Care Home: St Marguerite

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What the care home does well The atmosphere in the home was comfortable, homely and relaxed and staff were seen to be kind and caring towards people living in the home. Care planning systems ensure that social, personal and health care needs are identified and met. Residents spoken with said that mostly they liked the meals and were happy in the home. Wholesome, nutritious and well balanced meals are provided in addition to a wide range activities and outings. There is an open-house policy, which welcomes visitors at all reasonable times and complaints are handled well ensuring that residents and their relatives feel listened to and their views acted upon. People moving into the home are able to bring in their personal possessions to personalise their bedrooms and the home has gardens to the rear and front of the property. The home is mostly well maintained and both safety checks and quality monitoring systems ensure any shortfalls are identified and addressed. Staff are well trained and the manager provides good overall leadership and clear direction to staff. What has improved since the last inspection? This is a newly registered service. What the care home could do better: Shortfalls were identified in respect of more detailed risk assessments, new staff providing a full employment history and fitting window restrictors and individual controls to all bedroom radiators. The registered manager agreed to address these on the day therefore no requirements were made. Key inspection report Care homes for older people Name: Address: St Marguerite 10 Ashburnham Road Eastbourne E Sussex BN21 2HU     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: Gwyneth Bryant     Date: 0 5 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 26 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 26 Information about the care home Name of care home: Address: St Marguerite 10 Ashburnham Road Eastbourne E Sussex BN21 2HU 01323729634 01323722746 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): St Marguerite Residential Care Home Ltd Name of registered manager (if applicable) Mrs Billie Jo Anderson Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommmodated is: 17 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home St Marguerites is a large detached property, registered to provide residential care for up to 17 older people. The home is located in a quiet residential area on the outskirts of Eastbourne town centre, close to local amenities and facilities. Service users accommodation is arranged over three floors and comprises eleven single bedrooms and three double rooms. All rooms are individual in style and are fitted with a Care Homes for Older People Page 4 of 26 Over 65 17 0 Brief description of the care home washbasin and call bell system. Access to the upper floors is provided by three stair lifts. On each floor there are bathing and toilet facilities, including an assisted bath on the first floor. Communal areas comprise a dining room and a large lounge separated into one large area and one smaller one giving service users the opportunity to sit quietly. There are garden areas to the front and rear of the property. Copies of inspection reports and the Statement of Purpose are made available as part of the preadmission process and all prospective service users are invited to visit prior to admission. Currently weekly fees range from £360 to £600. Additional charges are made for hairdressing, chiropody, newspapers and toiletries. Intermediate care is not provided. The homes email address is stmarguerite@hotmail.co.uk. Care Homes for Older People Page 5 of 26 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 reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at St Marguerites will be referred to as residents. This was an unannounced inspection which began at 08:35 and ended at 13:20. The purpose of the inspection was to check compliance with key standards and other standards. There were thirteen people in residence on the day of which four were involved in the inspection. The Registered Manager, the Deputy Manager and the chef were also involved in the inspection. This is a newly registered service which was registered with the Care Quality Commission on 16 April 2009. A number of documents and records were viewed; including personnel files, medication charts and care plans. Nine bedrooms were visited as were two communal bathrooms, one communal toilet and the communal lounge and dining areas. Prior to the site visit we asked the Care Homes for Older People Page 6 of 26 Registered Providers to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. This was completed well and provided when we asked for it and the information included in this report as necessary. Ten service user surveys were returned and, in the main, responses were positive. Care Homes for Older People Page 7 of 26 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. 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 8 of 26 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 9 of 26 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. Satisfactory pre-admission assessments are carried out prior to residents moving into the home which ensure that their needs can be met and they are provided with detailed information on services provided by the home. Evidence: The Statement of Purpose and Service Users Guide have recently been updated and contain all the information required so prospective residents and their representatives are able to make an informed choice about where to live. A large print version of the statement of purpose is held in the homes foyer for those people who have impaired sight. Pre-admission documentation was viewed for the last three admissions and it is evident that these documents are used effectively to ensure the home is able to meet the needs of prospective residents. One assessment did not include information on the persons preferred leisure interests and the registered manager explained that this information was gathered following admission as the person was apprehensive prior to Care Homes for Older People Page 10 of 26 Evidence: admission. Care Homes for Older People Page 11 of 26 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. The care planning systems ensure that the health, medical and personal needs of those living in the home are identified and planned for in a consistent and comprehensive manner. Evidence: There is a computerised care planning system but handwritten notes for the night are still maintained to facilitate the review process. Four care