Care Home: St Giles Residential Home

What the care home does well There is information available to potential residents and their diverse social and care needs are identified with them, prior to their move to the home, to ensure that they can be met. Prospective service users are assessed by a multidisciplinary team and have the opportunity to stay at the home for a trial period before deciding whether they wish to move to the home on a permanent basis. Family members spoken to were happy with the information they and their relative received before they moved to the home, one saying ` the home were helpful and supportive at this very stressful time`. Residents` health, medication and personal care needs are met and in a manner that protects their privacy and dignity. A general practitioner visits the home regularly and residents have access to other members of the healthcare team.The home is welcoming and families and friends are welcome at any time. There are complaints, whistle blowing and safeguarding policies and procedures in place to protect residents and staff have had training in the application of these policies and procedures. The Commission for Social Care Inspection has not received any complaints about the service since the last inspection and has not been notified of any safeguarding concerns made to the local authority, which is the lead agency in these matters. The home is a comfortable, secure and homely place for residents to live. There is an ongoing programme of redecoration and pleasant gardens. There are sufficient staff who have had appropriate training to meet residents` needs in a timely way. Family members said that staff were kind and supportive to residents. The home is well managed in the interests of residents. There are quality assurance policies in place, which seek to ascertain the views of residents and their families. What has improved since the last inspection? The gardens have been improved and there is now better access to the gardens for people with disabilities. There has been an increase in training available to staff to give them the knowledge and skills to care for vulnerable adults. What the care home could do better: The care plans were not always complete and had not been updated regularly. The manager should address this to ensure that resident`s needs are met in a consistent manner and that the record of care is complete. The activities programme should be further developed to include individual activities for residents who do not wish to join group activities and to include more therapeutic activities for people with dementia. The manager and chef should be given the opportunity to undertake specialist training in meeting the nutritional needs of people with dementia. The hand washing facilities in the home must be improved and paper towels and soap should be provided for staff in residents` rooms. The recruitment process is fragmented and the files held in the home are incomplete. Insufficient checks on the suitability of staff who transfer from another care position with the council are made to ensure that they continue to be safe to work with vulnerable people. The provider must ensure that up todate, current references are obtained for all staff transferring to posts in the home. The provider must also ensure that evidence that the required checks on the suitability of staff have been undertaken is available in the home, for unannounced inspections. If this is not to be the case the provider must agree with the Commission for Social Care Inspection the means by which this evidence can be inspected. Further information is available on our website www.csci.org.uk The provider must monitor the quality of care on a regular basis. Reports of these visits must be written and copies should be available in the home and available for interested parties. The ongoing issues about the storage of staff recruitment files must be resolved. The quality monitoring system should be developed to include regular auditing of records and outcomes for residents to ensure that they meet the standard expected. CARE HOMES FOR OLDER PEOPLE St Giles Residential Home St Giles Mews Vicarage Road Stony Stratford Milton Keynes Buckinghamshire MK11 1HT Lead Inspector Chris Sidwell Unannounced Inspection 11th September 2008 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Giles Residential Home Address St Giles Mews Vicarage Road Stony Stratford Milton Keynes Buckinghamshire MK11 1HT 01908 566077 01908 261371 anne.walker@milton-keynes.gov.uk 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) Milton Keynes Council Mrs Anne Walker Care Home 35 Category(ies) of Dementia (35) registration, with number of places St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th September 2006 Brief Description of the Service: St Giles is a purpose built residential care home for elderly people who have dementia. It is owned by Milton Keynes Council. The home is located in Stony Stratford, close to shops, pubs, the post office and other amenities. Public transport is easily accessible. It consists of a two-storey building with three separate lounge areas, each with its own dining area. There are thirty-five bedrooms, which are fitted with wash hand basins. The first floor can be accessed via a passenger lift. A laundry is provided on site. The gardens are well maintained. St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The inspection was conducted over the course of five days and included a one day unannounced visit to the home. The key standards for older people’s services were covered. Information received about the home since the last inspection was taken into account in the planning of the visit. Prior to the visit, the manager completed an annual quality assurance self-assessment and surveys were distributed to service users, their relatives, visiting health and social care professionals and staff. Residents and families were also spoken to on the days of the