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Care Home: St. Michael`s Home

  • 251 Warwick Road Olton Solihull West Midlands B92 7AH
  • Tel: 01217079697
  • Fax: 01217079697

St. Michael`s is a purpose built care home, which was registered in November 1993. The home, which is privately owned, is on the corner of a main road and is easily accessible by public transport. There is a large car park. The home provides permanent placements for up to 21 frail older people over the age 2112009 of 65 whose care needs can be met within a residential setting. The home is located over two floors and comprises of 19 single rooms and one double room. All of the bedrooms are fitted with a wash hand basin. Bedrooms may be decorated and furnished to the choice of the occupants. The home has a shaft lift for ease of access to the first floor. The home has two assisted bathrooms and one assisted shower room. There are adequate numbers of toilets throughout the home some large enough to allow full assistance from staff. On the ground floor communal facilities comprise of an open plan small sun lounge, lounge and dining area and an additional small lounge. There are limited garden/patio facilities to the property. Up-to-date information relating to the fees charged for the service is available on request from the home.

  • Latitude: 52.43399810791
    Longitude: -1.8009999990463
  • Manager: Ms Anne Mary Farthing
  • Price p/w: -
  • UK
  • Total Capacity: 21
  • Type: Care home only
  • Provider: Dr Gurdial Mattu
  • Ownership: Private
  • Care Home ID: 14780
Residents Needs:
Old age, not falling within any other category

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for St. Michael`s Home.

Key inspection report Care homes for older people Name: Address: St. Michael`s Home 251 Warwick Road Olton Solihull West Midlands B92 7AH     The quality rating for this care home is:   zero star poor 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: Deborah Shelton     Date: 2 3 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 Older People Page 2 of 46 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) © 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 Older People Page 3 of 46 Information about the care home Name of care home: Address: St. Michael`s Home 251 Warwick Road Olton Solihull West Midlands B92 7AH 01217079697 01217079697 dmattu@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Gurdial Mattu Name of registered manager (if applicable) Ms Anne Mary Farthing Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be acommodated is 21. 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: Old age not falling within any other category (OP) 21 Date of last inspection Brief description of the care home St. Michaels is a purpose built care home, which was registered in November 1993. The home, which is privately owned, is on the corner of a main road and is easily accessible by public transport. There is a large car park. The home provides permanent placements for up to 21 frail older people over the age Care Homes for Older People Page 4 of 46 Over 65 21 0 0 2 1 1 2 0 0 9 Brief description of the care home of 65 whose care needs can be met within a residential setting. The home is located over two floors and comprises of 19 single rooms and one double room. All of the bedrooms are fitted with a wash hand basin. Bedrooms may be decorated and furnished to the choice of the occupants. The home has a shaft lift for ease of access to the first floor. The home has two assisted bathrooms and one assisted shower room. There are adequate numbers of toilets throughout the home some large enough to allow full assistance from staff. On the ground floor communal facilities comprise of an open plan small sun lounge, lounge and dining area and an additional small lounge. There are limited garden/patio facilities to the property. Up-to-date information relating to the fees charged for the service is available on request from the home. Care Homes for Older People Page 5 of 46 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: zero star poor 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 a key inspection visit and was unannounced. This means that the Home were not aware that we were going to visit. This visit took place on Monday 21 June and Wednesday 23 June 2010. The inspection process concentrates on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. Before the inspection we looked at all the information we have about this service such as previous inspection reports, information about concerns, complaints or allegations and notifiable incidents. This helps us to see how well the service has performed in the past and how it has improved. During the key inspection we used a range of methods to gather evidence about how well the service meets the needs of those people who use it. Time was spent sitting with people in the lounge watching to see how they were Care Homes for Older People Page 6 of 46 cared for and how they spent their day. Face to face discussions were held with people who use the service, staff and the owners. Information gathered was used to find out about the care people receive. We also looked at the environment and facilities and checked records such as care plans and risk assessments. Three people living in the Home were identified for case tracking. This involves reading their care plans, risk assessments, daily records and other relevant information. Evidence of care provided is matched to outcomes for the people using the service; this helps us to see whether the service meets individual needs. Care Homes for Older People Page 7 of 46 What the care home does well: What has improved since the last inspection? What they could do better: Pre-admission assessments should give a clear picture of peoples identified health, care and holistic needs with information about preferred routines, equipment and number of staff needed to provide care. The current pre-admission assessment is not always fully completed and does not always clearly state peoples needs and assistance required. Care planning is poor, we were told that there are only three completed care plans and only brief information or no information for the other fifteen people currently living at the Home. The manager is fully aware of the need to develop care plans and is currently developing them for everyone . However, staff should be able to refer to written information about peoples needs and abilities in order for them to provide care to meet individual needs. Risk assessments were either not available, or where available were not linked to care plans. These should record the level of risk for an individual undertaking an activity, the action and equipment needed to reduce or prevent the risk of harm. These need to be regularly reviewed and updated. Staff should ensure that they respect the privacy and dignity of everyone living at the Care Homes for Older People Page 8 of 46 Home at all times. Documentary evidence of activities undertaken should be available. On the morning of the inspection a majority of people in the lounge appeared unstimulated and there was no documentary evidence to demonstrate that activities regularly take place. Evidence in the Homes satisfaction survey recorded that some people were unhappy with the level of activities provided. People spoken to on the day said that not a lot happens. Although new menus have been developed, records seen demonstrated that meals provided are not always those recorded on the menu. Stocks of ingredients and foods were value brand and lower quality type, there appeared to be limited choice in some foodstuffs such as bread. People spoken to said that the food is OK, you get used to it. People should have the information available to them to know how to make a complaint. As people currently do not have a copy of the Service Users Guide and the complaint procedure is not on display in the Home, this information is not available to them. This may make it difficult for people who wish to raise concerns to do so. Staff should undertake training regarding safeguarding vulnerable adults. Work should be undertaken on all areas of the Home that look shabby, are in need of repair or items that are in need of replacement. We have received confirmation that work has started replacing ceiling tiles, cooker, chairs. The registered provider should ensure that an ongoing maintenance programme is developed to ensure that maintenance work needed is undertaken. Staff personnel files should be developed to provide documentary evidence that robust recruitment practices take place at the Home. Staff should undertake induction and ongoing foundation training in line with Skills for Care requirements and should receive training in mandatory and other areas. This is to ensure that they have the skills and abilities to meet the needs of those living at St Michaels. Quality assurance systems should be developed to ensure that the quality of the service provided at the Home meets the needs and expectations of those that live there. Health and safety checks should be undertaken on equipment such as fire alarms and emergency lighting systems to demonstrate that they are in good working order. Documentary evidence should be available to demonstrate this. 