Care Home: St Margaret`s

Similar services:

• Abbey The
• Snydale Care Home
• Hawkhills
• Larchfield Manor
• Beeches The - North Yorkshire County Council
• Carentan House
• Ravensworth Lodge

What the care home does well People live in a warm and friendly home. Staff aim to help them make choices in their daily lives. This helps people retain their individuality and independence. People are assessed before they move in, and information is collected from other professionals who may have been involved in their care. This helps thestaff to decide whether they have the resources to meet the person`s needs before offering them a place. Staff make sure they contact other health professionals for advice when people are not well, or guidance about maintaining their wellbeing is needed. People can have their friends and family visit whenever they want. Staff welcome them into the home. Visitors said they are always made to feel welcome at the home. One commented that they are `always greeted in a friendly manner`. Another that `The staff always make me feel welcome on my visits. I am encouraged to stay for a meal if my visit coincides with mealtimes`. This sort of welcome helps to make the visit an enjoyable social activity, and encourages important social links. People enjoy their meals. Mealtimes are not rushed, so they can be more of a social occasion. Staff are respectful towards people. Their representatives made comments like `The staff are kind and caring. Treat the residents as individuals`, `The staff seem to be caring and considerate to the residents`, `Nothing is too much trouble for staff. Very quick to respond if someone is ill`. `The staff go out of their away to make each resident comfortable... and they are treated as `adults`. They do a splendid job`, `The carers are lovely people and very approachable and relate to the residents really well.` What has improved since the last inspection? Risks to people`s health and welfare are now better linked to their plan of care. This makes it easier for staff to see the reason they should give care in a certain way, and why it is important for them to do so. The manager has worked hard to improve the medication practice by making changes to staff practice, and by making sure they all receive up to date training so that they fully understand their responsibilities. Although further improvements are needed, the activities programme has been improved so that there are planned activities each day for people to join in if they wish to. The home was suitably lit. The registered provider checks regularly to make sure that all light bulbs are in working order. A new manager is in post, who is eager to maintain and improve the service people get, and the training staff receive in order to make this service safe and consistent. What the care home could do better: Staff could follow what the care plans say about how to reduce risk to people. For instance, they could use the equipment to move and handle people that their care plan says is needed. Their training could be updated so they are reminded how to work in the safest way. This would keep people safe from avoidable injury. The way new staff are instructed in their induction about the safest way to provide care could be more closely linked to what is written in people`s care plan. This would ensure that care is always given in the way that has been judged safest. People`s social interests could be recorded better in their care plan. This would help to make sure that the activities they are provide with fit their individual needs. People or their representatives could be more involved in the review of their care plan so they can comment on their care, and how they would like it to be provided. Although a lot of improvements have been made to the medication systems, further improvement could be made to the way that some medication is stored, and the way that some topical medication is recorded. This would make the storage safer, and the records of what people are getting, more accurate. All staff could have some training in safeguarding people. This will make sure that they all know what to do, and who to report to, should an allegation of abuse ever be brought to their attention. Staff traffic in and out of the kitchen could be better monitored to reduce the risk from cross infection. As part of the decoration programme, consideration could be given to the redecoration of the communal areas that are `faded`, and the refurbishment of the top floor bathroom, so that people living there can get extra enjoyment from these areas. People could be given a satisfaction survey so their collective views about the home can be understood. This would help future planning for improvement to be more focussed on what people say and think about their home. CARE HOMES FOR OLDER PEOPLE St Margaret`s 25-27 Queens Road Harrogate North Yorkshire HG2 0HA Lead Inspector Anne Prankitt Key Unannounced Inspection 12th November 2008 09:30 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 Margaret`s DS0000007791.V373168.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 Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Margaret`s Address 25-27 Queens Road Harrogate North Yorkshire HG2 0HA 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) 01423 529544 01423 875151 info@stmargarets.biz Mr John Kneller Mrs Wendy Margarita Kneller Manager post vacant Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25) of places St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users to include up to 25 (OP) and up to 25 (DE(E)) up to a maximum of 25 Service Users. 20th November 2007 Date of last inspection Brief Description of the Service: St. Margarets provides a care service to 25 people who may have dementia. The home is situated in a residential area of Harrogate with good access to the towns services and amenities. It is set in a quiet street with gardens to the front and rear of the building. The premises are set on three floors, with passenger lift to all floors. There are two communal sitting rooms, and a dining area with enough room for everyone to sit together if they choose. On 12 November 2008 the registered provider said that the weekly charges range from £372.05 to £433.38. People pay extra for hairdressing, chiropody, newspapers and magazines. The Service User’s Guide tells people about the service, and is available from the manager on request. The Commission for Social Care inspection report is displayed on the notice board in the home. St Margaret`s DS0000007791.V373168.