Care Home: St Mary`s Residential Care Home

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What the care home does well The home has a very good team of committed staff who have the best interests of the residents at heart. The residents and relatives make positive comments about the food, the caring staff and the care that they receive. One resident told us "the care and support is good and we have good meals", a relative said "the home provides first class care, the staff are all friendly and very caring. They went on to tell us that "residents are free to do what they want and the food is excellent". One staff member told us "it was a pleasure working at the home". The owner of the home is keen to to ensure the home is run in the best interests of the residents and the manager always keeps us informed of things which have happened since our last visit. The service offers a homely, clean and comfortable environment for the people who live there. What has improved since the last inspection? Improvements have been made to the care planning system and has improved its process for getting people up too early in the mornings. More areas of the home have been re decorated and some facilities have been replaced. Activities have further improved. The administration of medicines has been improved so that residents receive their medication in a safe way. What the care home could do better: The lack of training in some areas and lack of detail within the care plan for some residents means that a few residents do not experience good outcomes. Although formal supervision is carried out it needs to happen more frequently. The quality monitoring system could be extended to include all people who use the service. Medicines that are prescribed on a use as necessary basis could be better managed. Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Mary`s Residential Care Home Market Place New Buckenham Norwich Norfolk NR16 2AN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marilyn Fellingham     Date: 2 1 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: St Mary`s Residential Care Home Market Place New Buckenham Norwich Norfolk NR16 2AN 01953860956 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Jaishree Banga,Jasvinder Paul Singh Banga care home 29 Number of places (if applicable): Under 65 Over 65 1 28 dementia old age, not falling within any other category Additional conditions: 0 0 One (1) person, over the age of 65 years with dementia may be accommodated. The total number not to exceed twenty-nine (29). Up to twenty-eight (28) Older People, not falling within any other category may be accommodated. Date of last inspection Brief description of the care home St. Marys is a large house facing the village green in New Buckenham. Bedrooms are on the ground and first floors and consist of twenty-nine single bedrooms, two of which have an en-suite facility. The Home has three communal rooms, a large reception area and a new shaft lift is provided to aid service users to the first floor. There is a pleasant dining room with easy access for wheelchair users. Car parking and two enclosed garden areas are to the rear of the premises. Care Homes for Older People Page 4 of 26 Brief description of the care home A hairdresser visits the home twice a week and chiropody services are available. The Home provides newspapers and toiletries for use by the service users. Fees range from £362385 to £425 weekly. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection that took place over nine hours and twenty five minutes. The key inspection for this service has been carried out using information from previous inspections, information from some residents, relatives, visitors to the home and people who work in the home. The main method of inspection was case tracking. This involved selecting individual care plans and information available about people who live in the home and tracking their experience as a result of the support provided. Care Homes for Older People Page 6 of 26 Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get Care Homes for Older People Page 8 of 26 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have their needs assessed prior to admission to ensure that their needs can be met. Evidence: We looked at the assessment records for two newly admitted residents, they had good and informative assessments in place relating to their needs which the manager or her deputy had carried out either in the residents own home or in hospital. Prospective residents are given the opportunity to visit the home prior to admission, unfortunately we were unable to communicate with these two residents to confirm this. The manager explained to us the procedure for admission to the home, however she does not send a letter of confirmation to the interested parties to say that the home can meet the needs of the prospective resident. Care Homes for Older People Page 11 of 26 Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although improved , the information in the care plans is not always sufficient to ensure that the residents needs are met in a consistent way. Some minor adjustments are needed in relation to the handling of medication so that the residents are not placed at risk. Evidence: We observed the early morning activity of the night staff having arrived at the home at 06.00hrs. Two care staff were on duty and five residents were already up and dressed and sitting in the dining room. We spoke with four of these residents who were up and ascertained from them that it was their wish to get up early; this information was also clearly recorded in their plans of care. One resident told us that they had been a baker all their lives and had always got up very early to bake the bread, another told us that they had been a nurse and were used to getting up early. One resident who was Care Homes for Older People Page 13 of 26 Evidence: unable to communicate had a letter in their records from their niece who stated that this person had always been an early riser and would get restless if not allowed to get up: the care plan for this resident reflected this information. One resident however informed us that she did not like getting up early and said it meant you were sitting for a long time. The care plan for this resident states that if restless to get them up and bring them downstairs, there was no care prescribed for other strategies to help the restlessness; there were also many entries in the daily notes to comment on their behaviour in the night. We noted on our arrival, one resident who was very restless, agitated, and very