Care Home: St Georges Park Care Centre

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What the care home does well Observations made during the inspection found staff to be kind in their approaches with people. Staff are good at offering choices and supporting people in decision-making. People are provided with an environment which is clean and homely and meets the needs and abilities of the people who live there. Training opportunities for staff are good which ensures people are cared for by a well-trained staff group. People who were unable to tell us their views looked clean, comfortable and well-cared for. What has improved since the last inspection? At the last inspection we did not make any requirements of the service to improve. The home has put in place a large storage unit, so that equipment which is not in use can be stored here rather than in areas where people live. What the care home could do better: This inspection identifies there has been a change of rating of the service and people are now receiving adequate outcomes. We found that although three of the four people we case tracked had their care planned and any risks to their health identified, staff had not identified any risks to another person’s health, safety and welfare. Staff had also not written a care plan to inform staff how to meet this person’s needs or shown how they had assessed the person’s suitability to have bed rails in place on their bed. We found that the home was not following manufacturer’s instructions with the way one type of medication was being stored.St Georges Park Care CentreDS0000022275.V378141.R01.S.doc Version 5.2 The home is not keeping written records of activities it has provided, which makes it difficult to find out how many people have been provided with opportunities to enhance their well-being and whether the opportunities are based on what they want to do. We found staff are provided with good training opportunities but need to increase their awareness of the possible impacts on the well being of people who have dementia. We found that the home’s recruitment process is not entirely robust We were informed by the manager that a proposal has now been made to increase staffing levels and to consider additional nurse cover on Rydal Unit. This proposal needs to be put into action and staffing levels kept under review on an ongoing basis Key inspection report CARE HOMES FOR OLDER PEOPLE St Georges Park Care Centre School Street St Georges Telford Shropshire TF2 9LL Lead Inspector Rosalind Dennis Key Unannounced Inspection 21st October 2009 09:30 DS0000022275.V378141.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Georges Park Care Centre Address School Street St Georges Telford Shropshire TF2 9LL 01952 616300 01952 616345 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) Modelfuture Limited, Mrs Elizabeth Anne Muir Care Home 71 Category(ies) of Dementia (32), Old age, not falling within any registration, with number other category (33), Physical disability (6) of places St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N; to service users of the following gender: Either; whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP (maximum number of places 33), Dementia - Code DE (maximum number of places 32); Physical disability - Code PD (maximum number of places 6). The maximum number of service users who can be accommodated is 71. 2nd October 2008 2. Date of last inspection Brief Description of the Service: St Georges Park is a Care Home located in the residential area St Georges near to Telford. The home is near to main transport routes such as the A5 and M54 and there is a bus stop close to the home. There is a car park at the front of the home. The home is made up of two Units, Rydal on the ground floor, which can accommodate a maximum of 31 older people who have dementia and nursing needs, and Derwent Unit situated on the first floor, which can accommodate a maximum of 40 older people requiring general nursing care. All bedrooms are single occupancy and with the exception of one room all have en-suite toilet facilities. There is level access from the car park to the reception on the ground floor and passenger lifts provide access from the ground to the first floor. There are lounges and dining areas available. There are bathrooms and showers with equipment to assist people who may have mobility difficulties. People can obtain information about this service from the home’s Statement of Purpose and Service User Guide. The Service User Guide did not contain information on the actual fees charged, therefore the reader is advised to seek information direct from the service. Inspection reports produced by CQC can be obtained direct from the provider or are available on CQC’s website at www.CQC.org.uk. St Georges Park Care Centre DS0000022275.V378141.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 service is 1 star. This means the people who use this service experience adequate quality outcomes This inspection was carried out over one day by one inspector. Another inspector attended for a short while to make some observations on Rydal unit. The home did not know we were going to visit. The focus of inspections we, the Commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection on 2nd October 2008. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law. We looked at the home’s Annual Quality Assurance Assessment. (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. We also looked at information which had been sent to us from other agencies, including the local safeguarding adults’ team and local authority. Four people living in different areas of the home were case tracked. This involves establishing individual’s experiences of living in the care home by meeting them, observing the care and support they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. The people we case tracked were not able to tell us about their day to day life at the home and the support they receive from staff, so we observed the care given by staff during the day. One inspector used a formal way to observe a group of people living on Rydal Unit to help us understand their experiences. We call this the ‘Short Observational Framework for Inspection (SOFI). This involved us observing people who use services and recording their experiences at regular intervals. We