Care Home: St Martins Residential Home

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What the care home does well The care plans for the people using the service give clear guidance to staff on the support they need. These are reviewed on a regular basis making sure that the information staff have is up to date. People are supported to remain healthy and staff are supporting people to attend health appointments on a regular basis. Staff showed good knowledge and understanding of the needs of the people living at St Martins. During this visit staff were observed talking to the people who use the service in a polite manner and showing a good rapport with them. We spoke to people living at the home about their home and the staff and most people told us they were happy living at St Martins. They said that the staff are respectful towards them and support them in whatever they wish to do. We received 7 comment cards from people living at the home which overall were mostly positive about their experiences. Some comments made were: "Staff look after me well." "The home does most things well." "The home makes sure I take my medications. "The home is clean, staff are caring and there are good meals." "The home caters for all needs. Im happy with the home." Staff spoken with said they believe a good service is provided to the people living at the home and that they are supported to make choices about their daily lives. They said a relaxed environment is provided which is suited to the needs of the people living there. What has improved since the last inspection? The statement of purpose and the service user guide for the home have been updated and now include the information that prospective and current service users need about the home. The manager and staff have worked hard in further developing in house activities so that people can enjoy time together socially. The home now has access to a 7 seater vehicle which has increased opportunities for the people using the service to go out. There was evidence that work had taken place to improve the appearance of the home since we last visited. For example, new flooring was available in the hall, conservatory, bathrooms and toilets. The conservatory, lounge and some bedrooms had been repainted, there were new carpets in some bedrooms and new curtains had also been made available. A further extractor fan had been provided in the conservatory. The manager is in the process of implementing a training plan to help to ensure that staff have the skills to meet peoples support needs and that they are up to date with current good practice. The home has exceeded the national standard for care homes with regard to staff qualifications. This states that at least 50% of the team should hold a care qualification (NVQ). A further member of staff is now on duty during the day whose focus is to support the people who use the service with their hobbies and interests and to engage people in activities. The staff spoken with reported that this allows more time to be spent with the people using the service and improves the quality of the care they receive. What the care home could do better: All incidents that involve the safeguarding of vulnerable adults must be reported to Wirral Social Services and the Care Quality Commission. Any other incidents that adversely affect the well being of people using the service must also be reported to the Care Quality Commission. This must be done in order to safeguard and promote the well being and safety of service users. Risk assessments must clearly identify the action that staff are to take to minimise risks. This is to ensure that the people using the service are supported to keep safe. Further work is needed on the financial care plans and clear policies are needed for the management of the finances of the people who live at St Martins in order to ensure they are safeguarded from any potential risk of financial abuse. The manager is to ensure that evidence is available to indicate the electrical wiring at the home is safe. This information is needed so that the Care Quality Commission can be sure that the people using the service and and the staff are being kept safe from any unnecessary risks to their well being. Two references must be obtained before a person is employed and references must contain sufficient information. This information is needed to determine whether an applicant is suitable for the post they have applied for. All staff must be suitably qualified and competent and must be given the right training to do their work. Updated training must include, medication administration, fire training, coshh and mental health needs. This is to ensure that staff can always support the health and welfare of people living at St Martins. An application must be made to the Care Quality Commission to register a manager for the service. This process helps to ensure the suitability of managers to manage a registered care home. The admissions procedure for the home is to be revised to ensure that it appropriately reflects the practices at the home. The manager should ensure a controlled drugs book is used to record and manage any use of controlled drugs to help show clear records and safe management of controlled medications.A maintenance, decoration and development plan should be put in place to let people know when improvements to the home environment are going to take place. A policy or guidance should be available to indicate when to make reports to the Care Quality Commission regarding adverse incidents regarded as regulation 37 reports. The quality assurance systems need further development in order to evidence improvements in the overall management and monitoring of quality in the service. Key inspection report Care homes for adults (18-65 years) Name: Address: St Martins