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 Care Homes for Older People Page 9 of 46 order line 0870 240 7535. Care Homes for Older People Page 10 of 46 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 11 of 46 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 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 abilities are not always clearly identified before the Home agree that they can move in. The statement of purpose and service users guide are not up to date, therefore people cannot be guaranteed that they have up to date information about the Home before they make a decision to move in. Evidence: The care file of the person who had most recently moved in to the Home was reviewed. This file was seen to evidence whether a pre-admission assessment had taken place. Pre-admission assessments are completed to gather information about a person. A decision can then be made as to whether the Home would be able to meet their individual needs. The Home should obtain sufficient information to enable them to provide care to the person when they move in. The care provided should then meet all of their needs and be provided in a way in which they prefer. In the file seen there was documentary evidence to demonstrate that a pre-admission Care Homes for Older People Page 12 of 46 Evidence: assessment had taken place. The manager told us that she completed the assessment. Documentation seen had not been dated or signed. It is therefore difficult to provide an audit trail of when information was obtained and difficult to refer back to the person recording the information if we do not know who that was. Pre-admission assessment documentation used by the Home is standardised, this means that the same questions are asked of each person who wishes to move in to the Home. Information regarding the next of kin and GP contact details are recorded. On the form seen the social worker details had not been completed. It would therefore be difficult for staff to contact the persons social worker in case of emergency or to gather further information. The aim of the assessment form is to find out information about peoples needs and abilities. Staff draw a circle on a line somewhere between good and poor to show how able someone is at a task, for example mobility, dexterity, diet, speech. The form seen did not clearly identify the persons needs and abilities. They were recorded as good, poor or somewhere in between but did not give staff any instructions of the actions that they were to take to meet areas identified as poor. Some of the information recorded on the form was contradictory, for example one summary recorded does have dentures but can refuse to wear them whilst another recorded has no dentures. The person was spoken to during the course of the inspection and was seen wearing dentures although these were very poorly fitting and the person was having difficulty keeping them in their mouth. The form records that the person requires a soft diet, but further on it says that the person has a normal diet but requires their meat cutting up. Providing a normal diet to someone who requires a soft diet could put them at risk of harm. A discussion was held with the manager regarding this, who told us that this person does not require a soft diet but does have their meat cut up and has some assistance to eat their meal. Some of the summary information recorded under each section did not appear to relate, for example the summary under self esteem, self worth, self neglect recorded needs assistance to mobilise. Some sections of the form had not been completed. The information regarding personal care was recorded so that the person put a circle on the line showing at one end, one carer needed to provide assistance and at the other end two carers needed. It was confusing if the line was circled somewhere in the Care Homes for Older People Page 13 of 46 Evidence: middle as this does not clearly detail whether one or two carers are required to assist. Following admission to the Home a care plan should be developed. This is used to record information for staff so that they can provide care for individuals. Information obtained during the pre-admission assessment should be used to form care plans. There was no care plan for the person most recently admitted to the Home. This person had been living at St Micheals for two weeks. In conclusion, pre-admission assessments did not give full details of peoples abilities or needs. There were limited instructions for staff on how to meet the persons needs and not all of the information had been completed. In addition to this care plans had not been developed on each occasion upon admission to the Home. A discussion was held regarding the Service Users Guide and Statement of Purpose. We were told that not everyone has a copy of these documents as they need updating and that these will be changed as soon as possible. Without this information people may not be fully aware of the services and facilities available to them at the Home. This information may also be useful for new people who may wish to move in to help them decide if St Michaels is the right place for them. This was raised as a recommendation for action at the last inspection of the Home and it appears that no action has been taken. We were also told that not everybody has a contract of residency. In two of the files seen there was a copy of the a contract between the placing authority for example, Birmingham or Solihull and the Home but none of the files seen had a contract between the Home and the person living there. The manager was aware of the need to complete contracts and to ensure that they are up to date for everyone living at St Michaels. People should have a contract which details terms and conditions of residency at the Home and what they are entitled to receive for the fee. This was identified as an issue at the last inspection and remains outstanding. Care Homes for Older People Page 14 of 46 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are not available for everyone living at St Michaels and written information to enable staff to provide care is limited. Lack of information puts people at risk of having care needs missed. Privacy and dignity are not always respected which could lead to low levels of self esteem, self worth and wellbeing. Evidence: We case tracked three people at this inspection, this involved looking at their care files, medication, accommodation and other records relating to their care. A member of staff was asked how she was made aware of peoples needs, abilities, preferences and details of equipment needed to provide assistance. This staff member said that everybody has a care plan stored in the managers office. Two of the care files we saw did not contain care plans. From review of care files it was noted that care plans are not available for everyone living at St Michaels. The manager confirmed that when she took over responsibility Care Homes for Older People Page 15 of 46 Evidence: at the Home, care plan information was brief or not available. She has started developing new care plans for everybody. To date she has nearly completed three and expects to have all others completed by the end of July. It was noted at the last inspection that some people did not have care plans and a recommendation was made that these should be available for everyone living at the Home. As no improvements were made to care planning systems and further issues were identified at this inspection, a Code B Notice was served. Evidence was taken to demonstrate that care planning is poor. From evidence available it will be decided whether there is a need to undertake enforcement action. There was no care plan for the person most recently