Care Home: St Mark`s Nursing Centre

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What the care home does well St. Marks offers a purpose built care home environment, and therefore has a completely accessible building. The corridors and doorways are wide, and there are passenger lifts available. The home is clean and fresh throughout, and residents spoken with were happy with their rooms and with the communal spaces available. There are regular activities at the home, and residents commented favourably on the variety of activities and in particular on how good the activities organisers were at arranging things. There were also favourable comments made on meals and mealtimes, and those spoken with in the dining rooms said they enjoyed the food. Residents can choose from a variety of meals and snacks, and this includes a cooked breakfast which is available seven days a week for anyone who wishes to have it. Care planning arrangements are well developed and the home uses the `Quest` assessments and care planning tools provided by BUPA; those sampled were completed in full and provided a clear picture of residents needs. The management arrangements have changed since the previous inspection and the new manager, who started in December 2008, demonstrated during the inspection, that she was both committed and enthusiastic regarding bringing about further improvements to the service offered at St. Marks. What has improved since the last inspection? The single Requirement made at the previous inspection has now been met. This concerned ensuring that all residents, irrespective of their funding source, had a contract setting out their terms and conditions with the home. A total of eight Recommendations were made, and most of these have been met. These included reviewing the number of pressure relieving cushions and mattresses available, giving the activities organisers some training in working with dementia clients, and ensuring that senior staff have had the local authority`s training on safeguarding adults. Staff are now given support when they are having video based training sessions, and relevant staff now have food hygiene training. Other improvements include a new and clear management structure for each Unit which is displayed on each Unit. It includes the names of staff who are taking the lead on various specialist areas for example infection control, activities, and clinical issues. Those staff spoken with supported the new management arrangements and demonstrated a good team spirit within the home. The new manager is bringing about improvements on the dementia Unit, including improving the decor, and introducing, with the activities organisers, `themed` areas which will add interest and stimulate reminiscence sessions with residents who live there. The home is about to introduce revised menus which have brought back the second hot meal option at lunchtime. The manager and the chef have worked closely to ensureresidents get more variety and, following the inspection, now have a separate vegetarian option menu available. The manager has put forward 10 members of staff for NVQ training, recognising that the home is still far from reaching the recommended 50% of care staff having a qualification in care work. She has arranged training for registered nurses in response to feedback from local health professionals, and now there should always be at least one member of staff on duty who can take blood from residents, or in appropriate circumstances, certify a death. Three senior staff have done advanced training in moving and handling, and each Unit now has their own moving and handling coordinator. Staff have also had more training on the use of pressure relieving equipment. What the care home could do better: One Requirement was made at this inspection and this concerned ensuring that all the information set down in Schedule 2 of the Care Homes Regulations is sought for all staff. Two Recommendations were made and these are listed at the end of this report. Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Mark`s Nursing Centre 110 St Marks Road Maidenhead Berkshire SL6 6DN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Dickens     Date: 0 7 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 32 Information about the care home Name of care home: Address: St Mark`s Nursing Centre 110 St Marks Road Maidenhead Berkshire SL6 6DN 01628582800 01628582899 mitchsus@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): BUPA Care Homes (ANS) Ltd The registered provider is responsible for running the service care home 80 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 0 80 dementia old age, not falling within any other category Additional conditions: 80 0 The maximum number of service users to be accommodated is 80. The registered person may provide the following categoryof service only: Care home with Nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age- not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home St Marks Care Centre is purpose built and was completed in 2005. The decoration and furnishings are of good quality and provide a very attractive environment. The home is built next door to the local hospital and is accessed via the hospital grounds. The home is arranged in four wings, one is a dementia care unit, one is a rehabilitation Care Homes for Older People Page 4 of 32 Brief description of the care home unit, provided under contract to the Primary Care Trust and two are care home with nursing units, offering care to a mixture of privately funded service users and service users funded by the local authority. All rooms are spacious and have en-suite facilities of a toilet, hand basin and shower. All four units have their own communal lounge and dining room, as well as a smaller lounge for private use. The home is arranged over two floors. There are gardens with seating arranged round the home. A separate, securely fenced garden is provided for the dementia unit. The home is close