Care Home: St Mary`s Nursing Home

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What the care home does well There is a good and committed staff team, which worked well together to provide care and support to people living at the home. Relatives praised the care staff, who they described as `good and work hard`. There is good partnership working between the home and the local NHS trust and other professionals. This is seen in the organisation and provision of the intermediate care services. People`s needs on this unit were identified an met. What has improved since the last inspection? The management of complaints had improved. Complaints were clearly documented and evidence was seen of investigation and outcome. This ensured people were listened to and taken seriously. Recruitment procedures had also improved, all required checks were seen in the staff files we looked at. This ensured people were protected. Social activities had improved. An activities co-ordinator was employed to work 15 hours each week. Another co-ordinator had recently been employed to also work 15 hours a week. This provided 30 hours of activities each week. The new co-ordinator was still getting to know what people liked doing and participating in and was adapting the activities to peoples abilities and choices. People told us `The activities lady is lovely she lights up the room when she is here, gets everyone motivated`. What the care home could do better: All people`s needs including health care needs must be identified in plans of care, together with measures in place to meet those needs to ensure peoples needs are met. Medication procedures must be improved to ensure people are given medication as prescribed to ensure their needs are met. People`s nutritional needs were not always met. Choices were not offered at meal times if someone did not eat their meal provided. Assistance was not always given. A congenial setting was not provided. Staff did not clearly understand what was required if someone was on an enriched diet. Procedures must be in place for staff to understand and follow the control of infection and cross contamination. This would ensure people are protected from the risk of cross infection. During our visit we identified that most staff had not completed any fire training or health and safety training. As a result of this we wrote a warning letter to the providers, asking them to put measures in place to ensure staff received this training. This would ensure staff are appropriately trained to do their jobs.The manager had left in November 2009 after only being in post six months. This meant the home had been without a permanent manager for 2 years. The intermediate care manager who was the deputy was overseeing the home as the acting manager. The home would benefit from a permanent manager to oversee the home and continue the improvements. To ensure the quality outcomes for people living at St Mary`s improve. Key inspection report Care homes for older people Name: Address: St Mary`s Nursing Home St Marys 101 Thorne Rd Doncaster South Yorkshire DN1 2JT     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: Sarah Powell     Date: 2 1 0 1 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 Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: St Mary`s Nursing Home St Marys 101 Thorne Rd Doncaster South Yorkshire DN1 2JT 01302342639 01302342639 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Leyton Healthcare (No 9) Limited care home 56 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of users who can be accommodated is 56 The registered person may provide the following category of service only Care Home with nursing - Code 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 - Code OP, maximum number of places, 56 Date of last inspection Brief description of the care home St Marys care home is registered to provide personal and nursing care and accommodation for up to 56 older people. It is situated about half a mile from Doncaster town centre, overlooking Town Fields. It comprises of two units. One is called the Lodge and has 25 places for people who require intermediate care services for a limited period. The other unit is called the Home and it has 31 places for older people who need either personal care or nursing care on a longer or more permanent basis. The accommodation is provided on two floors and there are stairs and a passenger lift Care Homes for Older People Page 4 of 29 Over 65 56 0 2 5 0 2 2 0 0 9 Brief description of the care home to facilitate access between them. We received information from the home on 25 February 2009, that the fees charged ranged between £390.14 and £436.96 per person per week. There were additional charges for hairdressing, private chiropody and other personal items like newspapers and transport. Care Homes for Older People Page 5 of 29 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 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: We went to the home without telling them that we were going to visit. This report follows the visit that took place on Thursday 21st January 2010. The visit lasted from 09:30 until 16:30. