Care Home: St Georges Nursing Home

Similar services:

• Chirnside House
• Keer Sands Residential Home
• Ruskin Lodge
• Bushell House
• Langrigg House
• Parkside
• Dystlegh Grange
• Thornton Lodge

What the care home does well Good information was gathered before people were admitted to the home so that staff were provided with a clear picture of individual needs to ensure that they were confident that the care and support required could be delivered. The plans of care provided staff with clear guidance about how the assessed needs of people living at the home were to be met and how people were to be supported to maintain their privacy and dignity. A variety of external professionals had been involved in the care of people living at St Georges Nursing Home to ensure that their health care needs were being appropriately met. Special occasions were celebrated and some activities were provided for people living at the home. The routines of the home were very flexible and when able people could come and go as they pleased. A minibus was available to take those who wished to participate on trips out during the better weather. The religious needs of people were being met with good support from a local church. Relatives spoken to were happy about how visitors were received into the home and they told us that the staff were all very friendly, kind and caring. Sufficient information was provided to people about the use of the local advocacy services to act on their behalf, should they so require and people living at the home were able to have some control over their lives by managing their own finances, should they so wish. People living at the home were provided with nutritious, well balanced meals so that their dietary intake was adequate and those requiring support with eating their meals were assisted in a discreet manner, whilst others were encouraged to eat independently. The complaints procedure was freely available within the home and it was also included within the service users` guide so that people were given enough information about how they could make a complaint should they so wish. The policies and procedures in relation to safeguarding vulnerable adults were easily accessible and staff spoken to knew the procedure to take should an allegation of abuse be received by the home. The home was tastefully furnished and pleasantly decorated to a high standard and the premises, both internally and externally were well maintained providing those living at St Georges Nursing Home with a safe, clean, comfortable and homely environment. Effective infection control measures were in place to ensure that the health and safety of people was adequately protected. Staffing levels were calculated in accordance with the assessed needs of people to ensure that appropriate care was being delivered and staff were well trained to provide the care and support which people needed. The registered manager holds relevant qualifications, has a lot of experience and is appropriately trained to manage the care home. Residents, relatives and staff thought highly of her and they all felt supported by the management of the home.The health, safety and welfare of residents was, in general protected by the policies, procedures and practices of the home to ensure that any hazards, which could pose a potential risk, were minimised or eliminated. When asked what the home does well one relative told us, `my father is fed well, cared for well and respected by staff` and another said, `the home does what it is supposed to do with regard to giving my mother the support and nursing care she needs. They (the staff) appear very caring and friendly and they are also interested in my father`s health as well`. One member of staff responded to the same question by saying, `this is one of the better care homes I have worked in`. What has improved since the last inspection? All four requirements made at the last inspection had been addressed showing that the manager and her staff team had worked hard to improve the quality of service provuded. The care planning process had improved since the last inspection and detailed accounts were available of people`s life history so that staff could discuss with them things that were important to them, which was considered to be good practice. The plans of care had been reviewed regularly and had been developed with the involvement of the people using the service so that they had some input in to the planning of their own care. The plans of care were very person centred documents, covering the assessed needs of people extremely well so that those working at the home knew exactly how to provide care and support to those living at the home. At the time of our visit to this service all facilities seen were accessible to those living at the home and emergency equipment was freely accessible by staff to promote the health, safety and welfare of people using the service. A range of risk assessments and audits had been conducted to ensure that systems were in place to protect the health and safety of anyone on the premises and the management of medications was, in general good. What the care home could do better: The hand written entries on the medication records could have been signed, witnessed and countersigned in order to avoid any transcription errors. The provision of activities could have been better as it was clear that care staff were having difficulty in providing daily uninterrupted periods of leisure activities so that people living at the home were stimulated and their interests maintained. Some attention was needed to the laundry floor so that it was made safe for people working in that department. The recruitment practices could have been better by ensuring that all required checks were undertaken before new staff started working at the home, including two written references and a Criminal Record Bureau disclosure so that the home was sure that people living there were protected. Surveys for staff members could have been introduced so that feedback could beprovided to the management team about what it was like working at St Georges Nursing Home. Meetings for people living at the home could have been held more regularly so that any important information could be passed on and so that people could discuss any relevant topics. Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Georges Nursing Home 2 - 4 Marine Drive Fairhaven Lytham St Annes Lancashire FY8 1AU     The quality rating for this care home is:   three star excellent 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: Vivienne Morris     Date: 1 7 0 2 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 33 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 33 Information about the care home Name of care home: Address: St Georges Nursing Home 2 - 4 Marine Drive Fairhaven Lytham St Annes Lancashire FY8 1AU 01253730502 01253730502 stgeorges@centuryhealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Century Healthcare Limited Name of registered manager (if applicable) Mrs Marie Noblett Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability 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 (maximum number of places: 27). Physical disability - Code PD (maximum number of places: 2). The maximum number of people who can be accommodated is: 27. Date of last inspection Brief description of the care home St.Georges Nursing Home offers personal care and nursing care for up to 27 older people, including two places for people with a physical disability. The home is situated within five minutes walk of Fairhaven Lake complex and is within easy reach of local shops, post office, and churches. There are regular bus services near by and Ansdell Railway Station is 10 minutes walk away. Accommodation is provided in a detached Care Homes for Older People Page 4 of 33 0 2 Over 65 27 0 care home 27 Brief description of the care home property, which has been modernised to suit the needs of the people living at the home, whilst still encapsulating the many original features of the Victorian period in which it was built. The fees at the time of the site visit ranged from £450:50 to £530:50. Additional charges are incurred for hairdressing, chiropody, toiletries, magazines and newspapers. Care Homes for Older People Page 5 of 33 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three star. This means that people who use this service experience excellent quality outcomes. The site visit to St Georges Nursing Home formed part of the inspection process and was conducted over one day in February 2009. It was unannounced, which means that the managers, staff and people living at the home did not know it was going to take place. During the course of the site visit, discussions took place with those living at the home, as well as relatives, staff and managers. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private Care Homes for Older People Page 6 of 33 accommodation was viewed and all communal areas were seen. Comment cards were received from three people who were living at the home and seven staff members and their feedback is reflected throughout this report. Every year the provider completes a self-assessment, known as an AQAA, which gives information to the Commission about how the service is meeting outcomes for the people living at the home and how the quality of service provided is monitored. We observed the activity within the home and tracked the care of three people during the site visit, not to the exclusion of other people living at St Georges. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service over a period of time. The Commission for Social Care Inspection had not received any complaints about this service since the last inspection. What the care home does well: Good information was gathered before people were admitted to the home so that staff were provided with a clear picture of individual needs to ensure that they were confident that the care and support required could be delivered. The plans of care provided staff with clear guidance about how the assessed needs of people living at the home were to be met and how people were to be supported to maintain their privacy and dignity. A variety of external professionals had been involved in the care of people living at St Georges Nursing Home to ensure that their health care needs were being appropriately met. Special occasions were celebrated and some activities were provided for people living at the home. The routines of the home were very flexible and when able people could come and go as they pleased. A minibus was available to take those who wished to participate on trips out during the better weather. The religious needs of people were being met with good support from a local church. Relatives spoken to were happy about how visitors were received into the home and they told us that the staff were all very friendly, kind and caring. Sufficient information was provided to people about the use of the local advocacy services to act on their behalf, should they so require and people living at the home were able to have some control over their lives by managing their own finances, should they so wish. People living at the home were provided with nutritious, well balanced meals so that their dietary intake was adequate and those requiring support with eating their meals were assisted in a discreet manner, whilst others were encouraged to eat independently. The complaints procedure was freely available within the home and it was also included within the service users guide so that people were given enough information about how they could make a complaint should they so wish. The policies and procedures in relation to safeguarding vulnerable adults were easily accessible and staff spoken to knew the procedure to take should an allegation of abuse be received by the home. The home was tastefully furnished and pleasantly decorated to a high standard and the premises, both internally and externally were well maintained providing those living at St Georges Nursing Home with a safe, clean, comfortable and homely environment. Effective infection control measures were in place to ensure that the health and safety of people was adequately protected. Staffing levels were calculated in accordance with the assessed needs of people to ensure that appropriate care was being delivered and staff