Care Home: St Michael`s Mount

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What the care home does well Detailed assessments are undertaken on all service users to ensure that the home can meet their needs. These form the basis for the care plans which are also comprehensive and informative. All areas of the home are bright and pleasant and it is evident that every effort is made to provide a warm and homely place for service users. Staff are provided in sufficient numbers and are well trained. Medications are handled safely and stored securely. Record keeping is organised and information is readily available. What has improved since the last inspection? The number and range of activities has increased since the last inspection to provide greater social stimulation for service users. The programme of redecoration and refurbishment has improved the environment for service users and staff. The gardens now provide an attractive area for service users to spend their day and provides a pleasant outlook from within the home. What the care home could do better: The owners and manager should continue with the good work that has taken place since the last inspection to further develop the home. Key inspection report Care homes for older people Name: Address: St Michael`s Mount Woolton Road Liverpool Merseyside L25 7UW     The quality rating for this care home is:   three star excellent 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: Jeanette Fielding     Date: 2 7 0 8 2 0 0 9 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 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: St Michael`s Mount Woolton Road Liverpool Merseyside L25 7UW 01514279419 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Michael Hanlon,Mr James Mutch care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home is within the following category: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 45. Date of last inspection Brief description of the care home St Michaels Mount is one of two adjacent care homes situated in a quiet residential area of South Liverpool. Both homes are owned by a private company. St Michaels Mount 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 side of the home. The building is purpose built and consists of two floors. The upper floor is served by passenger lifts and stairs. Accommodation for residents is provided in single rooms many of which have a toilet and hand wash basin. The home is centrally heated. There is a large central lounge, a separate dining room with conservatory. The home is close to public transport, rail and bus and is near Care Homes for Older People Page 4 of 25 0 Over 65 45 Brief description of the care home to the M62 and M57 motorways. The fees for the home range from 330 to 500 pounds per week dependent on the level of care required, with a top up of 17.50 to 25 pounds dependent on the room chosen. Care Homes for Older People Page 5 of 25 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: three star excellent 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 unannounced key inspection was undertaken in one day over a period of seven 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 further evidence of the actual care given. The care files of five service users were case tracked to evaluate their care. Discussion took place with the registered manager, deputy manager, nurses, care staff, service users and visitors to the home. The manager completed an Annual Quality Assurance Assessment form prior to the inspection to give additional information regarding the home. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 25 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 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive assessments are undertaken on all prospective service users to ensure that the home can meet the individuals, health and social care needs. Evidence: The home has produced a brochure for the home which incorporates the service user guide and the statement of purpose. This has recently been updated to reflect changes within the home. The brochure is issued to all prospective service users or their relatives and additional copies are available from the home on request. The document provides full information regarding the facilities and services offered by the home to enable prospective service users to make an informed decision regarding their care provider. All prospective service users are fully assessed prior to their admission. These assessments are undertaken by the deputy manager or one of the qualified nurses to establish the needs of the service user to confirm that the home can meet those Care Homes for Older People Page 9 of 25 Evidence: needs. The preadmission assessments of service users recently admitted to the home were inspected and were found to be detailed and informative. Information is gathered from the service user, their family and healthcare professionals who have been involved in their care. A specific form is completed which includes information about health needs, abilities and social needs together with details about individual preferences. This information is used to prepare the initial plan of care which provides information for the staff team. The preadmission assessments for service users who have recently been admitted to the home were inspected and all were found to contain full information to demonstrate that the home can meet their individual needs and preferences. Care Homes for Older People Page 10 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are provided with health and personal care in a way that shows respect for their privacy and dignity. Evidence: Individual care plans are prepared for each service user. These are prepared, initially based on the information gathered at the preadmission assesssment, and then built on and updated as more information is gathered about the service user or as their care needs change. All care plans are reviewed on a monthly basis and whenever necessary. Regular audits of the care plans ensure that they are up to date at all times. Detailed information is recorded to inform staff of the care required and of more specific details about how that care is to be delivered. Information is also recorded regarding individual preferences such as preferred time of rising or going to bed, daily routines and likes and dislikes. Dietary preferences are recorded together with preferred gender of the person to provide personal care. Spiritual needs and preferences are recorded and any specific communication requirements. Detailed risk assessments are undertaken and comprehensive risk management plans are prepared to remove or