admitted to the Home. We were told by the manager that they are awaiting information from the persons family before a care plan is developed. Information obtained during the pre-admission assessment should be used to form initial plans of care which give staff basic information on how to meet the individuals care needs. We spoke to a member of staff to find out if they were aware of the action to take to meet the needs of the person most recently admitted to the Home. Although, as there was no care plan, it was difficult to evidence that the information given was accurate, the staff member appeared to have some knowledge of how to meet this persons basic personal care needs but some health care needs had been missed. The member of staff said that XX had developed a pressure sore just after admission to the Home and the District Nurse dresses this. Pre-admission information records that this person has a history of pressure areas. Some of the documentation in the care file regarding pressure areas was blank such as the Pressure ulcer assessment/progress chart and the wound assessment dressing chart. This persons pressure sore risk assessment gives them a score of 19 which is a medium risk of developing a sore. We were also told that this person does not have a pressure relieving mattress on her bed or cushion on her chair. Care plan information should have instructed staff of the action to take to reduce the risk of a pressure area developing. The staff member was unaware whether this person was at risk of falling. Preadmission information provided by Carehome Selection and a hospital discharge letter records the main reason for admission to hospital was due to a fall. Without care plan information staff may miss care needs and this person may be at risk of harm. One file had care plans which had recently been developed by the manager. Care plans contained brief information which did not always give clear instructions to staff of the action to take to meet peoples needs, for example physical health and hygiene Care Homes for Older People Page 16 of 46 Evidence: to ensure XX remains as independent as possible without the risk of neglect, XX is offered regular showers and staff to assist to ensure a thorough wash, reviews of risk assessments and needs. This does not demonstrate that XX has been asked whether she prefers a bath or shower, what time of day she prefers, how many times per week and how many staff are needed to provide assistance. Physical abilities - to ensure XX remains as independent as possible without the risk of neglect, ensure that XX is offered support and knows how to ask for help if needed for example on using the call bell system, review of risk assessments and needs. This does not record how many staff or what equipment is needed to help provide care. As these care plans had been developed in June 2010 they were not in need of review. The manager said that once all care plans have been implemented they will be reviewed on a monthly basis. The medical history for one person records that they have an eating disorder, however there was no care plan regarding this. This care file records that the person is to be weighed weekly but there was no documentary evidence to demonstrate that this is being done. One person has signed documentation to say that they have been involved in the care planning process and there was evidence in this file that the person had been given the choice of having personal care provided by either male or female staff. The manager confirmed that this is part of the new care planning process and the three people who have new care plans have signed (or their relatives have) to show their agreement to the care prescribed and are offered a choice of gender of staff. Not all information in care files is dated and signed or fully completed. Risk assessments identify peoples risk of harm whilst performing tasks, those seen were not linked to care plans and did not give staff any instructions of the action to take to reduce any risks. Not all of the files seen contained a falls risk or moving and handling risk assessment. Risk assessments in care files had only recently been introduced and there was therefore no evidence that they had been reviewed previously. There was no specific risk assessment regarding the risk of developing a pressure area in one care file. Pressure area risk assessments in the two other files seen identified the level of risk such as low, medium or high but then did not link to care plans (which were not available) or detail any equipment to be used, dietary requirements, or give staff specific instructions of the action to take to reduce the risk of developing a pressure area. Daily records are completed per shift including night shifts. At night staff sign a preprinted document to show whether the person was awake, asleep or wandering. Staff Care Homes for Older People Page 17 of 46 Evidence: are signing pre-printed time sheets showing that half hourly checks are completed for 15 people currently living at St Michaels. These do not clearly demonstrate the actual time that staff checked on each person. The Homes records show that staff are checking everyone in the same half an hour time period, even though some tasks recorded such as personal care may mean that staff are not able to attend to everyone in the same half hour time slot for which they sign. Food and fluid intake records are completed as part of the daily entries. These are broken down into morning, afternoon and night. The meals that have been served are recorded on the sheet, for example, fish fingers, potatoes and mixed veg, tea x 2, juice, angel delight. It does not record on this form whether all of the meal or some of the meal has been eaten. However, there is a separate form which records breakfast, lunch, dinner and staff write a code showing whether all of the meal or what proportion of the meal has been eaten. It was noted that under the wellbeing section of the daily records for 21 June 2010, eight out of eleven records seen staff had recorded has been fine, mobility is good with zimmer meds given also used the toilet. This does not clearly demonstrate that details of individuals health and wellbeing is being recorded. Daily entries for another person living at St Michaels records feet swollen, elevate legs, there was no evidence in subsequent daily entries whether this persons legs were still swollen and being elevated or evidence of any further action taken. The new manager said that she was unable to find evidence that people had seen an optician or dentist recently and has therefore booked everyone in to see a dentist who will be visiting the Home in July 2010. It was evident from talking to one person that a dental check was required. When this person spoke the dentures were loose and moved around resulting in the person taking them out. The medication and records were reviewed for the three people being case tracked. From records seen it was noted that staff are not routinely recording the number of pain killing medications given, for example staff had not always recorded whether one or two paracetamol had been given, it was therefore difficult to count and evidence that the correct number of tablets were remaining. The facilities and records regarding controlled medications were reviewed and found to be satisfactory. There were no controlled medications in use at the time of the inspection. Care Homes for Older People Page 18 of 46 Evidence: Medication is stored appropriately in lockable fridge, trolley and cupboards all within a lockable room. The temperature of the medication fridge is recorded on a daily basis. Copies of prescriptions were seen and we were told that these are used to double check that medication received into the Home is correct. Medication is received in blister packs by a local pharmacy. Staff have received training from this pharmacy regarding the safe handling of medication. Unused medication is stored appropriately and returned as and when the manager requests this service. The pharmacy collect the unused medication and signs records to demonstrate that the medication has been removed from the premises. We were told that all staff who administer medication have undertaken training and are being given the option of undertaking the Advanced Safe Handling of Medication training course. Key custody practices were discussed and found to be satisfactory. There is a staff signature list with names so that it can easily be identified who has