Care Home: St Michael`s Manor

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What the care home does well All service users are accommodated in single bedrooms, many having en-suite facilities. Service users confirmed that the staff were kind and caring and would do all they could to meet any requests. Service users also said that the meals were good and were hot when served. A high number of activities are provided to promote stimulation and social interaction. Privacy and dignity were observed to be respected by the staff. What has improved since the last inspection? A high number of improvements have been made since the last inspection. Pre-admission assessments are now more detailed and clearly reflect service users needs. Care plans are comprehensive and new systems have been put in place to ensure that they are accurate and provide sufficient information for staff. Medications are dealt with in a safe manner and audit systems have been put in place by the manager. All staff have now been given training on the Protection of Vulnerable Adults to protect the service users. Extensive redecoration and refurbishment of the building has taken place to provide service users with a clean, fresh and homely environment and to make the home a pleasant place in which to live. All areas of the home are maintained in a clean condition. A high number of staff training events have taken place and the new Training and Development Officer has arranged for additional training to provide staff with the skills and knowledge in order that they can meet the individual needs of service users. What the care home could do better: The programme of redecoration and improvements should now continue to improve the environment for service users. The planned programme of garden improvements should commence to meet the planned timescale set by the home to provide a pleasant area for service users whilst the weather remains sufficiently warm for them to take advantage of it. CARE HOMES FOR OLDER PEOPLE St Michael`s Manor Woolton Road Woolton Liverpool Merseyside L25 7UW Lead Inspector Jeanette Fielding Unannounced Inspection 17th July 2008 10:20 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Michael`s Manor Address Woolton Road Woolton Liverpool Merseyside L25 7UW 0151 427 9419 0151 427 9421 stmichaelsoffice@yahoo.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) M.E.S. Pension Fund Mr Philip Sergeant Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 44 Nursing Care and 44 Personal Care within the overall number of 44 44 Nursing or 44 Personal Care of which 5 may be used for terminally ill (older people) (TI/E) One service user under 65 years of age requiring terminally ill care may be admitted within the overall number of 5 TI(E) 16th January 2008 Date of last inspection Brief Description of the Service: St Michaels Manor is one of two adjacent care homes situated on the same site in a quiet residential area of South Liverpool. A private company owns both homes. St Michaels Manor is registered both for residential and nursing care. Trees and grassed areas surround the home which gives a sense of privacy, plus the home has its own gardens, there is a car park to the front of the home. The building itself is an older Victorian dwelling, which has been modernised inside whilst keeping many of the attractive original features such as the ornate ceilings and a sweeping central staircase. Passenger lifts and stairs serve the upper floors. Accommodation for residents is provided in single rooms many of which have en-suite facilities. The home is centrally heated. There is a large central lounge dining room. The home is close to public transport, rail and bus and is near to the M62 and M57 motorways. The fees for the home range from £322.00 to £423 per week plus a top up fee of £17.50. St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use the service experience good quality outcomes. This unannounced key inspection was undertaken in one day over a period of seven and a half hours. As part of the inspection process, all areas of the home were viewed including many of the service users bedrooms. Assessments and care plans were inspected together with staff records and certification to ensure that health and safety legislation was complied with. Observation of the interaction between staff and people who live at the home provided evidence of the actual care given. Discussion took place with the manager, nurses, care staff, service users and visitors to the home. A preinspection questionnaire was sent to the home to provide inspectors with information regarding staff, service users and the premises and was completed and returned in a timely manner. What the service does well: What has improved since the last inspection? A high number of improvements have been made since the last inspection. Pre-admission assessments are now more detailed and clearly reflect service users needs. Care plans are comprehensive and new systems have been put in place to ensure that they are accurate and provide sufficient information for staff. Medications are dealt with in a safe manner and audit systems have been put in place by the manager. All staff have now been given training on the Protection of Vulnerable Adults to protect the service users. Extensive redecoration and refurbishment of the building has taken place to provide service users with a clean, fresh and homely environment and to make the home a pleasant place in which to live. All areas of the home are maintained in a clean condition. A high number of staff training events have taken place and the new Training and Development Officer has arranged for additional training to provide staff with the skills and knowledge in order that they can meet the individual needs of service users. St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed pre-admission assessments are now undertaken on all prospective service users to enable the home to identify their specific needs and preferences and prepare a plan of care. EVIDENCE: The service user guide has been reviewed and updated since the last inspection and it now includes full information regarding the facilities and services offered by the home. It is issued to all prospective service users and their families to enable them to make an informed choice regarding their service provider. Improvements have been made to the pre-admission assessment to identify their needs and to enable the home to establish whether they can meet those St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 9 needs. A selection of care files were inspected of service users who had recently been admitted to the home. All were found to contain detailed preadmission assessments. Full information was recorded regarding their health, care and social needs, together with information regarding their preferences of