unannounced visit. Discussions took place with the manager, care and ancillary staff. Care practice was observed. A tour of the premises and examination of some of the required records was also undertaken. The homes approach to equality and diversity was considered throughout. The home has also had two thematic inspections since the last full inspection. A thematic inspection is a short focussed inspection that looks specific themes. One thematic inspection looked at the quality of care that people with dementia experience when living in care homes and how their dignity is protected. The other looked at how vulnerable people are protected from abuse. The outcomes from these inspections are taken into account in this report. Details as to how to get copies of all inspection reports for this home are on the last page of this report. What the service does well: There is information available to potential residents and their diverse social and care needs are identified with them, prior to their move to the home, to ensure that they can be met. Prospective service users are assessed by a multidisciplinary team and have the opportunity to stay at the home for a trial period before deciding whether they wish to move to the home on a permanent basis. Family members spoken to were happy with the information they and their relative received before they moved to the home, one saying the home were helpful and supportive at this very stressful time. Residents health, medication and personal care needs are met and in a manner that protects their privacy and dignity. A general practitioner visits the home regularly and residents have access to other members of the healthcare team. St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 6 The home is welcoming and families and friends are welcome at any time. There are complaints, whistle blowing and safeguarding policies and procedures in place to protect residents and staff have had training in the application of these policies and procedures. The Commission for Social Care Inspection has not received any complaints about the service since the last inspection and has not been notified of any safeguarding concerns made to the local authority, which is the lead agency in these matters. The home is a comfortable, secure and homely place for residents to live. There is an ongoing programme of redecoration and pleasant gardens. There are sufficient staff who have had appropriate training to meet residents needs in a timely way. Family members said that staff were kind and supportive to residents. The home is well managed in the interests of residents. There are quality assurance policies in place, which seek to ascertain the views of residents and their families. What has improved since the last inspection? What they could do better: The care plans were not always complete and had not been updated regularly. The manager should address this to ensure that residents needs are met in a consistent manner and that the record of care is complete. The activities programme should be further developed to include individual activities for residents who do not wish to join group activities and to include more therapeutic activities for people with dementia. The manager and chef should be given the opportunity to undertake specialist training in meeting the nutritional needs of people with dementia. The hand washing facilities in the home must be improved and paper towels and soap should be provided for staff in residents rooms. The recruitment process is fragmented and the files held in the home are incomplete. Insufficient checks on the suitability of staff who transfer from another care position with the council are made to ensure that they continue to be safe to work with vulnerable people. The provider must ensure that up to St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 7 date, current references are obtained for all staff transferring to posts in the home. The provider must also ensure that evidence that the required checks on the suitability of staff have been undertaken is available in the home, for unannounced inspections. If this is not to be the case the provider must agree with the Commission for Social Care Inspection the means by which this evidence can be inspected. Further information is available on our website www.csci.org.uk The provider must monitor the quality of care on a regular basis. Reports of these visits must be written and copies should be available in the home and available for interested parties. The ongoing issues about the storage of staff recruitment files must be resolved. The quality monitoring system should be developed to include regular auditing of records and outcomes for residents to ensure that they meet the standard expected. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. There is information available to potential residents and their diverse social and care needs are identified with them, prior to their move to the home, to ensure that they can be met. EVIDENCE: The home is managed by Milton Keynes Council and is co located with a day centre. Prospective service users are assessed by care managers from the Milton Keynes older peoples mental health team and if they wish to move to the home their name will be put forward to a priorities panel. The manager will also assess their needs to ensure that they can be met by the home. There is information available to prospective service users and their families and many will have attended the day centre or had a period of respite care in the home and will therefore have had an opportunity to get to know the manager and the home. The assessment documentation has cues to prompt care managers and others to consider the diverse social and faith needs of St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 10 prospective service users. Service users may stay for a trial period before they and their families and care manager agree that it is the right home for them. Two