Care Home: St George`s Nursing Home

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What the care home does well The staff in the home showed that they had a good understanding of individual care needs and were providing care and support to people in a way that met their individual preferences. There continues to be a strong focus on listening and responding positively to the views of the people living in the home. Staff had developed good relationships with the people living in the home. All people spoken to were complimentary about the way in which the staff team supported them. Comments included: "The staff are lovely, they can`t do enough for you". "I love it here, It`s where I`ve been able to get my life set out. I`ve got my own routine and the staff support me to be independent". "I can talk to the staff about anything". Comments from relatives and visitors were also positive and mirrored the views of the people living in the home. One visitor told us that the staff were always pleasant and friendly. She said, "The people here have told me how lovely the staff are and I have seen them handling difficult situations well". The home has a motivated staff team and a supportive management structure. Staff who were spoken to were enthusiastic about developing their skills and knowledge. Some staff have opted to work in the new dementia unit, and there was evidence to show that their learning and development needs were being supported so that people in the home receive care and support from a well trained staff team. During this visit, staff were seen providing care and support in a sensitive manner. There was an emphasis on listening to the views of people in the home and responding positively by providing care and support in a way that suited the individual. People told us that the staff helped them to maintain independence and also supported them to live independently in their own rooms where preferences had been made to dine alone, or watch television and enjoy their privacy. There were good systems in place to monitor key areas of practice and to develop action plans where shortfalls were identified. This means that people in the home can be confident that polices and procedures in the home will protect their health and well being. What has improved since the last inspection? The service continues to improve the fabric of the building, and there had been several areas of re-decoration. A new safe enclosed patio area had been developed, proving a pleasant outside area. Care plans have been developed and show a person centered approach where people are encouraged to be involved in their care planning. What the care home could do better: The manager is aware that the leisure and activity programme needs to provide a consistent service to people living in the home. There have been no requirements made as a result of this inspection visit. Inspecting for better lives Key inspection report Care homes for older people Name: Address: St George`s Nursing Home 30 Stamford Street Stalybridge Tameside SK15 1JZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ann Connolly     Date: 2 2 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 26 Information about the care home Name of care home: Address: St George`s Nursing Home 30 Stamford Street Stalybridge Tameside SK15 1JZ 01613386908 01613385858 lbstgeorge@elderhomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr David Hetherington Messenger care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia 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 people 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. Dementia (10). The maximum number of people who can be accommodated is: 49. Date of last inspection Brief description of the care home St Georges is a converted school, which has been extended, standing in an elevated position above Stalybridge town centre. St Georges provides nursing care or personal care for up to 50 service users. One area of the home provides a unit for people who have dementia. The home is owned and operated by Mr David Messenger. The home is under the day-to-day control of a full time manager, who is also a registered Care Homes for Older People Page 4 of 26 Over 65 0 49 10 0 Brief description of the care home nurse. Accommodation is provided over two floors serviced by a lift. All of the bedrooms are single. All the rooms in the extension have en-suite facilities. Sixteen of the 28 bedrooms in the original building have en-suite facilities, whilst the others have toilet accommodation nearby. Four communal rooms offer a variety of settings in which service users are able to receive visitors, socialise and participate in activities. The home is situated near to Stalybridge town centre, close to local shops and bus routes. There is ample parking for those who choose to travel to the home by car. Fees for accommodation and care at the home range from four hundred and sixteen pound and eleven pence to five hundred and forty five pounds and sixty six pence per week. Additional charges are also made for hairdressing and chiropody services, newspapers and personal toiletries. Care Homes for Older People Page 5 of 26 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 that included a site visit to the home. The manager was not told beforehand that we were coming to inspect, this is called an unannounced inspection. This inspection looked at all the key standards and included a review of all available information received by the Care Quality Commission (CQC) about the service provided at the home since the last inspection. During the site visit a selection of records, care plans, policies and procedures were examined. Discussions took place with the manager, staff working in the home, and some relatives. Discussion took place with them to find out what they thought about the home and what they felt about how the staff supported them. A tour of the building took place and residents were asked for their comments and views about the environment. Before the inspection, we also asked the manager of the service to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they Care Homes for Older People Page 6 of 26 did well, and what they needed to do better. This is one of the ways that we get information from the manager of the service about how they are meeting outcomes for people using the service. The information provided on this occasion was detailed and comprehensive and showed us that this was an organisation committed to the ongoing development of the service and staff team so that residents in the home benefit from positive outcomes. Surveys were sent out to residents and staff and there was a good response which gave us more information about this service. Since the last inspection visit which took place on 24th April 2008, the Commission have not received any recent complaints about the service. There was evidence during this visit that the manger was handling complaints well and followed correct polices and procedures for manging complaints and safeguarding issues. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 26 The manager is aware that the leisure and activity programme needs to provide a consistent service to people living in the home. There have been no requirements made as a result of this inspection visit. 