were well trained to provide the care and support which people needed. The registered manager holds relevant qualifications, has a lot of experience and is appropriately trained to manage the care home. Residents, relatives and staff thought highly of her and they all felt supported by the management of the home. Care Homes for Older People Page 8 of 33 The health, safety and welfare of residents was, in general protected by the policies, procedures and practices of the home to ensure that any hazards, which could pose a potential risk, were minimised or eliminated. When asked what the home does well one relative told us, my father is fed well, cared for well and respected by staff and another said, the home does what it is supposed to do with regard to giving my mother the support and nursing care she needs. They (the staff) appear very caring and friendly and they are also interested in my fathers health as well. One member of staff responded to the same question by saying, this is one of the better care homes I have worked in. What has improved since the last inspection? What they could do better: The hand written entries on the medication records could have been signed, witnessed and countersigned in order to avoid any transcription errors. The provision of activities could have been better as it was clear that care staff were having difficulty in providing daily uninterrupted periods of leisure activities so that people living at the home were stimulated and their interests maintained. Some attention was needed to the laundry floor so that it was made safe for people working in that department. The recruitment practices could have been better by ensuring that all required checks were undertaken before new staff started working at the home, including two written references and a Criminal Record Bureau disclosure so that the home was sure that people living there were protected. Surveys for staff members could have been introduced so that feedback could be Care Homes for Older People Page 9 of 33 provided to the management team about what it was like working at St Georges Nursing Home. Meetings for people living at the home could have been held more regularly so that any important information could be passed on and so that people could discuss any relevant topics. 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 10 of 33 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 11 of 33 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. Peoples needs were thoroughly assessed before they moved in to the home so that the staff team were confident that they could deliver the care required. Evidence: At the time of our inspection there were 21 people living at St Georges Nursing Home. We tracked the care of three of these people. Information gathered about the needs of people before they moved in to the home was detailed and had been obtained from a variety of sources. This enabled the staff team to be sure that they could meet all the assessed needs of people before they were admitted. A policy was in place in relation to the pre-admission process so that staff were aware of the correct procedure to follow and what was needed before people went to live at Care Homes for Older People Page 12 of 33 Evidence: St Georges. We received comment cards from seven staff members and when asked if they were given up to date information about the needs of the people they supported they felt that in general they were. One staff member wrote, sometimes if anyone new comes in you only get told if you are on duty that day. If I am not on duty I read up what I need to know, another told us, a report is given to oncoming staff prior to them commencing work and a third said, we are always kept up to date before starting any shift. We received comment cards from three people who use the service and two of these people said that they had received enough information about St Georges before they moved in so that they could decide if it was the right place for them to live. One of them wrote on the comment card, I felt at home the moment I walked through the door. This is a true home in every sense of the word. One person felt that they had not received enough information about the service before they moved in. When asked what the service does well, the registered manager told us, prospective clients are given sufficient information about the home which helps them make an informed decision about moving in to the home. People are given the opportunity to look around the home without an appointment and to discuss any issues or worries. A detailed pre-admission assessment is carried out, usually by the manager and the relatives are invited to be present. Two relatives who sent in comment cards felt that they usually got enough information about the home to help them to make decisions. Care Homes for Older People Page 13 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs were fully met, their privacy and dignity being respected at all times and the management of medications was good. Evidence: The care records seen were extremely well written, providing staff with clear guidance about how peoples assessed needs were to be met. The plans of care were very person centered, being written in the first person and had been developed with the involvement of those living at the home or their relative. One person visiting the home confirmed that they had been consulted about the care planned for their relative. Care plans had been reviewed regularly and any changes in peoples circumstances had been reflected well, so that staff were provided with up to date information about the assessed needs of the people they were supporting. Records showed that a wide range of external professionals were involved with the care of people living at the home to ensure that their health care needs were being fully met. We saw one person being supported to attend a hospital appointment and Care Homes for Older People Page 14 of 33 Evidence: on our arrival to the home staff were dealing with a medical emergency efficiently and promptly. A variety of risk assessments had been conducted so that any hazards which could affect the health and personal care