confused; we looked at their care plan which noted that this resident had sudden mood swings and can become abusive. The care instruction was to calm them down but no instructions how to do this. The medicine record chart for this resident had gaps and no rationale for prescribed paracetamol; another residents medicine record chart had that they were prescribed paracetamol but had not required any for a considerable length of time. Some residents had been prescribed prn (as required) medication but we noted that they did not have records in place to clinically justify the continued use of these medicines. A random audit of medicines was carried out and all tallied with those recorded on the medicine record charts as having been given or refused. The care plans we looked at had risk assessments in place for falls and for skin integrity; there was evidence of continual evaluation and intervention when needs had changed. One resident we spoke with said the staff are good and look after me very well, another told us I have no complaints and I like living here. We spoke with a visiting community nurse who told us the staff are very caring and they always take on board what I say and they always know about the residents I have come to see. We were able to observe the communication between the staff and the residents, it was very respectful and the staff seemed to know what care was needed for each individual. During feedback to the manager and the provider over the phone they both agreed that more improvements could be made in the care planning process and the management of medicines. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to take part in meaningful activities on a regular basis and are helped to exercise choice in relation to their daily lives. Residents receive an appealing, balanced diet in pleasant surroundings. Evidence: We were able to discuss with the manager, some staff members, visitors to the home and some residents about activities that are provided and organised by the home: we were told by two residents about an Easter Bonnet competition who pointed out photographs of this activity and one resident introduced us to the winner of the competition. The response to the requests from residents for more activities has been appreciated and records have shown us that the provision of activities has improved greatly. One resident told us there is something happening every day. All residents who have joined in the activities have it recorded but do not have remarks about their actual participation in a plan of care. A number of outings have been organised for the summer such as a trip to Banham Zoo and coastal trips. We noted one relative had come to the home to take their mother to the local Good Companions Club and we were told by the staff that sometimes other residents go to the club also. The manager Care Homes for Older People Page 15 of 26 Evidence: told us that once a year the Good Companions visit the home and they have a tea party and entertainment with the residents and if the weather is good they all meet in the garden. The two carers who organise the activities are very enthusiastic about their role and enjoy with the residents help, and ideas more social activities. We talked with the cook who told us that they always used fresh vegetables for every meal, we looked at the menus which appeared very varied. We did notice that there was only one choice for each main meal, however after discussion with some of the residents this did not seem to be a problem for them. One resident told us I always eat what I am given, but I know I could have something else; another resident said to us food is excellent and always nice, whilst another said we should try it for ourselves then we would no how good it was. We talked with one resident about the food and they explained that they had lived in the home for eighteen months and only had to complain about the food once in all that time. The cook seemed very knowledgeable about the residents likes and dislikes. The manager told us that one visitor always joins their relative for Sunday lunch. On the day of our visit the residents were enjoying meat pie, carrots, swede and cauliflower and bread and butter pudding for desert. We observed lunch being served and saw those residents who needed help with feeding were being assisted in a dignified manner. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel safe, however staff would benefit from more training relating to safeguarding issues so that residents are not placed at risk. Evidence: A complaints procedure is in place and given to all residents and other significant people. We spoke with one relative and three residents who all told us they knew how to and to whom to share their concerns with. We looked at records for complaints and saw how they had been resolved. The staff members we spoke with knew how the complaints procedure worked and understood their responsibility in passing on information to the manager if they personally had received any complaints. We spoke with five members of staff about safeguarding issues, they had limited knowledge and would benefit from training other than from DVDs. The manager and the provider agreed with this and stated that they would ensure this training took place. We saw minutes of meetings and the homes news letters which confirmed that residents and relatives are given opportunities to air their views. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is suitable for its chosen clients. Evidence: We found the home to be very clean and tidy with no offencive odours. We looked at three rooms having first obtained the residents permission, these were homely and had evidence of personalisation. Some areas of the home and some rooms have been re decorated since our last visit. We noted that since our last visit an independent heating system had been put in the corridor that we had found to be very cold. A new carpet has been laid in the lounge and new washing machine with sluice had been purchased. In one toilet downstairs we found a terry towel and soap in a dish, this is an infection hazard and the manager immediately asked one of the domestic staff to remove them. We spoke with one of the domestic staff who told us they enjoyed working in the home and a resident we spoke with told us that they felt the home was clean and that their room was good. We looked outside and the gardens are very pleasant with seating arrangements out of the sun if desired. Whilst we were visiting, the gardener was busy in the garden and there was colourful display of plants and roses in bloom. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are good, however the staff need to receive more appropriate training to enable them to carry out their roles effectively. Evidence: When we arrived at 06.00hrs there were two carers who had been on duty for the night shift, later four more carers and the manager arrived for the day shift; two domestic cleaners were also on duty for the day. Before the night staff went off duty we were able to ask them about their responsibilities in relation to administering medicines to the residents, they informed us that they had completed medicine training and were now able to give out any medication that was required during the night. This was evidenced by the records for training that we looked at. During our visit we were able to talk to six staff members, all were enthusiastic about the team they work in and one new member commented that they were brilliant staff, another member of staff told us it is a pleasure working here. One senior carer told us that she was going to undertake a manual handling trainers course to enable her to do all in house training for this. After discussion with the staff, manager and looking at records we were able to ascertain that most of the training that the staff had received apart from NVQ training had been done via DVDs these included manual handling and safeguarding adults. The provider was made aware of this when we gave him feedback after our visit, he was Care Homes for Older People Page 19 of 26 Evidence: keen to reassure us that he would immediately sanction more training from outside facilitators. It was also clear to us that the staff required more training in relation to specific needs of the residents including looking after people with dementia as highlighted earlier in this report the staff do not appear to have the skills to look after mildly confused residents. We did note however that some of the staff have had or going to have some training in relation to medicines used in dementia. The home has managed to arrange for 92 of their staff to have undergone NVQ training 2 or 3, the cook has nearly completed NVQ in house keeping. Some training also is needed with regards to infection control especially for those staff who are responsible for cleaning. Some staff including the manager have been to training sessions to get information about the Mental Capacity Act and Deprivation of Liberty; the manager seemed to be aware of their responsibilities with regard to issues related to these. Records for newly appointed staff were looked at, these were seen to reflect a robust checking system before staff are employed. This was also confirmed by new members of staff we spoke with who also told ud about the thorough induction they had undertaken and the records we saw for this confirmed that all mandatory subjects had been covered. Most of the staff have received fire training and we saw records for this. Further discussion with the staff confirmed that they had a good understanding of their roles but agreed they needed more knowledge to give them the skills to look after some of their residents with more complex needs. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed well and the views of the residents are routinely sought. Evidence: Records were in place for formal supervision and we noted that the sessions need to be carried out more frequently. We spoke with two residents who told us that it was easy to talk to the manager and the staff told us that the manager was approachable and that the provider always spoke to them when he visited and that he always made sure they were alright and dont have any concerns. The manager endorsed this by saying that she always felt very well supported by the owner of the home and that he visited once a week and that spoke on the phone most days. We noted that communication between staff and the manager was good and minutes of meetings were in place that showed us that information continually passed onto the staff. Comments made to us in comment sheets returned to us suggested that the staff, residents and relatives were getting the support they needed from the management. Care Homes for Older People Page 21 of 26 Evidence: We looked at health and safety related information this showed that there are servicing arrangements for all equipment, these included the hoists, bath hoists, the lift and the boiler. Fire safety records were in place and we saw records for all fire training. The home does carry out some quality monitoring of the service it offers, however this could be extended to all areas of managing the home including obtaining information about the service they offer from other professional agencies. The manager needs to attend training for safeguarding adults so that she has a better understating of her role in relation to all areas of abuse. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 (2) (a) (b) All people using the service (c) must have an up to date, detailed care plan. This will ensure that they receive person centred support that meets their needs. 20/06/2008 2 9 13 (2) People who use the service must have medicines prescribed on p.r.n. (as prescribed basis) given to them by staff only when clinically justified and this can be demonstrated by record keeping practices. All staff must be adequately trained in the work they are to perform, this will ensure good outcomes for the people who use the service. 20/07/2008 3 30 18 (1) (i) 20/08/2008 Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 All people using the service must have a detailed care plan. This will ensure that they receive person centred support that meets their needs. 30/07/2009 2 9 13 Care plans must accurately reflect and give guidance on current prescribed instructions when medicines are to be administered at the discretion of nursing staff. This will ensure justification of continued use. 30/07/2009 3 18 13 All staff will benefit from further training with regard to Safeguarding Adults This will enusre that the residents are protected from abuse. 15/10/2009 Care Homes for Older People Page 24 of 26 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 12 The activities records should be linked to the care planning system to ensue that all residents needs in this area are being met. It would be beneficial to the overall management of the home if the satisfaction surveys were extended to other agencies who use the service. It is recommended that the supervision sessions are carried out more regularly. 2 33 3 36 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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