Care Home: St George`s Residential Home

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What the care home does well What has improved since the last inspection? The written care plans have improved since our last visit and now give more detail of what residents want and need. The environment has been improved with decoration to individual bedrooms and communal rooms, all the windows have been replaced or repaired and a new wall built around the garden that has improved security. Staff have had training updates to their knowledge of working with people with dementia. What the care home could do better: We recommend that the company review the way they handle complaints so that any complainant has a clear picture of the outcome of any complaint or concern. We were pleased to see that a lot of changes had been made to the environment but we recommend that the company look at the main kitchen and shared toilets, as these areas need upgrading. Surveys told us that there had been problems covering shifts in the home over the summer. The company tell us that they have had problems with recruitment in the area and are trying to deal with this. We want them to continue to deal with this problem. We also want the company to include further training and competence checks on two areas of staff knowledge and skills. We judged that people now need up-to-date training on Adult Protection and specific training on manual handling in relation to individual residents. CARE HOMES FOR OLDER PEOPLE St George`s Residential Home St George`s Road Millom Cumbria LA18 4JE Lead Inspector Nancy Saich Unannounced Inspection 26th September 2008 8:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St George`s Residential Home Address St George`s Road Millom Cumbria LA18 4JE Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01229 773959 StGeorgesmillom@aol.com Goldcare Facilities Management Limited Ms Janet Bosanko Care Home 38 Category(ies) of Dementia - over 65 years of age (10), Learning registration, with number disability (1), Old age, not falling within any of places other category (37) St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 37 older people (OP) of whom 10 may have dementia (DE(E)). 1 Person over 18 years of age with a learning disability (LD) Date of last inspection 14th August 2006 Brief Description of the Service: St Georges is a residential home offering care and services to people in the categories described above. The home is a Grade II listed building that has been extended and adapted to provide accommodation for up to 38 people. The home is set in its own grounds and is within walking distance of the centre of Millom. The home is owned by Goldcare Facilities Management Limited and Janet Bosanko manages the home on their behalf. The charges for the service range from £386 to £449 per week depending on care needs. Further information about the home and copies of inspection reports can be obtained from the manager or the provider. St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this service is two star. This means that people who use the service experience good quality outcomes. This was the main or key inspection for the year. The lead inspector, Nancy Saich, asked the manager to fill out a form called the Annual Quality Assurance Audit (the AQAA). This asks for details of what has improved in the home since the last inspection and for the plans for the coming year. This was completed promptly. We (the Commission for Social Care Inspection) then sent out postal surveys to people who live in the home and to the staff group. We had a good response to these surveys and we quote from them in the report. The responses were fairly positive and gave us a good picture of what its like to live and work in the home. We had gathered further evidence throughout the year from people who visit the home. We made an unannounced visit to the home. We spoke to residents, staff and visitors. We toured the building, sat in lounges and shared a meal with residents. We also looked at files and documents that backed up what was said and what was seen. What the service does well: This service is good at making sure they only take new residents who they know they can care for and who will fit in with the rest of the group. Residents told us they were happy with the way staff supported them in personal care. We also had evidence to show that people got the right kind of health care support and, as one person said: • I should like to say how well the GP and St Georges staff dealt with the last months of my relatives illness ... and showed kindness to me. St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 6 Our surveys showed that in general people were happy with staff approach and attitude. • “The staff are all very pleasant and always ready to help. I am very comfortable and feel well looked after.” We checked on medicines and they were being managed correctly. Residents were happy with the activities on offer and several people spoke about the work that the activities co-ordinator did. • • I enjoy the musical activities especially ... I dont always take part but there are different things on offer and we have parties and entertainments. Surveys, comments and observation on the day gave us evidence to show that residents enjoy the food on offer. • The food is high quality, nicely presented and a good variety. Appropriate homemade sauces enhance the food and are very good. People told us they were happy with levels of cleanliness: • “I am impressed with the cleanliness of the home and with the way that all the residents are helped to be fresh and clean. The staff work enormously hard to achieve this standard.” The manager makes sure she only takes on new staff once she is sure that she has checked their backgrounds and knows they are the right kind of people to care for vulnerable older people. Most staff in this home have already achieved NVQ in care at levels 2 or 3. They also receive regular updates to training. The home is managed by a suitably qualified and experienced person and both she and the company ask service users about the quality of the service and try to include them in future planning. The home looks after small sums of cash for residents and this was being done correctly. The manager is good at making sure that checks on health and safety, food hygiene and fire safety are up to date. St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. This service only admits new residents after they are sure that they can give them the right kind of care and that they will fit in with other people in the