sent many surveys to the home for people and staff to complete. We only had a small number of surveys returned to us, so during the inspection we looked at responses in surveys which the home had sent out to people earlier this year We looked around some areas of the home and observed a sample of care, staff and health and safety records. We spoke with staff during the inspection St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.2 Page 6 to establish their views of working at the home and if anything needs to be improved. What the service does well: Observations made during the inspection found staff to be kind in their approaches with people. Staff are good at offering choices and supporting people in decision-making. People are provided with an environment which is clean and homely and meets the needs and abilities of the people who live there. Training opportunities for staff are good which ensures people are cared for by a well-trained staff group. People who were unable to tell us their views looked clean, comfortable and well-cared for. What has improved since the last inspection? What they could do better: This inspection identifies there has been a change of rating of the service and people are now receiving adequate outcomes. We found that although three of the four people we case tracked had their care planned and any risks to their health identified, staff had not identified any risks to another person’s health, safety and welfare. Staff had also not written a care plan to inform staff how to meet this person’s needs or shown how they had assessed the person’s suitability to have bed rails in place on their bed. We found that the home was not following manufacturer’s instructions with the way one type of medication was being stored. St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.2 Page 7 The home is not keeping written records of activities it has provided, which makes it difficult to find out how many people have been provided with opportunities to enhance their well-being and whether the opportunities are based on what they want to do. We found staff are provided with good training opportunities but need to increase their awareness of the possible impacts on the well being of people who have dementia. We found that the home’s recruitment process is not entirely robust We were informed by the manager that a proposal has now been made to increase staffing levels and to consider additional nurse cover on Rydal Unit. This proposal needs to be put into action and staffing levels kept under review on an ongoing basis If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 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 Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 is not applicable to this home. People using the 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 able to visit the home and have their needs assessed before they make the decision to move in, which means the home should know enough about them to meet their needs EVIDENCE: We looked at the care records for four people who have moved to the home since the last key inspection. We saw that information had been sought about individual preferences and whether the person has any religious or cultural needs. The manager had fully assessed each person’s needs by meeting them in hospital before they were admitted to the home and seeking information about their illness and care needs. This helps to ensure that only people whose needs can be met at St Georges Park Care Home are admitted. St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 10 For three of the people, whose care we looked at, information from the initial assessment had been used to write care plans with the person and/or their representative. This helps staff to know how to give care based on the person’s needs and wishes. However for the other person, cared for on the nursing unit, staff had not looked at any possible risks to the person’s health, safety and welfare since their admission, neither had a care plan been written to inform staff how the person wants their needs met. It is therefore not clear how staff have been able to determine the care this person needs. We looked at the service user guide, which contains information about the home, so that people know what the service provides. We noticed the guide contains information on what is included in the fees however it doesn’t state the weekly fees charged which it should do, so that people know the exact fee. St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be confident that the service will plan their care or identify risks to their health, safety and welfare as the home does not have effective systems in place to ensure everyone has their needs identified and set out in a plan of care. EVIDENCE: The people who we case tracked were unable to give their views on the home and the care provided, so most of this inspection is based on observation, looking at documentation to show how people’s needs are met and speaking with staff. In the area of the home where people with dementia live (Rydal Unit), there was a calm and cheerful atmosphere and people appeared content. We looked at the care records for the one person we case tracked. Their care plans were St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 12 clear and assessments of possible risk to their health, safety and welfare were documented well. Their care plan describes how they like to look smart and “smell nice” and we observed the person’s appearance reflected what was written in the care plan. We spoke with care staff on this unit who told us they contribute in the writing and reviewing of care records and that they look at people’s care plans to ensure the care they give is based on the planned care. Care staff were able to describe to us the care needed by different people living in this part of the home. We spent some time observing how staff interact with people. We saw that staff were kind in their approaches with people and attended to any care needs promptly. We looked at the medication chart for the person we case tracked on Rydal Unit and saw staff had completed this accurately with all medication signed and accounted for. On Derwent Unit we met people who require nursing care, however most people because of their illnesses were unable to give their views on the