to the centre of Maidenhead, with a large shopping centre and other community facilities. St. Marks provides accommodation for up to 80 service users (20 per unit). Care Homes for Older People Page 5 of 32 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: This Key Inspection was unannounced and took place over 8 hours. The inspection was carried out by Mrs. Helen Dickens, Regulatory Inspector, and the new manager, in post since December 2008, represented the establishment. A partial tour of the premises took place and a number of files and documents, including four residents care plans, staff training and recruitment files, quality assurance information, and the Annual Quality Assurance Assessment (AQAA), were examined as part of the inspection process. The inspector also spoke with 12 residents and 4 members of staff during the day. A total of 11 surveys were returned to the Commission from residents, staff and health Care Homes for Older People Page 6 of 32 professionals who work with this service, and these were used in writing this report. Four follow up telephone calls were also made to health professionals. Current fees at this home range from 750.00 to 1000.00 per person per week depending on the needs of the client. Please contact the home for more details about fees. The inspector would like to thank the residents, staff and the new manager for their time, assistance and hospitality. What the care home does well: What has improved since the last inspection? The single Requirement made at the previous inspection has now been met. This concerned ensuring that all residents, irrespective of their funding source, had a contract setting out their terms and conditions with the home. A total of eight Recommendations were made, and most of these have been met. These included reviewing the number of pressure relieving cushions and mattresses available, giving the activities organisers some training in working with dementia clients, and ensuring that senior staff have had the local authoritys training on safeguarding adults. Staff are now given support when they are having video based training sessions, and relevant staff now have food hygiene training. Other improvements include a new and clear management structure for each Unit which is displayed on each Unit. It includes the names of staff who are taking the lead on various specialist areas for example infection control, activities, and clinical issues. Those staff spoken with supported the new management arrangements and demonstrated a good team spirit within the home. The new manager is bringing about improvements on the dementia Unit, including improving the decor, and introducing, with the activities organisers, themed areas which will add interest and stimulate reminiscence sessions with residents who live there. The home is about to introduce revised menus which have brought back the second hot meal option at lunchtime. The manager and the chef have worked closely to ensure Care Homes for Older People Page 8 of 32 residents get more variety and, following the inspection, now have a separate vegetarian option menu available. The manager has put forward 10 members of staff for NVQ training, recognising that the home is still far from reaching the recommended 50 of care staff having a qualification in care work. She has arranged training for registered nurses in response to feedback from local health professionals, and now there should always be at least one member of staff on duty who can take blood from residents, or in appropriate circumstances, certify a death. Three senior staff have done advanced training in moving and handling, and each Unit now has their own moving and handling coordinator. Staff have also had more training on the use of pressure relieving equipment. 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 set out 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 9 of 32 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 32 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. No service user moves into the home without their needs being properly assessed and being assured these will be met. Service users referred solely for intermediate care are helped to maximise their independence and return home. Evidence: Four residents files were sampled and all found to contain a BUPA Quest assessment, and a Map of Life. The Quest assessments were completed in full and all but one was signed. The unsigned assessment had only just been completed for a new resident, and was signed during the inspection. The BUPA assessment format takes an overview of all the key areas, which leads on to a related care plan if the resident has any needs in that particular area, for example in relation to communication, mobility, personal care etc. BUPA policy ensures that all residents who wear spectacles have a care plan on this matter which ensures residents are supported in this regard. Care Homes for Older People Page 11 of 32 Evidence: The Map of Life sets out a residents social history and interests and hobbies. All files sampled had these and some had additional written information from residents families. A number of other standard documents on each file included consent to have photographs taken (for example a facial photograph for each persons medication file), and records of health visits, family visits, and a health and safety checklist which is completed on the bedroom as each new person moves in. One recently admitted resident had turned out to have greater needs than had been anticipated during the assessment, and staff where working closely with this resident, their family and medical practitioner, to address some of the difficulties which had arisen. Five surveys were returned from service users and four said they had received a contract from the home about their terms and conditions. A fifth survey left this answer blank. The inspector asked to see the contracts of the four residents whose files were being sampled. The administrator