lifestyle. Sufficient information is recorded to enable appropriate equipment to enable their needs to be met and for the initial plan of care to be prepared. The documentation used for the gathering of information is clear and enables staff to gather information from the service user, their relatives and any other health care professional involved in their care provision prior to admission. The home does not offer intermediate care. St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Great improvements have been made to the management of medications to ensure that service users receive the appropriate medication at the correct time and in a safe manner in order to protect them. EVIDENCE: Individual care plans are prepared for each service user. Work has taken place to improve the plans to ensure that they contain full information to enable the staff to meet the service users needs. Risk assessments are undertaken and risk management plans put in place to remove or reduce potential risks. Information is recorded with regard to moving and handling and identifies the specific type of hoist and sling to be used for individual service users where necessary. Special diets are identified on care plans and details of these are also given to the chef. Wounds are mapped and photographed to provide evidence of improvement or deterioration. The services of the Tissue Viability St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 11 Nurse Specialist are sought where necessary and the information given by them is duly recorded in the plan of care. Records clearly show that wounds have been treated in accordance with the plans. Daily records completed by the staff are informative and provide evidence of the actual care given and show that service users health care needs are met. Profiling beds are now provided where it has been identified that these are necessary for meeting service users needs. Specialist equipment is provided according to individual assessment and need. None of the service users at the home administer their own medications although a procedure has been put in place in the event of service users wishing to attend to their own medications in the future. The medications policy and procedure has been placed in the medications room to provide advice and information to all staff who are involved in the administration of medications. Medication Administration Record sheets are completed appropriately and were found to be up to date. The manager has implemented a strict procedure for the storage, administration, recording and disposal of medications, together with training for staff, and this has proved to be effective in ensuring that service users have sufficient medications in stock and that all medications are handled safely. Comprehensive and regular audits are undertaken on medications by the manager and the records of these show that there are now no irregularities relating to medications. Controlled medications are securely stored and the records were accurate. Evidence of the training undertaken by staff is held on their personnel file. Service users spoken to during the inspection confirmed that staff respected their privacy and dignity. A group of service users spoken to all said that the staff were kind and caring and would do anything they could to meet requests. Staff were observed to speak in a dignified manner and to knock on bedroom doors prior to entering. St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are stimulated and entertained through a high number of social activities within the home. EVIDENCE: On admission service users are asked about their lifestyle, choice of foods and preferences of the social activities they would like to take part in. The service user with help from a family member or staff completes a social questionnaire, which includes schooling, work, hobbies, food likes and dislikes and television and radio preferences. This information is used to form an activities plan. A detailed record of the activities that service users have participated in is held and include ball games, board games, cards, bingo, quizzes, art, music, dancing, playing musical instruments and more recently, a group of service users have been re-developing their handwriting skills. The activities coordinator said that a number of service users have said that they do not have a reason to write any more and had forgotten how to write letters and cards. St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 13 The handwriting group has proved very successful and service users spoken to said that they enjoyed ‘putting pen to paper again’. Birthdays and notable dates are celebrated with cakes and parties. All service users are welcome to participate and photographs of events are taken. Members of Clergy visit the home on a regular basis and provide services for those who wish to participate. One service user said that she would like to go out more frequently to local shops ‘just to see how prices have gone up’. She said that she had been told about changes in supermarkets and would welcome the opportunity to have a cup of tea in a supermarket restaurant. The home does not provide transport but taxis can be provided for short trips. Some service users are taken out by their relatives but all those spoken to said that they are usually taken to their family members own home for a meal and would love to go further afield. Visitors are welcome at the home at any time but are requested to avoid mealtimes as some service users rush their meals or do not finish them as they want to spend time with their relatives. Relatives are encouraged to assist their relatives with their meals where this is appropriate. One relative said that she tried to visit at mealtime so that she could assist with feeding her husband and by doing so, felt that she was part of the care giving process. Meals are served in the dining room, lounge or service users own bedroom as they wish. Dining tables are attractively laid and the meal served on the day of the site visit looked and smelled appetising. Service users said that the food was ‘lovely’ and ‘just the way I like it’. Special diets can be provided on the advice of the GP or dietician or on the request of the service users. Meals are prepared in the main kitchen and served from heated trolleys in the dining room. Meals served to service users in their bedrooms were observed to be appropriately covered during transportation. Drinks and snacks are served between meals and on request. Drinks can be made in the kitchenette which is located off the main dining room and is accessible to staff and visitors. Service users are discouraged from making their own drinks for safety reasons. St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is available to visitors and people who live at the home and can be confident that their