Residential Home 63 Martins Lane Wallasey Wirral CH44 1BG     The quality rating for this care home is:   one star adequate 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: Beate Field     Date: 1 5 0 6 2 0 1 0 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 Adults (18-65 years) Page 2 of 34 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 Adults (18-65 years) 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: St Martins Residential Home 63 Martins Lane Wallasey Wirral CH44 1BG 01516399877 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Assistwide Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 16 Date of last inspection Brief description of the care home St Martins Residential Home is situated in a residential area of Wallasey, close to Liscard Village. It is a detached property with three floors and a number of internal changes of level. The building does not have a lift. The home would not be suitable for an independent wheelchair user or anyone with a physical disability. St Martins is not externally identified as a care home and blends in with the surrounding buildings. There are twelve single bedrooms and two that can be shared if Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 16 Brief description of the care home people wanted to. The home has a dining room, one lounge, and a conservatory which overlooks the large garden and also serves as the smoking room. Shops, a post office, pubs, restaurants, other community facilities and bus routes are available in Liscard, a short walk from St Martins. A service user guide and a statement of purpose, which describe the services offered is made available to people who are interested in St Martins. A copy of the most recent inspection report can be obtained from the manager. The fees for the home are GBP1445.64 per month. Care Homes for Adults (18-65 years) Page 5 of 34 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We carried out an unannounced visit to the home on the 15th June 2010. This visit took place over 6 hours. Our visits involve measuring a number of standards considered as important by the Care Quality Commission. The Care Quality Commission considers 22 standards for Care Homes for Adults as key standards, which have to be inspected during a key inspection. All key standards for this type of service are highlighted in bold in the relevant sections of this report. Before the visit, we asked the manager to complete a detailed questionnaire about the home that we call an annual quality assurance assessment (AQAA). This gave us lots of information about developments at the home and statistical data that we used to plan our visit to the home. Care Homes for Adults (18-65 years) Page 6 of 34 Before our visit we sent out survey forms to the home. We received 7 from people living at St Martins and 6 surveys from members of staff. Their replies helped us with planning our visit and in writing this report. During our visit, we talked with people who live at the home and with staff. We observed how staff were providing support for the people living at the home and we looked around the building to see its facilities, including a sample of bedrooms. We also spent time looking at records and policies and procedures. The inspection was carried out with the manager of the home. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? The statement of purpose and the service user guide for the home have been updated and now include the information that prospective and current service users need about the home. The manager and staff have worked hard in further developing in house activities so that people can enjoy time together socially. The home now has access to a 7 seater vehicle which has increased opportunities for the people using the service to go out. There was evidence that work had taken place to improve the appearance of the home since we last visited. For example, new flooring was available in the hall, conservatory, bathrooms and toilets. The conservatory, lounge and some bedrooms had been repainted, there were new carpets in some bedrooms and new curtains had also been made available. A further extractor fan had been provided in the conservatory. The manager is in the process of implementing a training plan to help to ensure that Care Homes for Adults (18-65 years) Page 8 of 34 staff have the skills to meet peoples support needs and that they are up to date with current good practice. The home has exceeded the national standard for care homes with regard to staff qualifications. This states that at least 50 of the team should hold a care qualification (NVQ). A further member of staff is now on duty during the day whose focus is to support the people who use the service with their hobbies and interests and to engage people in activities. The staff spoken with reported that this allows more time to be spent with the people using the service and improves the quality of the care they receive. What they could do better: All incidents that involve the safeguarding of vulnerable adults must be reported to Wirral Social Services and the Care Quality Commission. Any other incidents that adversely affect the well being of people using the service must also be reported to the Care Quality Commission. This must be done in order to safeguard and promote the well being and safety of service users. Risk assessments must clearly identify the action that staff are to take to minimise risks. This is to ensure that the people using the service are supported to keep safe. Further work is needed on the financial care plans and clear policies are needed for the management of the finances of the people who live at St Martins in order to ensure they are safeguarded from any potential risk of financial abuse. The manager is to ensure that evidence is available to indicate