plans were viewed and it is clear that they have been developed from the information in the pre-admission assessments. Care planning documents included information on meeting residents healthcare needs such as hearing and eyesight checks and also provided clear direction to staff as to how residents daily care needs are to be met. Each plan also includes information on the residents daily routines such as preferred times of getting up and having breakfast. It was good to note that night notes indicated residents were able to go to bed at times of their choosing and are given drinks if they rise early. Each plan includes a daily event sheet which outlines which activities residents participated in, however discussion with the registered manager found that these notes do not fully outline residents involvement in activities as they consist of brief Care Homes for Older People Page 12 of 26 Evidence: notes on how residents spent their day. Care plans included information on visits from district nurses and GPs and there was evidence that regular reviews of the plans takes place. The plans are written in a person centred way and although not all were signed to indicate residents were involved in compiling them, the registered manager confirmed she discusses the plans with each resident. Risk assessments had been carried out and were regularly reviewed, however those relating to self medication and going out alone need to be more detailed to ensure identified risks can be monitored more closely. Residents spoken with said that staff were very kind and that they felt well cared for. Medication records and storage arrangements were viewed and systems are effective. Medication administration charts were up to date, accurate and clear. Medication is stored in a locked cabinet, within the office, to ensure unauthorised persons cannot access it. Only staff who have been trained, administer medication and this was confirmed by staff training records. Night notes showed that medication is administered in a person centred way with those residents who have woken early given medication if required. Currently no residents take controlled drugs but there is an approved controlled drugs cupboard should it be needed in the future. Through direct observation and discussion, it is clear that staff are aware of the care needs of those living in the home and of how to ensure their privacy and dignity is protected. One comment from a survey was most helpful when needed and what more could residents wish for? Care Homes for Older People Page 13 of 26 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. People in the home have the opportunity to experience a lifestyle that matches their expectations, choice and preferences in respect of leisure activities and meals. Evidence: The home has a wide variety of activities both during the morning and afternoons. These activities included exercises, Wii, quizzes, bingo, arts and crafts, sing-a-longs and visiting entertainers. Religious needs are met by visiting ministers, church groups or going to the local churches. In addition to the day to day activities, the home provides regular get togethers for Barbecues, birthday parties and various outings including pub lunches, theatre trips and visits to local attractions. The registered manager outlined a plan to have one of the carers trained to drive the minibus which will enable the home to offer more outings to residents. Residents are encouraged to remain independent and some go out alone. One resident was on holiday on the day of the site visit and arrangements were in place to ensure they have access to prescribed medication whilst away. Residents are given a front door key to enable them to go out at times of their choosing but there is an agreement that they inform staff when they leave the home and when they expect to return. Care Homes for Older People Page 14 of 26 Evidence: Menus were viewed and demonstrated that meals were nutritious and well balanced and alternatives are offered for each meal. One resident spoken with said that when they asked for two particular food items for breakfast, they were provided but not cooked properly. Discussion with the registered manager found that this had happened but she ensured that staff now understand that they need to seek advice if they do not know how to prepare certain foods. The lunchtime meal was viewed and was attractively presented. One resident said that although the main meals were fine there were not enough home made desserts and too much ice cream. This was discussed with the registered manager who agreed that they are working on providing more home made desserts. Water machines are provided in the communal areas of the home and following consultation with residents bottles of squash are also provided near to the water machines. Of the ten returned surveys four, in response to the question about meals said that they usually liked the meals and the other six said they always liked them. One comment was kept very clean and serve good food. Care Homes for Older People Page 15 of 26 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 home has a satisfactory complaints procedure with evidence that those living in the home feel that their views are listened to and acted upon. People living in the home are further protected by satisfactory safeguarding adult systems. Evidence: Information in the AQAA indicated that the home has policies and procedures for both complaints and Safeguarding Adults. The home has not received any complaints and the registered manager explained that either residents raise concerns directly with her or via the residents meetings therefore complaints are rarely made. Of the ten returned surveys eight indicated that the resident knew how to make a complaint but all knew who to speak to if they had any concerns. Information in one care plan showed that it had been identified that the resident was unsure how to make a complaint and recognised that the person would need to be reminded should they express any concerns. Residents spoken with all said they would be happy to talk to the manager if they had any concerns. Comments in one survey included: no complaints - everything seems to run smoothly. The registered manager is aware of the implications of the Mental Capacity Act and the need to use Deprivation of Liberty Safeguards where appropriate. She also Care Homes for Older People Page 16 of 26 Evidence: confirmed that all staff have been trained in Safeguarding Adults and this training is regularly updated. Care Homes for Older People Page 17 of 26 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 standard