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 set out 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 9 of 26 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 10 of 26 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. There is sufficient information about the home to help people in making a decision about their future care and support arrangements. Individual care needs are assessed prior to arranging an admission into the home. Evidence: The information about the home was available in a document called the statement of purpose and service user guide. This had recently been updated to reflect the changes in the registration category to include the new dementia unit. These guides, along with the most recent inspection report were available in the reception area of the home. This information is useful in helping people making an enquiry about a placement in the home. It gives them information about what they can expect if they move into St Georges. We spoke to several people living in the home and their relatives. There were mixed views about the accessibility of information about the home. Some people said they felt they had been provided with sufficient information about the home, whilst others couldnt remember being given any information at all. The manager told Care Homes for Older People Page 11 of 26 Evidence: us that she would be pro- active in ensuring that information was more accessible to people making an enquiry to the home. Three care plans were looked at and all of these contained a pre-admission assessment. The quality of information in the assessment details varied, and this was also the finding at the last inspection visit. New paperwork had been introduced and this focused on a person centered approach. The manager told us that assessment procedures were being audited so that all people admitted to the home could be confident that their care needs were fully considered before they were offered a place. Care Homes for Older People Page 12 of 26 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 are consulted about their health and personal care requirements so that people receive care and support based on their individual need and in a way that meets their personal preferences. Evidence: Three care plans were looked at during this visit. A new care plan format had been introduced and this focused on a person centred approach which encouraged the individual and their family to contribute to the care planning process. The plans focused on how individuals wanted to receive care and support and on the abilities of the individual. There was a section which looked at high dependency and the levels of support required. This part of the plan was enhanced by a section which was entitled, My personal preferences and wishes. This approach to care planning shows that the service is being pro-active in listening to the views of people living in the home and providing care and support that is preferable and in line with the wishes of the individual. Care plans identified needs and provided staff with instructions and guidance on how Care Homes for Older People Page 13 of 26 Evidence: to meet needs. The recordings in the care plans varied in the content and quality. One care plan was detailed and comprehensive. One plan showed the identified need, the intervention and strategies to meet need, however, the supporting documentation did not record that the care needs had been attended to. The lack of recordings could result in a care need being overlooked and this could potentially cause anxiety to an individual. The manager showed us systems and procedures that had been put into place to monitor care plans. This involved regular audits, and when audits had been completed, these were followed up with a report on the findings and any action plans. Records were in place to show that people had access to healthcare professionals such as General Practitioners, chiropody services and opticians. Record showed that there were systems in place to monitor nutritional intake, fall and risk. During a tour of the building it was noted that some information about individual nutritional requirements was written on notice boards. It is important that personal information about people living in the home is recorded on individual files which will ensure their privacy and dignity. This shortfall was addressed during this visit, and personal information was recorded appropriately in care plan files. People living in the home and their relatives were positive about the care and support provided by the staff team. Comments included: Visitor-Sometimes I think the home would benefit from more staff, but I really feel all staff do a good job looking after residents. Ive seen staff attend to people quickly if they want to go to the toilet or get a drink. The staff are lovely, they cant do enough. Medication was looked at including controlled medication. Documentation was in place to record the receipt and disposal of medication and for the daily administration of medication. Since the last visit to this home, a system had been put into place for the manager to carry out regular audits of medication practices. Records showed that the last audit was carried out on 6th February 2009. The system used by the manager ensures that the potential for errors is minimised and promotes good pratice in ensuring people receive their medication safely. One person was self medicating and appropriate risk assessments were in place. Care Homes for Older People Page 14 of 26 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. The daily routines are flexible although the lack of regular social activities means that life in the home may not always meet individual expectations. Evidence: There was an open visiting policy in place and relatives were encouraged to keep in contact. This was evidenced during this visit as there were numerous visitors to the home including relatives and visitors from the local Church. The staff were seen making people feel welcome. People who were spoken to told us they could receive visitors at any time. People in the home were helped to exercise choice and control over their lives. Some people told us that they preferred to spend time alone in their bedroom. Arrangements has been made for these people to have their meals in their room, this showed a flexible approach to day to day activities. There was evidence during this visit that staff listenend to people and responded positively to their preferred lifestyle choices. One person said, I love my room, its like a flat. The girls ( staff) are very nice and they bring my meals to my room. One person told us, I love it here, its where Ive been able to get my life set up. Ive got my own routine and the staff help me to keep my independence. Care Homes for Older People Page 15 of 26 Evidence: The manager told us that the service was in the process of recruiting for a full time activities organiser. In the meantime, Two existing care staff had been given additional hours to arrange activities. The manager was aware that the opening of the new dementia unit would require a member of staff dedicated to organising appropriate activities on a regular and consistent basis. There were mixed