of people living at the home were identified and strategies implemented in order to protect them from harm. We spoke to three staff members who all said that they felt that peoples needs were being fully met at St Georges Nursing Home. We spoke to the people whose care we tracked and comments received included, I cannot fault the staff. They are fantastic and the nursing care provided is wonderful and they (the staff) are all kind, caring and attentive. The Statement Of Purpose included information about how the privacy and dignity of people living at the home was to be protected. A policy was in place telling staff about the importance of treating people in their care with respect to ensure that their privacy and dignity was promoted at all times. This was confirmed by the well written care plans and observation of staff interacting with those living at the home. Induction records for new staff showed that maintaining peoples privacy and dignity was an important aspect of life at St Georges. The management of medications was good, with satisfactory records being maintained. However, hand written entries on the Medication Administration Records had not always been signed, witnessed and countersigned in order to reduce the possibility of any transcription errors. When asked what they do well the registered manager wrote on the self-assessment, care plans include specific management assessments including bed rails, falls, fire and challenging behaviour if appropriate. The plans ensure that there is sufficient staff, trained appropriately and the amount of specialised equipment is in place to ensure the best care is provided. Medication procedures are robust and audited regularly by the manager and Director of Nursing. There is input and assessments from the pharmacy. Residents and relatives are always given the opportunity of privacy in their own rooms. All residents are treated with respect and dignity. Comment cards were received from seven members of staff. All felt that, in general, they had the right support, experience and knowledge to meet the differing needs of people who use the service. Although one person wrote on the comment card, there is not always enough support from some of the General Practitioners. Care Homes for Older People Page 15 of 33 Evidence: When asked if they received the care and support needed, two people living at the home who submitted comment cards said that they always did and a third responded by saying they sometimes did. This person wrote, the care and support is not as good as I would like. However, one person commented, the care is of the highest standard. Every concern is attended to and day to day observations of each resident are carefully noted. Two relatives told us that the different needs of people living at the home were usually met. Two of the three people who send in comment cards said that they always received the medical support needed and another said that they usually did. One person wrote, the medical support here is second to none. It speaks for itself as we have residents over 100 years old. In my opinion the care couldnt be surpassed. When asked what the service does well, one member of staff wrote on the comment card, it makes sure that each individual residents needs are looked after as every resident has different needs. Care Homes for Older People Page 16 of 33 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 of the home were flexible and people were encouraged to maintain their leisure interests and hobbies whilst living there. The management of meals was good and visitors were made welcome to the home. Evidence: The care records examined contained extremely detailed information, providing staff with a clear pen picture of peoples lives throughout the years. This enabled staff to be fully aware of individuals interests so that they could discuss with those living at the home topics that were important to them. We had a long discussion with one person whose care we tracked during our inspection. She told us that she was very independent and could come and go as she pleased. She confirmed that the detailed plan of care in relation to her leisure interests was an accurate account of what she was able to do. This person said, I love living here. There are no restrictions and I can live how I choose to do. I go to my sisters regularly who lives locally and we sometimes go out. I receive pastoral care from the local church, which is important to me. I attend church services and coffee mornings. I walk up to the lake and feed the birds and often sit and read for a while. I have Care Homes for Older People Page 17 of 33 Evidence: applied for voluntary work and am just waiting for my checks to be completed before I can start Another person told us that birthdays and special events were always celebrated in style at the home. She said, on Burns night we had haggis and all the trimmings and another person living at the home told us, we had a lovely Christmas here. Everyone enjoyed it. We were told that activities were arranged by the care staff and that a planned programme had been tried, but did not work because of the frailty of most of the people living at the home. On the day of our visit there was no evidence that any organised activities were being provided. We were told by people living at the home that some external entertainers visited on occasions so that anyone could join in if they wished to do so. Three staff spoken to all felt that activities could be improved because the care staff could only provide a limited amount because they are too busy to concentrate on the activity side of the home. When asked if there were suitable activities provided by the home, two of those who submitted comment cards said that there sometimes were and one said that there never was. One person wrote, matron does her best to provide entertainment, but it is very difficult as a lot of the residents have poor eyesight and very bad hearing. Even conversation is limited. All three people who submitted comment cards indicated that, in general they enjoyed the meals at the home. One person wrote, the meals are very good and very varied. When asked what the service