of decor and maintenance within the home is satisfactory, providing people living in the home a safe, homely and comfortable environment. Evidence: A tour of the premises was carried out and eleven bedrooms were visited in addition to two communal bathrooms and toilets, the laundry, the communal lounge and dining room. Most parts of the home are well maintained and decor is generally good, with individual bedrooms being attractively decorated and comfortable. Two windows did not have restrictors fitted and one resident was not able to adjust the heating in their room as the control on the radiator was missing. The registered manager explained that the maintenance person was due to visit on the day and would deal with these matters with immediate effect. The work on the rear garden has almost finished, providing an attractive place for residents to sit. There is on-going work to ensure continual improvements are made and the registered manager explained a plan to provide raised beds to enable residents to do some gardening and grow herbs for use in the home. The home has introduced pressure mats for those residents who wake at night. This measure enables staff to be alerted when these residents get out of bed and, as a result falls at night have been significantly reduced. The laundry facilities are satisfactory and washing machines are able to wash clothes at temperatures that control the risk of infection. Staff are trained in infection control Care Homes for Older People Page 18 of 26 Evidence: and as an additional measure against cross infection, hand gel is available outside all communal toilets and bathrooms. Care Homes for Older People Page 19 of 26 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. There are sufficient staff with appropriate skills to meet the needs of those people living in the home and the recruitment practice is also sufficiently robust to safeguard those living in the home Evidence: There are currently two care staff on duty for each daytime shift with an extra carer for the busy times of 6.30 am -10.30am. This is in addition to the registered manager, cooks and domestics. The home has recently employed a supper cook which gives carers more time to provide care to residents. Night staff comprises one waking and one sleeping carer with one of the managers or providers also on call. The registered manager has introduced a means of consulting with residents in respect of new staff prior to staff being permanently employed. This system allows residents to comment on the care given and general competence of new staff and have a say in how the home is run. There is a robust staff training programme and of the fourteen care staff, ten either have or are working towards gaining National Vocational Qualifications in care at level 2. Therefore the home exceeds the required 50 of staff with this qualification. The deputy manager has already achieved this qualification at level 3 and is in the process of working towards gaining level 4. The registered manager confirmed that thirteen staff have been trained in dementia care and all staff are required to do mandatory training in fire, infection control and manual handling. Two new staff have Care Homes for Older People Page 20 of 26 Evidence: yet to do their manual handling training and the registered manager confirmed that they will not assist residents with transfers until this training has been done. Staff are supported via regular meetings and one-to-one formal supervision. Throughout the visit it was evident that staff were comfortable approaching the manager with any queries. The recruitment records for the last three people to be recruited were viewed and all had provided the required documentation of a Criminal Record Bureau check, two written references and proof of identity. Two people had not provided a full employment history with a written explanation for any gaps. The registered manager agreed to deal with this on the day therefore no requirement was made. Care Homes for Older People Page 21 of 26 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. People living in the home and staff benefit from clear leadership and direction and all aspects of their health, safety and welfare are protected and promoted. Evidence: The registered manager has the required qualifications in management and care and has worked at St Marguerites for a number of years. The home uses a variety of information to inform the quality monitoring systems including minutes from staff and residents meetings, complaints and concerns and inspection reports. In addition further information is gathered from questionnaires completed by residents. It was good to note that some residents meetings have been chaired by a resident which indicates that there are good systems in place to consult with residents. Where issues have been raised the manager has acted upon them. This is evidenced by the changes in menus and providing a tuck shop each fortnight. The home has introduced external quality monitoring in the form of health and safety and the CQS ISO9001. Earlier this year the home achieved the Investors in People Care Homes for Older People Page 22 of 26 Evidence: award, which indicates good staff training and management programmes. All staff have regular one-to-one supervision and these records demonstrate these sessions are used to effectively identify training needs. The registered manager said she is in the process of reviewing and updating all the homes policies and procedures to ensure they accurately reflect current services provided. She also intends to revise the staff handbook. Information provided prior to the site visit showed that regular safety checks are carried out on all equipment, electrical and gas appliances and systems. All staff receive regular fire safety training and a fire risk assessment has been carried out and all recommendations met in line with the set timescales. Regular fire drills are carried out and fire alarm systems regularly tested ensuring neither staff nor people living in the home are at risk in the event of fire. The accident book was viewed and found to be maintained in line with current legislation and the manager regularly reviews the book to identify areas where residents may be at risk. Care Homes for Older People Page 23 of 26 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 24 of 26 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 25 of 26 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). 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. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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