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The purpose of the visit was to make sure that the home was operating and being managed in the best interests of people living there. Information has been used from different sources for this report. These sources include; Care Homes for Older People Page 6 of 29 Reviewing information that has been received about the home since the last inspection. The annual quality assurance assessment. The manager had completed an annual quality assurance assessment (AQAA), which was completed with detailed comprehensive information. The AQAA focuses on how well outcomes are being met for the people using the service. It also gives us some numerical information about the service. Notifications (Regulation 37) relating to incidents in the home affecting people using the service. Details of complaints and allegations raised by people connected to the service. 7 surveys returned to us completed by the people who live at St Marys Nursing Home. At the site visit one inspector spent 7.0 hours at the home. This inspection visit included talking with people living at the home, their relatives, the acting manager, activities coordinator, visiting professionals, nurses and five care staff. During the visit we also walked round the building to gain an overview of the facilities. We also checked a number of records. Feedback was given to the acting manager at the end of the inspection. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: All peoples needs including health care needs must be identified in plans of care, together with measures in place to meet those needs to ensure peoples needs are met. Medication procedures must be improved to ensure people are given medication as prescribed to ensure their needs are met. Peoples nutritional needs were not always met. Choices were not offered at meal times if someone did not eat their meal provided. Assistance was not always given. A congenial setting was not provided. Staff did not clearly understand what was required if someone was on an enriched diet. Procedures must be in place for staff to understand and follow the control of infection and cross contamination. This would ensure people are protected from the risk of cross infection. During our visit we identified that most staff had not completed any fire training or health and safety training. As a result of this we wrote a warning letter to the providers, asking them to put measures in place to ensure staff received this training. This would ensure staff are appropriately trained to do their jobs. Care Homes for Older People Page 8 of 29 The manager had left in November 2009 after only being in post six months. This meant the home had been without a permanent manager for 2 years. The intermediate care manager who was the deputy was overseeing the home as the acting manager. The home would benefit from a permanent manager to oversee the home and continue the improvements. To ensure the quality outcomes for people living at St Marys improve. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 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. Peoples needs had been assessed. The intermediate care unit helped to maximise peoples independence and enabled them to return home. Evidence: We looked at two peoples plans of care during our visit. The assessments of needs in these plans, which are carried out prior to admission to the home, were not fully completed. They did not therefore identify all peoples needs, which would not enable staff to determine if their needs could be met at St Marys. Dedicated accommodation was provided for the intermediate care. There was a dedicated staff team with a unit manager. Specialist facilities and equipment were provided for the unit. An Occupational Therapist we spoke to told us the staff were very good. They delivered short-term intensive rehabilitation and were enabling people to return home. Care Homes for Older People Page 11 of 29 Evidence: The records we looked at on the unit confirmed that the majority of people admitted for intermediate care were rehabilitated and sent home. Only a few, following full assessments were referred for long term care. People we spoke to on this unit were full of praise for the staff and services. Care Homes for Older People Page 12 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs and risks were identified, but not always followed through so needs were not always met. Medication procedures did not always protect people. Evidence: We looked at three peoples plans of care in detail to determine if their needs had been identified and met. Most peoples needs had been identified, however, there was lack of detail contained in the plan to be able to meet these needs. For example one person had a care plan for lack of mobility and as a result could be at risk of developing pressure sores. The plan did not detail the action to take, it did not identify if any pressure relieving equipment was used or if the person required assistance with changing positions to prevent pressure sores. When we observed the person they did sit on a pressure relieving cushion. This was not documented in the plan of care. This did not enable staff to be able to meet peoples needs. Another person had a care plan for nutrition. It clearly stated they had lost weight and Care Homes for Older People Page 13 of 29 Evidence: had measures in place to monitor the weight loss. It stated to weigh weekly, keep a diet chart, to give assistance with meals if required and offer a high nutritional diet. We looked at the diet chart for the week commencing 18 January 2010. There were three days recorded and from the records kept the person had eaten 1 slice of toast, half a banana and a quarter of one meal. The lack of diet taken had not been recorded in the care plan, the nurses had not reviewed the situation and no professional advice had been sought. This did not ensure the persons needs were met. We also observed