could do better one person told us, to provide a better TV in the lounge and another person said, occasionally my relative has food on her chin which should have been washed off. Otherwise we are happy with her care. We saw a care worker accompanying one person to a dental appointment in a taxi, who asked him if he would like to go for a cuppa on the prom after visiting the dentist, to which he readily agreed. We spoke to five people living at the home and several relatives, who were visiting. Everyone told us that they were very happy with the service provided. One person said, this home is the centre of excellence and a relative commented, St Georges is a wonderful place to be. The staff are marvelous and very caring. One person told us that there was a minibus available to take people on trips out during the better weather. Those spoken to confirmed that activities were provided and they felt that these were sufficient for their needs. Care Homes for Older People Page 18 of 33 Evidence: Staff told us that because care workers were responsible for arranging activities, this was the area which was disrupted should any emergency occur or if anyone needed additional support. We noted that visitors were welcomed to the home in a friendly manner and that information was available for people about visiting arrangements and how they could access an independent person to act on behalf of people living at the home if they so wished. The visitor spoken to confirmed that they felt comfortable visiting the home and that the staff were all very approachable and empathetic to peoples needs. We observed lunch being served, which showed that meal times and nutritional requirements were managed well. The menu offered a choice of meals. People spoken to confirmed that they were given choices and we saw different meals being served on the day of our visit. The meals looked appetising and nutritious so that people received a well balanced diet. We saw a care worker assisting one person with their meal in an appropriate manner whilst chatting to her and offering good support. Special diets were catered for and specialised utensils were provided as required in order to promote independence. People were seen eating at the dining tables or within the privacy of their own bedrooms, if they preferred. All those spoken to were satisfied with the quality of food provided. One person said, on the whole the meals are most enjoyable. When asked what the service does well, the registered manager wrote on the homes self assessment, a range of activities suitable to the residents needs are provided. The home encourages residents to maintain contact with their past interests and residents are able to receive visitors in private. The home provides a varied and nutritional balanced diet. All special needs are catered for. Independence is promoted but residents are supported and assisted with their meals in a dignified manner. The routines within the home are flexible to meet residents needs. One relative summarised what life was like for the people living at St Georges by saying, residents are free to live as they wish. Everybody is made to feel welcome and rules and regulations seem few and far between. Care Homes for Older People Page 19 of 33 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. A system was in place so that complaints could be managed well and people living at St Georges were adequately safeguarded by the robust policies and procedures adopted by the home. Evidence: Sufficient information was available telling people how they could make a complaint, if they wished to do so and the clear written procedure informed them of the complaint process. Those spoken to told us that they would know how to make a complaint if they needed to do so and they would know who to speak to if they were not happy about something at the home. A system was in place for recording and monitoring any complaints made to the home. However no complaints had been received by the home or the Commission for several years. The training matrix and staff records showed that those working at the home had received training in the Protection Of Vulnerable Adults to ensure that people living there were well protected. Policies were in place at the home so that staff were aware of what they should do if they suspected that anyone in their care was being harmed. The policies also reminded staff of their responsibilities in reporting any suspected or actual allegations of abuse so that those living at St Georges were safeguarded. Care Homes for Older People Page 20 of 33 Evidence: Staff spoken to told us that they would know what to do should they have any concerns about the well being of those they supported. When asked what the service does well, the registered manager told us, all the residents are safeguarded by the homes robust complaints procedure and protection of vulnerable adults procedure. Staff are trained in the protection of vulnerable adults. We respond to any complaints within agreed time scales. All seven staff members who submitted comment cards said that they would know what to do if a person living at the home, their relative, friend or advocate had any concerns about the home. Two people who use the service and who submitted comment cards said that staff listen and act on what they say and that they would know how to make a complaint, should they need to do so. The other person said that they would not know how to make a complaint and that staff dont always listen and act upon what is said. One person living at the home wrote on the comment card, both matrons are wonderful. They go out of their way to help. They are always there for me. They are understanding and kind. They are really the head of a true family and another said, sometimes staff act on my concerns, but not always. Care Homes for Older People Page 21 of 33 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 provided a safe and comfortable environment for the people living there. Evidence: A lot of improvements had been made to the environment since we last visited the service. Some areas had been re-carpeted and some bedrooms redecorated so that people lived in pleasant