signed MAR charts showing they have given out medication. The lunchtime medication round was observed, the medication trolley was taken into the room and medication was administered from blister packs into individual pots and then given to each individual. Medication administration records (MAR) charts were completed after each time someone took their medication. The staff administering the medication ensured that the trolley was secure if she had to leave the room. During the inspection a member of staff was heard asking a person living at the Home if they needed the toilet, the person replied that they didnt need it any more because they had done it in their pad and said they would wait until after lunch to change their pad. On this occasion the privacy and dignity of this person was not respected as all of those present in the lounge would have been able to hear the conversation. This persons self esteem and wellbeing could be affected if they are unable to wait long enough for staff to assist them to use the toilet. People were appropriately dressed for the time of year and peoples hair was neatly brushed. Care Homes for Older People Page 19 of 46 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. There was limited documentary evidence to demonstrate that people are involved in activities or are provided mental stimulation on a daily basis. Food provided does not always match that recorded on the daily menu, supplies were mainly value brand and there appeared to be limited choice for items such as bread or preserves. Evidence: A discussion was held with the manager regarding activities. We were told that the Home does not employ an activities co-ordinator. The duty rota seen did not record any dedicated hours for staff to complete activities with people. During the morning of the inspection people were sat in the lounge snoozing or staring into space and looked un-stimulated. The television was on but nobody appeared to be interested. At one point in the morning staff turned off the television and put music on, after approximately 15 minutes one person asked if it could be turned off as it was getting on her nerves. Nobody else appeared to be listening to the music and nobody was singing. Later on in the morning staff were seen playing dominoes with one person for over 30 Care Homes for Older People Page 20 of 46 Evidence: minutes. A gentleman had a very quick game of snakes and ladders and one person was seen reading the newspaper, all other people in the lounge remained unstimulated. During the afternoon a holy communion took place and all those in the lounge appeared to enjoy the experience. People said that they had enjoyed the service and asked the manager if they were going to visit again. We were told by the manager that there had been no religious services recently but a request has been made that people from the local church visit on a regular basis to give holy communion. The manager said that an external entertainer visits once per week. People living at the Home told us that apart from this little goes on. The manager said that staff have been asked to spend time each day sitting and chatting to people to try and stimulate them. Religious needs were not recorded in all of the care files seen. In the care file newly developed there was a care plan regarding meeting religious needs, this was non specific and did not say what religion the person was for example - to ensure that Xs religious beliefs are met, ensure the local minister visits regularly. This does not mention what religion X is, how often the minister visits or whether X has any other religious needs or requests. We asked the manager how they ensure that people maintain relationships that are important to them. We were told that the Home has an open visiting policy and people can visit at any reasonable time. People are able to see their visitor in the lounge or in their bedroom if they prefer. Some people have mobile phones and there is also a pay phone for people to use. This is located under a stairwell in a corridor. This area is also used to store items such as the hoist, wheelchairs, painting equipment, step ladders. The manager agreed that sitting under a stairwell amongst broken equipment may not provide a relaxing atmosphere to enjoy a telephone conversation. Visitors were seen during this inspection and they appeared to be at ease in their surroundings. The first day of this inspection visit took place on a hot day and some of the paperwork was completed in the lounge which was very warm. A member of staff was asked to get a room thermometer and it was agreed that the temperature in the lounge was 30 degrees Celsius. During the visit from approximately 10:40 am until 2:50 pm people were seen to be offered a cold drink with their lunch and a hot drink with a biscuit during the afternoon. People were given one biscuit unless they asked Care Homes for Older People Page 21 of 46 Evidence: for more, and no plate was given which meant that people generally rested the biscuit on their knee. Staff did not offer people extra fluids due to the hot weather. When questioned, a member of staff said that they would probably offer a cold drink at about 4pm. When the weather is hot people should be offered extra fluids to prevent dehydration. People were not seen to be offered fresh fruit. The cook said that they had fresh fruit available for people if they wished. The fruit bowel was placed on the unit in the back of the dining room. The bowel contained five apples and two small oranges which may not be sufficient for 18 people. The kitchen was reviewed and a discussion was held with the cook. The cook confirmed that she placed the orders for food but was not responsible for buying items. The menu for the day of inspection was reviewed and it was noted that the meal should have been pork chops but fish fingers were served as they did not have any pork chops. We were told by the cook and the manager that they are not always able to provide the meal as recorded on the menu but new menus were being developed. The new menus were seen and these do not record a choice of meal on each day such as Friday or Sunday. It was noted in the kitchen that a majority of food was value brand or smart price. There were jars and tins that had been opened and stored in the fridge which did not have a date of opening recorded on them. It was therefore difficult to identify when these had been opened and whether they were within their shelf life. There was also a large pan of potatoes which the cook said had been peeled on Sunday by the weekend staff, some used on Monday and some were to be used on Tuesday. The manager was told that there would be no nutritional value in these potatoes by the time they would be eaten and the practice of preparing vegetables too far in advance should be stopped. The fridge also contained a large bowel of grated cheese, a large bowel of jelly, some sandwiches for the evening meal, a small amount of fresh vegetables, milk and white bread. We asked if wholemeal bread was also available for people to enable them to have a choice of white or brown bread. We were told by the cook that only white bread is provided. The food storage area was checked, it was noted that a majority of the food items stored were value brands, there did not appear to be a choice of jam or marmalade for the morning as only Jam was available. A large plastic container was seen which Care Homes for Older People Page 22 of 46 Evidence: had crumbled grayish coloured mixture in it. We were told by the cook that this is pastry mixture which is replaced on a monthly basis. There was no evidence that the box is cleaned out each time the new mixture is put in the box and no evidence that the mixture is within its use by date. The fridge and freezer temperature records were requested, these had not been completed for the previous weekend. There were large tubs of washing up liquid on the window sill in the kitchen which were accessible to people living at St Michaels and could put them at risk of harm if they were to accidentally swallow the liquid. The cook was asked if they provided any special diets, it was noted that there are no special dietary requirements, the diabetic people have low sugar products. The cook showed a packet of cake mix which stated it was suitable for diabetics. Care Homes for Older People Page 23 of 46 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is no accessible information for people which guides them of the action to take