the meal and the person was struggling with their food. Staff gave very little encouragement and no assistance was offered. In fact the person sitting next to them offered to cut up their food and they accepted. The staff did not intervene to assist. There were no enriched foods offered, no alternative when they did not eat the meal and no record of any snacks offered between meals or at different times. Staff were not following the care plan and were not meeting the persons needs. We looked at risk assessments. Peoples risks were identified, however, these also lacked detail and errors were observed, which meant people were not protected. An example, was a persons nutritional risk assessment had been reviewed and they had been assessed as at moderate risk of poor nutritional intake. When we looked at the assessment in detail the score was wrong. If it had been assessed correctly they would have been at high risk of poor nutritional intake. The procedure for a high risk outcome was for the person to be referred to a dietician to ensure their needs were met. The acting manager was very concerned this had not happened when we explained the mistake. The acting manager told us at the end of the visit that a GP visit had been arranged for the next day and they would ask for a referral to the dietitian to ensure they persons needs were met. The plans were well set out and information was easy to find, however more detail needed to be documented and reviews needed to be carried out for any changing needs. Then actions must be documented and followed to ensure peoples needs are met. Daily records were kept in peoples rooms. They were not always completed correctly and gave very little information. The acting manager told us she would review these to ensure the correct information was recorded and concerns followed through to be able to meet peoples needs. Care Homes for Older People Page 14 of 29 Evidence: People and their relatives we spoke to told us they were aware of the plans, knew about the records staff kept and could look at them if they wanted. This ensured people were involved in their care. In the intermediate care section, we looked at one plan of care and it contained all the details required. There was also a good working relationship between the homes staff and health care professionals who formed part of the multidisciplinary team. This ensured the persons needs were met. One relative told us, Most staff are lovely they look after people very well, I am very happy with the care my relative receives. We had received seven surveys completed by people living in the home which told us their view and concerns. The comments received were mixed. They said most staff were very good, however always very busy. Two people commented that the nurses were only out of the office when medication was given. They would like to see them more involved with care. The majority of people told us that they could do with more care staff as they were always very busy. We looked at medication procedures. There were good records of receipt and most administration were recorded correctly. However some discrepancies were found. A hand written entry had been recorded yet there was no record of who had written it or if anyone had checked it. There was no record when the medication was received and how much was received. This did not protect people. We also found two instances were medication was signed for but not given. Medication should be signed for once the person has taken it this prevent errors and ensures people are given the correct medication. Requirements regarding peoples care and medication needs were made at the last visit, in February 2009. These were only partially met, therefore new requirements have been issued following this visit. Care Homes for Older People Page 15 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People exercised choice and control over their daily lives and activities ensuring their needs were met. Meals and mealtimes did not always meet peoples needs. Evidence: An activities co-ordinator was employed to work 15 hours each week. Another coordiantor had recently been employed to also work 15 hours a week. This provided 30 hours of activities each week. We spoke to the coordinator who was enthusiastic, understood peoples needs and adapted activities to suit individuals. This ensured peoples needs were met. The coordinator told us the new co-ordinator was still getting to know what people liked doing and participating in, and was adapting the activities to peoples abilities and choices. Group activities and 1 to 1 sessions were organised depending on the peoples needs and choices. Activities were varied and changed depending on the choices of the people, records were kept of activities delivered and the records showed varied and appropriate activities to meet peoples needs. Care Homes for Older People Page 16 of 29 Evidence: People told us on the returned surveys that they enjoyed the activities and the activity lady was very good. Another person told us at the visit, The activities lady is lovely she lights up the room when she is here, gets everyone motivated. The people and their relatives we spoke to all said that contact with family, friends and the local community were encouraged by the staff. All said relatives were always made welcome. A varied, balanced and wholesome diet was provided for the people with good choices available. We observed a meal, which was well presented. People told us they enjoyed their meals. The acting manager had recently sent out a