was able to demonstrate that three out of the four had contracts, and the fourth person, a newly admitted resident, was waiting for the contract to be signed by a relative. The Requirement made on this subject at the previous inspection is now deemed to have been met. The home is divided into four units, and one provides intermediate care and rehabilitation. Temporary residents are funded by the PCT for a course of rehabilitation and recuperation. The home has its own rehabilitation gym, set up by the PCT, and for the exclusive use of their clients. Visiting health professionals provide specialist support e.g. Occupational Therapists and Physiotherapists. One residents file was sampled and found to contain appropriate assessments, care plans and risk assessments. Two health professionals visiting the unit made a number of comments including Good environment - new and pleasant building to work in. There were a few comments relating to shortage of staff, and the training of staff which were brought to the attention of the manager to deal with. These issues are also discussed under Standard 8 on health care. Care Homes for Older People Page 12 of 32 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. Residents benefit by having detailed care plans in place, and by the arrangements for supporting them with their health care. Medication administration is well organised, and residents are treated with dignity and respect. Evidence: Four residents files were sampled, one from each Unit. All had care plans in place and these had been generated from the BUPA Quest assessments outlined in the previous section of this report. In the main, there was a good level of detail about care needs, and staff were using a person centred approach. One personal care plan needed more detail and the nurse in charge said this would be rectified. The manager said all care plans are kept in residents rooms though during the afternoon all care plans which were seen by the inspector were at the nurses stations; staff said this is because they were being up-dated with daily notes etc. The manager may wish to consider, where possible, having these up-dates made with each resident to ensure their continued involvement in their own care planning. Those care plans Care Homes for Older People Page 13 of 32 Evidence: sampled had been reviewed at least once per month and those residents with fluctuating or changing needs were reviewed more frequently. Care plans included relevant risk assessments e.g. in relation to skin integrity, falls, nutrition, and moving and handling. Mental Capacity Act assessments are on each residents file though the inspector queried whether these assessments are too generic, that is, they are completed by staff in a way that comments on the overall mental capacity of a resident, rather than their mental capacity in relation to specific decisions they have made or may be asked to make. The new manager said she would follow this up with BUPA. The manager was familiar with the Deprivation of Liberty Safeguards Guidance from the Department of Health but was asked to follow up, with the local authority, whether any specific assessments were needed for residents in the dementia unit where the key pad on the door and lifts acts as a locked exit. There are good arrangements in place for managing residents health needs including a specialist GP visiting the rehabilitation Unit twice per week, and other professionals attending daily including physiotherapists and occupational therapists. The other Units have a different GP and both the GPs, and an occupational therapist returned surveys to the Commission. Relevant care plans were in place in relation to health concerns such as nutrition, pressure ulcers and skin integrity. Those who had specific health and medical needs had the relevant care plans, including for example for catheter care, for high doses of opiates, and for behaviour monitoring. There were good records of health related visits and appointments. One file sampled showed the resident had come in with pressure sores and a good level of record keeping was noted in this regard. Permission to take photographs was signed by their family (as the resident was unable to do this) and there was a specialist care plan for the pressure sores. BUPAs own template was used for up-dating and reviewing the residents condition, and there were good daily notes and a body chart which noted the specific areas affected. There was a written up-date on progress with the ulcers, and a short term care plan for antibiotic treatment. Surveys returned from the two health professionals who go to the rehabilitation unit had concerns about staffing. They both agreed, in follow up telephone calls by the inspector, that the Unit Manager was very good but standards are not so high when she is not present. Residents discharges from this Unit have recently been organised when the Unit Manager is on duty to avoid some of the problems experienced in the past. The manager will be advised to liaise directly with them to address some of these concerns. Care Homes for Older People Page 14 of 32 Evidence: The GP who covered the remainder of the home had some positive comments including, in answer to What do you feel the care service does well? noted; Seems to maintain a good community spirit and seeks to improve the physical, emotional and social needs of the patient. This GP also noted that I feel that some of the nurses feel a little out of their depth when faced with certain situations and more often than not will involve the GP. Better training and more staff will improve this. The manager said that more staff have now been trained to take blood, and to certify deaths, as these were two areas specifically highlighted by visiting health professionals. Out of five service user surveys returned to the Commission, four ticked that they Always received the medical support they needed, and one ticked Usually. The medication arrangements were checked on one unit