Care Home: St Michaels Nursing Home

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What the care home does well People are well informed by the service information provided and their needs are properly assessed before any decision is made to move into the home. People`s health care needs are well met by staff. That is respectful and sensitive in their approaches with them.People told us. `Care and support is excellent, exceeds all my expectations always.` `I am very I impressed, the staff do such a good job, nothing is too much trouble.` People are provided with nutritious food, which suits their preferences and assessed needs. People told us, ` Food quality is excellent, the cook always talks to us about the menus and food provided.` `The staff show respect and support and enable my father to take Holy Communion.` Complaints and concerns are always taken seriously by the home and acted upon and they are protected from harm and abuse. The home is clean, comfortable and reasonably well equipped and overall suits people`s needs. Staff effectively recruited, inducted, trained and deployed. The home is consistently well-managed and run in people`s best interests. People told us, `The home is well organised and spotless.` `Good all round standards.` What has improved since the last inspection? They have ensured that recognised standards of practise for the recording of medicines administered to people are always applied. They have continued to develop people`s written care plans in a person centred style and with staff that are well familiarised with people`s individual routines and lifestyle preferences, which relate to their personal care. The provision for people`s social and recreational stimulation has developed well in accordance with individual`s choices, assessed needs and individual diversity. They have improved the information provided for people about how to complain. The substantial improvements made to the organisation and provision of staff training as identified at the last key inspection have been continued and sustained. The manager submitted her application to us for registration under the Care Standards Act 2000, which is since approved. They have sustained the improvements made at our last key inspection concerned with the management and running of the home, including quality assurance and monitoring systems and have continued to develop these in the best interests of people who use the service. They have ensured that action is always progressed within agreed timescales to implement requirements identified in CSCI inspection reports. What the care home could do better: Ensure that where necessary, bathroom flooring is either replaced or made good and kept in a good state of repair. Provide staff with training/instruction in respect of the Mental Capacity Act 2005 so that people rights to make key decisions about their lives in accordance with their given mental capacities are always best upheld and accounted for. Make sure that the home` complaint`s procedure accurately reflects the role of the Commission (including people`s rights to contact us at any time). Whilst ensuring that the Commission is not identified as responsible for any of the stages of the process that people are instructed to follow when making a complaint via the home`s procedure. CARE HOMES FOR OLDER PEOPLE St Michaels Nursing Home 9 Chesterfield Road Brimington Chesterfield Derbyshire S43 1AB Lead Inspector Susan Richards Unannounced Inspection 25th June 2008 09:00 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 Michaels Nursing Home DS0000059738.V367568.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 Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Michaels Nursing Home Address 9 Chesterfield Road Brimington Chesterfield Derbyshire S43 1AB 01246 558828 01246 233768 suncarehomes@hotmail.com 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) Sun Care Homes Ltd Vacant Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 39 service users to be accommodated, which includes x 3 service users aged under 65 years, category PD as named in the notice of proposal letter. The registration includes the accommodation of a named service user under the category DE, E - not transferable to any other service user, other than the person named. Completion of the programme of redecoration, upgrading and renewal of the fabric of the home in accordance with that detailed separately in writing - letter dated 220506, by 31 October 2006. 25th June 2007 2. 3. Date of last inspection Brief Description of the Service: St Michaels Nursing Home provides accommodation, nursing and personal care and support for up to 39 older persons. It is located approximately 2.5 miles north east of Chesterfield town centre on a direct bus route and within a residential area. The home provides a choice of lounge/dining space and individual accommodation comprises of 29 single bedrooms and 10 shared (two of which are currently used for single occupancy). Fifteen of the single bedrooms have an en suite. There is a pleasant enclosed rear patio and wellkept garden area providing a choice of seating, which is accessed via a conservatory. There is a choice of bathroom and toilet facilities to each floor. There are a range of aids and adaptations to assist those who may have mobility problems, including a passenger lift, an emergency call system throughout, corridor hand rails and grab rails in toilets and bathroom along with hoist equipment. Individual’s care is assessed, planned and reviewed by Registered Nurses employed in the home, who are supported by a team of care and hotel services staff led by the manager, Carol Wignall, who since this inspection visit has received registration approval as registered manager for the home The range of fees charged by the home are as follows: £345.52 to £616.00 per week. Fees charged are dependant on individuals’ assessed needs and may also include