family members were spoken to on the day of the unannounced visit to the home and both said that they were pleased that their relative had been able to move to the home and felt that they had been given sufficient information to support their relative before they moved. All those who returned the questionnaires said that had received information and were complementary about the support that they received. The home does to offer intermediate care and therefore Standard 6 does not apply. St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. Residents health and personal care needs are met and in a manner that protects their privacy and dignity. There is a need to ensure that residents care plans are complete and updated on a regular basis to ensure that their needs are meet consistently. EVIDENCE: All residents had care plans although the level and detail of each varied. Five were looked at in detail. They held details of service users health care needs and some held good details of residents personal and social history. There were some inconsistencies and not all care plans had been updated on a regular basis. Residents were assessed as to their risk of falling or losing weight although some staff were clearly unfamiliar with the tools and care plans were not always put in place to address the result of the assessment. Care however was provided. Those residents who had been assessed as at risk of weight loss had seen the dietician and been weighed regularly although the written care plan may not be up to date. One resident was confined to St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 12 bed. She had been assessed as to her needs and the appropriate pressure relieving mattress had been supplied. She was repositioned regularly and staff were monitoring her nutritional needs. There are medication management policies and procedures in place and the staff spoken to were aware of these. Storage facilities are satisfactory. Records are kept of medication entering and leaving the home. The medication administration records were accurately completed. Controlled drugs were stored satisfactorily and all entries to the controlled drug register were signed. The carers spoken to said that medication was not administered covertly. If a resident refused medication this would be recorded. If the medication was essential and the resident lacked the capacity to make to the decision, the doctor and family would be informed and a way forward agreed. Staff have had training in medication administration. Staff were observed to be kind and caring towards residents. All personal care is given in residents rooms and staff addressed residents calmly and showed respect towards them. Staff had had training in person centred care and there were policies and procedures guiding staff about supporting residents in a manner which protects their privacy and dignity. There was evidence in the care files that residents see a general practitioner regularly and other members of the healthcare professional team when necessary. Family members said that they were happy with the care provided commenting the staff are always ready to talk to sort things out and I am very impressed with the healthcare support. A doctors advice is always sought for any problems and this is always reported to me. St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. Residents have a choice as to how they spend their day and they are encouraged to join in communal activities. There is a need to develop the activities programme further to include more one to one activity and more purposeful therapeutic activity designed for those with dementia. EVIDENCE: The home has an activities coordinator who works one day a week. Her role is to coordinate the planned activities in the home. A programme is displayed in the home. The gardens have been improved over the last year and there is better access now for people with disabilities, with level walkways, raised beds and a summerhouse. Entertainers visit the home regularly and families spoken to said that musical entertainment was a particular favourite. Care staff and the activities coordinator also take residents to the local shops if they wish. The manager said in the annual quality assurance assessment that she intended to make enabling residents to take more trips outside of the home a priority for the coming year. The carers spoken to said that they supported residents to do as much for themselves as possible but that their time was limited and that one to one activities with residents were not always possible. St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 14 There is an opportunity to develop the activities programme further and to incorporate therapeutic activities designed for people who have dementia. Families told us that they are welcome at the home at any time and residents are supported to remain in contact with their families. Residents and families are supported to make decisions and there is information about local advocacy groups on display to advise them if necessary. There is a varied menu. There are three meals a day, with snacks and drinks available in between meals. Most of the food is home cooked and residents said that they enjoyed their meals. A recommendation was made at the last thematic inspection that mealtimes were reviewed to ensure that it was a positive experience for all residents. This had been done and staff were observed to be assisting residents discretely with their meal. They were giving individual residents their full attention and talking to them gently. Special diets were available for residents who need them. Whilst the chef was very aware of the dietary likes and dislikes of the residents neither she nor the manager has had any specific training in meeting the nutritional needs of people with dementia. St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. There are complaints, whistle blowing and safeguarding policies and procedures