and medication was found to be kept securely in a locked trolley in the clinical room. St. Marks uses blister packs and preprinted medication administration records from the pharmacy. Both the room and the trolley were clean and tidy, with extra stocks kept in a separate locked cupboard. Unit managers audit medication records, but not on their own Unit.The ordering arrangements were explained to the inspector and staff said records are in triplicate with one each for the pharmacy, the home and the GPs surgery. Records are kept of medication consigned for destruction. One medication administration record was sampled and there were no unexplained gaps. The Controlled Medication (CDs) was also checked for one resident, and the medication tallied with the record in the CD book. Staff said the Controlled Drugs are checked at shift handover and signed for in a separate book. During the inspection, residents were seen to be treated respectfully, for example by staff knocking on doors and giving residents choices. All five residents who completed a survey said staff listened to them and acted on what they said. Good records were kept of personal preferences and some individual care plans were noted to address the issue of preserving the residents dignity whilst providing care. One resident who was making a complaint to the manager was dealt with courteously, and steps had been taken to discuss this with senior managers to ensure the fairest outcome for the resident. Care Homes for Older People Page 15 of 32 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. Residents have a variety of activities available to them, and their family and friends are made welcome at the home. They are given opportunities to make decisions in their daily lives, and are offered a varied diet in pleasant surroundings. Evidence: Residents assessments contain information about their social history, and any activities they are interested in. There are a variety of activities available at the home and two part time activities co-ordinators. There are excellent hairdressing facilities with a luxurious salon and a dedicated and enthusiastic hairdresser. It was noticeable how many residents had very well kept hair. The manager said the activities organisers work in the dementia Unit during the morning, and then have activities in a dedicated activities room in the afternoon. The home is working towards improving activities for residents on the dementia Unit and the manager, who has done training herself and accessed a specialist report from another home, has worked with activities co-ordinators on this. They have developed themed areas in three corridors on the dementia Unit. There will be objects which residents can see and feel (e.g. clothes and objects from years gone by), and laminated pictorial information on the relevant themes, for example sport and famous people. Care Homes for Older People Page 16 of 32 Evidence: During the inspection, residents complimented the activities organisers for the work they did, one telling the inspector The activities are different every day.....the activities staff work very hard. There was bingo in the activities room on the day of the inspection. Residents can have the option of an alcoholic drink with their meal and one person who was having a glass of wine told the inspector I totally approve of this. Five residents who returned surveys to the Commission all ticked that there were always activities they could join in with at the home. Some added comments such as Thoroughly enjoy; Very good; and one noted it would be nice if BUPA had a mini bus to take residents out. Residents can have visitors at any reasonable time and friends and relatives are welcome at the home. BUPA produces leaflets, available in the reception area, aimed at relatives and friends. Two of those residents whose files were sampled had had very close family involvement during their admission and whilst at the home, one from a daughter, and the other from a spouse. Staff spoken with were knowledgeable on family wishes and involvement, and they said care plans are kept in residents rooms which helps their family to stay involved in their care. The manager also aims to ensure the home remains part of the local community and she informed the inspector that she had organised a community tea party for residents and their families, and she had invited members of the local authority and GP practices. Residents are given some opportunities to exercise choice and control over their lives They are allowed to bring personal possessions and the bedrooms visited had a variety of photographs, pictures, and personal memorabilia. Residents are offered a choice of food, with the option of a cooked breakfast each morning if they wish. Regrettably a previous manager had reduced the lunchtime choices from two down to one choice of hot main course. The new manager and the chef were reintroducing this second option from the end of the month, as soon as the new menus could be typed up. Nutritional risk assessments are in place at this home for all residents and any special diets are noted on their care plans. The staff could give examples of where a dietitians advice had been sought. The inspector visited two dining rooms at lunchtime and spoke with around ten residents who were having their lunch. St. Marks has pleasant dining areas with linen cloths and napkins. Those residents spoken with made positive comments including; Shepherds Pie quite nice;On the whole its good;and Carers ask everyone what they would like for all meals. Care staff were noted to be helpful to those residents who needed support, and this Care Homes for Older People Page 17 of 32 Evidence: was obviously appreciated as several residents praised the staff, one saying Staff here are nice caring people. The chef was interviewed and found to be enthusiastic and knowledgeable on residents preferences. He was particularly knowledgeable about the likes and dislikes of one vegetarian