surroundings. The home was warm and homely providing a cosy and comfortable environment for those living at St Georges. It was tastefully decorated and the furnishings were of a good quality providing a suitable standard of accommodation for people to live in. Those spoken to were very happy with their private accommodation and the communal areas of the home. One person said, my bedroom is very comfortable and I have all my belongings around me. I am very happy here. I couldnt wish for any more. The bedrooms contained peoples personal possessions, which made them homely and individualised and people living at the home were able to have a lock fitted on their bedroom doors, if they wished to do so, in order to protect their belongings and to promote their privacy. Care Homes for Older People Page 22 of 33 Evidence: The kitchen flooring needed some attention. However, we were told that the kitchen is due to be completely refurbished and the flooring replaced. The flooring in the laundry also needed some attention to ensure that it was made safe for people working in this department. The home was clean and in general odour free, providing a pleasant atmosphere for those living there. Policies and procedures were in place in relation to infection control and clinical waste was being disposed of in the correct manner so that people living at the home were protected from cross infection. Records showed that staff had received training in the control of infection so that they were aware of the correct measures to take in order to reduce the possibility of the spread of infection. All three people who submitted comment cards and who use the service said that the home is usually fresh and clean. One person wrote, the home is immaculate. Care Homes for Older People Page 23 of 33 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 number and skill mix of staff on duty met peoples needs. However, the recruitment practices adopted by the home could have been more robust in order to better protect those living at the home. Evidence: At the time of our visit to the service there were 21 people living at St Georges. We examined the staff rota, which showed the staff on duty at any time of the day and night so that the home could ensure the correct skill mix was deployed. It was evident that shifts were staggered throughout the day in order to accommodate the needs of people living at the home and to best suit the routines of the service. This showed that the staffing levels varied in accordance with the needs of people living at the home at any one time. The three people who submitted comment cards and who lived at the home provided varied responses when asked if staff were available when they were needed. One of these people wrote, staff seem to take their breaks at the same time and another commented, the staff are usually always available unless there is a shortage of staff. When this happens a member of staff will get back to you as soon as possible. Records showed that 63 of care staff had achieved a recognised qualification in care Care Homes for Older People Page 24 of 33 Evidence: so that the staff team were sufficiently trained to provide the support required by the people living at the home. Induction records examined demonstrated that a wide range of topics were covered to ensure that new staff were competent to do the job properly before they worked alone, so that people living at the home received the care required. All seven staff members who sent comment cards to us indicated that their induction period, in general covered everything, which they needed to know to allow them to do the job. One person wrote, it covered all the basics. The rest I picked up as I went along. All seven said that training is provided, which is relevant to their role and helps them understand and meet individual needs and helps them keep up to date with new ways of working. One wrote, to me every day is a learning day. The training matrix showed that a wide range of mandatory training was provided for staff as well as training specific to the needs of people living at the home to ensure that the staff team could collectively meet the needs of everyone living at St Georges. A variety of staff training certificates were on display showing that those working at the home continued to improve their knowledge and skills in order to provide high standards of care and support to the people living at the home. One staff member told us that there was a lot of training provided now. She said that she had done all the mandatory courses, plus some others and a recognised qualification in care. The files of three staff members were examined during our visit. The recruitment procedures adopted by the home could have been more robust so that those living there were better protected. All three staff members had been checked against the Protection Of Vulnerable Adults register before employment to ensure that they had not been listed for any misconduct. However, Criminal Record Bureau (CRB) disclosures had only been obtained shortly after people had started work at the home and there was no evidence to demonstrate that these three staff members had been employed under exceptional circumstances in accordance with current CRB guidance. Nor was there any written documentation to show that these three staff members had been supervised at all times until their CRB disclosures were obtained. We were given a list of staff employed and on examination of this it was apparent that out of 27 people CRB disclosures had not been obtained before employment for 15. Only one reference was available for one staff member and two references had not been dated for others, so it was not possible to identify if they had been received before employment started or not. Care Homes for Older People Page 25 of 33 Evidence: One staff member told us that all approriate checks had been done for her. She said, I couldnt administer medications until my CRB was received. Care Homes for Older People Page 26 of 33 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 home was managed very well so that the health, welfare and safety of the people living and working there was