the electrical wiring at the home is safe. This information is needed so that the Care Quality Commission can be sure that the people using the service and and the staff are being kept safe from any unnecessary risks to their well being. Two references must be obtained before a person is employed and references must contain sufficient information. This information is needed to determine whether an applicant is suitable for the post they have applied for. All staff must be suitably qualified and competent and must be given the right training to do their work. Updated training must include, medication administration, fire training, coshh and mental health needs. This is to ensure that staff can always support the health and welfare of people living at St Martins. An application must be made to the Care Quality Commission to register a manager for the service. This process helps to ensure the suitability of managers to manage a registered care home. The admissions procedure for the home is to be revised to ensure that it appropriately reflects the practices at the home. The manager should ensure a controlled drugs book is used to record and manage any use of controlled drugs to help show clear records and safe management of controlled medications. Care Homes for Adults (18-65 years) Page 9 of 34 A maintenance, decoration and development plan should be put in place to let people know when improvements to the home environment are going to take place. A policy or guidance should be available to indicate when to make reports to the Care Quality Commission regarding adverse incidents regarded as regulation 37 reports. The quality assurance systems need further development in order to evidence improvements in the overall management and monitoring of quality in the service. 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 Adults (18-65 years) Page 10 of 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 34 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Prospective service users are given the information they need to help them decide if the home is right for them. Evidence: An information brochure about St Martins is available to tell people about the services and support they can expect. This helps everyone to decide if St Martins is the right place for the person to live in and if their needs and choices can be met there. This brochure is called a statement of purpose and provides information around the admissions procedure, care planning, a desription of the home and bedroom sizes, healthcare, medication and the complaints procedure. This document has been updated since our last inspection and now provides the required information. No new people have begun using the service since our last visit to the home. We discussed the admissions procedure with the manager who said that a full assessment would be carried out of a prospective resident prior to them being offered a service so as to ensure their needs could be met. The manager said that this assessment would include gathering information from any social and health care professionals working Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: with the person. A sample of records relating to 3 people using the service showed that they had been assessed prior to using the service. The admissions procedure was seen and is in need of revision. This refers to an assessment being conducted within a week of admission where there is no current professional involvement with a prospective resident. This would not ensure that the manager had the information needed to decide whether the home is suitable for the person concerned. The procedure needs to state that an assessment is to be carried out prior to a person being offered a service. Visits can be made to the home by prospective residents to meet the people living there and staff and to discuss the service with the manager. Residents spoken with had visited the home before moving in. A sample of contracts between the home and residents were seen. These were signed by the resident and manager and covered notice periods, trial stays and payment of fees. Care Homes for Adults (18-65 years) Page 13 of 34 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 individual needs of the people living at St Martins are identified by staff and recorded in care plans so staff can support them to meet those needs. Evidence: We looked at three care plans. The plans were well presented and covered each aspect of the persons personal and healthcare needs. The care plans demonstrated that there is up to date information around healthcare, communication needs, personal care, mobility, mental health needs and social support. The plans also had various details showing how each person was supported to stay healthy and safe and supported with specialised healthcare appointments such as visits to the dentist, the doctor and hospital visits. There was evidence that each aspect of the care plan is reviewed on a regular basis and updating information clearly recorded for staff to refer to. Risk assessments showed that in general any risks to the people using the service are Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: clearly identifed and there is clear information for staff to follow around how these risks are to be minimised. The risk assessments for a person identified with the manager needed some further information in order to clearly show how risks to this persons well being are to be managed by staff. The manager agreed to make this information available following the inspection. We spoke to people living at the home about their home and the staff and most people told us they were happy living at St Martins. They said that the staff are respectful towards them and support them in whatever they wish to do. We received 7 comment cards from people living