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 star. This means the people who use this service experience good quality outcomes. The key inspection included a review of the following information to provide evidence for this report: Information that has been received about the home since the last inspection. A self assessment called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the registered provider thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Completed comment cards from two people living at the home, seven relatives/representatives, two staff and one health professional. An unannounced visit to the home by one inspector lasting for approximately seven and a half hours. During the visit to the home, several people who live there and three staff were spoken with. Three people’s care plans were looked at in detail, and one in less detail. We also looked at two staff recruitment files and some health and safety records. Care practices were observed, where appropriate. Some time was also spent watching the general activity to get an idea about what it is like to live at St Margaret’s. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: People live in a warm and friendly home. Staff aim to help them make choices in their daily lives. This helps people retain their individuality and independence. People are assessed before they move in, and information is collected from other professionals who may have been involved in their care. This helps the St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 Page 6 staff to decide whether they have the resources to meet the person’s needs before offering them a place. Staff make sure they contact other health professionals for advice when people are not well, or guidance about maintaining their wellbeing is needed. People can have their friends and family visit whenever they want. Staff welcome them into the home. Visitors said they are always made to feel welcome at the home. One commented that they are ‘always greeted in a friendly manner’. Another that ‘The staff always make me feel welcome on my visits. I am encouraged to stay for a meal if my visit coincides with mealtimes’. This sort of welcome helps to make the visit an enjoyable social activity, and encourages important social links. People enjoy their meals. Mealtimes are not rushed, so they can be more of a social occasion. Staff are respectful towards people. Their representatives made comments like ‘The staff are kind and caring. Treat the residents as individuals’, ‘The staff seem to be caring and considerate to the residents’, ‘Nothing is too much trouble for staff. Very quick to respond if someone is ill’. ‘The staff go out of their away to make each resident comfortable… and they are treated as ‘adults’. They do a splendid job’, ‘The carers are lovely people and very approachable and relate to the residents really well.’ What has improved since the last inspection? What they could do better: St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 Page 7 Staff could follow what the care plans say about how to reduce risk to people. For instance, they could use the equipment to move and handle people that their care plan says is needed. Their training could be updated so they are reminded how to work in the safest way. This would keep people safe from avoidable injury. The way new staff are instructed in their induction about the safest way to provide care could be more closely linked to what is written in people’s care plan. This would ensure that care is always given in the way that has been judged safest. People’s social interests could be recorded better in their care plan. This would help to make sure that the activities they are provide with fit their individual needs. People or their representatives could be more involved in the review of their care plan so they can comment on their care, and how they would like it to be provided. Although a lot of improvements have been made to the medication systems, further improvement could be made to the way that some medication is stored, and the way that some topical medication is recorded. This would make the storage safer, and the records of what people are getting, more accurate. All staff could have some training in safeguarding people. This will make sure that they all know what to do, and who to report to, should an allegation of abuse ever be brought to their attention. Staff traffic in and out of the kitchen could be better monitored to reduce the risk from cross infection. As part of the decoration programme, consideration could be given to the redecoration of the communal areas that are ‘faded’, and the refurbishment of the top floor bathroom, so that people living there can get extra enjoyment from these areas. People could be given a satisfaction survey so their collective views about the home can be understood. This would help future planning for improvement to be more focussed on what people say and think about their home. 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 Margaret`s DS0000007791.V373168.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 Margaret`s DS0000007791.V373168.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 outcomes in this area. People are always assessed to check their needs can be met before they are admitted. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People are assessed before they are admitted, and before a decision is made as to whether the home can meet their needs. This includes collecting information from other professionals, such as the hospital, staff or the person’s care manager, where the person has had contact with these professionals. This helps the staff at the home to build up a picture about what help and support the person will need when they arrive, and to decide whether staff have the skills to meet these needs. Some of the information asked for in the assessment completed by the home had not been filled in. The manager explained that this information, which included details about people’s social needs, their personal abilities, and their short and long term goals, was sometimes difficult to get when this first meeting took place. However, the missing information had been collected soon St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 Page 10 after the admission took place, when the person’s care plan was being developed. People are also invited to come and look round the home, and meet the staff and others who live there. This gives them the opportunity to see first hand whether it is somewhere they may like to live. The manager said that people are given written information before they arrive if they ask for it. It would be good practice for them to be given this information as a matter of course. They may not know that it exists, and by having it, they and their family can look at leisure to see what services the home offers, and whether it will provide them with everything they want and need. The home does not provide intermediate care. Therefore standard 6 is not applicable. St Margaret`s DS0000007791.V373168.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 outcomes in this area. Improvements made to the way that people’s care is recorded, and the way that their medication is handled, should make their care safer and more consistent. However, staff need to use this information when providing hands on care. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Each person has a file, which outlines the care they need, or have received. This includes an initial assessment, a personal profile and general health information. A care plan, which is based on outcomes for people, is then produced using this information. It identifies how outcomes can be improved for people, areas where people may be at risk, and it alerts staff to complete a risk assessment in these areas. This plan contained some good information which described the strengths of the individual, and how they should be supported to remain independent. It also explained what the person likes to do in their daily lives, and when. For instance ‘Likes watching TV, particularly Emmerdale Farm’, ‘Every morning makes her own bed’. St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 Page 12 The records showed that people have access to their doctor, district nurse and other health professionals, such as the mental health team, which will help to maintain their health. One such professional commented, ‘The staff are kind and caring. Treat the residents as individuals’. Although there was a good potted history about the person’s past social history and interests, this information had not been used to create a care plan purely about how people’s individual social needs could be met now. It would be good practice to develop this further, so it is clear to staff how they can support people in meeting these needs. The care plans are reviewed on a monthly basis. This means that they are kept up to date, and reflect current need. People and their family are not involved in this review, which was completed by staff. It would be good practice to encourage people, where possible, to join in with this review of their care, so that they can agree that care is being provided in the way that they prefer. Despite improvements being made to the way risks to people’s health and welfare is documented, staff practice suggested that they do not always refer to these assessments when providing hands on care. This relates specifically to the way people are moved when they need help. Staff did not use the equipment that the care plan said they should, and some people were transferred in a clumsy way, and without sufficient preparation to make sure the area was free of obstacles. One incident was recorded in a person’s care plan, which appeared to be caused by poor moving and handling technique. And a relative commented ‘Although the staff have been on handling courses I wish they would remember what they have been taught. Management cannot always be around to pick up bad handling’. Staff training in this area will be discussed further in ‘Management and Administration’, because it has a direct impact on people’s health and safety. However, our concerns were discussed with the manager during the site visit, who addressed these with staff on duty straight away. People were spoken to with dignity and respect during the course of the site visit. Staff interacted well with people socially, and were very patient when offering them help, for instance with their drinks and meals. This will stop people from feeling rushed. People responded to this well, and enjoyed staff company. Care was provided in private. Both people who returned their survey said they were always happy with their care, and agreed that staff always listen and act on what they say. One said ‘the home is OK’. The other commented that they are ‘very fond of all the carers’. They said there was nothing they thought that the home could do better. St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 Page 13 Relatives made comments like ‘The staff seem to be caring and considerate to the residents’, ‘Nothing is too much trouble for staff. Very quick to respond if someone is ill’. ‘The staff go out of their away to make each resident comfortable… and they are treated as ‘adults’. They do a splendid job’, ‘The carers are lovely people and very approachable and relate to the residents really well.’ Good improvement has been made to the way that people’s medication is handled. The manager has obtained a copy of the most recent pharmaceutical guidelines so she can refer to these when making the system as safe as possible. The manager explained that all staff have now had some form of training in the safe management and administration of medication. Further training was soon to be provided by the Primary Care Trust, so the manager could be confident that staff all approached their responsibilities in line with up to date guidance. Medication charts were signed up to date, and all medication was stored appropriately, excepting medication which needs to be kept cold. This was stored in the domestic fridge in the kitchen. This arrangement is not ideal. Firstly, because it means that it is not locked away, and therefore more people have access to it. Secondly, because it means that more staff are entering the kitchen where it is stored. This is not good practice, because it increases the risk from cross infection. Staff who apply creams do not sign for these. This makes it look as if the creams have not been used, and causes problems when the doctor reviews their effectiveness, because he cannot tell from the records how often it has been applied. Staff who apply the medication should be allowed to sign to say that they have done so. Ways of achieving this were discussed with the manager. She intends to discuss this with the pharmacist who supplies the medication to the home. St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People who use the service experience good outcomes in this area. Although further improvements could be made to the activities once individual social needs are better planned, people receive meals which they enjoy, and their visitors are welcomed into the home so that important links with them can be maintained. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home does not have an activities organiser. Staff organise activities, and the plan of events displayed in the hallway tells people what activity is likely to happen each day. Activities were being planned for Christmas, including an entertainer, who has been booked to visit the home. On the day of the inspection, people chatted together, or sometimes with staff, and others watched the television. A staff member organised a game of ‘I spy’ in one of the communal lounges. The game came as a surprise to two people who had previously been watching the television in the same room. One commented ‘It’s like being back at school’. Although everyone enjoyed the game, it would be better in future if the agreement of everyone using the room was sought before the activity began, to make sure that they do not mind being interrupted. St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 Page 15 We were told that individual activities are also organised with people, such as nail painting, and one to one chats with staff. One person enjoyed looking through a book whilst singing along to music. Another person gets a regular visit from the priest, who offers them communion. This helps to meet their spiritual needs. One person said that there were usually activities for them to join in. The other said this was sometimes the case. Relatives made comments like ‘From what I have seen there does not seem to be enough stimulation for the residents’, ‘If they had more staff it would be good to see staff having time to chat with, and try to encourage conversation with the residents’. A staff member commented that ‘there could be more activities if there were more staff’. A visiting professional commented that the staff ‘try their best to offer some sort of stimulation in the afternoons’. They recognised that this was difficult because of the needs for the people who live at St Margaret’s. People’s current social interests are not yet recorded in any great detail in their care plan, although staff seemed to know them well. People did not appear bored, and appeared interested in the general activity in the home. However, by linking activities to people’s personal interests when these plans have been developed, it will be easier to tailor the activities to meet people’s individual needs. People can have their visitors when they wish. Visitors said they are always made to feel welcome at the home. One commented that they are ‘always greeted in a friendly manner’. Another that ‘The staff always make me feel welcome on my visits. I am encouraged to stay for a meal if my visit coincides with mealtimes’. This sort of welcome helps to make the visit an enjoyable social activity, and encourages important social links. People sometimes have to have decisions made on their behalf when they are not able to make these themselves. Staff however said they always try to provide flexible care, and aim to provide choice, so that one day does not have to be the same as the next. They gave examples such as giving people the choice of rising and retiring times, where and what they eat, and what they wear. The smell of home cooked food travelled round the home prior to the mealtime. It smelled very appetising, and people appeared to enjoy their two course lunch. The cook said they get enough provisions including fresh meat, vegetables and fruit, to make sure people get a good nutritious diet. People have three meals a day, and also supper. Plenty of hot and cold drinks are served in between, along with biscuits or cakes, and there is food available in the kitchen day and night for anyone who may feel hungry. People are asked before each meal whether they would like something different from the planned main course. This is provided when requested. One person was seen St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 Page 16 enjoying their choice of chips to accompany their meal, which differed from the advertised choice. They shared these, which were served in a separate dish, with others on their dining table, which made the meal quite a social occasion. Special diets are catered for, including vegetarian and diabetic. The cook understood about how to enrich meals so they provided people with more calories, if this was needed. She also knew how to serve liquidised meals so they still looked appetising. Staff have organised the mealtimes so that nobody has to feel rushed. This means that they can also concentrate on those who need extra help to make sure that they can be assisted with their meal without interruption. The people who returned their surveys said they ‘always’ or ‘usually’ liked the meals. One relative said that the staff go out of their way ‘to make sure each resident gets the food that they like’, and that staff are ‘very attentive’ at mealtimes. A visiting professional also commented that there ‘Appears to be a good standard of food’. St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good outcomes in this area. People’s complaints and concerns are taken seriously. However, safeguarding training for staff would help to make sure that the right professionals are always promptly informed so that people are protected from harm. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The complaints procedure was displayed on the notice board in the main hallway for everyone to see. There have been no complaints made either to the home or to the commission during the period since the last inspection. People and their families said they know how to complain, and who to, should they have any concerns that they want sorting out. Although the survey information received before the site visit told us that these staff do not know what to do if someone has concerns about the home, those spoken with on the day were very clear about their responsibilities in reporting abuse, or any incident which affected the welfare of people living at the home. In turn, the manager knew that any such incident must be reported to the local authority as lead investigators, without delay. The policy at the home does not support this action however. It needs to be amended so anyone who refers to it in the future knows exactly what to do to keep people safe and protected from abuse. As none of the staff have received training in abuse awareness, and how to report, the manager was asked to approach the local authority for training about abuse awareness, and the procedure to follow should they need to St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 Page 18 report an allegation. Staff also need to have this training, so people can be assured that they will all act correctly should an incident at the home ever arise. St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience adequate outcomes in this area. Although some areas are in need of decoration, the premises are warm and comfortable. The outside areas could be improved to give people more choice and freedom. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: St Margaret’s is near the centre of Harrogate, which has many shops and facilities for people to enjoy. The home itself is situated on a quiet street. There are two sitting areas and a separate dining area. There is also a small smoking area, which need only be accessed by those who choose to smoke. Since the last site visit a ramp has been purchased. This means that people who use wheelchairs can now use the front entrance of the building, which has steep stone steps leading to the front door. There are gardens to the front and rear of the building. Those at the front are well maintained. In better weather, people can sit out, but with staff supervision, because the driveway leads directly onto the road. Those gardens St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 Page 20 at the back are not so well kept, but could be used as an alternative outside space for people to use if made safe. However, the registered provider said it is the policy of the home that people do not go out without staff supervision, and that people never access this area. A relative commented ‘Would be nice to see a secure seating area in the garden’. When deciding upon further improvements to the home and its surroundings, consideration should be given to making this area safer and more accessible to people, so they have another outside area to enjoy. Some areas of the home would benefit from some redecoration. However, it was generally clean, warm and tidy. Relatives comments included ‘The property internally is a little ‘faded’ and could do with being decorated as it is looking rather shabby. However, the care of the people is obviously more important than the appearance of the place and I have no concerns about that’. And a health professional also commented that the surroundings and furnishings could be improved upon. However, we were told before the site visit that some improvements to the environment have been made for people, because two bedrooms have been decorated. The manager said it is for this reason that the bathroom on the top floor is not used. We were told a decision is being made as to whether this should be refurbished to make it more pleasant. Although a walk in shower has recently been provided on this floor, it would be nice for people to be able to remain on the floor on which they live to have a bath, if this is their choice. People can have a single bedroom, or can share with another person if they choose to. Bedroom doors have a picture displayed of the person to whom the room belongs. This makes it easier for people to recognise their room. In one shared room the second chair had been removed to make it easier for staff to manoeuvre equipment. However, the manager told us that, should the person want to sit in their room, the seating would be returned straight away. One bedroom carpet smelled unpleasant, and was stained in several places. The registered provider was advised that the carpet must be cleaned or replaced. Feedback has been received that a new carpet is now on order. This will make the room much nicer for those who occupy it. There is a lift to each floor, and to the basement, where the laundry facilities are situated. The staff told us that there is sufficient equipment there to make sure people’s clothes get well laundered. The washing machine has a sluicing facility, and the laundry staff member said that care staff tell them when they are delivering soiled linen, which arrives in separate bags which dissolve in the wash. There is also a supply of disposable gloves and aprons for staff use. This protects the laundry staff, and also reduces the risk from cross infection. St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People who use the service experience adequate outcomes in this area. The staff training programme is being reviewed. This will help to make sure people get safe and consistent care. However it cannot be assured that the induction training staff get is linked to keeping risks to people to a minimum. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: In addition to the manager, who is not included in the staff numbers, and available during the week, there are four care staff provided during the day, three in the evening, and two waking staff at night. Laundry, kitchen and domestic staff are employed in addition. Staff did not appear rushed on the day of the site visit. Although some comments were made about the staff numbers available. A visiting professional commented that the home could ‘provide more staff’, adding that the home ‘always seemed to be short staffed’. A relative said that ‘If they had more staff it would be good to see staff having time to chat with, and try to encourage conversation with the residents’. However, out of eight responses, five relatives said the home always meets the needs of their relative, two agreed this was usually the case and one said it was sometimes the case. The files for two recently recruited staff were looked at. In both cases, the staff members had started to provide care after their POVAFirst check had been returned, but before the full police check had been received by the home. This arrangement is permitted only in exceptional circumstances. The manager explained that this was indeed the case in both instances, because there were St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 Page 22 not enough staff working at the home to maintain the level of care that people living at the home are used to. One of these staff said that they were being supervised until the full police check was returned. If this arrangement is to be repeated in the future, then the manager should make a clear record so staff know who has been given the responsibility to supervise the new employee over the course of the shift. When they begin to work there, staff get a basic induction which tells them about the home, and how it runs. A new staff member said that they were not expected to carry out any tasks that they had not learnt about, and that they were always supervised by another more experienced member of staff. The records showed that staff inductions were started promptly. This is good practice. However, staff should undertake with the full ‘Skills for Care’ induction, which will help prepare them for further studies towards their National Vocational Qualifications in Care. There is an active programme in place for staff to undertake these qualifications. In addition, the induction needs to be linked more closely with people’s personal care, and what is assessed as being needed within their care plan. For instance, staff supervising the new starter had given the wrong information about how to move and handle people. This is not good practice, and suggests that staff are not referring to the care plan when linking induction and care plan information with hands on care. One relative said that staff always have the right skills to look after people properly. The remainder said this is usually the case. The manager is sourcing a range of further training to update staff skills. This will help to maintain a good level of consistent care for those who live at St Margaret’s. St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 Page 23 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 outcomes in this area. The management have shown that they are keen to improve standards at the home for people, and that they are listening to people’s views. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: There is a new manager in post since the key inspection last year. She is currently applying to become registered with the commission. She has many years experience of working with older people. She has already completed the Registered Manager’s Award. She is settling into the home, learning about how it runs, and is getting to know people, their families, other professionals and staff who work at the home. As part of this, she is looking at where she need to focus on her own training updates, so she can best train and support staff in the work they do. For instance, she intends to complete a ‘Back Care for Managers’ course. By doing St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 Page 24 so, she can then give the right ‘hands on’ advice to staff about moving and handling people safely. As part of this process, the manager should send out surveys to ask people and their representatives their views about how the home is operating. This will give the registered provider and manager clear indication about what they think the service does well, and where it could improve, and will help to prioritise plans for future improvement based on their views. One staff said that the management team are ‘supportive’, and that they ‘listen’. Another commented that the manager ‘listens’, and that they have been invited to ‘loads of meetings’ held by the manager lately. This will foster good communication between the staff team. A relative commented that the manager was ‘absolutely excellent’. They said the home ‘really do care’. The home does not look after people’s finances. These are managed by people’s representatives. If any items are purchased on people’s behalf, then this representative would be invoiced. However, the manager said that, should people wish to keep any valuables in their room, they would be provided with lockable facilities so they could be kept secure. The manager is aware that there are gaps in compulsory staff training relating to health and safety. She is currently prioritising this training, so that those staff update in fire safety, moving and handling, infection control, and food hygiene, does not fall any further behind. We were told that there is always a first aid qualified person on duty to deal with such emergency situations. Fire training has not been provided for over a year, and the moving and handling practice seen on the day of the site visit was not satisfactory. Therefore it was agreed that these areas should take priority. It was organised on the day that all staff will receive fire training in December 2008, and assurance has been given that staff will complete moving and handling training in the new year, once the manager has finished the training which will