Care Home: St Margarets

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What the care home does well The home continues to be careful when they employ new staff, they make sure that they check where they last worked and carry out another check against a special register that helps them make a decision if that person is suitable to work. This is needed before someone is allowed to work in a home, as it provides information on the member of staff character for example. This means people can feel safe knowing that the home is cautious. This means that the risk of someone who is not suitable being employed to work at the home is reduced, so protecting the people living there. The manager had sent out surveys to relatives and to seek their views. She was looking at the feedback received through these to look in to how improvements could be made to the standard of care. This means that management are willing to listen to comments and suggestions on how to make things better and are willing to make changes. The standard of hygiene at the home is also good. Housekeeping staff are employed to undertake cleaning duties and they do this very well. Several people commented on how clean the home is kept, one person said, "my room is spotless they are forever cleaning in here". What has improved since the last inspection? There had been several improvements since the last inspection, these included: Improvements to documents known as care plans. These documents tell staff all about the person and what they should do to support them in meeting their needs. This is very important so everyone working to support the person does so in the same way and continuity of care is given. There was a plan in place for each assessed need of a person and the guidance to staff was clear in how a person should be supported. Medication systems for ordering and storage are good. When we last inspected the balances of stock for some people had not been correct. The manager has since made improvements to the medication system and all balances at this visit were correct. There is a local multi agency protocol for safeguarding adults, within this is guidance as to when and how any suspicion or allegation of abuse must be reported. The home did not have a copy of the most recent guidance at the last inspection. They now had the up to date guidance in this area. What the care home could do better: The documents the home has to let people know what services are provided, about the staff and how to complain have been updated since the last inspection. However they were not on display, this information should be accessible to everyone. Key inspection report Care homes for older people Name: Address: St Margarets St Margarets 10 Rothsay Road Bedford Bedfordshire MK40 3PW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Katrina Derbyshire     Date: 2 2 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: St Margarets St Margarets 10 Rothsay Road Bedford Bedfordshire MK40 3PW 01234345964 01234345964 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Calsan Limited care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home St Margarets is a privately owned care home and is able to accommodate 21 people who are 65 years of age and over. The home is an attractive detached Victorian building situated in a quiet residential area of Bedford just a few minutes walk from the banks of the River Ouse. Bedford town centre is also within walking distance, and the home is well served by public transport. The home has 17 single rooms and two doubles; two of the rooms have en-suite facilities. The home has a lift, and an extension has been added to the kitchen area. The extension also provides a staff room and two additional toilets. There are public parking bays to the front of the home, (pay and display) and a parking bay for the disabled is provided. Care Homes for Older People Page 4 of 25 Over 65 21 21 21 21 0 0 0 0 3 0 1 0 2 0 0 8 Brief description of the care home Information about the home is given out on request by phone or when visiting. weekly fee rates are between £468.48 and £500.00. The Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection carried out on the 22nd October 2009. The care of two people was looked at in detail and this is known as case tracking. Tracking peoples care is the methodology we use to assess whether people who use social care services are receiving good quality care that meets their individual needs. Through discussion, observation and reading records, we track the experiences of a sample of people who use a service. During the visit the communal areas of the home were seen alongside some of the individual rooms. Time was spent with many of the people who live at the home in one of the sitting areas. Care Homes for Older People Page 6 of 25 Observations of care practise and communication between the people living at the home and staff was also made at the inspection. The managements submission of documentation was also considered prior to the site visit. The focus of this inspection was to look at the key standards. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 25 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information available about the home and the services available is sufficient, to assist people when making a decision on whether to move into the home. Evidence: As reported at the previous inspection the statement of purpose that usually is one document was written using several documents displayed within the home or in the office, alongside other literature on a noticeboard in the front hallway. This gave information as to the services available at the home and the staff. This remained in place at this inspection alongside two other documents. One of the two new documents gave brief details of the home and services in large print and the other provided everything needed to show what the service offered, about the staff and also how to complain. These need to be on display so that the