assist I the development of an organisational training plan annually Our medications policy is used as a template for good practice by our supplying pharmacist when reviewing other homes both the manager and lead nurses for medications are involved with the Wirral PCT medicines management team Our slips trips and falls policy and other policies are used to demonstrate best practice in other homes by the main agency supporting our staff through NVQ development What has improved since the last inspection? Every person using the service now has a care plan to ensure that their needs can be met and reviewed. Care Homes for Older People Page 9 of 30 Staff now adhere to the medication procedure which promotes the health and well being of people using the service. The standard of the environment has now improved. The cleanliness of the flooring in peoples bedrooms has now been addressed. The services Annual Quality Assurance Assessment considers the following has improved: We have reviewed and updated many of our policies and procedures and introduced new ones dining room presentation slips trips and falls clinical procedures and several general administration policies we continually seek to review and improve documentation We have put in place a St Georges Care Homes Website We have increased the number of care staff holding NVQ qualifications from around 8 to 16 with a further 2 currently working toward level 2 qualification and 11 working toward level 3 We have purchased new beds and bedroom furniture for many of our rooms Our activities coordinator 3 hours per week continues to make improvements to activities programmes and the range of activities equipment supplies available activities We have most of our auxiliary staff qualified to NVQ level 2 with some working toward a level 3 award We continue to make improvements to bedrooms and other facilities as rooms become available We have created a new nurses station upstairs to promote better monitoring and management of residents spending their in the lounge days or their own bedrooms upstairs What they could do better: The service must ensure that checks are made on at least a weekly basis to the fire alarms within the building. The service must ensure that the Care Quality Commission are notified of all incidents which adversely affect the wellbeing of the people who use the service. In addition to this, a number of recommendations are raised in respect of the care provided by the service. The services Annual Quality Assurance Assessment considers it could improve in the following areas: We will be continuing to refine and improve our quality management systems by the use of monthly and quarterly quality review meetings in line with Iso 9001 standards We would like to introduce a post admission questionnaire for newly admitted residents and generally improve the frequency in which we use feedback questionnaires for residents, visitors and staff We would like to introduce a system for involving residents and their families more in the planning and implementation of care for individuals Would like to train more of our nursing staff to level 4 management standards to improve their skills in staff & resource management. We would like at least one of our Care Homes for Older People Page 10 of 30 nurses to receive specific training to become acredited in house trainers We would like to develop roles for Senior Care Assistants to improve the supervision of carers in the provision of basic care duties We will continue to upgrade the facilities in many of our bedrooms to improve the availability and siting of nurse call points and electrical sockets. We aim to redecorate bedrooms as empty rooms facilitate such work We will look to replace older less appealing and worn out furniture, carpets, etc 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 11 of 30 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 12 of 30 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. The needs of those who come to live at St Georges have their needs met by the way in which the service assesses their needs and obtains other assessments before they come to live there. Evidence: We looked at the personal files of six people who had some to live at St Georges within the past twelve months. In all cases, there was evidence that the service had used its own assessment form to gain an indication of the main needs of the person. This is based on a recognised model of nursing care and covers all aspects of the persons life. In addition to this, assessments from social workers and hospitals had also been gained to confirm the needs of each person. We spoke with two relatives, one of whose relation had only just come to live at the service and the other whose relation had lived there for longer. In both cases, they were able to confirm that the Manager of the service had spent time with them showing them around the building and had provide them with a statement of purpose and service user guide. Care Homes for Older People Page 13 of 30 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. The needs of people who live at St Georges are met by the way the service has devised care plans outlining their needs. Their health is maintained by the service. Their health and safety is promoted by the safe management of medication. People are treated in a dignified way and have their right to privacy respected. Evidence: We looked at care plans relating to six people. Each care plan includes a summary of the needs of each person and the action needed by staff to meet these needs. These needs vary dependent on the unique needs of each person. There was evidence that each care plan had been reviewed each month. There was no evidence that individuals and their families had been consulted about the contents of the care plan. This is something the service should do so that people are fully involved in deciding the care they receive. The Manager has introduced a computer based system which enables care plans to be created at the point when people are admitted and provides the opportunity for unique needs to be recorded and care plans to be reviewed. Care plans are subject to a regular audit to ensure that they are up to date. Care Homes for Older People Page 14 of 30 Evidence: We looked at how the service maintains peoples health. We interviewed four people about their health. In all cases