feeling about activities in the home, comments included: I dont feel there are many activities and we were told there would be. There used to be a lot of activities, we could do with some more. The manager acknowledged that this was an area that needed to be prioritised so that people in the home have the opportunity to live a fulfilled lifestyle and there was evidence that this was being addressed. Most of the people we spoke to were satisfied with the quality of the meals served in the home. One person said, The meals are lovely, theres always something to suit. Care Homes for Older People Page 16 of 26 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. There are good procedures so people who live in the home are able to express their concerns and be listened to. Their rights are protected and they are safeguarded from abuse. Evidence: The complaints record was looked at and provided evidence that the service takes all complaints seriously, even those of a minor nature. One complaint was looked at in detail and recordings showed the nature of the complaint, the investigation process and the response to the complainant. The complainant received a written response within twenty eight days. There had been two safeguarding incidents. The manager followed local safeguarding procedures and notified the Commission of the events. The service has received five complaints made directly to the home, the Commission has not received any recent complaints about this service. People who were spoken to told us they felt confident in raising any issues of concern. Most relatives said they felt confident that they could make a complaint if they had to. Two people said they werent sure that their concern would be taken seriously. These people were advised to use the procedure and to speak with the manager or staff if they had any concern. Care Homes for Older People Page 17 of 26 Evidence: Most of the staff team had a good understanding of safeguarding procedures. The training matrix ( plan) showed that staff were booked in for safeguarding training in 2008 and 2009. The manager told us that this was part of an ongoing programme and that the next training was scheduled for 20th May 2009. Care Homes for Older People Page 18 of 26 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 home is appropriately maintained, decorated and cleaned to a good standard to ensure that people who live there are provided with a safe and pleasant environment. Evidence: This was an unannounced visit to the home. As part of the visit a tour of the building took place. All communal areas were cleaned to a good standard. Health and safety checks had been carried out on the equipment and environment to ensure that people living in the home were safe. There was evidence of a rolling programme of decoration and refurbishment including adaptations and changes in the building to provide accommodation for people with dementia. Several rooms had been upgraded and careful colour co-ordination had been used to help people with visual impairment and those who experience problems finding their way around their environment safely. External ground provided a safe and pleasant area for people to enjoy all year round. An additional garden and patio area had been developed and this provided people with a safe secure area. Many people had personalised their bedroom space. One person told us, I love my room, its like a flat, my own space. Care Homes for Older People Page 19 of 26 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. People receive care and support from staff who have the skills to support them correctly. Evidence: During this visit there were sufficient staff on duty to meet the needs of people living in the home. Comments from visitors were positive and one Person told us-how quickly the staff were to respond to individual needs. Information in the AQAA confirmed that fifty percent of staff were qualified to NVQ Level 2 or above. Staff who were spoken to told us that training had improved and that there were plenty of training and development opportunities. During this visit a training session was in progress involving a large group of staff. Staff told us that they received good support and were paid to attend training sessions. The training programme was looked at and this showed that staff had attended a wide range of training courses, for example, training in dementia awareness was booked for the 16th June. This shows that staff working on the dementia unit are being supported to develop their knowledge and skills so that they can give the right support to people living in the home. Three staff files were looked at and all of these contained the documentations required Care Homes for Older People Page 20 of 26 Evidence: by legislation including criminal record disclosures, and two written references. Comments about the staff were very positive and these included: The staff are wonderful, you can have a good joke with them. They are very good and do anything I ask them. The staff are great. I can do things for myself, but I have seen them help other residents and they are very attentive. When I do need help, they are very good. Care Homes for Older People Page 21 of 26 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 service is run in the best interest of the people living in the home and the manager ensures that their health, safety and welfare is promoted. Evidence: The manager has the experience, skills and qualifications to manage the home. She has completed the NVQ 4 in management and has a portfolio that show an ongoing commitment to training and development. Recent courses attended by the manager include deprivation of liberty and the mental capacity act. She has recently undertaken a considerable amount of work to support the application for a change in registration conditions to enable the service to accommodate people with dementia. She has fully addressed the requirements for this application. Staff who were spoken to told us that they felt fully supported by the manager and could approach her at any time for informal support. The manager is currently attending a series of workshops and in house management Care Homes for Older People Page 22 of 26 Evidence: meetings within the organisation. The workshops are looking at all the key areas of practice and developing action plans to further improve the service. There was evidence that people in the home were consulted formally and informally and their views were sought using survey questionnaires. There was a new IT system in place which flagged up any key management audit tasks. When the manager has completed the audits, she sends a report of her findings to the head office. Audits include medication, complaints, falls and accidents. Care Homes for Older People Page 23 of 26 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 24 of 26 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 12 A regular and consistent programme of activity should be implemented as soon as possible so that people in the home experience a lifestyle that matches their expectations and preferences and satisfies their social, cultural and recreational interests. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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