information is also accessible to the people already living at the home. Care Homes for Older People Page 11 of 25 Evidence: Assessment of peoples needs were seen to be in place within the care records examined. These documents described the needs of the people prior to moving into the home. At the front of individual records was a sheet named Resident on admission details, this sheet provided very basic information for example name, next of kin, and date of birth. A further document provided sections in which a persons needs were assessed. The sections covered emotional physical and social needs. Further information for a person who had moved into the home recently by one of their family members, they had written details to help build up a fuller picture of the person and the life that they had lived. Another person who had lived at the home for some time had in place a document that had been updated 6 monthly, this is where staff had re assessed the persons needs. When changes had taken place, these had been entered. One example was following discharge from hospital the person had been prescribed a nebulizer, this information had been added to the assessment. Intermediate care is not provided at this home. Care Homes for Older People Page 12 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Medication systems are good and ensure people recieve their medication when they should. Evidence: Care plans were examined within the records of the people selected for case tracking. A plan was in place for each assessed need of each person, the documents described the need and then gave guidance to staff on how to meet the need. The format was easy to understand, written simply yet would enable staff to know exactly what they should do to ensure consistency of care. One example of this was that a person had developed difficulty with swallowing whilst living at the home. A referral was made for an assessment to be carried out, this was done. The care plan then documented simply but sufficiently what staff should do, this included: sitting the person up and adding thick and easy to all drinks. We met this person and saw that this was being carried out. Daily records were also maintained, these documented any changes in a persons condition. In addition various risk assessments were in place including one for falls. Care Homes for Older People Page 13 of 25 Evidence: This risk assessment provided a format that staff needed to check against, areas covered included lighting, diet, footwear and medication. In checking against and improving in these areas the level of risk would be reduced. Medication stocks were examined alongside the records relating to this area. The storage of medication had moved location since the last inspection, it was seen to be secure. The controlled drugs were stored within an appropriate cupboard, although its location meant that staff have to kneel on the ground to access it. Records for both the controlled drugs and other medication at the home was correct. The majority of medication was given using a monitored dosage system. The systems in place for managing medication had improved significantly since the last inspection. The stock, storage, ordering and administration of medication was good. All policies regarding confidentiality as described at the last inspection remain in place. Observing staff during the inspection showed them to be polite and courteous to the people living at the home. Comments about the staff included, they treat me very well, and yes I would say they are respectful to me. Records are available at the home that detail when a person has received medical support. One example is when a Nurse visits someone at the home they document their findings within the individual notes of the person. All people are registered with a General Practitioner, when they need a referral made staff request this via the G.P. Care Homes for Older People Page 14 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in opportunities for social activities meets peoples individual preferences and needs in this area Evidence: At the last inspection there were two small dining spaces available, since that time the wall between these two areas has been knocked through. This has now created one large space and increased the amount of natural light to one of the areas. A board was in place on the wall in the dining room, this provided information on what options were available at mealtimes alongside the day and date. The majority of people spoken with were positive on the standard of food at the home. Everyone had a nutritional risk assessment in place and where a high risk had been identified a care plan had been written. Meals at the home provide a range of protein, carbohydrates and dairy alongside fruit and vegetables. Jugs of squash were available to people living at the home and were left in the lounge areas. There had also been changes to the activities available in the home. The manager explained that some activities followed the seasons and had created an album to capture this these were in addition to regular activities. During the inspection a person Care Homes for Older People Page 15 of 25 Evidence: who specialises in activities was visiting the home, the majority of people joined in a quiz and reminisce session that she held. Varying parties had also been held including one for valentines day and a summer party. In addition the home had been active in being involved in the Race for Life in 2009 in Bedford. There were no relatives visiting during this inspection, however documents were seen within the care records to show that families were involved. One person had completed a document to provide the history of their relative, other documents seen showed that staff had contacted family members to update them if a persons circumstances had changed. Care Homes for Older People Page 16 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The training of staff is sufficient to ensure they