Care Home: St Vincent House

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What the care home does well The home has a pre-admission assessment process in place to ensure that the home is able to meet the needs of people who move into the home. Potential residents and their relatives are encouraged to visit the home before they move in. The home is warm, homely and welcoming and people told us they enjoyed the views of Southsea seafront from the front of the home. People living in the home have a wide choice of communal space including a well appointed dining room, three lounge areas, including quiet spaces, and a sunny and secluded courtyard garden that is accessible and furnished with outdoor tables and chairs. Two people we spoke to said that the meals are good and choices were available to them. Hot and cold drinks are available to residents at all times. Residents have opportunities to take part in organised activities and social events. What the care home could do better: Plans of care do not contain sufficient detail about all personal and health care needs for individual residents. This means that staff may not have clear and written guidance on what they must do to meet all care needs safely and consistently, and some care needs may be overlooked. This puts people at potential risk of poor outcomes to their health and well being. Prescribed creams and lotions are not being recorded when being dispensed by staff. This means that the home is not able to demonstrate that people are receiving these medicines in the way that has been prescribed by their doctor. In the interests of people receiving their medicines in the way that has been prescribed by their doctor; there should be a clear and accurate audit trail of all medicines received, dispensed or returned to the pharmacy. Hand written entries on the medication charts should be signed and witnessed to reduce the risk of prescribing instructions being wrongly transcribed. Random inspection report Care homes for older people Name: Address: St Vincent House 20 - 21 Clarence Parade Southsea Hampshire PO5 3NU two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Annie Kentfield Date: 2 9 0 6 2 0 1 0 Information about the care home Name of care home: Address: St Vincent House 20 - 21 Clarence Parade Southsea Hampshire PO5 3NU 02392422822 Telephone number: Fax number: Email address: Provider web address: murat@stuch.1wanadoo.co.uk Name of registered provider(s): Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: Conditions of registration: Category(ies) : St Vincent Care Homes Ltd care home 27 Number of places (if applicable): Under 65 Over 65 0 0 0 dementia old age, not falling within any other category physical disability Conditions of registration: 0 0 0 The maximum number of service users to be accommodated is 27. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) Physical disability (PD). Date of last inspection Care Homes for Older People Page 2 of 10 Brief description of the care home St Vincent House is one of four care homes for older people, owned by St Vincent Care Homes Ltd. The home is a large and well-maintained period property in a popular location. There are fine views at the front across the Southsea Esplanade and the Solent. There is plenty of communal space including three lounges, a dining room and a secluded courtyard garden at the rear. The accommodation is arranged over four floors with 21 single bedrooms and some shared rooms, all with en-suite facilities. There is a wide staircase and a passenger lift that provide access to the upper floors. Outside there is a ramp for wheelchair access to the front of the home. There are no parking facilities at the home but there is plenty of on-street parking nearby. The fees vary and there are additional charges for chiropody, hairdressing, newspaper, transport and the cost of staff escorts. Information about fees and other charges is available from the home. Care Homes for Older People Page 3 of 10 What we found: We made an unannounced visit to the home on 29 June 2010 and over a period of four hours, with one inspector; we looked at the care records for one service user and other records relating to staffing, staff training, and the management of health and safety. Two residents, the manager and deputy manager and other members of staff were involved in the inspection visit. The visit was undertaken because the home has not had a registered manager for over two years. A manager was appointed almost 12 months ago and this person is responsible for the day to day running of the home in consultation with the responsible individual (one of the directors who was previously the registered manager). We were told that the manager is in the process of applying for registration with the Commission and is awaiting confirmation of some of the pre-registration checks, that are required, and an application will be submitted as soon as possible. Since our last visit to the home in February 2009 the care planning system has been changed and a computerised care planning system is in place. However, we were told that this system is not yet fully operational until more staff have received appropriate computer training. The individual plans of care are generated from the initial assessment of care needs and include current medical needs, a brief personal history, mobility and an assessment of any potential risks to people during the provision of personal care. We chose to look at one plan of care in detail in order to follow through how that person was receiving their care and look at medication that had been prescribed. The plan of care contained some details about the service users needs and an action plan to meet those needs. However, the plan of care was not detailed in places and did not provide clear guidance for care staff on how some needs were to be met in a consistent and organised way. For example, the care plan did not contain any information about particular aspects of personal care such as shaving or hair care and the service users personal preferences. When we looked at the daily records (of the care that has been provided); there was insufficient detail to show that all aspects of personal care had been met for this person. The records showed that the care needs for this person have changed but