at the home which overall were mostly positive about their experiences. Some comments made were: Staff look after me well. The home does most things well. The home makes sure I take my medications. The home is clean, staff are caring and there are good meals. The home caters for all needs. Im happy with the home. Staff spoken with said they believe a good service is provided to the people living at the home. They said that service users are supported to make choices about their daily lives. They said a relaxed environment is provided which is suited to the needs of the people living there. Care Homes for Adults (18-65 years) Page 15 of 34 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 people using the service are able to take part in appropriate activities. Evidence: Staff have developed care plans to include details of each persons social needs and what they like to do socially. A list of all weekly activities is available in the dining area. Since the last inspection a further member of staff is on duty to support the people using the service with activities. Staff spoken with said the extra staff hours for activities means they get more time to spend with residents. Records of what activity the staff have offered and who has attended the activity are available. Since the last inspection a 7 seater St Martins and its sister home. The been on day trips with further trips limited as only the manager is able Care Homes for Adults (18-65 years) vehicle has been purchased to be shared between records showed the people using the service had out planned. At present access to the vehicle is to drive it. This is limiting trips out to every other Page 16 of 34 Evidence: week. The people using the service said they have enough to occupy them at the home. During the inspection we observed that some people were pursuing their own hobbies and interests and some went out independently. The manager reported that some people go out when they want to and need little support. Support is given to enable the people using the service to go to church if this is required. The gardens were well maintained and offered a nice area for people to look at and enjoy with a safe patio area for people to freely use whenever they wanted. Some people using the service attend day centres during the week and some have access to a befriender who supports them in community activities outside the home. Some people have work placements were this has been identified as something they wish to do which would be of benefit to them. Records show that the people using the service are supported to maintain contact with family and friends. The people we spoke with said that their visitors are welcomed to the home. People living at the home and the staff have regular meetings to discuss the management of the home. We looked at some of the minutes of these meetings which showed regular discussions taking place about various areas and aspects at the home keeping everyone informed and up to date with things such as meals and activities. The dining room offered a domestic style area with tables and chairs and a small fridge and kettle were everyone had access to make their own drinks throughout the day. We noticed that this was a good facility that helped to maintain and develop peoples independence. The chairs and tables in the dining area appeared worn and it is recommended that these be replaced in order to provide a more attractive area for residents to eat their meals. People using the service in general said they like the food at the home. The cook works from 1pm to 5pm 5 days a week and prepares the evening meal. The menu showed that a variety of meals are offered. Care staff support the people using the service to prepare their own breakfast and they prepare lunch for the residents after asking the people using the service what they would prefer. Care Homes for Adults (18-65 years) Page 17 of 34 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. People are treated well and their healthcare needs are monitored and supported to ensure they stay healthy and safe. Evidence: Each resident is given a key worker on admission to the home. The staff spoken with said that the key worker coordinates and reviews the residents care plan and arranges health and social care appointments. Both staff spoken with said that the key worker system is very effective in ensuring the needs of residents are met and care plans are up to date. The home has a policy and procedure around the administration of medication. Staff spoken with said they had received recent training on the safe handling of medication. The staff and manager said that an annual refresher training around medication management is provided to staff. Records showed that a number of staff are due to receive this annual training and that dates have been identified for this. We looked at samples of the medications held and records relating to it and in general found them to be accurate. Medication records have a photograph of the resident to Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: aid identification and reduce the risk of a medication error. A check of controlled drugs at the home showed that one medication had 2 fewer tablets remaining than records indicated. At present the back of the medication administration record sheet is used to keep a check of the amount of controlled drugs at the home. The manager should ensure a controlled drugs book is used to record and manage any use of controlled drugs to help show clearer records and safe management of controlled medications. Following the inspection the manager told us that she had addressed this. Records and care plans showed that the home provides a good level of support to people in accessing healthcare. This includes regular healthcare and visits to the doctor and