quality monitoring questionnaire to people regarding meals. We were shown the returned questionnaires. These were mostly very positive comments. This showed people were listened to and their views sought. Communication to the people from staff when the meal was served was not always good. People were not offered assistance and were not offered an alternative if they did not eat the meal provided. This did not ensure peoples needs were met. People were asked if they were finished before plates were taken and a choice of drinks were also offered. This ensured peoples choices were considered. We observed the meal and noticed one person struggling with their food. Staff did not offer assistance. The person sat next to them offered to cut up their food and they accepted. The staff did not intervene to meet their needs. The mealtime was very disorganised and very noisy. It did not provide a congenial setting for people to enjoy their meal. People also told us that morning drinks were usually very late so people could have a drink at breakfast at 9am and then not get another drink until 11.00 - 11.30. There were no cold drinks available in the lounge for people to help themselves, or make it easily accessible for staff to give drinks if requested. This did not meet peoples needs. An Environmental Health Officer had inspected the kitchen in November 2009 and they had awarded a four star good quality rating. This showed the kitchen maintained the required standards to safeguard people. Care Homes for Older People Page 17 of 29 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. People who lived in the home were listened to and protected. Evidence: There was a comprehensive complaints procedure, which was clearly displayed, in the entrance hall. All people we spoke to were aware of the procedure and told us they would either speak directly with the acting manager or staff. The acting manager had received a number of complaints in the last year, which had been fully investigated and resolved. We saw evidence of this in the complaints log. This ensured people were listened to and taken seriously. Relatives told us, the acting manager is always approachable. However most had not needed to raise any concerns and told us their relatives were looked after well. People did say the home needed a permanent manager. It had not had a permanent manager for a while, as the last one only stayed six months. Most staff had received training in adult safeguarding. All staff we spoke to had a good knowledge of the procedures and what to do should an incident occur. Staff we spoke to were also aware of the whistle blowing policy, which safeguards people in the home. Care Homes for Older People Page 18 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In general the home was well maintained, clean, pleasant and comfortable ensuring people lived in a safe environment. Evidence: The location and layout of the home was suitable for its stated purpose. Mostly the environment was maintained to a good standard. It was homely and well decorated. The standard of cleanliness observed during the visit was satisfactory, however there were a number of infection control risks identified during the visit, which posed a risk to people. A dirty commode was found stored in the bathroom, clean linen was stored directly next to dirty, linen was stored on the floor, mops were stored in dirty water and mops stored on the floor. These could all pose a risk of cross contamination. The home had a number of residents with a viral infection and the infection control nurse had visited. The acting manager told the inspector that what they had identified had also been identified by the Infection Control Nurse. Therefore should have been resolved to prevent spread of the viral infection to other people. During the tour of the building we also noticed care staff wandering around corridors from room to room with the same gloves on. Once the dirty task is completed gloves Care Homes for Older People Page 19 of 29 Evidence: should be disposed of and hands washed. This would help prevent cross contamination. The acting manager told us she had drawn up an action plan following the Infection Control Nurses visit. She said she would ensure this was implemented and all staff aware of procedures to follow, to ensure safety of all people. Care Homes for Older People Page 20 of 29 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. Staff were not appropriately trained, this did not ensure people were in safe hands at all times, had their needs met and were protected. Recruitment procedures were robust and protected people. Evidence: There were 43 care staff employed at St Marys, 25 had achieved NVQ level 2 or above. The acting manager is trying to secure places on further NVQ courses for other care staff to ensure people are in safe hands at all times. We looked at staff training as part of this visit and we found some staff had not received appropriate training to meet peoples needs. We held a management review meeting and we decided to send a letter to the provider outlining the key areas of concern, that needed to be addressed as a matter of urgency to ensure people were in safe hands. We wrote that the providers had failed to ensure that staff working at St Marys receive training appropriate to their work, to meet the needs of the people accommodated at St Marys. Thirty six members of staff had not received fire safety training; a training course had been provided in November 2009, however only 9 people had attended. Twenty staff Care Homes for Older People Page 21 of 29 Evidence: had been allocated a place on this training. The acting manager told us staff do not always attend training that is arranged. This did not ensure peoples needs could be met. The acting manager also arranged a fire safety course for 4 February 2010, while we were on site. It is necessary to ensure staff attend this training. We also told the providers they must also ensure staff that are on duty receive information on fire safety. This will ensure they have a basic understanding of fire safety procedures to safeguard people until they receive the full training. It was also identified that 46 members of staff had not received training in health and safety, although a course was taking place on 22 January 2010. 