if they wish to make a complaint. Some staff require training regarding protection of vulnerable adults to help them identify and take appropriate action if abuse is suspected. Evidence: We talked to the manager about how people are able to raise any concerns or complaint that they may have. We were told that if people wanted to raise an issue they could speak to her and she would record the details in the complaint log book. There is also a compliments, comments and complaints log book which is kept in the entrance porch for people to complete if they wish. We looked at the complaint log book and nothing had been recorded since 2005. There was nothing in the compliments, comments and complaints book since 2008. The manager said that she has not received any complaints or safeguarding issues since she has been in post. We could not see a copy of the Homes complaints policy clearly on display. The manager confirmed that this needs updating and is therefore not on display. We were told that the manager wants to update the complaints policy, add a suggestions box and make complaints information more accessible to help people raise any issues that they may have. The manager was aware of the shortfalls regarding the Homes complaints process and of the action to take to address these Care Homes for Older People Page 24 of 46 Evidence: shortfalls. Records seen did not confirm that all staff have up to date protection of vulnerable adults (safeguarding) training. The manager said that she is in the process of booking safeguarding training for all staff and is awaiting the dates of the training to be confirmed Copies of the local authority safeguarding policy were seen in the managers office. We were told that new staff have to read the safeguarding policy but there is no documentary evidence to demonstrate that this takes place. Staff do not currently sign anything to say that they have read the policy and are willing to work to it. Care Homes for Older People Page 25 of 46 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. Some areas of the Home are in need of updating and some fixtures and fittings are shabby and in need of replacing. Heat provided by a radiator that could not be turned off added to the excessive heat in the lounge making the area uncomfortable. Evidence: St Michaels is a Care Home set in a residential area in Solihull. The Home was purpose built as a Care Home in 1994 and has adaptations to meet the needs of those that live there. Bedrooms are located on the ground and first floor. There are nineteen single and one double room, all with a wash hand basin, some have en suite toilets. A passenger lift and a staircase give access to first floor. We looked around the Home and saw that communal areas consist of a lounge/dining room, a small conservatory area attached to the main lounge, and a quiet lounge. The small quiet lounge contained eight chairs, two of which had small tears in the fabric and one had a small hole. One large table, a TV and two wall units. For the size of the room there appeared to be a large amount of furniture making the room look cluttered. The curtains were not fully attached to the curtain rail and looked untidy. Since the inspection we have received a copy of a letter from an external organisation confirming that new chairs will be delivered to the Home in July Care Homes for Older People Page 26 of 46 Evidence: The carpet in the conservatory is marked and in need of a thorough clean or replacing. The main lounge with adjoining dining room was clean and no unpleasant odours were noted. There was a large television displaying subtitles for people to view if they wished. Seventeen lounge chairs were placed around the outside of the room. The layout of these chairs did not enable small groups of people to sit together and have a conversation. The chairs were so close together that the chair arms were touching each other, therefore it would be difficult to move people with the use of equipment. It was noted that the arms of lounge chairs were worn. One set of curtains were not attached to the rail fully making the curtains look untidy. The lounge was extremely hot and through discussions with one person living at the Home it was noted that one of the radiators did not switch off. We felt the radiator and noted that it was hot. A staff member fetched a room thermometer and we noted that the temperature in the lounge was 30 degrees Celsius. The inspection took place on a hot day and there was a fan in the room. One person complained that they were too hot and went to change their clothing. We mentioned the urgency of ensuring that this radiator has a thermostatic device fitted to ensure that it could be turned off. During the second day of our visit the handyman had fitted a thermostatic device and the radiator was not on. The dining room adjoining the lounge contained dining tables and chairs and a large cupboard and drawer unit at the back of the room. Dining chairs had no arms which may make it difficult for some people to remain independent and sit at/leave the dining table unassisted. We observed people going to the dining area to be seated for the lunchtime meal. Some people appeared hesitant to sit down on the chairs and others required assistance of staff to help them get seated. The legs on chairs were marked and scuffed. It was noted that there are four dining tables that can accommodate 17 people (The Home is registered for 21 people). A member of staff told us that they never have too many people in the dining room and everyone can sit in the dining room if they wish. We were told that one person eats meals in the lounge as she needs assistance to eat and she does not sit in the dining room. The small conservatory adjoining the lounge had three chairs, one of which was apparently specially made for an individual living at the Home. Curtains in the conservatory were not fully attached to curtain rails and looked untidy. The handle was broken off one window in the conservatory. A member of staff was asked how they close the window, we were told that someone has to go outside and push the window shut. This window could not therefore be locked shut and could put people at risk. This window was repaired by the handyman on the second day of our inspection. Care Homes for Older People Page 27 of 46 Evidence: When we looked around the kitchen we noted that the tap to the sink in the kitchen did not turn off and was constantly running, one of the gas rings on the cooker did not work and the cheese grater on the draining board was broken. The windows and fly screens were dirty and in need of cleaning. The whole of the kitchen including the cooker was grubby and looked like it is in need of a deep clean. Since the inspection we have received a copy of a letter from an external spring cleaning company confirming that a deep clean has taken place in the kitchen area including all fly screens, floor and wall tiles. We have also received a copy of an order confirmation showing that a new cooker has been ordered to replace the broken one currently in use. We have been forwarded two kitchen cleaning proformas, one for daily and one for monthly use. There were large tubs of washing up liquid on the window sill in the kitchen which were accessible to people living at St Michaels and could put them at risk of harm if they were to accidentally swallow the liquid. The laundry was clean and appeared to be hygienic. There is one washing machine and one dryer, both were in good working order. Staff bring items to be laundered in wash baskets, soiled items are placed in red washable laundry sacks. Use of these helps to prevent the spread of infection as the number of times staff handle soiled laundry is reduced. The washing machine has a sluice cycle and can be programmed to reach temperatures which meet infection control standards. Disposable gloves and aprons are not kept in the laundry, these are kept in a cupboard in the unit in the dining room. The manager said that all staff know where these are kept. Bathrooms were viewed and it was noted that some work is required to flooring and some ceiling tiles. The manager was fully aware of all environmental issues and confirmed that there is an action plan in place to demonstrate that these issues have been identified and the intended action to address issues. We were told that all pipework in bathrooms is to be boxed in to prevent the risk of scalding if someone were to fall against a hot pipe. The side panels to some baths are to