protected. Evidence: The registered manager of St Georges Nursing Home had been in post for a significant number of years. She had the required qualifications and experience and was competent to run the home. During the time she had been in post she had worked hard to improve the service and to provide an increased quality of life for the people living there. There was a strong belief of being open and transparent in all areas of running the home so that people were kept informed of matters involving them. The manager had completed a variety of additional training courses and supported the staff team well. One resident spoken to said, you could not get a better matron than we have. She is fantastic. This comment was followed by a thumbs up sign by the person making it. Care Homes for Older People Page 27 of 33 Evidence: We spoke to three staff members who all said that they were well supported by the management of the home and that the manager was very approachable and encouraged an open door policy so that anyone could go to her at any time to discuss any concerns or issues. Surveys had recently been conducted so that the views of people living at the home, their relatives and stakeholders in the community had been obtained about how the service was performing. The information gathered was put together and produced to show interested parties the strengths and weaknesses of the service. It is suggested that surveys for staff members could now be introduced so that feedback could be provided to the management team about what it was like working at St Georges Nursing Home. A variety of meetings had been held and these were recorded as minutes, so that people were kept informed of any relevant matters. However, it is recommended that the meetings for the people living at the home and their relatives be held on a more regular basis so that current and up to date information can be passed on to all concerned. The home had been accredited with two external awards, showing that it was audited on a regular basis by external professional bodies. The registered manager had put in place a variety of regular, detailed checks using the taste for life assessment audit tool. This enabled her to identify and address any shortfalls within the systems in place at the home and closely monitor the quality of service provided. A wide range of risk assessments had been conducted, which were sufficiently detailed, showing that systems had been put in place in order to reduce the possibility of injury to people living at the home. Systems were in place at the home to ensure that residents finances were adequately protected. The relatives of residents were often responsible for the management of their money. However, personal allowances of a small number of people were retained by the home, where residents were unable or did not wish to manage their own affairs. Clear records were kept of any money or valuables retained at the home on behalf of people living there so that the possibility of any mishandling was reduced. Receipts were retained for any expenditure so that a clear audit trail could be conducted. People were supported to manage their own finances if they wished to do so and one person living at the home told us that she looked after all her own money and visited the bank when she needed to. The homes self assessment showed that all systems and equipment within the home had been appropriately checked so that the health and safety of people living there was protected. This was confirmed by examination of a random selection of service Care Homes for Older People Page 28 of 33 Evidence: certificates. Accidents occurring in the home had been accurately recorded so that the manager was able to audit and monitor the frequency of accidents. The environment was very well maintained and was free from any hazards, which could pose risks to those living at the home. The training matrix showed that staff had received training in Health and Safety and detailed policies and procedures were in place at the home so that staff were aware of any precautions they should take to protect themselves and the people living at the home from injury. Safety notices were prominently displayed and all fire precautions were followed to ensure that staff knew what they should do in the event of the fire alarm sounding. When asked if there was anything else that people living at the home would like to tell us, one person wrote on the comment card, this home is where I shall live until I die. I am quite young in comparison to some residents. The future holds no fear for me as I know I will be well looked after. Care Homes for Older People Page 29 of 33 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 30 of 33 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 29 19 Criminal Record Bureau 30/04/2009 disclosures and two written references must be obtained before people start work at the home. This is to protect the people living at the home from potentially abusive situations. 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 9 All hand written entries on the Medication Administration Records should be signed, witnessed and countersigned in order to avoid any transcription errors. It is recommended that an activities co-ordinator be appointed so that uninterrupted daily activities could be provided for those wishing to participate in order to prevent boredom and to avoid care workers being taken away from their normal duties. Some attention was needed to the laundry floor so that it was made safe for people working in that department. 2 12 3 26 Care Homes for Older People Page 31 of 33 4 29 It is recommended that all references be dated so that it is possible to identify if they have been received before employment or after. It is suggested that surveys for staff could be conducted so they could tell the managers of the home what it was like working at St Georges. It is recommended that meetings for people living at the home are held more regularly so that any important information is passed on and so that people can discuss any relevant topics. 5 33 6 33 Care Homes for Older People Page 32 of 33 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!