any financial contributions as may be determined via the local primary care trust in respect of free nursing care and or local authority in respect of personal care and accommodation. This information was provided at our inspection visit. There are additional charges for personal hairdressing and private chiropody. St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 5 A copy of the most recent inspection report is openly displayed in the home’s reception area along with the home’s service guide. St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. For the purposes of this inspection we have taken account of the information we hold about this service. This includes our previous key inspection report of 22 November 2007 and our annual quality assurance assessment questionnaire (AQAA), which we asked the home to complete in order to provide us with key information about the service. At this inspection there were twenty-seven people accommodated, including twenty-one people who receive nursing care and six who are provided with personal care and support only. We used case tracking as part of our methodology, where we looked more closely at the care and services that three of those people receive. We did this by talking with those people, direct observation of staff interactions with them, looking at their written care plans and associated health and personal care records and we also looked at their private and communal accommodation. We received survey returns from six residents and three of their representatives. We spoke with staff about the arrangements for their recruitment, induction, training, deployment and supervision also and the manager about the arrangements for the administration and management of the home. We examined records related to the above and during the course of our inspection we made general observations relating to staff interventions and approaches with people, and cleanliness and safety in the home. All of the above was undertaken with consideration to any diversity in need for people who live at the home. At the time of our visit all people accommodated are of British white backgrounds and of Christian based religion (either practising or non-practising). What the service does well: People are well informed by the service information provided and their needs are properly assessed before any decision is made to move into the home. People’s health care needs are well met by staff. That is respectful and sensitive in their approaches with them. St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 7 People told us. ‘Care and support is excellent, exceeds all my expectations always.’ ‘I am very I impressed, the staff do such a good job, nothing is too much trouble.’ People are provided with nutritious food, which suits their preferences and assessed needs. People told us, ‘ Food quality is excellent, the cook always talks to us about the menus and food provided.’ ‘The staff show respect and support and enable my father to take Holy Communion.’ Complaints and concerns are always taken seriously by the home and acted upon and they are protected from harm and abuse. The home is clean, comfortable and reasonably well equipped and overall suits people’s needs. Staff effectively recruited, inducted, trained and deployed. The home is consistently well-managed and run in people’s best interests. People told us, ‘The home is well organised and spotless.’ ‘Good all round standards.’ What has improved since the last inspection? They have ensured that recognised standards of practise for the recording of medicines administered to people are always applied. They have continued to develop people’s written care plans in a person centred style and with staff that are well familiarised with people’s individual routines and lifestyle preferences, which relate to their personal care. The provision for people’s social and recreational stimulation has developed well in accordance with individual’s choices, assessed needs and individual diversity. They have improved the information provided for people about how to complain. St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 8 The substantial improvements made to the organisation and provision of staff training as identified at the last key inspection have been continued and sustained. The manager submitted her application to us for registration under the Care Standards Act 2000, which is since approved. They have sustained the improvements made at our last key inspection concerned with the management and running of the home, including quality assurance and monitoring systems and have continued to develop these in the best interests of people who use the service. They have ensured that action is always progressed within agreed timescales to implement requirements identified in CSCI inspection reports. 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 Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 9 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 Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 10 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): NMS 1 & 3 (The home does not provide for intermediate care, therefore NMS 6 is not applicable to this service). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are well informed by the service information provided and can be assured that they will not move into the home without their needs being fully assessed. EVIDENCE: At our last key inspection of this service we judged that people’s needs were effectively assessed in consultation with them. St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 11 In our annual quality assurance questionnaire completed by the home, they say that they ensure that people do not move into the home without engaging in a thorough assessment to determine their needs and admission process. They also tell us that they have improved their admissions process over the last twelve months by ensuring an open door and in encouraging people to visit and to stay for meals before they are admitted there. And, that over the next twelve months they aim to improve the standard and format of service information they provide for people, including reviewing the service guide and ensuring provision of key information in alternative, suitable formats. At this inspection people told us that they received a contract and enough information about the home before they moved in so they could decide if it was the right place for them. One person said ‘Communication was excellent.’ At this inspection visit, the home’s service guide had been reviewed and updated. It is available in large print format and is currently in process of being put onto audio-tape to assist those who may have significant sight deficits. It includes all key service information, including a standard form of contract and an insert to provide individual fees information. Information is also included about how to access outside agencies, including local authority and primary care trusts, the Commission and advocacy services. People told us that staff are conversant with their needs and the recorded needs assessment records we examined for those people case tracked were comprehensive, person centred in terms of reflecting people’s known preferred daily living routines and likes and dislikes, within their daily living plans. They also had recorded reviews. . St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 12 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): NMS 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health care needs are well met in a respectful and sensitive manner. EVIDENCE: At our last key inspection of this service we judged that people’s health care needs are generally well met, although inconsistencies in the recording of medicines administration may place people at risk of not receiving medicines as prescribed. We made an immediate requirement about practises concerned with the storage and administration of an identified prescribed medicine and we asked the home to tell us in writing what action they had taken to comply with this. This was received within two days of that key inspection and gave us the information we asked for and in compliance with our requirement. St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 13 We also made a requirement in our report of that inspection, relating to three areas of medicines practise, in respect of ensuring the safe storage and administration and including record keeping practises. These are achieved at this inspection. We also recommended that the home continue to develop their care plans in order to best promote a person centred approach to people’s care, which they are also achieved at this inspection. In our annual quality assurance questionnaire completed by the home, they say that they provide that people’s health care needs are met. That they have continued to develop person centred care plans, which are regularly reviewed and formulated in accordance with people’s known lifestyle preferences/choices and risk assessed needs. They also say that people’s dignity and privacy is always promoted and their rights to be treated with respect upheld. They tell us that they have improved over the last twelve months by ensuring that staff will receive the right training and instruction to assist them in delivering the care and support people require. And, that they are seeking to incorporate the implications of the Mental Capacity Act 2005 within their care planning practises. They say that they intend to continue with the above and will be including the ‘dignity challenge’ in their care planning process. At this inspection people who use the service told us that they receive the care and support they need, including medical support. Two relatives told us they felt that the home always meets the needs of the service user and two said they usually do. Comments received included: ‘Care and support is excellent, exceeds all my expectations always. ‘I am very impressed, the nurses and care staff do such a good job and nothing is too much trouble.’ ‘Staff are calm and reassuring.’ ‘My husband is totally dependant and his nursing needs are always well met.’ Throughout our inspection visit staff we observed to approach people in a respectful manner and were sensitive to their needs. The written care plans of those people we case tracked were formulated in accordance with their risk assessed needs and is person centred. They have regularly recorded reviews and are reflective of recognised practise guidance concerned with the care of older persons. St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 14 People’s health care needs were also well accounted for within their care records. The arrangements for the ordering, receipt, storage, administration and disposal of people’s medicines for people case tracked were in accordance with safe and recognised practise and also the home’s own policy and procedural guidance. St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 15 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): NMS 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provision for individual’s social and recreational stimulation has developed well in accordance with people’s choices, assessed needs and individual diversity. People are provided with nutritious food, which suits their preferences and assessed needs. EVIDENCE: At our last key inspection of this service we judged that although some activities were organised for people, the more active promotion of a person centred approach to people’s social care and lifestyle activities may better ensure that their interests and needs are met in accordance with their expectations and preferences. We also judged that people are provided with a good standard of food, which accords with their individually assessed needs. St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 