in place to protect residents. EVIDENCE: There are complaints policies and procedures in place. The manager said that she had received two complaints since the last inspection, which had been resolved. Families spoken to said that they knew who to speak to if they were unhappy. All those who returned the questionnaires said that they knew who to speak to if they were unhappy and that they knew how to make a complaint. The home has an up to date copy of the local multi-agency strategy for safeguarding vulnerable adults. Staff have had safeguarding training and those spoken to said that they would have no hesitation in reporting any concerns about resident’s welfare. There are whistle blowing policies and procedures in place. The Commission for Social Care Inspection has not received any complaints about the service since the last inspection and has not been notified of any safeguarding concerns made to the local authority, which is the lead agency in these matters. St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 16 St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The home is a comfortable and homely place for residents to live. The infection control procedures and facilities for hand washing should be improved to reduce the risk of acquired infection for residents. EVIDENCE: The home is divided into three units. The general décor is acceptable although some areas are shabby and in need of redecoration. There are rails in the corridors to help residents. Residents are encouraged to personalise their rooms and some had chosen to do so. the communal lounges and dining rooms are comfortable and homely. There are numerous sitting areas and residents can choose where to sit. One family member said that the redecoration and the improvements to the gardens had improved the home St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 18 and said it is important for us to think we are respected and our family member is living in a warm, well maintained environment. There are infection control policies and procedures in place. The home has participated in an audit undertaken by the local Primary care Trust and has received up to training in infection control. There were no offensive odours and the home was clean and tidy on the day of the unannounced visit. Some bedrooms have paper towels and soap for carers but not all. This should be addressed and all rooms should have paper towels and soap for staff to help minimise the risk of cross infection within the home. The team leader stated that sometimes alcohol hand rub was available in the home for staff and others but not at present. This should also be addressed. St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. There are sufficient staff who have had appropriate training to meet residents needs in a timely way. The recruitment process is fragmented and the files held in the home are incomplete. Insufficient checks on the suitability of staff who transfer from another care position with the council are made to ensure that they continue to be safe to work with vulnerable people. EVIDENCE: The staffing levels have been maintained since the last inspection. There are six carers and a team leader on duty in morning, five carers and a team leader in the afternoon/evening and three carers and team leader at night. The staff said that they were often busy but that they felt that they could give the care that was needed in a timely way. The families spoken to said that the carers were kind and helpful and had infinite patience. There was a calm and unhurried atmosphere in the home. The home has access to Milton Keynes adult social care training courses and the training records showed that staff had a wide range of training opportunities. A new training records database is being implemented, which the manager said would assist in keeping a record of staff training and update requirements. A high proportion of staff hold the National Vocational Qualifications in Care at level 2 or above. The records showed that new staff undertake an induction programme. St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 20 Staff recruitment is shared between the home manager and the Milton Keynes Council Human Resources department. This is managed by a management company. Five recruitment files of recently recruited staff were selected at random and examined. They homes files were not complete and did not contain copies of references or Criminal Records Bureau (CRB) disclosures as required. The administrator said that she had asked for copies of the relevant documents to be sent to the home but that despite agreeing to do this, this had not happened. This has been a subject of previous inspection requirements, which has not been addressed. By the second day of the inspection the manager and deputy had visited the central human resources department and photocopied the records of those staff who had been selected at random to update the staff records held in the home. Of the three records checked two had the required documentation in the files by the second day of the inspection. References and Criminal Records Bureau disclosures had been sought and there was evidence of training and supervision of the staff in the folder. The third recruitment file was that of a carer who had transferred from the home care division of Milton Keynes Council. A new CRB disclosure had not been sought. The rational for this was that the employee remained a member of staff of Milton Keynes Council and continued to be employed at the same grade, albeit in a different location, and therefore did not need a further disclosure. It is also the policy that only one reference will be sought when a person is transferred within the Council. The request for a reference was by email and read can you please write a few lines as reference for X, she has been offered a post with y, thanks. This is poor practice. The referee actually wrote a more comprehensive reference but not against