people stated that they were well but on occasion when they needed medical assistance, the staff team did not hesitate to ensure that they had access to health professionals. Details in care plans suggested that any appointments with medical professionals are recorded with details of action that needed to be taken. Such appointments provided evidence of visits to and from General Practitioners, Community Nurses, Physiotherapists, Dietitician and Opticians. We looked at information for people who had just been admitted. There was evidence that health professionals are invited to meet with the individual to assess their medical needs further. The service conducts a number of assessments related to the health needs of people. In all cases we found that peoples nutritional needs are assessed and this determined whether they needed to be referred to a dietitician. There were further assessments completed on continence, the likelihood that people will develop pressure sores, fall risk assessments and assessments on their mental health. The service also monitors peoples health through regular checks on their blood pressure and weight. We spoke to three relatives who confirmed that when they is a change in the health of their relations, they are informed immediately. We looked at how the service manages medication. All medication is stored in lockable facilities and is accounted for by the records maintained by the service. These records include evidence of receipt, administration and disposal of medication. There had been improvements from our last visit in relation to the way the service records when medication has been given and in measuring the temperatures in the medication refrigerator. We looked at the way the people who use the service have their privacy and dignity upheld. We interviewed four people and three relatives. In all cases, there was the view that the privacy of people was respected and that staff treated people in a dignified manner. There are a number of shared rooms in the building. In some rooms, partitions had been created to allow privacy between occupants. In two rooms we noted that there was no screening in place and as a result their privacy was compromised. The service should ensure that the privacy of individuals is promoted at all times. We were able to interview people and their relations in private during our visit. Care Homes for Older People Page 15 of 30 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. People using the service are provided with a choice of meaningful activities and are able to maintain contact with their families and friends. Their independence is maintained as far as possible and their nutritional needs are met. Evidence: The service employs an Activities co ordinator. An activities room is available and shows evidence of arts and crafts done by individuals. Interviews with people confirmed that they had the opportunity to do activities. Some preferred not to join in while others did. Those who did not wish to join in stated that they were given the choice to do so. Others confirmed that they attend a day centre on a regular basis. On the day of the visit, a quiz was being held in the lounge. This was well attended and there was evidence of people participating in this. Records are maintained by the activities co ordinator as a diary of events and there is an evaluation of activities recorded which includes the names of people involved in the activity and a general overview of the outcome for these individuals.There was evidence that entertainers had visited the service of late and were due to visit in the future. A summer fete had been held within the past few weeks and there was a recognition peoples birthdays through the year. Musicians have come into the service with individuals being involved in playing instruments. This was confirmed in discussions with one relative Activities Care Homes for Older People Page 16 of 30 Evidence: such as cards, scrabble, quizzes, newspapers hairdressing and manicures had taken place. A visitors book is available and this indicated that many people visit. Many visitors were present during our visit. We spoke with four relatives. All confirmed that they are able to visit when they want interviews with four individuals all confirmed that when they receive visitors they are able to do so in private. Observation of care practice noted that people are enabled to remain independent in their daily lives. We observed lunch. This confirmed that most people were able to eat independently and for those who require assistance, they are provided with adapted cutlery and plate guards as outlined in their care plan. We noted that they are encouraged by staff to do this. This independence extended to the mobility of people. One person was observed using a walking frame and was encouraged by staff to do this so that their mobility was improved. For others those who need assistance with mobility are encouraged to do so as independently as possible. No one uses advocacy services at present although information in statement of purpose providing contact details. Interviews with people were held in their bedrooms. This noted that some rooms had been significantly personalised with photographs of families and other personal items. One person confirmed that even though they had just arrived, they had had the opportunity to place some personal possessions within their room. The service does not deal with the finances of people this is left to their families or the individual ensures peoples financial affairs are independent of the service. Interviews with people confirmed that they were all happy with the standard of the food provided. They further confirmed that there were choices and alternatives available if wanted. All care plans viewed included details of nutritional assessments for people as well as referrals to dietiticians if needed. Details on care plans included reference to whether people needed adapted cutlery. We observed lunch in the dining room. A dining room is available and staff explained that one person preferred to use the lounge for meals. It was explained that this was a personal preference for this person and that their appetite was enhanced as a result of this choice. The dining room has a number of chairs and tables and appeared to be able to cater for most individuals. A four week menu is on display