concerns would be taken seriously. EVIDENCE: The home has a robust complaints procedure which is detailed in the Statement of Purpose and also displayed within the home to inform service users and visitors to the home of how to complain and the person to whom the complaint should be directed. The home has had a very low number of complaints and the records show that these have been dealt with appropriately and in a timely manner. Service users said that if they had any concerns, they would feel comfortable in expressing these to the manager. All staff within the home have had training on the Protection of Vulnerable Adults. Staff spoken to during the inspection were able to demonstrate that they were aware of the action that they were required to take in the event of abuse being suspected. St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Investment has resulted in improvements within the home to create a more comfortable and safe environment for those living there and visiting. EVIDENCE: Considerable improvements have been undertaken since the last inspection. The programme of redecoration, refurbishment and improvements are well underway. A number of bedrooms have been redecorated, and those that are still awaiting redecoration have been improved through the provision of new curtains and bedspreads. New bedroom furniture has been provided where this has been identified as necessary and all rooms were clean and fresh. Service users now have some choice with regard to the colour schemes within their bedroom and those that have been redecorated are bright and pleasant. St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 16 Service users are encouraged to personalise their bedrooms with small items of furniture, pictures, photographs and items of memorabilia to make their rooms more homely. This enables service users to live amongst familiar items and promotes reminiscence and topics of conversation. All service users are accommodated in single bedrooms, many of which are provided with en-suite facilities. The programme of redecorating corridors is continuing and new carpets have been fitted in areas that have been redecorated. New lighting has been fitted in redecorated corridors which are now bright and attractive. The lounge is large and is decorated and furnished to a high standard. The staff have laid out the chairs in the lounge to enable service users to sit in small groups where they can interact more closely with others. Work continues to improve the bathing facilities within the home and most bathrooms and toilets have been redecorated. The home provides a specialist hairdressing room which has been fitted with an appropriate hairdressing sink. A professional hairdresser visits the home on a regular basis and is available to all service users. Risks, identified at the last inspection, have been addressed to ensure that staff and service users live and work in a safe environment. The home is clean and fresh throughout. Work has not yet commenced on improving the garden area. The gardens provide a large grass area, which is uneven in places, but seating has been provided for service users and a ramp is provided from the dining area into the garden to give full access to service users. St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff training needs have been identified and appropriate training given to ensure that all staff have the skills necessary to meet the needs of service users. EVIDENCE: Staff rotas indicate that there are sufficient trained nurses, senior care staff and health care workers on duty throughout the day and night. There are separate domestic and kitchen staff and the home employs a handyman and administration staff. The home has a robust recruitment procedure and the care files of new staff provided evidence that the procedure has been followed to ensure the protection of the service users. All prospective staff are required to complete an application form prior to being called for interview. Two references are taken and checks are made through the Criminal Record Bureau and Protection of Vulnerable Adults registers. A comprehensive induction training programme is followed and evidence of this is held on the staff files. The training requires that competencies are assessed St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 18 and the staff are required to have knowledge and understanding of the home’s policies and procedures. The home now employs a staff Training and Development Officer who has now had the opportunity to identify staff training needs and has taken appropriate action to ensure that these needs are being met.’ A high number of training events have taken place for staff and further training has been planned. All staff have been given training on abuse and were able to demonstrate that they were aware of the procedure to be followed in the event of this being suspected. Qualified nurses have been given additional training on medications and their competency to deal with medications has been assessed to protect service users. All staff are now given regular formal supervision to identify training needs and to give the opportunity for career development issues to be discussed. St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is supported by the senior staff in providing clear leadership throughout the home with staff demonstrating an awareness of their roles and responsibilities. EVIDENCE: The registered manager is a qualified nurse who is experienced in managing care services for elderly people. The manager has sound knowledge of the owner’s strategic and financial planning systems and the business plan for the home. The manager leads and supports a strong staff team who have been recruited and trained to a good standard. The manager promotes equal St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 20 opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. Tests are made on fire detection equipment and records are held of these. Regular fire drills are now held to ensure that staff are aware of the procedure to be followed to ensure that service users are protected. Checks have been made on all equipment within the home and records of these are held and were made available for inspection. Service users money can be held in a non-interest bearing account on their, or their next of kin’s request. Detailed records are held of all money held on service users behalf and receipts are held for all purchases. Regular visits are made by a representative of the owners to monitor the home and speak with the manager with regard to the progress of the service improvements. St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Michael`s Manor DS0000025418.V368643.R01.S.doc Version 5.2 Page 24 - 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. 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