home. EVIDENCE: We had evidence from discussion and from surveys that showed that the manager went out to visit prospective new residents and made sure that they could give them the appropriate levels of care. People spoke about visiting the home and one person who had only been in for a few days said they had been helped to settle by the kindness of the staff. We also read individual residents files and saw Social Work and health care assessments as well as the written assessments of the manager. St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People who use this service were satisfied with the levels of care given to them. EVIDENCE: We read approximately half of the written care plans in some depth, especially those where we spent some time with the individual service users. We found that the care plans had been improved on since our last visit and care plans are now up-to-date and have good levels of detail to help residents have the kind of life they want. We look forward to seeing this improvement continuing - especially with people who have dementia. St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 11 We saw that most people were well groomed and residents told us that staff gave them good levels of personal care. One survey did say that they thought more attention should be taken with the care of finger and toenails and we did see one or two people who needed some help with their fingernails. The manager said that she would talk to the staff about this and said that as chiropody services only came every 20 weeks she could arrange for people to have private treatment if necessary. We did have some other evidence that showed that personal care standards had slipped during a period when the home was understaffed. We judged that this matter had been dealt with but we discuss this further under Staffing. We saw in the care plans and in the daily notes that people received good standards of support to get the kind of health care they needed. We spoke to two healthcare professionals on the day and they said that they were called in appropriately. One person told us about how the staff worked with the local GP to give good end of life care. We checked on the medication kept on behalf of residents and we watched staff give this out to people. We judged that this was being done correctly and that medicines were stored appropriately. Staff told us that they had recently completed training on the safe handling of medication and the manager was checking on how a particular member of staff was doing this while we were there. We observed staff treating people with respect and dignity and we saw that they used discretion when helping people with personal care. Staff knocked on bedroom doors and addressed people by their preferred name. We spent some time with groups and individual residents and they said that staff approach was very good. St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. This home provides the people who live there with the kind of lifestyle they prefer. EVIDENCE: The inspection started at eight oclock in the morning and only a handful of people were having breakfast. Staff and residents said that people got up as they chose. One or two residents said they were early risers and it suited them to come down, other people spent the morning in their own rooms and had breakfast brought to them and only came down at lunchtime. Residents said that staff were very relaxed about the routines of the day and they went along with whatever people chose. This home has an activity co-ordinator who works four hours, five days per week. On the day of the visit she was going out to a training course about providing suitable exercise for people in care homes. She told us that she had done other training courses with the Alzheimers Society. St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 13 People told us that they had opportunities to join in with different types of activities and that this staff member also did some one-to-one work. One person said that they were helped to go down into the centre of town to shop or have coffee. Generally, people were happy with the way activities and parties were organised and a number of residents said that they felt they had an influence on these activities and outings. Our surveys and discussions did bring up an issue that residents feel concerned about. This is in relation to the television reception and several people wanted the company to upgrade the aerial before the digital switchover in the area. The Inspector discussed this with the manager. We shared a meal with the residents at lunchtime and observed breakfast being prepared. Residents have a three course lunch every day that includes homemade soup. We spent some time with the cook and we judged that she had a good level of knowledge about the nutritional needs of older adults. We did think that some improvements to the kitchen would help give residents even more choice than they have at the minute and we discussed this under ‘Environment’. Residents said that the food was very nice and everyone enjoyed the meals on the day. The dining room in this home has been enlarged and this is now a very pleasant place to spend time in. Residents were very relaxed with each other and mealtimes seemed to be a chance to socialise and enjoy good food. St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The company has suitable systems in place to deal with allegations and complaints. EVIDENCE: There had been one formal complaint received and we asked the company to investigate this. This had been done within the 28 day period set out in the regulations. At the time of the inspection the person who had made the complaint was still considering the outcomes. We judged that the complaint had been looked into in some depth but that the report needed to be a little clearer about the outcomes they reached. Residents told us that they were comfortable making complaints to any one of the staff but would go to the manager if things were not resolved. There were details available in the home so that residents could make a complaint. We also asked residents about how well they thought staff protected them from abuse. The people we spoke to were very positive about this and said that staff have their best interests at heart. We also spoke to visitors to the home and everyone said there was nothing untoward going on at St Georges. St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 15 We spoke to a number of staff about their understanding of what was abusive and we thought that they had a very good understanding of this. We