the care plan had not been changed to reflect this. The care plan contained an action plan to guide staff on how to meet the social and psychological needs of the service user, but there was no evidence that staff were following the action plan and nothing had been recorded in separate records of social activities. A risk assessment was in place that highlighted any risks to the service user. However, the care plan did not contain a clear plan of action on how risks or events were to be safely managed or minimised by care staff. A record of two hourly checks was being kept by staff, however, these records were not being regularly monitored by the manager or senior staff and the care plan updated to reflect the monitoring action by staff. This means that the service user may be at risk of receiving poor outcomes to their health and well being and some care needs may be overlooked. The home maintains a record of accidents/falls as required. However, the care records we looked at did not contain current information on how some events had been followed up. For example, one care plan recorded that a follow up visit by a GP should be arranged but there was no record that this had been actioned. Care Homes for Older People Page 4 of 10 We discussed our findings with the manager and other staff in the home and we were told that immediate action would be taken to review and develop all care plans to ensure that care is provided in a consistent way by all staff. We were told that action would taken to follow up referrals to health care professionals and record outcomes, immediately, so we did not make an immediate requirement on this occasion. We looked at the storage and recording of medicines that are received into the home and overall medication is securely stored and dispensed by staff in line with the homes policies and procedures for the safe administration of medication. However, prescribed creams, lotions and ointments are not recorded to show that people are receiving these in the way that has been prescribed by their GP. We looked at one preparation that has been prescribed to be used every day but there were no records to demonstrate that the cream/lotion had been dispensed, as prescribed. The manager told us that the home would put procedures in place to ensure that all prescribed creams/lotions etc were recorded as they are used to demonstrate that people are receiving these medications. The practice of the home is to check medication every month to ensure that medication has been received, dispensed, or returned, and to prevent over stocking. These monthly checks are not recorded. It would be good practice to record all medication audits as part of the overall system of checks and audits in the home. This would provide a clear audit trail of medication received into the home. Although medication is checked when received, the checks are not always recorded on the medication administration charts and signed by the person who receives the medication. Some hand written medication records had not been signed and witnessed by two people who are deemed competent to do this. This means that there is a risk of errors when transcribing the instructions from the original packaging onto the medication charts. We were told that the home will ensure a correct audit trail of medication is recorded. We looked at staff recruitment records for two new members of staff. These demonstrated that satisfactory checks are in place before new staff start working in the home. This means that staff are suitable to work with people living in the home. Residents are protected by policies and procedures for safeguarding residents and records demonstrated that any concerns or allegations are reported to the Local Authority Safeguarding Team. Training records confirmed that staff receive training in what they have to do in the event of any concerns or allegations that affect the safety and well being of residents. The home employs a staff training co-ordinator and there is an ongoing programme of training that covers all aspects of basic good working practice as well as dementia care and the Mental Capacity Act. During our last visit we highlighted concern about the lack of heating in one en-suite bathroom. The home confirmed that a heater has now been installed. The manager told us that any repairs or work needed to the home environment is noted and action is taken to ensure that work is carried out. The home has introduced a new system for auditing and monitoring the service they provide and this covers internal checks and audits and customer satisfaction surveys. The systems are newly in place and will be reviewed to monitor their effectiveness. Care Homes for Older People Page 5 of 10 What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 13(4) The registered person must ensure that all parts of the home to which service users have access are free from hazards to their safety. Unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. Identified risks to service users must be recorded and reviewed with clear guidance for care staff on how risks or events are to be managed. 30/03/2009 Care Homes for Older People Page 7 of 10 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 All prescribed medicines, 30/07/2010 including creams and lotions, must be dispensed as prescribed. Appropriate records for the receipt, dispensing or return of medication must be kept to maintain an accurate audit trail of medication received into the home. People living in the home must receive their medicines in the way that is prescribed by their doctor, at all times. 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 9 In the interests of people receiving their medication correctly and safely; hand written medication records should be signed and witnessed as correct, to avoid the risk of any error when transcribing the prescribers instructions. In the interests of people receiving their medication safely and correctly; a record should be kept of medication received into the home, or returned, to ensure there is an Page 8 of 10 2 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations organised and correct audit trail of all medication prescribed for residents. Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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