resident, who later told the inspector the food is lovely. The inspector noted that this persons choices were rather limited. Following some discussion the chef agreed to do a vegetarian menu which care staff could let the resident choose from on a daily basis. On the day following the inspection, the manager rang the inspector to confirm this had been done. Care Homes for Older People Page 18 of 32 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. Complaints are listened to and taken seriously at St. Marks, and the policies and procedures in place should protect service users from abuse. Evidence: The BUPA complaints policy is in place and displayed in communal areas for residents and relatives to see, and residents have a copy in their rooms. BUPA monitor complaints centrally and the home sends a monthly return to their head office. The monthly Regulation 26 visits on behalf of the provider also cover complaints on their standard agenda for the visit. Complaints records were sampled for the last three months, January to March 2009. Only one complaint was received during this time, which was a safeguarding adults matter and referred, by the home, to the local authority. This has now been satisfactorily concluded. One complaint had been made in April and the resident involved checked on progress with the manager during the inspection. The resident emphasised that at this stage they did not want to make this an official complaint. Another resident made a complaint during the inspection, and they reported this to the administrator and the manager in the first instance. Out of the five surveys returned to the Commission from residents, three ticked they would Always know who to speak to if they were not happy, one ticked Usually, and Care Homes for Older People Page 19 of 32 Evidence: one ticked Sometimes. All five ticked Yes in response to the question asking them if they knew how to make a complaint. BUPA has policies and procedures are in place to safeguard vulnerable adults, and the home uses the local authority multi agency procedures alongside their own. Training records showed that all staff, including recent recruits, have done safeguarding adults training. In the last 12 months there have been five safeguarding adults referrals made to the local authority in relation to this home. The safeguarding adults co-ordinator at the Royal Borough of Windsor and Maidenhead was contacted by the inspector prior to this visit and confirmed that all these matters had now been satisfactorily concluded. Care Homes for Older People Page 20 of 32 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. St. Marks offers a pleasant and well maintained environment for residents to enjoy. The home is clean and hygienic throughout, and now has much improved measures for preventing the spread of infection. Evidence: A partial tour of the premises took place and each Unit was visited at least once during the inspection. Some communal rooms, bedrooms, and domestic areas were looked at in more detail. The home is purpose built and accessible with wide corridors and doorways, and lifts and equipment suitable for the purpose. St. Marks was clean and tidy, with no unpleasant odours. The building is well maintained and individual health and safety assessments are carried out on each bedroom as new residents are admitted. Residents told the inspector they were happy with their rooms. Those bedrooms visited had been personalised with each residents belongings, and were well furnished with colour co-ordinated curtains and bedspreads etc. Positive comments included Its lovely here. The hairdressing salon is stylish and comfortable and is well used. There is a dedicated activities room and there are planned activities each weekday afternoon. The kitchen is large and well fitted out. A recent Environmental Health Officers report Care Homes for Older People Page 21 of 32 Evidence: mentioned only one minor repair which the manager said has now been done. There is also a large laundry room with commercial washers and driers, and sufficient staff employed to carry out this work. More work is being done on the dementia Unit including redecorating the hallways. The manager said they are working on three themed areas to interest and stimulate residents, and some of the items, for example a period wedding dress, were shown to the inspector. The manager said she had also had the ornamental fireplace installed in the Units lounge to give it a more homely feel. The rehabilitation Unit has its own gym for the exclusive use of residents on that Unit, and health professionals visit the Unit to carry out various therapies. The dining areas visited were very pleasant with linen tablecloths and napkins, and residents commented on the pleasant dining area. During the tour of the premises the inspector noted a number of notices in communal areas which instruct staff regarding various BUPA safety policies. There were also handwritten notes on scraps of paper taped to furniture (in bedrooms and communal areas) to remind residents with dementia where things were kept. The inspector felt these arrangements detracted somewhat from the otherwise homely ambiance that staff were trying to create. Having visual reminders for dementia care clients is a good idea where these are well done and neatly attached. There were no unpleasant odours in this home and nine domestic staff are employed to keep the home clean and tidy, two of whom work in the laundry. The manager said all staff do infection control training and records sampled showed that out of a total of over 100 staff, only seven had yet to complete the course. The home has had three outbreaks of infection over the winter and the manager said they have worked with the Health Protection Agency and the local PCT nurse specialist to deal with these outbreaks and to improve arrangements for prevention. The inspector spoke with both the HPA and the specialist nurse who thought the home had worked well with them and was