be replaced and ceiling tiles are to be replaced. The manager said that work was due to start during the week of this inspection. Bathrooms and toilets seen contained liquid soap and disposable hand towels and use of these should help prevent the spread of infection. In one bathroom a wire was seen attached between the radiator and the thermostatic mixing valve, the manager was unsure why this was there and confirmed that she would ensure the handyman looked Care Homes for Older People Page 28 of 46 Evidence: into this matter. Another bathroom appeared to be quite cluttered with trolleys, the manager confirmed that they intend to put new shelving units in the bathrooms to give a more homely feel. The sluice room was seen, this room was not locked when not in use, this was identified as an issue for action at the last inspection of the Home. Leaving this door open could increase the risk of spread of infection as people have open access to this restricted access area. The stair well which houses the pay phone was cluttered with items such as a hoist, painting and decorating equipment, ladders, vacuum cleaner and wheelchairs. The manager agreed that this was not the ideal place for storage of such items or for the pay phone. A selection of bedrooms were viewed. Rooms had been personalised with pictures and ornaments, some showed evidence of people continuing with hobbies and interests such as knitting. We were told by the manager that there is lockable storage cupboards in bedrooms, however, some of these do not work and they are all due to be replaced with new bedside units with a lockable drawer facility shortly. We were shown documentary evidence to demonstrate that the Registered Person has asked everyone currently living at the Home if they are willing to wait for lockable facilities in their bedroom, three people have said that they do not want this facility. All of the bedrooms seen were clean with no unpleasant odours noted. A discussion was held with the manager regarding the types of taps available in some hand wash sinks in bedrooms. Some of the taps required the user to push down hard on the top to get water out. On one tap tested by the time the user released the push down in order to wash their hands the water had stopped flowing. It would therefore be difficult to wash your hands. The manager confirmed that these taps are due to be replaced. Some of the ceiling tiles in bedrooms and in corridors had moved revealing a hole in the ceiling. We were told that the handyman is in the process of replacing all of these ceiling tiles. An issue was noted at the last inspection regarding the ceiling in one bedroom, this had not been addressed but the manager assured us that this will be addressed as part of the replacement of these tiles. The manager confirmed that the ceiling tiles in the kitchen are also to be replaced. The garden was seen, one person was asked if she went out into the garden in the nice weather. This person said that they hadnt been outside. It was noted that there is only one small bench available. The manager said that although the garden is very Care Homes for Older People Page 29 of 46 Evidence: small, people may enjoy going out and she has therefore asked the owner to purchase some garden furniture to enable people to sit outside. Care Homes for Older People Page 30 of 46 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is insufficient documentary evidence to demonstrate that sufficient staff are on duty each day. Update training is required in some mandatory areas. Evidence: Staffing levels were discussed with the manager and a copy of the duty rota was taken for review. We were told that the number of staff on duty on a daily basis is as follows:Early 7.30am - 2.30pm 3 care staff Late 2.30pm - 9.30pm 3 care staff Night 9.30pm 7.30am 2 care staff We were shown documentary evidence to demonstrate that some shifts are covered by existing staff such as the cook. We spoke to the cook who said that she had initially worked at the Home as a care assistant and therefore has experience of care work. The duty rota and other paperwork seen did not clearly demonstrate that sufficient staff were on duty on each shift. The manager said that agency staff are now being used to cover shifts if necessary and that 21 shifts have been covered by agency staff within the last month. Two new staff have been employed to work on the Homes bank, this should help to ensure that staff do not work excessive hours. The manager confirmed that staff no longer work more than six shifts in a row and must have at least one day off work per week, documentation seen confirmed this. Care Homes for Older People Page 31 of 46 Evidence: The duty rota seen did not clearly demonstrate that domestic, catering or laundry duties were provided for. The manager said that there is one domestic who works 4 hours per day Monday to Friday and then 2 hours doing laundry duties. Care staff are responsible for domestic and laundry duties at the weekend. Catering staff work seven days per week but we did not see documentary evidence of the hours that they work. The managers hours were not recorded on the duty rota. The manager said that she is developing a monthly planner to record her hours. A discussion was held regarding Criminal Records Bureau (CRB) checks and Independent Safeguarding Authority (ISA) checks. We were told that the Registered Provider is completing the ISA over the internet and these are now returning quickly within 48 hours. We were shown documentary evidence that demonstrates that there are seven CRBs outstanding, one of these staff has not started working at the Home yet. There is only one staff member who does not have an ISA working at the Home. The manager said that these staff have been working at the Home for over a year, she expects to receive the ISA within the next few days. The manager was told that until the required information is received that risk assessments should be put in place to demonstrate that any risk of these people working with vulnerable adults has been identified and any appropriate action taken to ensure that they are safe to work with the people living at St Michaels. Three staff employment files were reviewed. Staff files contained application forms, job descriptions, written references, copies of passports and driving licences and one file had a health declaration. Not all of the files contained a contract of employment, one file had a contract dated 2000. The manager confirmed that not all staff have contracts of employment and the contracts available require updating. We were told that staff contracts are going to be updated shortly. Documentary evidence was available to demonstrate that the manager has taken appropriate action when issues are identified with CRBs and work permits. Two of the files had documentary evidence that the manager has started undertaking supervision with staff. The manager confirmed that she has not been able to undertake supervision with all staff as yet but supervision is planned. Copies of training certificates from the persons previous place of employment were available in one file. Training certificates in staff files seen showed that some training is out of date and updates are required. Care Homes for Older People Page 32 of 46 Evidence: Staff training was discussed with the manager and we were told that the Home have recently joined a training group and have requested safeguarding training for all staff. The Infection control department are providing two training sessions for staff. The manager said that all staff will have to attend one of these sessions. The manager said that she is aware that some staff require update training and intends to ensure that all staff undertake all outstanding mandatory training by the end of July 2010. Following the inspection we were sent a training matrix which shows training undertaken and planned. The matrix confirms that some staff require training regarding moving and handling, health and safety, food hygiene, protecting vulnerable adults, First Aid and Infection Control. In addition to this a letter of confirmation from a training organisation shows that training regarding Fire, health and safety, control of substances hazardous to health and manual handling have been booked for the end of July. Documentary evidence of other training booked was also forwarded following the inspection. This shows that safeguarding, mental capacity and deprivation of liberty safeguarding, basic food hygiene and