specialist appointments. The manager has developed care plans to include mental health assessments to try and improve the records to show what support and care can be given to people with their mental health needs. Care Homes for Adults (18-65 years) Page 19 of 34 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. Records do not show that peoples finances are adequately safeguarded. Evidence: A complaint procedure is available at the home and is displayed on the residents notice board in the dining room and is contained within the service user guide. We spoke to people using the service who said they knew how to raise a concern regarding the service. Comment cards returned by 7 people using the service showed they were all aware of how to make a complaint if they needed to. Most of the comments received from people living at the home indicated they felt safe and were able to go to staff with their concerns and queries, especially to the manager. We looked at the complaints record book which showed that one complaint had been made since the last inspection. The outcome had not been recorded in the complaints record book but was recorded in the records of the resident. Care should be taken to ensure that the outcome of all complaints are clearly documented in the complaints record book so there is clear information to show the actions taken. Staff spoken to and the 6 who returned comment cards said they knew what action to take should anyone raise a concern about the service. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: The 2 staff spoken with told us they had received training in recognising and dealing with safeguarding vulnerable adults and they were clear about the actions they would take to make sure people are safe. Wirral Borough Councils procedure for safeguarding vulnerable adults from abuse was available at the home. The manager is required to notify the Care Quality Commission of any incidents that adversely affect the welfare of the people using the service. Records showed that 3 incidents had not been reported to us. 2 of these incidents should also have been reported to Wirral Social Services under the safeguarding of vulnerable adults procedure. Following the inspection the manager informed the Care Quality Commission and Wirral Social Services about the incidents. The manager explained that some people have the capacity to organise and manage their own finances and some people get support from their families. The only monies managed and recorded by the homes manager continues to be for personal allowances for a small amount of people living at St Martins. Records show accurate management of peoples personal allowances that are transferred to St Martins each week. Records are kept of any ingoing and outgoing monies with receipts kept on file. Since the last inspection the manager has updated care plans with information around how personal allowances are managed. Some peoples benefits are managed by the sister home and no records of these were available at St Martins. There was no information regarding what benefits each person was receiving and how much they receive. There was also no record of an agreed appointee, if any. The manager and people living at St Martins had no access to any details of were peoples monies are stored at the sister home. They had no details of the name of the account were the monies are held in or details of any savings or updated statements. The service had no policies or procedures to describe the current processes offered to people to support them with their money. There was no written consent or protocol to tell people how their money was stored and managed at the sister home. Clear and accurate financial policies and care plans need to be in place to show accessible and transparent management of each persons finances. Care Homes for Adults (18-65 years) Page 21 of 34 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. St Martins provides an adequate and comfortable environment for people to live in. Evidence: St Martins residential home is a detached house in a residential area. It is similar to other houses in the local area and does not stand out as a care home. The home is located close to shops, pubs and other community facilities including public transport links. Shared space in the home consists of a domestic style dining kitchen, a small lounge and a conservatory that leads in to the garden were people can currently smoke in. We saw a sample of areas throughout the home during our visit. The home was decorated and furnished to an adequate standard and was tidy throughout. There was evidence that work had taken place to improve the appearance of the home since we last visited. For example, new flooring was available in the hall, conservatory, bathrooms and toilets. The conservatory, lounge and some bedrooms had been repainted, there were new carpets in some bedrooms and new curtains had also been made available. A further extractor fan had been provided in the conservatory. There were still however some areas of the home where improvements could be Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: made. The carpet in the hall, landing and stairs was looking tired and replacement would make this area more pleasant for the people using the service. Some furniture in bedrooms seen was worn and so were the tables in the dining area. The manager reported that there are plans in place to address this, however there was no maintenance, decoration or development plan to let people know when this would happen. We saw a sample of bedrooms, some were personalised were some people had various personal items to help them individualise their room. Some people chose to keep their bedroom doors locked, which provided them with their own private living area. A sample of maintenance certificates