home. The care files for three of the people we case tracked had detailed care plans and risk assessments in place. This means staff have information on how people prefer to have their needs met taking into account any risks to them. A person who currently has a wound, had documentation in their file showing the care needed of this wound to promote healing, including the type of wound dressing and how often it needs to be changed. The wound had been checked and measured on a frequent basis so that staff can determine if the wound is healing. Their care records showed contact and visits by health care professionals who specialise in wound care. We also saw the home had contacted their GP when it was identified the person was losing weight. Staff had recorded when they had a discussion with the person and their relative about care needs and the relative had signed to confirm they were satisfied with the planned care. This shows staff are aware of the importance of keeping people informed when people’s needs change. We observed that, for two people assessed as being at risk of developing pressure sores they had specific mattresses on their beds which are designed to reduce the risk of pressure sores occurring and care plans described what staff need to do. We also saw clear guidance how people with specific dietary needs and swallowing difficulties need to be positioned to assist with their eating and at lunch we observed staff following the guidance. Staff were seen throughout the inspection checking if people were comfortable and needed anything. As mentioned earlier in the report one person, recently admitted to the nursing unit, had not had any risk assessments or care plans completed since their admission. This is considered a serious shortfall by the home because it shows staff had not identified any risks to this person’s health, safety and welfare. This person needs staff to know how to manage a medical condition they have St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 13 and there was no care plan or risk assessment to guide staff to manage this condition, or when to seek professional advice. Nursing staff had made some written entries when they had measured the amount of sugar in this person’s blood, however this was not consistent and without a care plan it is not clear how staff knew how often they should monitor the person’s blood sugar. We also saw from the written records that staff had given foods which contain sugar, without an explanation being made why they had done this. During the inspection we observed a carer assisting the person to eat their meal and the carer knew the person needs a specific diet low in sugar. There was nothing to show staff had looked at the safest ways to move the person or whether they are at risk of developing sore skin. We looked at this person’s bedroom and saw they had a special mattress on their bed. We also saw bed rails were in place on the side of their bed, which are designed to reduce the risk of falls out of bed. The bed rails were fitted correctly but there was nothing written down in the form of a risk assessment to show that the risk to the individual of bed rails being used had been looked at. We observed the person in bed and saw them fidgeting and moving around the bed. We informed the manager that the person had not been assessed for the safe use of bed rails and the manager assured us that this would be done. We were contacted by the manager shortly after the inspection who informed us of measures which have been put in place to ensure people have suitable care plans and risk assessments. It is a concern that none of the staff involved in planning the care of this person had identified the shortfalls and taken appropriate action before our inspection. We did not look at how medication is stored on Derwent unit. On Rydal Unit we found medicine which is injected to control blood sugar was not being stored correctly and informed the nurse in charge of this. We also saw written records showing that staff monitor the temperature of the room and fridge used to store medication but this shows that the temperature is sometimes too high or is at the maximum temperature it should be. Information supplied by the manager before the inspection tells us that a member of staff has completed training in end of life care and training has started for other staff, which means that staff will have the supporting knowledge to provide this care. St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information provided by the home suggests that some people are provided with opportunities to enhance their well-being, however there is a lack of evidence to show that everyone is offered these opportunities and whether they are based on what people want to do or their needs and capabilities. EVIDENCE: The manager told us the home has a programme of activities and we saw a copy of the programme in the main reception and in other areas of the home. However when we asked to see evidence to show who had taken part in these activities, we established that the home has not been keeping any written records. This makes it difficult to find out how many people have been provided with opportunities to enhance their well-being and whether the opportunities are based on what they want to do. We spoke with the manager and activities person who told us about what has been provided for people at the home. They told us that students from a local college have been providing arts and crafts sessions each week and there are St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 15 plans for complementary therapy and beauty sessions. We were informed that representatives from a local church visit the home and there are opportunities for people to take part in flower arranging and Bingo. Two outings are planned to enable people to see a Pantomine at Christmas. Two carers we spoke with, who work with people living on the nursing unit, described how they talk with people about their lives before their illness and about current events and news. During the inspection a consultant in psychiatry visited to speak with relatives and staff about dementia related conditions, which is good practice as it helps people know more about the condition. At the last key inspection we advised the home to consider increasing the availability of staff who