have a satisfactory level of understanding of the safeguarding protocols to protect the people living at the home. Evidence: The complaints procedure policy of the home remains the same as previously assessed it is clear in its guidance to management and staff and includes timescales that the complainant should be responded to if they raised a concern. No complaints had been received by the service or the Care Quality Commission in the past 12 months regarding this service. People as previously assessed stated that they did feel comfortable raising any concerns that they had, they did not feel that they would be treated any differently if they did. Records showed that staff had undertaken training in abuse, this was supported by information within the AQQA. The copy of the local protocols in safeguarding adults was now in date, following a requirement made at the last inspection. In addition the homes own policy in safeguarding had been updated. The manager confirmed that the home was now fully aware that all alleged incidences of abuse must be referred to the local safeguarding team, it is then decided how and who should undertake the investigation and that management would not investigate first to ascertain if the allegation was true or not. Care Homes for Older People Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The level of cleanliness at this home is good and provides a pleasant environment for people to live in. Evidence: The communal areas in the home as assessed at the previous inspection were noted to contain furnishings that were in a good state of repair. The decoration in these areas were also of a sufficient standard, and the use of pictures and plants helped in creating a homely environment. Again individual rooms contained personal items of the person including photographs and ornaments. The small outside area was well maintained, there were flowers and shrubs to the front of the home. Alongside the changes to the communal space a new boiler had also been fitted since the last inspection. Everyone spoken with stated that they felt the home was very clean. All the communal areas and a random selection of individual rooms seen at this visit showed that this was the case, the standard of cleanliness in these areas was good. There were no odours detected at this inspection. Staff were seen to follow hygiene standards when carrying out varying tasks. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Training arrangements for staff is sufficient for staff to be able to demonstrate a clear understanding of their role and meet the needs of the people living at the home. Evidence: The homes recruitment policy and procedures as previously assessed are clear. Three files were examined at this inspection of those staff most recently employed by the home. All three files contained an application and references. In addition a POVA First check had been undertaken prior to their commencement at the home, evidence of a criminal records bureau check was also in place. Communication and interaction between people living at the home and staff was seen to be supportive and frequent. The interaction suggested that good relationships had been built up over time. Training records were examined, these showed that training had been undertaken by staff in the following areas, moving and handling, food hygiene and health and safety. In addition training had taken place in nutrition and swallowing, diabetes awareness and falls awareness. Certificates of training were also on display in the home. People living at the home who were spoken with reflected the outcome detailed at the last inspection and felt that the staff had a satisfactory level of knowledge and felt confident in their abilities to meet their needs. Information provided by the service show that there has been a low turnover of staff in the past 12 months. Care Homes for Older People Page 19 of 25 Evidence: The home employ catering and housekeeping staff alongside varying levels of care and support workers. Again people felt that there were sufficient staff on duty to meet their individual needs. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of management in the home is good and so ensures people are supported in a respectful manner and have their needs met. Evidence: The Registered Manager at the time of this inspection has been in post for several years. Staff had previously spoken highly of the support that she offered them in carrying out their roles and responsibilities in the home. They find her approachable and clear in her guidance to them, describing her as valuing their contribution to the running of the home. The manager works in a hands on way and works alongside the care team and provides personal care herself. The manager stated that she ensures that she sees every resident every day. Observation of her interaction with people living at the home and a visiting Nurse showed her to be professional and proficient. The manager had acted upon the requirements made at the last inspection and all have been met. The views of people that have been involved in the home had been sought through the Care Homes for Older People Page 21 of 25 Evidence: sending out of questionnaires. The manager advised that any comments that were received would be acted upon. The returns made in 2009 were viewed and showed that feedback on the service being offered was good. Health and safety records were examined. These showed that safety checks including fire, water temperature and electrical appliance had been carried out. Staff training records showed that staff had also received training in the varying areas of health and safety. Risk assessments had also been carried out, these showed where there was a possible risk and gave guidance on what staff should do to reduce this risk. No monies are held by the service on behalf of anyone living at the home. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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