reduce any potential risks. Moving and handling equipment, assisted Care Homes for Older People Page 11 of 25 Evidence: bathing aids and pressure relieving equipment are available in the home and are used following a detailed assessment of need. All staff have been given training in the use of equipment to ensure that service users are protected. All accidents are recorded and the manager undertakes audits on all falls and accidents to put plans in place to prevent reoccurrence. Daily records are completed by the staff and provide evidence of the actual care provided. These records provide evidence that the healthcare needs of the service users are met. Specific charts are maintained where the needs of the service users identify these as necessary i.e. turning, fluid intake and dietary intake. Medications are administered to the service users by the qualified nurses. Service users may hold and administer their own medications subject to an assessment of ability and risk. Medications were seen to be dealt with in accordance with the homes policy and procedure. Medication administration record sheets were seen to be well maintained and up to date. Medications are securely held and all storage areas were clean and organised. Arrangements are in place for all unwanted medications to be disposed of safely and detailed records are held of medications entering or leaving the home. Specific forms are placed on the MAR sheets with regard to medications that are required on an as necessary basis and evidence that these medications have been agreed by the GP is held. Where these medications are required on a regular basis, the GP is requested to review the medications prescribed. Medications are audited on a regular basis and a record of the findings of the audit are held. Service users spoken to on the day of the inspection said that the staff were kind and caring and confirmed that all their needs were met. One service user said that the home had improved his quality of life. One relative said that the staff did all they could to meet their relatives needs and would go the extra mile whenever this was needed. Observation of staff and service users at the time of the visit showed that staff spoke discreetly with service users when referring to personal care. Service users interacted with the staff and the staff were polite and professional at all times. Care Homes for Older People Page 12 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. Evidence: The home has recently employed a hobby therapist for three hours on two days each week. Staff who completed the surveys sent by CQC said that the service users would benefit from additional activities to provide additional stimulation. One respondent said that service users would enjoy more trips out but these were not always available. The home has recently purchased a minibus and so arrangements should now be put in place for trips to be made. Service users spoken to said that some activities were provided but that there were not enough to keep them busy during the long days. At present, staff provide the majority of the activities for service users but these do not take place when care giving takes priority. Consideration should be given to increasing the number of hours provided by the hobby therapist to provide activities in line with the preferences and abilities of service users. Meals are taken in the dining room, the lounge or the service users own bedroom as they wish. Dining tables were observed to be attractively laid with tablecloths, napkins, place mats and napkins. Cruet sets were provided together with a selection Care Homes for Older People Page 13 of 25 Evidence: of individually packaged sauces. Meals were observed to be well presented and smelled appetising. Service users spoken to said that the meals were lovely and confirmed that a choice was offered. The menu provided evidence that a varied and nutritious diet is provided. Fresh fruit was readily available for service users and a good supply was seen in the kitchen. The kitchen is extremely clean and organised and all items in the refrigerator were labelled and dated. A record of all special diets are held in the kithcen and the chef confirmed that any special diet or meal preference can be provided. Relatives and friends are free to visit service users at the home at any time and two relatives said that they were always made very welcome. They confirmed that the manager and staff were always available to discuss the care of their relative. Care Homes for Older People Page 14 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure is good so people wo live in the home are able to express their concerns and be listended to, their rights are protected and they are safeguarded from abuse. Evidence: The home has a robust complaints procedure which is displayed in the foyer and also detailed in the service user guide. The home has received a low number of complaints over the last year and the records held in the home show that each has been fully investigated and action taken where appropriate. Records show that responses have been made to the complainants and that all were dealt with in a professional and timely manner. Two service users said that if they had any concerns, they would speak with one of the nurses or the manager, but that there was no reason to make any complaints. One relative said that she knew where the information was about how to make a complaint but had not had any need to do so. All staff are given training on the protection of vulnerable adults during their induction training and were given subsequent updates on this on a regular basis. Evidence of training is documented in the staff training files and in the minutes of staff meetings. Staff spoken to said that they had been given training on the different types of abuse and would report any concerns to the manager. All staff are required to be fully vetted before they commence work at the home to Care Homes for Older People Page 15 of 25 Evidence: ensure that service users are protected. The home has a whistleblowing policy and details of this are readily accessible to all staff. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Continued investment in the home has resulted in service users being provided with a high quality, comfortable and safe environment. Evidence: Improvements continue to be made to the home through redecoration and refurbishment. Since the last inspection, 20 bedrooms have been redecorated and fitted with new carpet. some rooms have been provided with new furniture. Bedrooms are bright and homely and service users have been encouraged to personalise their rooms with small items of furniture, pictures and photographs. Plans are in place to replace the curains in bedrooms to further enhance the home. The main lounge has been redecorated and provided with a new carpet and furniture. This room is pleasant and has a new television. The conservatory has been provided with new furniture and provides a ramp to the garden. Considerable work has taken place within the garden to provide raised flowerbeds and a pagoda. Plans are in place to fit lighting to the pagoda to enable this to be used during the evenings in the warmer weather. The garden has flower beds and a pond with an ornamental feature. Seating is provided and service users are free to use the garden at any time. The dining room has a conservatory which has been provided with new tables and chairs, and new blinds have been fitted to the windows. This conservatory leads on to a small couryard with a feature fish pond. Seating is provided and this area is often Care Homes for Older People Page 17 of 25 Evidence: used by service users and their visitors. Service users personal clothing, together with the homes linens are laundered on site. It was noted that the ironing board and iron were in a poor condition and require to be replace. Some of the clothing for service users was noted not to have been ironed and the manager stated that this would be addressed to ensure that all clothing was ironed where appropriate. Some towels were noted to be fraying and now require replacement. All areas of the home were observed to be clean and fresh and there were no unpleasant odours. Infection control policies are in place and it is evident that staff follow procedures at all times. Repairs and safety issues are addressed as soon as they are identified to ensure that service users and staff have a safe place in which to live and work. Care Homes for Older People Page 18 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements, recruitment and training ensure that service users are cared for and supported safely. Evidence: The home provides qualified nurses on duty at all times who are supported by care assistants. A clear staff structure is in place with a registered manager, deputy manager, qualified nurses, senior care assistants, care assistants, domestic, catering, laundry and maintenance staff. All staff are aware of their role and responsibilities within the home. The home has a robust recruitment procedure. All prospective staff are required to complete an application form prior to being called for interview. Two references and taken and checks are made through the criminal records and protection of vulnerable adults bureaux. Staff files are currently held in the adjacent care home, which has the same owners. Some of the staff training files are held in the home and some in the adjacent home and it would be beneficial for all files to be held together and securely stored in the home with access being available for the manager and designated persons only. Files inspected were found to contain all necessary information and were up to date. Training for staff is ongoing and the home employs a training officer to identify Care Homes for Older People Page 19 of 25 Evidence: training required to make the appropriate training arrangements. It was evident that training for all staff is on-going. In the survey forms completed by staff, all checks were made on them prior to commencing work at the home, full induction training was given and additional training was provided. The main comment from staff was that benefits would be obtained by the provision of a computer to enable information to be obtained easily and to aid communication. Staff meetings are held on a regular basis and minutes of the meetings are held. These meetings provide an opportunity for open discussion and the disemination of information. The home rarely requires to use the services of agency staff to cover for sickness and annual leave and so a care is provided to service users by staff that they know. Service users said that the staff were lovely and one service user said they are like family to me, they are here for me whenever I need them. Care Homes for Older People Page 20 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed to ensure that it is run in the best inerest of the people who live there. Evidence: The registered manager is a qualified nurse and experienced in the management of care services for older people. She continues to develop her knowledge through continued training and is promotes a high level of care through staff supervision. She holds an NVQ in management at level 4. The manager is supported by a very experienced deputy manager and a well trained staff team. Staff spoken to during the inspection said that the manager was firm but fair and that the care of the service users was always her priority. Regular meetings are held with service users and relatives and minutes of these meetings are held. The manager speaks with service users and relatives on a one to one basis to offer information and support wherever necessary. Care Homes for Older People Page 21 of 25 Evidence: Record keeping within the home is of a very high standard and extremely organised. All information requested was readily available and found to be well maintained and up to date. Where possible, service users or their relatives deal with personal financial matters. The home has a non-interest bearing bank account for service uss money which they can use if they wish. Information regarding this is detailed in the statement of purpose. The records in the home provide evidence that the premises and the equipment used in the home is checked on a regular basis and certification of this is maintained. Health and safety issues are addressed as soon as they are identified to ensure that service users, staff and visitors are protected. Regular satisfaction surveys are carried out by the manager which involves sending questionnaires to service users and their relatives to seek their views of the home and the service provided. Information received is used to identify areas where service provision can be improved. The manager is well supported by the owners of the home and regular meetings are held to discuss all aspects of the home. Care Homes for Older People Page 22 of 25 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 23 of 25 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 Consideration should be given to increasing the number of hours provided by a hobby therapist to provide a greater number and range of activities for service users. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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