were seen which showed up to date checks of the gas and fire safety systems. The certificate for the electrical wiring dated 04/02/2010 showed that the electrical wiring is not satisfactory. The manager reported that the works identified have been attended to however there was no record to support this. The manager is to ensure that evidence is available to indicate the electrical wiring at the home is safe. This information is needed so that the Care Quality Commission can be sure that the people using the service and and the staff are being kept safe from any unnecessary risks to their well being. Care Homes for Adults (18-65 years) Page 23 of 34 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. The people living at St Martins are adequately supported by caring staff who know their needs and how to meet them. Evidence: Discussion with the staff and observations of how they interact with the people showed that staff have a good understanding of the people they support and are able to understand their needs and requests. Over 50 of the staff hold a care qualification (NVQ called a national vocational qualification) and other staff are working towards this. This helps to ensure staff are aware of current good practice in the area of care and how to support people safely and well. The manager had developed a detailed training plan displayed in the main office so that all staff could be included and updated on the mandatory training that would be offered to them. The training plan showed that some staff still need to be provided with updates around the management of medication, fire safety, COSHH, safeguarding of vulnerable adults, infection control, food hygiene and first aid. The manager has identified dates for all staff to attend this training. Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: The manager acknowledged that some staff had not yet received training in mental health but had identified several courses run by MIND which staff are beginning to attend. Good management of staff training is needed to demonstrate that staff are provided with the right training and skills to help them do their job and to help them to support people living at the service in the right way. The staff spoken with and those who returned surveys said there are good training opportunities, regular supervision and good support from the manager. They said the people using the service are well cared for and that there has been improvements to the care provided now there is extra staff available and the activities offered are better organised. People using the service said that the staff are friendly and helpful and that they treat them with respect. Following our last visit there have been some changes to staffing levels in that an additional member of staff now works from 10am - 5pm to support the people using the service with activities. Support staff are still responsible for undertaking cooking duties 2 days a week and in the mornings and lunch times when the cook is not available. Support staff are also responsible for cleaning the home at weekends. It is recommended that further cooking and domestic hours are provided to enable support staff to spend further time meeting the care needs of the people using the service. The recruitment records for 2 staff members were seen. One member of staffs records showed that 2 references had not been obtained. The reference available was not dated, was very brief and did not state in what capacity the person knew the applicant. References must contain sufficient information to determine whether an applicant is suitable for the post they have applied for. Care Homes for Adults (18-65 years) Page 25 of 34 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. The home is adequately managed. The views of the people who use the service help to inform how the home is run. Evidence: The manager of St Martins has been in place for over 2 years and is not registered with the Care Quality Commission. A registered manager must be in place at the home and therefore an application to register a manager for the home must be submitted. This process helps to ensure the suitability of managers to manage a registered care home. Since the last visit to the home the manager has been working on her knowledge of the Care Home Regulations 2001 with support from the manager from St Martins sister home. It is of concern however that the manager has not reported incidents to the Care Quality Commission that affect the well being of people using the service. This was identified at the last inspection as an area that the manager did not have sufficent knowledge around. These reports are necessary and are required by law to be reported to the Commission to show how incidents that affect the welfare of service Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: users are managed and to show what actions are taken by managers and providers to ensure people at the service are safe. Following the inspection the manager informed the Care Quality Commission and Wirral Social Services about the incidents. A policy or guidance should be available to indicate when to make reports to the Care Quality Commission regarding adverse incidents regarded as regulation 37 reports. The manager has undertaken various training since the last inspection including completing the NVQ 4 in Leadership and Management and mandatory training courses. The training plan for the year included further training the manager will be undertaking to ensure all the mandatory training is complete. The manager is also planning to attend training courses with MIND which specifically relate to supporting people with their mental health. It is important that the manager undertake training around meeting peoples mental health needs as she has no formal qualifications in this