provide activities, so that people less able to participate in group activities are provided with opportunities to enhance their well-being. The manager told us in the AQAA that the home could do better by providing more “one to one” activities for those people unable to join in group activities and informed us during the inspection of plans to do this by utilising volunteers. It is disappointing that the home has not yet improved this activity provision or improved how it records when activities are provided, areas which were discussed as needing improvement at the last key inspection. We conducted a short observational exercise on Rydal unit, when we observed reactions from a group of people and observed interactions between them and staff. We saw that staff were kind in their approaches to people but when people started to show signs of discontent staff were not quick to notice this. For example we observed a group of people seated in a lounge watching television, they appeared content and enjoying the programme they were watching. The television programme suddenly went off, leaving a loud noise and no picture on the screen. It was apparent from observing people’s reactions that they were disturbed by this. However despite staff coming in and out of the room, none of the staff noticed the effect the loud noise was having on the people in the room. After some time a staff member came in, noticed the noise and took action. We also saw a person having difficulties eating their lunch as the plate was sliding across the table and they did not complete their meal. Staff had not looked at ways to stop this from happening, such as placing a special mat under the plate to stop it from sliding. Further observations during the inspection showed that staff were good at offering choices and supporting people in decision-making, for example asking people what they want to eat and where they would like to sit. Objects seen throughout Rydal unit are placed to promote and encourage responses from people living here. The garden provides people living at the home with a safe outside space specifically designed to promote sensory awareness and the manger told us how people and their relatives are involved in the ongoing development of this outside space. St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 16 We observed staff serving and giving meals out to people. Meals reflected people’s preferences and specific dietary needs, such as swallowing difficulties. The manager and staff confirmed that people are offered a choice of where they want to eat and we saw one person on Derwent unit choosing to eat their meal in the dining room. Other people we saw on Derwent unit remained in their bedrooms to eat their meals and staff were assisting them to eat their meals. We saw that staff had good approaches with people, speaking with them and supporting them to eat and drink. We heard staff on Rydal unit at lunch and tea offering people choices of what they would like to eat and drink. Apart from the observation when a person was having difficulty eating because the plate was sliding, staff were observed encouraging and supporting people to eat independently. Two people who completed surveys for us told us the home “usually” arranges activities and they “never” like the meals. The other person said the home “sometimes” arranges activities and they “sometimes” likes the meals, commenting they would like “more trips out (one per year at the moment) and more social activities”. Surveys sent out by the home, which were examined during the inspection showed varying feedback, some people indicating their satisfaction with social activities and others less satisfied. This shows that further work still needs to be done by the home. St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the 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 has a complaints procedure, which provides people with information so they know how to complain and ensures concerns and complaints are acted upon. Staff know how to safeguard adults from the risk of harm and abuse. EVIDENCE: The complaints procedure is displayed on a notice board in the reception and is also available within the service user guide. The procedure provides people with clear information on the process to follow and who to contact if people want to complain. One person who completed surveys for us indicated they do not know how to make a complaint and the manager was informed of this. The manager told us at the time of completing the AQAA that the home has received seven complaints, which includes concerns raised to the local authority for investigation under the safeguarding adult’s process. We looked at the method used by the home to record and respond to complaints, and this showed there is a process in place, with complaints and the action taken recorded. A complaint mentioned in the last key inspection was investigated by an independent investigator, assigned by the local authority. We received a copy St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 18 of the report and discussed with the manager the actions taken as a result of the recommendations made within the report. The manager was not aware of the outcome of the report or recommendations, which is disappointing as these had been communicated to the company earlier in the year. We discussed the recommendations with the manager. The manager could tell us improvements that have taken place which have subsequently addressed all recommendations, apart from a recommendation to consider increasing staffing levels at night on Rydal Unit which has not happened. These findings show the company should ensure the manager is kept fully informed of the outcome of complaints, so that the home can learn from complaints and take action to reduce risk of re-occurrence. The training records we looked at and the staff we spoke with demonstrates that all staff working at St Georges Park receive training on safeguarding vulnerable adults from the risk of abuse. We spoke with six staff who were able to tell us their role in safeguarding adults from the risk of harm and abuse. Over the past twelve months, referrals have been made by the home and other professionals to the local safeguarding adults team about concerns which have arisen regarding people who live at the home. It is considered that