putting the necessary measures in place to minimise the risk. One factor which can increase the risk of an outbreak is admitting people from the acute hospital sector, and this home has its own dedicated rehabilitation unit where many clients do come directly from hospital. During the outbreaks the Unit affected would be closed to visitors and special measures were put in place; a deep clean is then carried out once the outbreak is over. The specialist nurse is returning to the home in May to carry out an audit of the improved arrangements. Care Homes for Older People Page 22 of 32 Evidence: The new manager outlined the steps she had taken including giving a member of staff an overall lead for infection control at the home. This person was interviewed and found to be knowledgeable and enthusiastic, outlining arrangements for training and an action plan which is already underway to improve infection control compliance prior to the audit planned for May. Care Homes for Older People Page 23 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users needs are met by the numbers and skill mix of staff, but more work needs to be done with visiting health professionals as outlined in the report. Fewer than 25 of care staff have a qualification in care work and the manager is working hard to increase the number of staff with NVQ Level 2 qualifications. Recruitment arrangements are well developed but further work is needed. Staff training arrangements continue to improve at St. Marks. Evidence: The new manager outlined the staffing arrangements at the home, and has good systems in place to organise the workforce. Each unit has 4-5 staff, one would be an RGN and they would allocate work to the staff on the Unit for the next day. There are clear staffing and management structures in place for each Unit and a copy of the chart is in each Unit for staff to see. Staff are given opportunities to take the lead on specific areas including infection control, health and safety, and moving and handling. Seven new care workers started in March and domestic staff are employed in sufficient numbers to effectively manage the catering and housekeeping operations. A number of concerns were raised on surveys returned the Commission regarding staffing levels and competency. These were highlighted to the manager who was able to outline how she felt these were already being dealt with. On the issue of shortage of Care Homes for Older People Page 24 of 32 Evidence: staff, she said that for a variety of reasons, a number of permanent staff had left the home and she had now recruited replacements. As the home is not currently full, she said the staffing levels were very good. Another issue from health professionals related to staff training, for example staff not being able to take blood, or (in appropriate circumstances) to certify deaths. The manager said there would now be sufficient staff trained to carry out these tasks as more staff were now trained, for example there were now 8 staff trained to certify deaths. A third issue concerned the arrangements on the rehabilitation unit where both health professionals who completed surveys for the Commission in relation to the unit, said that the Unit manager was very good, but in her absence, other staff were unable to maintain the same standard, for example in relation to the smooth discharge of patients. As the surveys were completed in February, at least 7 weeks before the inspection was being carried out, the inspector suggested contacting the respondents to see if their opinions had changed, in view of the improvements the manager was making. Two of the three were contacted (a third has moved away from the area) and, in the main, they were of the same opinion. These comments were passed to the manager and a recommendation is being made that she liaise more closely with visiting health professionals to ensure the best possible service for residents. The National Minimum Standards recommend that, in addition to having trained nurses, at least 50 of the care staff should be trained to at least NVQ Level 2. The manager has recognised the homes shortfalls in this respect and has worked hard to increase the numbers. Out of a total of 39 care staff, 9 already have NVQs, 8 are currently working towards this qualification, and she has nominated 10 more to start the course. The manager also said that 4 of the care staff have a nursing qualification gained abroad. Recruitment files are well kept and two were sampled for recently recruited staff. Both had Criminal Records Bureau checks, and POVA checks to ensure they had not been deemed unsuitable to work with vulnerable people. Two references were on file for each worker, and each had a written employment history to show where they had worked prior to starting work at this home. However, the first had a gap in employment history. The manager said she remembered this person had been away from the workplace due to family Care Homes for Older People Page 25 of 32 Evidence: commitments, but this needs to be properly documented. The other also had gap from 2004 and the manager thought this was due to bringing up children; again this was not documented. One person had previously worked with young children but no reference had been sought from that employer and the manager was asked to follow this up. A Requirement will be made in this regard. All new staff receive an induction, and the two staff files sampled for new staff, both had the proper induction arrangements in place. The manager signs off each induction and BUPA arrangements fit with the recommended Skills for Care Common Induction Standards Three training areas were sampled: safeguarding, moving and handling, and infection control. It was found that all staff had done safeguarding adults and moving and handling training, and only seven had yet to complete infection control training out of over 100 staff at the home. Training records were well kept and a staff training matrix is in place. Some blank