16 We recommended that they continue to develop social care and activities to better account for the above. This is achieved at this inspection. In our annual quality assurance questionnaire completed by the home, they say that they ensure people can regularly access social and recreational activities within the home and with a Committee in place that organises trips out and entertainment. They say they have improved by ensuring dedicated care staff hours to organise and deliver activities. They feel they could improve further by employing an activities co-ordinator to post and by providing training for more care staff in activities organisation. They say that over the coming twelve months they aim to make key environmental changes/improvements to aid people in their occupation and leisure, set up a residents committee and provide people with greater opportunity to access to local community. At this inspection, six people told us that there are always activities that they can join in and two said there usually are. Four relatives told us that the service usually supports people in the way they choose. One person told us: ‘The staff show respect and support and enable my father to take Holy Communion.’ Four people told us that they always enjoy meals at the home and four said they usually do. The arrangements for people’s social, leisure and recreational activities have developed considerable since our last key inspection. A named care, has dedicated hours to facilitate these, who has undertaken identified training, which she has applied to activities provision. This includes the development of an activities programme in consultation with people and by providing a comprehensive information/activities folder. This gives details of innovative approaches to activities, occupation and stimulation, including handcrafted games, tailored to the needs of people accommodated. A separate record is also being developed of individual’s social profiles, and about their choices, preferences, engagement and expressed views as to activities provided. This had been completed in consultation with eight people so far. Picture signs have are also being used around the home to assist people who may be confused in their orientation. St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 17 People told us about key celebrations in the home in accordance with calendar events and about activities and entertainments over the past months. These have included a magic show, film shows, entertainers, shopping trip, crafts and competitions, and people told us that the residents committee fund raise to assist in their provision. We observed lunches being served. Tables were attractively set and people who required, were assisted by staff in a sensitive manner and provided with eating and drinking aids in accordance with their individually assessed needs. People are encouraged to personalise their own rooms and are provided with information about advocacy services in their service guide. St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 18 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): NMS 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People may be assured that the home will take any concerns or complaints they have seriously and act upon these and that they will be protected from abuse. EVIDENCE: At our last key inspection of this service we judged the home’s management and handling of complaints to be substantially improved, thereby increasing people’s confidence in the home’s ability to listen, take seriously and act upon any complaints or concerns, which may be made. We made a recommendation about the provision of key contact details within the home’s complaints procedure to better inform people. This is complied with at this inspection. In our annual quality assurance questionnaire completed by the home, they say that they ensure people are properly informed in respect of their rights to complain and that they take seriously and act on any complaints made. They also tell us that they ensure staff are effectively trained and instructed with regard to ensuring people are safeguarded from abuse. St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 19 They have not identified any improvements made or planned in respect of Complaints and Protection within the AQAA. At this inspection complaints records are well maintained and provide detail of each complaint made, its investigation outcome and any action taken. Records detail five complaints received about the home, including one allegation of neglect, which was referred and investigated via joint agency safeguarding adults’ procedures and was not substantiated. The other complaints referred to involved: No fresh milk during one specified night, missing laundry items and unprofessional behaviour of a staff member. These were upheld and the action taken in respect of these is satisfactory. Also, alleged communal use of one service users personal equipment. This was not substantiated. The home’s complaints procedure has been reviewed since our last key inspection and amended to give more accurate detail as to who to contact in the event of any complaint and when. It is displayed in large print format and information about how to complain is also provided in the home’s service guide. Although it details that the Commission is part of the stages that a complainant may go through as part of the home’s complaints procedure. This information is not correct and we discussed this with the manager who agreed to amend this. All people told us that they know who to speak to if they are unhappy and how to make a complaint (except one person who told us by way of anonymous survey) that they did not know the latter. Four relatives said that the service had always responded to any issues or concerns, which may have been raised by them or the person using the service. One person said. ‘All matters are addressed at once and seen to.’ Staff spoken with is conversant with their roles and responsibilities in respect of handling complaints, recognising abuse and acting on any suspicion or witnessing of the abuse of any person, which accord with the home’s policies and procedures for these. St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 20 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 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People continue to live in a clean and comfortable environment, which is reasonably well equipped and suits their needs. EVIDENCE: At our last key inspection of this service we judged that people live in a safe, clean and comfortable environment, which is reasonably well equipped and suits their needs. In our annual quality assurance questionnaire completed by the home, they say that they the home is well maintained and suits people’s needs and has an ongoing programme of repairs, refurbishment and upgrading. St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 21 They say they always aim to improve in consultation with people and by routine auditing and monitoring of the environment and by listening to what people who use the service tell them. They identify key areas for development over the coming month, prioritising the upgrading of bathrooms and the review of hoist equipment. At this inspection people told us that the home is always fresh and clean and that they are satisfied with their own rooms and accommodation provided in the home. Overall, areas we inspected were clean, comfortable, reasonably well equipped and well decorated. The home’s programme of upgrading and refurbishment is ongoing, with many areas of renewal since our last key inspection. These have included new comfortable chairs, dining tables, dining chairs and side tables in the lounge and dining areas, three new special chairs, and programmes for areas of further re-carpeting and bed replacement are underway. The manager also advised us of action taken in respect of the most recent visit from an officer of Derbyshire Fire Authority, which includes a programme for the replacement of identified fire doors. As identified by the provider, bathrooms are tired and in need of attention, with some needing replacement flooring, due to areas where this is lifting or no longer fits due to recent equipment and facilities changes. These are included in the home’s refurbishment programme, although timescales for the achievement of these was not made clear. A used cleaning mop was stored head down left out on the floor of one bathroom. The majority of areas seen were safe and free from hazards and people’s bedrooms were personalised. However one person’s bedroom that we looked at, had trailing electrical wires plugged into extensions around the room. The manager liaised with the on site maintenance person about this hazard, who rectified this during our visit. Another person’s own room was very sparse, having no comfortable chair and with a bedside locker, which was in need of replacement. However, During discussions with that person they told us that they had been accommodated at the home for a period of respite care, now extended into a full time placement there and that they were arranging for their personal effects to be brought into the home. St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 22 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): NMS 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be assured that their needs will be met from competent staff and that they are in safe hands. EVIDENCE: At our last key inspection we judged that staff were being effectively recruited, inducted, trained and deployed, which was in the best interests of people accommodated. We made a requirement that the substantial improvements made to the organisation and provision of staff training must be continued and sustained to ensure that people consistently benefit from their needs being effectively met. This is achieved at this inspection. In our annual quality assurance questionnaire completed by the home, they say that staff are effectively trained and supported and that they have worked hard over the last eighteen months to develop their staff team and to improve the morale of staff. St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 23 They also gave us some factual information about staff training. This includes that out of eighteen permanent care staff, five have achieved at least NVQ level 2, with six working towards this, which totals above 50 either having or working towards. They also tell us that over the coming twelve months they intend to continue with these and to ensure that more staff achieve NVQ training, to review the staff handbook, and their personnel policies and procedures. At this inspection people told us that staff are always or usually available when they need them and that they always listen and act on what they say and that staff are skilled and look after them properly. (See also management section of this report regarding comments received from the home’s most recent satisfaction survey). Staff spoken with described suitable arrangements for their recruitment, induction, training and deployment. Records we examined in respect of these also reflected this. Access to training for care staff has developed well, is focused and in accordance with recognised workforce skills standards. Two of the registered nurses we spoke with told us about the arrangements for their professional training and development, which indicates that they are also well supported in this area and access the training they need, including NVQ leadership training. However, no staff has yet accessed training in respect of the Mental Capacity Act 2005, although the manager is aware of this and advised that she is currently seeking access to training for this. The manager also showed us training plans in place for all staff up until March 