did however discover that it had been some time since staff had received training updates on Adult Protection and that some were a little unsure about how to manage any concerns. We discuss this further under ‘Staffing’. St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. This home needs to continue to upgrade the environment so that residents are always comfortable. EVIDENCE: On the day of the visit the home was clean, neat and orderly. We could see that the dining room, hall and several bedrooms had been decorated and that all the windows had been replaced or repaired around the home. A new garden wall had been built so that people could sit outside in safety and security. We spoke to the manager and she told us about the companys plans to continue to improve the environment. She told us that this was to include upgrade to toilets and bedrooms and a new call bell system. St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 17 Some of the areas of the building do need to be redecorated and modernised, for example, the shared toilets around the home need to be upgraded - and we look forward to the next phase of work to be completed in the home. We did think that the main kitchen needed some new equipment and some other updates. We recommend that an upgrade to the main kitchen is included in any future plans for the building. We saw that staff paid good attention to infection control and residents were happy with the way their personal laundry was done. St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Problems with staff recruitment and some training issues mean that people who use the service may not always have the level of care they want or need. EVIDENCE: Staff and residents’ surveys and the AQAA described problems with staffing. The manager says that these problems relate to recruitment problems in the Millom area. However, the manager had recruited some new staff and was using agency staff on the day of the visit. She said the company had other plans in mind to deal with this. We recommend that the company devised an action plan for dealing with this that they share with staff, residents and relatives. We could see from staff training files that most people had achieved national vocational qualifications in care at level 2 and that a number of people were also working on level 3. We checked on a number of staff files for both new recruits and people who had been working there for a number of months. We found that the manager had recruited them appropriately and all the relevant checks had been made so that she was sure that they were the right kind of people to work with older adults. St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 19 We looked at records of training and spoke to staff and residents about this. We discovered that new starters had suitable induction and we saw a senior carer being mentored by the manager on the day of the visit. Staff said they had attended training in handling medication, infection control, dementia care, fire safety, health and safety and challenging behaviour. The manager had a training plan that showed plans for future training in nutrition, first aid and manual handling. On the day of the visit we thought there was an issue with manual handling, with one person that needed further staff training and competence checks and perhaps some advice from an occupational therapist. We want the manager to make sure that this specific training need is dealt with. When speaking to staff we discovered that people were very aware of what constitutes abuse but now need updates on how any potential or actual abuse is handled by individuals in the team. We want this to be done so that staff feel confident about taking the right kind of action to protect people. St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home has suitable management systems in place to allow the people who live in the home to get good levels of care and services. EVIDENCE: Janet Bosanko has been the manager of this service for a number of years. She has gained the Registered Managers Award at National Vocational Qualification level 4 and updates her training on a regular basis. All the residents spoken to were happy with the way she runs the home and a number of people said that she was always available and very approachable. Staff were happy with the way the home was being managed and no one had any issues on the day of the inspection. St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 21 We saw evidence to show that the company and the registered manager ask residents and their relatives about the standards in the home. We also saw other evidence to show that there were suitable checks on quality in the service. Residents said that they were asked their opinions and had some input on things like décor and activities. A number of surveys showed that high quality targets are being met in things like catering and cleanliness of the home. The manager told us that the provider was in the process of completing an audit of the quality systems and we look forward to seeing a copy of this. We checked on money kept on behalf of residents and found that this was accounted for correctly. We checked on the routine maintenance and health and safety checks for the home and we saw very good records of daily, weekly and monthly checks on things like water temperatures, fire equipment and systems, the call bell system, the lift and the emergency lighting system. We checked the fire log book and that was also in order. St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP16 OP19 Good Practice Recommendations It is recommended that the company review and update the procedures for investigating complaints so that outcomes can be seen clearly. It is recommended that the company prepare an action plan so that everyone who lives or works in the home has a timetable showing when improvements will be made to individual and shared areas and when areas like the main kitchen will be upgraded. It is recommended that an action plan is prepared and made available for residents and staff in relation to the ongoing problem of recruiting enough staff to give good levels of care at all times. It is recommended that updates to managing adult safeguarding and to manual handling are included in the home’s training plan. 3 OP26 4 OP30 St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection NW Regional Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St George`s Residential Home DS0000022666.V371700.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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