basic life support training has been booked for some staff. Records seen show that there are currently 12 care staff employed, two of these staff have a National Vocational Qualification (NVQ) at level two, five staff have signed up to start this training and one staff member has NVQ level three. The two staff who already have NVQ level two are starting the level three course in July. A copy of the Homes induction package was taken for review. We were told that this induction package was in place when the new manager commenced her employment at the Home and is apparently in line with the Skills for Care (the national training organisations) requirements. We asked to see any paperwork that the staff have or have to complete. The manager said that staff do not have any written information. The induction paperwork seen was more of a induction to the Home and would not meet the Skills for Care - Common Induction Standards. The manager was advised that Skills for Care have a website and to obtain the information regarding induction via this source. Care Homes for Older People Page 33 of 46 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. The new manager was fully aware of all issues that are to be addressed and was working with the Registered Provider to address issues in a timely manner. However, some management issues from the previous inspection remain outstanding. Evidence: The manager is new in post and has been working at the Home for approximately six weeks. We were told that the manager has over ten years experience of working in a care setting as either a care assistant, senior, deputy or more recently as a manager. The manager has obtained the NVQ level four qualification recently and is waiting for her certificate to confirm this. We were told that she has agreed to sign up for the Leadership and Management qualification and also wants to undertake an assessors course. This newly employed manager has not as yet completed the application form to become registered with us as the manager for St Michaels. Care Homes for Older People Page 34 of 46 Evidence: Lines of accountability were discussed, care staff report to senior care who reports to the manager who reports to the Registered Provider. From discussions with staff working at St Michaels it was evident that they were aware of who to talk to if they have any issues or concerns. We asked the manager about on call arrangements and were told that currently there are no on call processes in place. It has been agreed that the manager and senior staff will each complete the on call duty for a week at a time. This helps to ensure that staff have access to help and advice at all times of the day when the manager is not on duty. We spoke to the manager about quality assurance systems and practices, we were told that they have been unable to find any quality assurance documentation and new systems are therefore being developed. There are currently no written, pre planned audits, however the manager said that as she is new in post she is reviewing all systems and practices in the Home and will develop paperwork to demonstrate this. A satisfaction survey was sent out recently to everyone living at St Michaels. Twelve responses have been received so far. Social activities were rated as poor and quality of care rated as fair by some people. Comments were made such as need more things to do, one member of staff is too bossy, it depends sometimes staff are not friendly. We were told by the manager that the registered provider and a senior care assistant ares going to analyse the results. The senior care assistant is going to speak to people who have responded and ask them for their views on how improvements can be made. An action plan will then be developed showing the issues and the action taken to address them. Since this inspection we have been sent newly developed satisfaction surveys asking about food and general satisfaction regarding the Home. We have also received a letter from a Care Consultancy company who are at present providing care and support to St Michaels to help them address any issues that have been identified since the new manager took on her role at the Home. A residents/relatives meeting was held in May 2010, the minutes of this meeting show that people had commented about the fact that there is no garden furniture, thermostats in bedrooms get stuck on and rooms get hot, people bought their own bedding which is being used by other people. There was no action plan in place to demonstrate action taken to address these issues. However, the manager confirmed that new garden furniture has been requested and the maintenance person added a thermostatic valve to the radiator in the lounge on the day of the inspection and was Care Homes for Older People Page 35 of 46 Evidence: aware that others needed valves adding. A staff meeting was held on 13 May 2010, the minutes were seen and these identified various issues which the manager is in the process of addressing. A further staff meeting is planned for week commencing 28 June 2010. We were told that the Home do not hold any money on behalf of people. Families give their relative small amounts of money and they pay for any items that they want. The Home do not get involved in any invoicing or holding funds on behalf of anyone. Families bring in toiletries, buy clothes and pay for chiropody or hair. One person who has no relatives has a power of attorney looking after their financial matters. The manager said that she had no documentation regarding peoples finances. Staff supervision was discussed with the manager who said that she could not find any evidence that supervision of staff had taken place before she started working at the Home. She confirmed that she has started undertaking supervision, this was demonstrated in two of the three staff files seen. We discussed observation and monitoring of working practices and were told that spot checks currently cannot be undertaken at night as doors are locked and the latch put down, therefore restricting entry into the Home with a key. The manager was keen to resolve this issue with the Registered Provider as she believes that it is important to undertake some spot checks. As mentioned in other sections of this report some documentation in care files is not dated and signed by the person recording the information. It is therefore difficult to evidence back who was responsible for completing documentation and the accuracy of the information recorded. Some information in care files was also left blank and some care plans not available. Record keeping at the Home requires improvement to ensure that all information is up to date and available. The manager is aware of this and is working on new systems. A selection of records were reviewed to evidence whether health and safety practices are up to date at the Home. Weekly fire alarm testing records showed that it was last tested in January 2010. The records do not demonstrate that the broken fire panel covering which was identified at the last inspection has been repaired. The manager said that the maintenance person has been asked to fix this. Records show that emergency lighting was last tested in December 2010. This should be tested on at least monthly basis to ensure that emergency lighting is in good working order. Records show that the lift, hoist and bath hoist have been serviced as appropriate. Care Homes for Older People Page 36 of 46 Evidence: There were no records to show that Portable electrical appliances have been tested recently, this was identified as an issue for action at the last inspection of the Home. The manager could not find any records to demonstrate that the call alarm system has been serviced, but did confirm that one of the call bells in a bedroom did not work so it was assumed that the call alarms had not been serviced. The servicing of the call alarm system was identified as an issue for action at the last inspection. Care Homes for Older People Page 37 of 46 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 38 of 46 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 1 4 The Statement of Purpose must be updated as necessary to include up to date information and this document should be available for review and for any person who comes to live at the Home. This is to ensure that people have up to date information about the services and facilities available at the Home. 10/08/2010 2 2 5 The Service Users Guide 10/08/2010 must contain up to date information and should be available for any person who requests a copy. This is to ensure that people have up to date information about the services and facilities available at the Home. Care Homes for Older People Page 39 of 46 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 3 7 15 Care plans must be developed for each person living at the Home covering each area of need. This is to ensure that staff have sufficient written information to enable them to meet the needs of people under their care. 05/08/2010 4 10 12 The privacy and dignity of people living at the Home should be promoted on all occasions. This is to ensure that peoples wellbeing does not suffer as a result of poor practice. 