2009. St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 24 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 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is consistently well-managed and run in people’s best interests. EVIDENCE: At our last key inspection of this service we judged that the clear and positive improvements made concerned with the management and running of the home, if sustained and developed, should continue to promote the best interests of people and their health, safety and welfare. We made two requirements that, the acting manager submit an application to the Commission for their registration under the Care Standards Act 2000 and St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 25 that the provider continued to develop its quality assurance and monitoring systems, which had been introduced. We also made two recommendations, that the results of any satisfaction surveys are collated and published and to produced an annual development plan for the home. These are all achieved at this inspection. In our annual quality assurance questionnaire completed by the home, they say that there are effective management and administration systems in place and that the acting manager has applied for registration with the Commission. They also told us that they intend to ensure that the home continues to be effectively managed and gave us satisfactory information about their arrangements for the testing and maintenance of key equipment at the home. At this inspection the acting manager gave us satisfactory information about her training and development over the last twelve months and since our inspection we have approved her application as registered manager for the home. Staff told us that they are well supported and that they are trained and equipped to do their jobs in respect of ensuring safe working practises. They described satisfactory arrangements in respect of these. They are also clear about their own roles and responsibilities in relation to those of others within the staff team and the home’s aims and objectives. The home safe-keeps small amounts of personal monies for one of the people we case tracked and the arrangements for their safe storage and record keeping in respect of these are satisfactory. One person to kept these in their room in a lockable facility (see also Choice of Home section of this report with regard to needs assessment information). There is a full quality monitoring and assurance system operating in the home. This includes regular full service auditing, action plans, reports of the monthly visits from the registered provider, regular satisfaction surveys of people who use the service, their representatives and outside health and social care professionals. Key quality assurance information is provided in the main reception area of the home, which people can access. This includes details of recent satisfaction surveys undertaken, including their results and examples of people’s comments about the home and its services. There is also an annual development plan in place for November 2007 to November 2008. This includes the aim to produce a video for potential service users, which gives St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 26 key information about the home and, with the permission of existing service users, will include their directly spoken views. Comments received in respect of the most recent satisfaction survey include: ‘The home has improved significantly, it is calm and safe.’ ‘Carers are happy and always to hand and professional.’ ‘Food quality as excellent, the cook always talks to us about the menus and food provided. ‘The home is well organised and spotless.’ ‘Care is up 100 .’ ‘Good all round standards.’ ‘The home communicates well and empowers and nurtures.’ Open days are held once a month and are advertised in advance. Feedback forum meetings are held for people and their representatives on a regular basis, the last one being in May 2008 with good attendance. Minutes are kept of these meetings and are displayed. St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 27 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 2 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 28 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. 1. Standard OP19 Regulation 23(2) Requirement Where necessary, bathroom flooring must be either replaced or made good and be kept in a good state of repair. Staff must receive training and instruction in respect of the Mental Capacity Act 2005 so as to ensure that: People’s rights to make key decisions about their lives in accordance with their individual given mental capacities are upheld, and that, Staff is fully conversant with the key principles of the Act and its implications for their practise in respect of individual needs assessments, care planning and record keeping practises. Timescale for action 25/09/08 2. OP30 18(1)(c) 25/09/08 St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations People’s needs assessment records, should be developed to better account for their individual capacities in respect of making key decisions and choices about their lives in accordance with the Mental Capacity Act. Examples relating to this inspection include the use of bed rails and people’s capacity and choices in respect of the handling of their financial affairs. The complaints procedure should be amended so as to correctly reflect the role of the Commission in that people have the right to contact us at any time (and with our contact details). However, the Commission should not be identified as responsible for any of the stages of the process that people are instructed to follow when making a complaint via the home’s procedure. 2. OP16 St Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Michaels Nursing Home DS0000059738.V367568.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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