allow her to update them. Neither the fire officer nor the environmental health officer have visited recently. We were told by the registered provider that both were satisfied following their last visit with the systems in place. From the information provided before the site visit, and the sample of documents seen during the site visit, it could be confirmed that the premises are kept maintained. In house checks are completed to make sure that systems are kept safe on a day to day basis. For instance, checking hot water is maintained at a safe temperature, and that the fire alarm remains in working order. There was a lot of activity in the kitchen area. Staff, who had been providing care, walked in and out, without wearing protective clothing. This was discussed with the manager and registered provider, who said they would remind staff straight away that they must wear protective clothing before St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 Page 25 entering. Traffic in and out of the kitchen area should be kept to a minimum to reduce the risk from the spread of infection. There are steep concrete steps down to the laundry. The door leading to the steps is kept open when the laundry staff are working there. People living at the home could access the steps, which we were told they had occasionally tried to descend. This was deemed unsafe, and the registered provider agreed to have a keypad fitted, after discussing whether this was a suitable arrangement with the fire authority. We were informed that this work was completed the next day. This will help to keep people safe from the risk from falls down the stairs. St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 Page 26 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 2 8 3 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 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 1 St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 Page 27 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 OP38 Regulation 13 Requirement As discussed and agreed at the site visit, staff must follow the instructions written in people’s risk assessments, which tell them how people can be moved and handled in the safest way. All medication, including that which needs to be kept cold, must be stored securely, and in line with current law. Advice must be sought from the pharmacist, and followed, to establish what equipment is needed for the correct, safe storage of such medication. As discussed and agreed at the site visit, topical creams prescribed for people must be signed for when, and by, the member of staff who has applied them. This is so is it possible to confirm that the creams are being used as prescribed. Training must be arranged for the manager and staff which is linked to the agreed local authority safeguarding procedures. This is so that everyone at the home is clear DS0000007791.V373168.R01.S.doc Timescale for action 12/11/08 2 OP9 13 30/11/08 3 OP9 13 12/11/08 4 OP18 13 30/11/08 St Margaret`s Version 5.2 Page 28 5 OP38 13 6 OP38 13 about what to do if a person raises concerns about the way they get their care, or if any allegations of abuse are made. The ‘abuse policy’ available at the home must be amended so that it supports this procedure, so anyone who refers to it takes the right action should they need to report an allegation. Compulsory training for staff must be brought up to date and maintained. Specific to this, training in safe moving and handling must be arranged, and provided, for all staff so that they work in a safe way which minimises risk to people. As advised on the day of the site visit, staff traffic in and out of the kitchen must be kept to a minimum, and protective clothing should be worn when entering. This action will reduce the risk from cross infection. 31/01/09 12/11/08 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 OP7 Good Practice Recommendations People and/or their representatives should be more involved in the development and review of their care plan. This will help to make sure that agreement is reached that their care is being provided in they way that they prefer. People should have a proper care plan which explains their social needs and interests in more detail, and how staff can support them in meeting these. Further work should be done to make sure that the activities provided for to meet people’s social needs are directly linked to their personal interests. DS0000007791.V373168.R01.S.doc Version 5.2 Page 29 2 OP12 St Margaret`s 3 OP19 When deciding upon further improvements to the home and its surroundings, consideration should be given to making the back garden area safe and more accessible to people, so they have another outside area to enjoy. The decoration plan currently in place should also give consideration to the redecoration of the communal areas, and the refurbishment of the top floor bathroom, so that people living there can get extra enjoyment from them. Staffing numbers should be kept under review, based on fluctuating levels of dependency, and the number of people living at the home. This will help to maintain a consistent level of care and attention. Pending return of their full police check, a more robust way of recording which new staff member is being supervised, and by whom, should be developed. This will help to make sure both staff members are fully aware of their responsibilities during the course of the shift. Staff induction programme should meet the Skills for Care standards so that they are fully aware of the national minimum standards relating to good care practice. This induction should be linked to direct care practice as detailed in people’s care plans. Priority should be given to sending out satisfaction surveys to people who use the service, their representatives, and professionals who support them. By doing so, the manager will have first hand information which will allow her to focus on a plan of action for improvement based on their views. 4 OP27 5 OP29 6 OP30 7 OP33 St Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Margaret`s DS0000007791.V373168.R01.S.doc Version 5.2 Page 31 - 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!