any structured guidelines. There was no information as to how long the person had worked or whether there had been any gaps in the employment or other absences, for instance. Structured references should be sought for all applicants to posts in care home particularly if Criminal Records Bureau disclosures are not sought. The provider must ensure that full records of staff recruitment files are available for inspection. If they are not to be held in the home the provider must agree with the Commission for Social Care Inspection the means by which they will be made available. The registered manager must be able to check that all documents have been received and are satisfactory before the staff member commences work. The provider must ensure that up to date, comprehensive references are sought for all staff transferring to or commencing a new post in the home. St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The home is well managed in the interests of residents. There are quality assurance policies in place, which seek to ascertain the views of residents and their families. However the provider must monitor the quality of care on a regular basis and the ongoing issues about the recruitment of staff should be resolved for residents and their families are to have full confidence in the quality of the service. EVIDENCE: There is an experienced manager in post. She is a registered nurse and holds a National Vocational Qualification in Management at level 5. The atmosphere in the home was open and friendly and she appeared approachable to residents and staff. She was knowledgeable about the care needs of residents. St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 22 She has undertaken a specialist course in dementia care mapping, which is designed to measure the quality of care for residents although has not yet put it into practice in the home. The home has a quality monitoring group called the Heart of St Giles to which families, residents and staff are invited. The manager said that the agenda was driven by families but that she attended with the aim of introducing quality improvements that they identified whenever possible. The regular monitoring of the quality of the service that should be undertaken by the provider in line with Regulation 26 of the Care Homes regulation has not been undertaken since September 2007. The manager said that the way in which the provider will support the registered manager is under review. The provider must ensure that these quality-monitoring visits are undertaken on a monthly basis whilst the review is being undertaken and must be undertaken on a regular basis thereafter. There is no systematic auditing of records, for example care plans, recruitment files or medication records, to ensure that they are up to date and kept to the required standard. This should be considered. None of the residents are able at present to manage their own financial affairs. Most are assisted by their families. Milton Keynes Council acts as appointee for those whose families are unable to assist. The home provides safekeeping for small amounts of personal allowance. Records are kept and receipts are given for all expenditure incurred. The system is audited on a regular basis. One record was checked at random and found to be correct. There are health and safety policies and procedures in place. The Annual Quality Assurance assessment showed that services and equipment is maintained in a regular basis. There was evidence in the training files that staff had had training in safe working practices. Incidents are recorded and monitored by Milton Keynes health and safety manager. Generic risk assessments are in place to promote safe working practices. St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 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 1 X 3 X X 3 St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 OP26 Regulation 13(3) Requirement The home must provide paper towels and soap in residents rooms for the use of staff and visiting healthcare professionals, to minimise the risk of cross infection for residents. The provider must ensure that two references are sought for staff who are appointed or transferred to the home, to protect residents from unsuitable carers. The provider must ensure that copies of references and a recent photograph are held in the home in staff’s files. The provider must undertake monthly quality assurance visits to the home and must prepare a written report following that visit, which is kept in the home, to ensure that high standards are maintained for residents. Timescale for action 31/12/08 2 OP29 19 schedule 2 and 4 30/11/08 3. OP29 19 Schedule 2 and 4 26 30/11/08 4 OP33 30/11/08 St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard OP7 OP12 Good Practice Recommendations The care plans should be completed in greater detail and should be updated regularly. The activities programme should be further developed to include individual activities for residents who do not wish to join in group activities and to include more therapeutic activities for people with dementia. The manager and chef should be given the opportunity to undertake specialist training in meeting the nutritional needs of people with dementia. The provider should agree with the Commission for Social Care Inspection (CSCI) the way in which recruitment files are to be made available for inspection in order that the CSCI can judge whether the process is robust and residents are protected from unsuitable carers. The provider should ensure that there is an effective quality assurance programme in the home to ensure that high standards of care are maintained for residents. The programme should include regular audit of records and outcomes for residents. 3 4 OP15 OP29 5 OP33 St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Giles Residential Home DS0000032628.V372112.R01.S.doc Version 5.2 Page 27 - 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!