20 people were due to attend on this date. This is necessary to meet peoples needs. The providers must respond to us what they are doing to rectify the situation. The providers have responded to our letter they have arranged training to address the lack of staff training. this will ensure staff are appropriately trained to meet peoples needs. They also told us non attendance by staff would not be accepted. A thorough recruitment procedure was in place. We looked at two staff files on the day of our visit, they contained all the required information, protecting people who lived there. Care Homes for Older People Page 22 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management and administration did not always safeguard people. Good health and safety policies and procedures were in place, however not all staff had received training to ensure the safety of people in the home. Evidence: At the previous visit in 2009 there has been no registered manager at the home for almost two years. An acting manager was in post. A new manager was appointed in June 2009 however she left in November 2009 so the home was again without a manager. People we spoke to all told us that they felt the home was in need of a permanent manager to ensure standards were at least maintained but hopefully improved. The acting manager is the deputy and unit manager of the intermediate care unit. She is a qualified nurse, with knowledge and experience of managing care services. However she is managing the home as well as still trying to do her appointed job. This did not always meet peoples needs. Care Homes for Older People Page 23 of 29 Evidence: Some quality monitoring had been carried out. Quality monitoring questionnaires had been sent to people regrading meals to gain peoples views. However some of the audits for example on care plans and medication had not been carried out. The acting manager said she would ensure this was commenced to ensure these areas improved, to meet peoples needs. The home had a comprehensive health and safety policy. We were able to evidence that regular maintenance of equipment and systems was carried out. Risk assessments were carried out on all safe working practices. The maintenance person employed by the home carried out regular audits on the building and environment. These records were seen and were very comprehensive and ensured peoples safety. We looked at accident records. These were properly recorded and reported, ensuring people in the home were safeguarded. Care Homes for Older People Page 24 of 29 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 25 of 29 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 7 15 All people who live in the 01/04/2010 home must have their identified needs documented in the plans of care. This will ensure how the persons needs in respect of health and welfare are to be met. 2 8 13 All peoples health care 01/04/2010 needs must be identified and where necessary seek advice, treatment and any other services from health care professionals. To ensure peoples needs are met. 3 9 13 Arrangements must be in 01/03/2010 place for the recording, handling, safe keeping and administration of medication received into the home. This will ensure people received medication as prescribed. Care Homes for Older People Page 26 of 29 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 4 15 12 Peoples nutritional needs must be met, by providing choices at meal times if someone does not eat their meal provided, giving assistance, providing a congenial setting and by staff understanding an enriched diet. This will ensure people will receive adequate nutrition and peoples risk of poor nutritional intake is managed to protect them. 01/04/2010 5 26 13 Procedures must be in place for staff to understand and follow for the control of infection and cross contamination. To ensure people are protected from the risk of cross contamination. 01/03/2010 6 30 18 Staff must receive training 01/04/2010 appropriate to the work they are to perform. In particular fire safety and health and safety training. To ensure they are able to meet peoples needs. 7 33 24 Quality monitoring must continue to include auditing of care plans and medication. 01/04/2010 Care Homes for Older People Page 27 of 29 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 To ensure standards are maintained and peoples needs met. 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 3 The pre admission assessments of needs should be completed, to determine peoples needs and if these can be met at St Marys. Consider providing more external activities to meet all peoples needs. A registered manager should be appointed to manage the home. 2 3 12 31 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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