05/08/2010 5 15 16 People must be offered a 06/08/2010 regular supply of fluids, which should increase during hot weather. This is to prevent the risk of dehydration during hot weather. 6 15 16 Menus and food items 30/07/2010 should be reviewed to ensure that people are receiving nutritious foods on a daily basis. Documentary evidence should be available to demonstrate that menus are nutritionally balanced. Care Homes for Older People Page 40 of 46 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 people eat a balanced, wholesome, tasty diet each day 7 22 16 Repair or replace all furnishings which are torn (chairs), broken (lockable storage units) or missing (lampshades). This is to ensure that people live in a comfortable, homely environment. 8 30 18 Staff must receive training in order for them to be able to perform their job. This is to ensure that staff have up to date skills and knowledge to meet the needs of those under their care. 9 38 17 Documentation must be available to demonstrate that fire alarm and emergency lighting systems are checked on a regular basis and are in good working order. This is to ensure that the health and safety of staff and those living at the Home is maintained. 10/08/2010 10/08/2010 06/08/2010 Care Homes for Older People Page 41 of 46 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 2 All people should be issued with a terms and conditions of residency. These documents should be signed and dated by all parties involved. Pre-admission assessments should clearly identify peoples needs and abilities, any equipment and the number of staff needed to provide care. Documentary evidence should be available in daily records to demonstrate that follow up action is taken to address any issues identified. Daily records are completed to show that half hourly checks are undertaken on some people at night. These should record the actual time that the check was undertaken. They should not record information against a pre-printed time sheet which may not accurately reflect the time of the half hourly check. Care plan instructions should be followed by staff to ensure peoples needs are met, for example if the care plan records the need for the person to be weighed on a weekly basis, documentary evidence should be available to demonstrate that this takes place. Documentary evidence should be available to demonstrate that people are involved in the care planning process, including agreeing to care to be provided Risk assessments should be completed for activities that involve risk, they should record the action that staff should take to reduce the risk and should be linked to care plan information. Staff should clearly indicate whether one or two tablets have been taken on each occasion. This is to ensure that audits can be undertaken to evidence that medication is being administered and recorded correctly. Evidence should be available to demonstrate that regular activities or mental stimulation takes place for people living at the Home suited to their wants and needs. Details of individuals religious needs should be recorded in their care file and arrangements should be made for people to attend religious services of their choice. The Homes payphone should be more accessible to those who wish to make a phone call. The payphone should not Page 42 of 46 2 3 3 7 4 7 5 7 6 7 7 8 8 9 9 12 10 12 11 13 Care Homes for Older People 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 be located in a storage area. 12 15 The practice of peeling potatoes and leaving them in the fridge for use in the next two days meals should stop. The nutritional value of these vegetables would be lost if they are stored for such a long time period. The practice of storing pastry mix in the large tub without evidence of date of opening or use by date should be stopped. Alternative storage methods should be sought. People should have the option making choices for their meals, for example either brown or white bread, jam or marmalade. The date of opening should be recorded on all items once opened ready for use. This is to ensure that items are stored within their shelf life to preserve nutritional value and taste. The meals as recorded on the Homes menu should be served on a daily basis. If there is a need to provide an alternative documentation should be avaialbe to record what alternative was served and the reasony why the menu option was not available. The complaint procedure should be updated to record current information to enable people to raise concerns if they wish. A copy of the complaints procedure should be on display in the Home in a format which is accessible to all those that live at the Home. All staff should undertake training in the protection of vulnerable adults to ensure that people living at the Home are safeguarded. A repair should be made of the ceiling which has the ceiling tiles attached by tape. This looks unsightly and does not give a homely, welcoming feel. Curtains should be attached to curtain rails to ensure their functionality and so that they do not give an untidy appearance to the room. Consideration should be given to the layout of the lounge chairs to ensure that people ar able to have small group conversations if they wish and to ensure that staff are able to provide assistance to these people who need help Page 43 of 46 13 15 14 15 15 15 16 15 17 16 18 16 19 18 20 19 21 20 22 20 Care Homes for Older People 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 getting in and out of their chair with equipment. 23 25 The temperature of communal areas should be monitored and when excesssively hot additional cooling measures should be put in place such as fans, air conditioning etc. Work should be undertaken to ensure that all radiators are able to be turned off in hot weather conditions and people are able to individually turn the temperature up if they are cold. The sluice room door should be kept locked when not in use, this is to prevent cross infection. Documentary evidence should be available to demonstrate the hours that ancillary staff such as domestic, laundry and catering staff work on a daily basis Duty rotas should clearly demonstrate the number of staff on duty on a daily basis. At least fifty percent of care staff employed should have obtained a national vocational qualification in care at level two or above. Risk assessments should be in place to demonstrate that those staff who do not have a criminal records bureau or independent safeguarding authority check are safe to work with the vulnerable people living at St Michaels. Contracts of employement should be availalbe for all staff employed at St Michaels Care Home. Staff induction should be completed in line with the requirements of the Skills for Care - Common Induction Standards. Systems should be put in place to ensure that the quality of service at the Home is reviewed and action taken to address any issues identified. Further work should be undertaken to ensure that all staff receive supervision on a regular basis. Systems should be put in place to ensure that the manager is able to undertake spot checks of staff working practices at any time of day or night without staff being alerted to her presence. All documentation in care files should be dated and signed 24 25 25 26 26 27 27 28 27 28 29 29 30 31 29 30 32 33 33 34 36 36 35 37 Care Homes for Older People Page 44 of 46 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 by the person recording the information. 36 38 Records should be available to demonstrate that regular servicing is undertaken on the call alarm system and that it is good working order. Care Homes for Older People Page 45 of 46 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 Older People Page 46 of 46 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!

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