area. During our visit the manager displayed a good awareness of the support needs and choices of the people living in the home. Observations of the manager with the people using the service showed there was a good rapport between them. We chatted to two staff during our visit and they were very complimentary about the manager and the way she runs the home and said that she has made the home a better place for the residents to live and for the staff to work. The manager was seen to have an open door policy and everyone had access to the manager and we noted that she also works regularly as part of the team. The manager has been allocated 20 hours a week supernumerary to support hours to help her to manage the home. As part of the homes quality assurance process and in accordance with Regulation 26 of the care homes regulations the owner provides reports on his visits to the premises. It is important that this is done to check the standard of care and management in the home. Records show that the visits and reports have been carried out at least monthly. During our visit we found that the quality assurance systems needed further development in order to evidence improvements in the overall management and monitoring of quality in the service. The manager continues to organise regular staff meetings. This ensures that staff members have a regular forum to discuss issues that may affect the service provided to people. We looked at the minutes of the last staff meeting which showed various Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: issues about the management of the home had been discussed, such as, training, activities, the management of medication and staff breaks. Care Homes for Adults (18-65 years) Page 28 of 34 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 Adults (18-65 years) Page 29 of 34 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 9 13 Risk assessments must clearly identify the action that staff are to take to minimise risks. To ensure that the people using the service are supported to keep safe. 15/07/2010 2 23 20 Updated financial care plans 15/09/2010 and clear policies are needed for the management of the finances of the people who live at St Martins. In order to demonstrate that their finances are managed in their best interests and ensure they are safeguarded from any potential risk of financial abuse. 3 23 37 Any incidents that involve the safeguarding of vulnerable adults must be reported to Wirral Social Services and the Care Quality Commission. The Care Quality Commission 15/07/2010 Care Homes for Adults (18-65 years) Page 30 of 34 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 must always be informed of any event that adversely affects the welfare of any person using the service. In order to safeguard and promote the well being and safety of people using the service 4 24 13 The manager is to ensure that evidence is available to indicate that the electrical wiring at the home is safe. This information is needed so that the Care Quality Commission can be sure that the people using the service and and the staff are being kept safe from any unnecessary risks to their well being. 5 34 1 Two references must be obtained before a person is employed and references must contain sufficient information. This information is needed to determine whether an applicant is suitable for the post they have applied for. 6 35 18 All staff must be suitably 15/09/2010 qualified and competent and must be given the right training to do their work. Updated training must 15/07/2010 15/07/2010 Care Homes for Adults (18-65 years) Page 31 of 34 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 include, medication administration, fire training, coshh and mental health needs. In order to ensure that staff can always support the health and welfare of people living at St Martins. 7 37 1 An application must be made to the Care Quality Commission to register a manager for the service. This process helps to ensure the suitability of managers to manage a registered care home. 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 15/09/2010 1 2 The admissions procedure for the home is to be revised to ensure that it appropriately reflects the practices at the home. The chairs and tables in the dining area should be replaced in order to provide a more attractive area for residents to eat their meals. The manager should ensure a controlled drugs book is used to record and manage any use of controlled drugs to help show clearer records and safe management of controlled medications. Care should be taken to ensure that the outcome of all complaints are clearly documented in the complaints record book so there is clear information to show the actions 2 17 3 20 4 22 Care Homes for Adults (18-65 years) Page 32 of 34 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 taken. 5 24 A maintenance, decoration and development plan should be put in place to let people know when improvements to the home environment are going to take place. It is recommended that further cooking and domestic hours are provided to enable support staff to spend further time meeting the care needs of the people using the service. It is important that the manager undertake training around meeting peoples mental health needs as she has no formal qualifications in this area. A policy or guidance should be available to indicate when to make reports to the Care Quality Commission regarding adverse incidents regarded as regulation 37 reports. The quality assurance systems need further development in order to evidence improvements in the overall management and monitoring of quality in the service. 6 35 7 37 8 37 9 39 Care Homes for Adults (18-65 years) Page 33 of 34 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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