spaces where the matrix had not been updated were brought up to date during the inspection. The manager is very committed to staff training and has worked hard on this since her arrival at the home. Care Homes for Older People Page 26 of 32 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 home has a new manager who is committed to improving standards and to managing the home well. Quality assurance processes are in place to ensure the home is run in the best interests of service users. The financial interests of people who live at the home are safeguarded by BUPAs policies and procedures. The health, safety and welfare of residents and staff are promoted at this home. Evidence: The new manager started at St. Marks in December 2008. She is competent and committed and has made a number of improvements in the last 4 months. For example staff are clearer about their responsibilities and those spoken with supported the new manager in the improvements she was making. She has been a registered manager for four years in another home before moving to St. Marks. She is a Registered Nurse who has degree level qualifications in dementia, tissue viability, and mentorship. She also has a Masters Degree and recent practical training in first aid, fire training, and palliative care. She has completed the managers induction Care Homes for Older People Page 27 of 32 Evidence: programme with BUPA, and has completed the Registered Managers Award. There are clear lines of accountability within the home and she has introduced a printed management structure for each unit, with staff having delegated responsibilities and areas of special interest. Staff were seen to be given autonomy and offered support to develop their particular areas. The manager also holds a short daily meeting with the nurses in charge of each unit to look at key performance indicators such as admissions and discharges, any staffing issues, and any incidents on the units. A number of positive comments were made in relation to the new management of the home and both staff and residents appreciated the current management style. The new manager has not yet started her registration with the Commission. This was discussed during the inspection and she said BUPA policy was that managers started registration following a six month probationary period. She thought this would be brought forward following this inspection. The previous registered manager left in September 2008 so the home has already had 6 months without a registered manager. Quality assurance arrangements at St. Marks follow the BUPA policy including assistance from national quality and compliance officers. They support quality issues within the home including auditing and providing guidance on policies, procedures and practice. The home carries out a variety of audits for example in relation to medication, health and safety, and care plans. There are also internal and external BUPA surveys. A representative of the provider carries out monthly Regulation 26 visits to the home, and BUPA reviews their policies and procedures in the light of changing legislation and good practice. The manager was keen to receive feedback during the inspection and to rectify any shortfalls as soon as possible. The single Requirement from the previous inspection has now been met, as have most of the 8 Recommendations that were made. Residents or their families can deposit small amounts of money with the home for use on day to day expenses for example chiropody, newspapers, and the hairdressers visits. A small float is kept in the home so that residents can obtain cash when they need it. Interest is added to accounts monthly. There are computer records and a receipts book which the administrator uses to do a reconciliation each month. The manager also checks these accounts once per month. The Regulation 26 visit looks at the previous months reconciliation and a senior financial administrator also checks accounts when he visits (twice since January). BUPA also arranges occasional spot checks from external auditors and the last one was in 2007 at this home. Care Homes for Older People Page 28 of 32 Evidence: The home uses standard BUPA policies and procedures to maintain a safe environment and regular monitoring is carried out. For example all new residents have a health and safety assessment in their room when they move in and these were seen for all those residents files sampled. There are risk assessments in place for potentially hazardous activities such as the use of bed rails, and moving and handling. Potentially hazardous areas were kept secure when not in use, for example the gym, the laundry, and the hairdressing salon. Health and safety is covered during induction for new staff, and training is provided on related topics such as moving and handling. Some cleaning materials were left in a storeroom on one unit and these were moved immediately by the manager. She reminded staff about their responsibilities in this regard. The potential risk was minimal as the storeroom was not in an area accessible to residents with dementia or cognitive impairments. Care Homes for Older People Page 29 of 32 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 30 of 32 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 1 26 19 All the recruitment 07/05/2009 information set out in Schedule 2 of the Care Homes Regulations 2001 (as amended), must be sought for all staff prior to them working at this home. This should include a documented full employment history, and appropriate references. For the safety and welfare of service users. 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 1 8 The home should liaise more closely with visiting health professionals to ensure the best possible service for residents. The home has been without a registered manager since September 2008 and this should be addressed as soon as possible. 2 31 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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