the home is making appropriate referrals and puts action plans into place as a result. Three staff we spoke with, who were working on Rydal Unit, told us they had not received training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. The Act governs decision making on behalf of adults, and applies when people lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth. It is important that staff know how to put the Act into every day practice and the procedure to follow should peoples freedom need to be restricted. The manager has attended training and is aware that staff also need to have awareness of the Act. St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the 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 provided with an environment which is clean and homely and meets the needs and abilities of the people who live there. EVIDENCE: We looked at the rooms for the people we case tracked, which were clean and well-maintained. We saw that people are able to bring in items which are important to them, such as photographs, pictures and small items of furniture. Some bedrooms on Rydal Unit were in the process of being decorated and the manager told us that there is an ongoing refurbishment plan for the whole home. Bedrooms have an en-suite facility of toilet and wash hand basin. Additional toilets, baths and showers are near to people’s rooms, which means there is a St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 20 choice of washing and bathing facilities. We saw that the home has equipment to help people to move safely and to get in and out of the baths. There is a choice of stairs or passenger lift to the first floor and level access to a patio and the fully enclosed rear garden, which means the home is accessible to people who use wheelchairs. On Rydal Unit tactile pictures and objects are displayed along corridors to prompt responses from the people who live here. The home now has a large outside storage unit and we did not see items being stored inappropriately inside the home as we had done at the last inspection. We did not notice any unpleasant smells in the parts of the home we looked at. Observation of training records show that staff receive training in infection control and we observed staff washing their hands between procedures and using protective clothing, such as aprons and gloves. The manager told us the home has cleaning staff who work every day, including weekends and in the evenings. St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff who have the skills and knowledge to meet their needs, however the home’s recruitment procedure is not entirely robust, which means people may be cared for by staff who have not been fully checked for their suitability to work with vulnerable adults. EVIDENCE: We observed staff working hard on both units responding to people’s needs and requests as they arose. Three staff who responded to our surveys described how there is “usually” or “sometimes” enough staff on duty. One person who responded to our surveys commented that more carers are needed to “provide more time with residents”. On Derwent unit we spoke with three staff, observed them working and discussed staffing levels with the manager which indicated that sufficient skilled care and nursing staff were on duty to meet the needs of people currently living in this part of the home. We spoke with three staff who work on Rydal Unit and they told us they think the people living there would benefit from having more staff available. The unit has one nurse working during the day, supported by five care staff and the nurse told us that because of the busy nature of the unit and people’s needs that additional nurse input would be beneficial. This has been St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 22 communicated by us to the company since 2007. We spoke with the manager who confirmed that a proposal has now been made to increase staffing levels at night and to consider additional nurse cover. This proposal needs to be put into action and staffing levels kept under review on an ongoing basis. In addition to care and nursing staff the home also employs kitchen, domestic, laundry, maintenance and administrative staff to ensure that all aspects of peoples needs are met. The home is currently without a Registered Mental Nurse (RMN) working on Rydal Unit, although this is viewed as a temporary arrangement. The manager confirmed that advice and guidance is sought as necessary from specialist nurses such as Community Psychiatric Nurses (CPN). The nurse on duty on Rydal Unit on the day of inspection told us they have undertaken training in dementia care and they appeared to have a good knowledge of the mental health needs of the people living here. The manager has an effective process to show when staff are up to date with training and when training is needed. This demonstrates that regular staff training takes place, which should ensure staff have the skills and knowledge to meet the needs of people living at the home. Training which has been provided recently includes training in safe working practices such as fire safety, infection control, food hygiene and safe use of bed rails as well as more specific training including dementia care, managing behaviours of concern and prevention of pressure sores. The staff we spoke with told us they are provided with good training opportunities and gave us examples of the training they have done at the home. We were informed that 67 of care staff have achieved a recognised qualification in care (National Vocation Qualification), which should contribute to ensuring the staff team have an effective knowledge of social care. We saw documentation which shows that new staff are provided with an induction when they first start working at the home. We looked at the process used by the home to recruit three members of staff who have started working at the home since the last key inspection. All the necessary pre-employment checks had been obtained for one member of staff. For the other two staff, one had started work and worked for around nine months before their second reference was obtained and for the other member of staff a reference had not been sought from their most recent employer. All other pre-employment checks, such as CRB (Criminal Records Bureau) disclosures and checks on nursing