and this provides the opportunity for alternatives. It was observed that one person had refused the main meal and alternatives were offered. Interviews with another person confirmed that breakfast offered was substantial and he was very pleased with this. It was observed that hot Care Homes for Older People Page 17 of 30 Evidence: and cold drinks were on offer through the day. Throughout lunch, staff were supportive to individuals throughout. One person needed assistance with eating and staff supported them on a one to one basis and explained what the contents of the meal was and this was done in an unhurried manner. We viewed the kitchen area. Menus were on display as well as alternatives from menus. Information was available about the presentation of softer diets for some people and their dietary needs. The kitchen is well equipped and food stocks are sufficient. Care Homes for Older People Page 18 of 30 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. The people who use the service and their families have the information they need if they wish to express any concerns about the service. People are protected from abuse. Evidence: We looked at the way the service enables people to make concerns about the quality of the support they receive. The service has a complaints procedure which outlines the action people can take if they are not happy with the standard of care provided. In contrast to this, the service has a system for recognising the compliments sent to them by people and their relatives. We asked people about who they would speak to if they had a complaint. They stated that they would tell the manager and felt confident that he would deal with their issues. Complaints records were examined. Records indicated that two complaints had been received within the past twelve months. There was evidence that each concern had been investigated and that a response to the complainant had been made in each case. The complaints procedure is subject to a regular audit to ensure that the complaints system is as effective for people as possible. We looked at how people are safeguarded from abuse. The service has its own abuse procedure and this includes a flowchart of how staff should deal with an allegations made. Staff confirmed that they have received training in safeguarding adults and understand the whistle blowing procedure. The Local Authority abuse procedure is in Care Homes for Older People Page 19 of 30 Evidence: available to staff. The people we interviewed felt safe living at St Georges. The Manager is aware of the potential to refer staff to the safeguarding adults register but has not had to do this. Care Homes for Older People Page 20 of 30 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. The people who live at St Georges live in a well maintained, pleasant and hygienic environment. Evidence: We toured the building to determine the decorative standards and facilities within the building. The building has been subject to internal refurbishment and this visit found that this refurbishment was almost complete. The newly refurbished areas had been redecorated and new flooring had been put down. New facilities had been created including improvements to bathroom and bedroom areas. We noted that there had been some disruption to individuals who tended to use the upper lounge on the day of our visit. This was addressed later and individuals could then return to the lounge. We interviewed four individuals who live at St Georges. In all cases, they stated that they had not experienced any adverse upheaval during the building work. We also spoke to five relatives. Again in all cases, they stated that the building work had been going on for some time yet they considered that their relations had not experienced any disruption. The view from all was that the work had improved the environment for all. We received surveys from staff. Some staff stated that the building work had caused some disruption to them while others did not. A repair book is in place for maintenance staff to refer to when repairs are needed. A garden area is available and this is situated to the rear of the building. This is a Care Homes for Older People Page 21 of 30 Evidence: pleasant and well maintained environment offering seating for people and a privacy while they used the garden area. The garden is accessible to all and receives sunlight in finer weather. No close circuit television cameras are in use on the property. The same tour of the building enabled us to assess the hygiene standards within the building. There were no offensive odours in any parts of the building and the all areas remained fresh and clean. We spoke with four individual who live at St Georges and five relatives. In all cases they considered the home to be clean. Domestic staff are employed within the building to maintain standards. There was evidence that personal protective equipment such as aprons and gloves were available to staff. A laundry area is available with staff employed to work in this area. This facility is separate from food storage and preparation areas. It is an organised facility with industrial washing and drying appliances available. A hand wash facility is available to staff in this area. The building has a sluice room facility which is separate to toilet and bathroom areas used by the people who live there. Care Homes for Older People Page 22 of 30 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. The people who live at St Georges are supported by staff who are sufficient in number to meet their needs, are well qualified to do the job and receive training relevant to their role. The recruitment of staff protects individuals from abuse. Evidence: We looked at the staff rota. This suggested that there was a registered nurse on duty at all times during the day and night and that other health care staff were employed in sufficient numbers to meet peoples needs. In addition to care staff, the service employs a number of ancillary staff including administrators, kitchen, laundry, maintenance and domestic staff. In discussions with people who use the service, individuals stated that they considered staff to be helpful and attentive to their needs. Information was sent to us by the service prior to our visit in respect of qualifications. The information suggested that 68 per cent of care staff had attained at least a