registration had been sought. This shows the home needs to tighten up on its recruitment processes to ensure it complies with our regulations and so that people are not placed at risk of being cared for by staff who may not be suitable to work with vulnerable adults. The home confirmed that it would start action to obtain the reference from the staff member’s most recent employer. St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 23 St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the 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 managed in the best interests of the people who currently live at St Georges Park. However further effort is needed by the manager to be effective in her role in overseeing processes which may impact on people’s well being. EVIDENCE: The manager has worked at St Georges Park for sometime and has completed her registration with us. Since the last inspection the manager has also completed a management qualification which supplements management experience. Staff spoke positively about how the home is managed and told us St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 25 they are encouraged to work as a team to benefit people living at the home. We saw written records which show meetings are held on a regular basis to keep staff informed of changes within the service, implementing good practice and where changes to practice are needed. The manager also attends meetings looking at matters such as health and safety within the home. A representative of the company monitors quality at regular intervals with monthly unannounced visits. We observed the reports produced as a result of these visits which show the visits look at a wide range of matters to ensure the service is operating well and that people are pleased with their care. We saw that questionnaires are sent out to people, their relatives/representatives and to staff to obtain their views about the service. The manager acknowledged that the results from a survey completed last year should have been collated and an action plan produced so that people are informed of any action taken by the home in response to their comments. We looked at a selection of questionnaires which were sent out by the home around July 2009. This shows that most people and/or their relatives are satisfied with the care provided and with other aspects of the service. Some of the comments included “ I am very happy with the care”, “All staff are good to me, pleasant and take care of my needs”, “I am amazed at the care and sensitivity of the whole staff”, “ the staff on Rydal do a good job, they are friendly and approachable. It would be nice to have a named nurse”. Some questionnaires indicated areas for improvement, such as with activities and provision of meals. Staff gave positive responses in questionnaires they completed. The manager confirmed that all responses will be looked at and used to identify where improvements are needed. We looked at records relating to the management of small amounts of personal monies and the process used by the home appeared robust with receipts kept to show spending and transactions checked by two people, which should ensure peoples money if held safely. Information was provided within the AQAA to confirm servicing and maintenance of equipment is undertaken and policies and procedures are reviewed. We looked at a selection of maintenance and servicing records, all were up to date and demonstrate that systems are in place to ensure the home and equipment is safe. We saw that staff have regular training in health and safety, which ensures they are provided with the knowledge and skills to help people keep safe. For example, staff receive training in the safe use of bed rails, so they should know how to keep people safe when they are in bed. However as noted earlier in the report staff had not assessed a person, for the safe use of bed rails. The home keeps us informed of the occurrence of accidents and incidents and knows when to inform other agencies. St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 26 St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 27 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 28 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. 1 Standard OP7 Regulation 15 Requirement People must have their care needs planned in the form of a care plan. This is to ensure people receive the care they need and to provide information to staff on how the person’s care needs are to be met The home must ensure any risks to the health, safety and wellbeing of people living at the home are identified, recorded and managed according to the persons wishes and capabilities. This is to ensure that unnecessary risks to the health and safety of people are identified and as far as possible eliminated. Medication must be stored in accordance with manufacturers’ instructions. This is to ensure that medication is stored correctly to prevent people being placed at risk of harm and from receiving ineffective medication. Timescale for action 12/12/09 2 OP8 12 (1) (a) (b) 12/12/09 3 OP9 13 (2) 12/12/09 St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 29 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 Refer to Standard OP1 Good Practice Recommendations The Service User Guide should be amended to show the fees charged by the home. This is to ensure people are provided with clear and up to date information on fees and to assist them in their decision making. The home should ensure that all people living at the home are provided with opportunities to enhance their social well being and develop a system so that it can demonstrate how it has provided these opportunities. The effectiveness of these opportunities should be evaluated on an ongoing basis to ensure they are appropriate and meet with people’s expectations and needs. As part of the home’s review of nursing and care staffing levels, the home should also consider increasing the availability of staff who provide activities. This is to ensure that people who are less able to participate in group activities are provided with opportunities to enhance their well-being 21/10/09-Not achieved. 2 OP12 3 OP27 St Georges Park Care Centre DS0000022275.V378141.R01.S.doc Version 5.3 Page 30 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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