National Vocational Qualification at Level 2. This exceeds what we would expect the service to achieve. A discussion was held with an external National Vocational Qualification assessor who was present for some of the visit. They considered that the manager had been supportive and had enabled staff to pursue this qualification and confirmed that other staff had commenced the qualification at Level 3. The Manager considered that the assessor had enabled staff to attain the qualification effectively. Care Homes for Older People Page 23 of 30 Evidence: We looked at four files relating to staff who had commenced at the service within the past twelve months. These confirm that all the checks the service needs before staff work at the service had been done. These checks included a check to see if staff had been included on the safeguarding register, a criminal records check, two references and proof of staff identity. We interviewed two staff and received surveys from staff about their experiences of working at the service. In all cases, there was a suggestion that staff received regular training in mandatory health and safety topics and had also received training in safeguarding adults. We looked at training records. These suggested that other training such as dementia awareness, customer care, activities management and staff development had also been undertaken by staff. Care Homes for Older People Page 24 of 30 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 people who live at St Georges receive care from a service managed by a qualified and experienced individual. The views of individuals who receive and provide support is taken into account and the service regularly monitors its care for the benefit of individuals. The health and safety of individuals in the main is promoted. Evidence: The Manager is registered with ourselves as the registered manager and has been the manager of the service for a number of years. The manager holds a nursing certificate as well as other certificates such as executive diploma in management. We received staff surveys which commented on the Manager. These suggested that staff received support from the Manager. Other comments considered that the Manager is approachable. Other comments suggested that the Manager needed to be more approachable and supportive. Reports are written about the service on a monthly basis and the registered provider is involved in this process. These report are known as Regulation 26 visits and there Care Homes for Older People Page 25 of 30 Evidence: was evidence that these continue on a monthly basis. The service has responded to the requirements raised at our last visit. We were able to gain access to all the records we asked for and to interview service users and staff in private. The service is subject to an annual audit from an external agency and this was last completed in June 2009. Other audit tools include the auditing of complaints, staff supervisions, care plan reviews, activity audits, food catering audits, staff audits and staff induction audits. Surveys have been sent to all groups of people who are involved with St Georges. Surveys for the people who use the service and their families were last sent in July 2009. Other audits that are completed have involved how the service cares for individuals who require wound care and audits of the medication system. The service does not deal with the finances of people living at the service so as a result this standard is not applicable. We looked at how the service promotes the health and safety of those who use the service. We noted that fire alarms and emergency lights had not been tested for some time. Tests to these systems must be done on a weekly basis. We noticed that fire extinguishers had been tested within the past twelve months. Accidents are recorded and when completed these are included within the care files of each person.The frequency of accidents is audited and this was last done in April 2009. Radiators are covered and there are thermostatic valves in place on all hand wash basins. Despite having controlled temperature valves,water temperatures are still monitored when people have baths or showers. Portable appliances have been tested and both portable and fixed hoists are serviced every six months. The safety of gas systems and electrical wiring were confirmed. Security measured are in place at the front entrance. The service has taken out appropriate and current insurance and the home retains its certificate of registration. It was confirmed through staff interviews and surveys that health and safety training had been received and this was further confirmed through training records and certificates. The service last received a food hygiene inspection in August 2009 and no issues were raised. The service lets us know when incidents have occurred in the service that adversely affect the well being of people using the service. It was noted in care files that this is not always done. The service must consistently notify us when these incidents occur. Care Homes for Older People Page 26 of 30 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 27 of 30 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 1 38 23 Fire detection equipment must be checked weekly to ensure that they are working effectively so that the health and safety of the people who use the service is promoted. 04/09/2009 2 38 37 Notifications indicating that 04/09/2009 events have occurred that have adversely affected individuals living at St Georges must be consistently sent to the Care Quality Commission so that the health and safety of the people who use the service is promoted 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 7 The service should provide evidence that they people who Page 28 of 30 Care Homes for Older People 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 use the service and their families have confirmed the content of care plans so that people are actively involved in their care. 2 9 Staff who are responsible for the administration of medication should consistently receive periodic medication awareness training. Screening should be consistently provided for occupants of shared rooms so that their privacy is upheld. 3 10 Care Homes for Older People Page 29 of 30 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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