Care Home: St Winifreds

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What the care home does well Two people who use the service told us that they liked living at St Winifred`s and the staff are polite and kind. Carers were seen knocking on doors and pausing before entering, assisting people to eat in a sensitive manner and encouraging them to finish their their lunch. A relative told us that overall she was happy with the service being provided and she would recommend the home. What the care home could do better: Improvements are required to make sure that all care plans are completed in a consistent manner so that staff have clear guidelines in place to meet the needs of the people. Random inspection report Care homes for older people Name: Address: St Winifreds 236 London Road Deal Kent CT14 9PP one star adequate service 21/01/2010 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: Penny McMullan Date: 0 5 0 5 2 0 1 0 Information about the care home Name of care home: Address: St Winifreds 236 London Road Deal Kent CT14 9PP 01304375758 01304370911 st.winifreds@nellsar.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Janet Louise Spree Type of registration: Number of places registered: Conditions of registration: Category(ies) : Nellsar Ltd care home 59 Number of places (if applicable): Under 65 Over 65 0 59 dementia old age, not falling within any other category Conditions of registration: 59 0 The maximum number of service users to be accommodated is 59. 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). Date of last inspection Brief description of the care home St Winifreds is a large care home situated on the London Road in Deal. The property has been extended over a number of years to its current size, which provides Care Homes for Older People Page 2 of 9 2 1 0 1 2 0 1 0 Brief description of the care home accommodation for fifty nine service users. The home is located half a mile from the town centre of Deal and is on a local bus route. There is off street parking to the front and the side of the home. Accommodation comprises fifty one single and four double rooms, mainly situated on ground and first floors, with two rooms at second floor level. All areas are accessible via the two shaft lifts, one at either end of the home. All bedrooms have a wash hand basin and a large proportion of the single bedrooms have en suite facilities. All rooms are provided with a telephone. The home has five lounge/dining areas and also a porch, which serves as an additional small sitting area. Kitchen facilities are provided for service users able to make themselves drinks and snacks. Service users also have the benefit of well maintained and accessible gardens in which to enjoy the sunshine and fresh air. The current fees for the service at the time of the visit range from £475 to £570 per week. Information on the home`s services and the CQC reports for prospective service users should be detailed in the Statement of Purpose and Service User Guide. Care Homes for Older People Page 3 of 9 What we found: The reason for this inspection was to check compliance with the statutory requirement made at the previous inspection on 21st January 2010. One requirement was made with a timescale of 27 April 2010 for the home to take action. This report details the information as to how the home has improved and met the requirement. This unannounced random inspection was carried out on 5th May 2010 between 9.30 and 2.30pm. The Registered Manager and temporary Assistant Manager assisted throughout the inspection. We looked at three care plans, accident reports, medication storage and records, staffing levels, quality assurance and the programme of supervision for staff. These were shortfalls identified in these areas in the last inspection report. The Registered Manager told us that three quarters of the care plans have been completed with the new format. We found that the care plans had improved to make sure that peoples health care needs are monitored and recorded as to what action has been taken. There are clear guidelines for staff to follow to support people who may have challenging behaviour and what interventions should be used. The plans also include details of individual nutritional needs and how to maintain skin integrity and bathing regimes. The moving and handling risk assessments show staff what they should do to make sure people are moved safely. In some of the care plans and risk assessments there is detailed information, however others do not have the same depth of information and guidance for staff. The new format is not being used consistently by all staff. Clarity is also required to make sure that old records are not updated and become part of the new format of the current care plan. The Registered Manager told us that she intends to oversee the care plans to implement one consistent format and monitor and improve the standard of recording. There was evidence that plans had been reviewed and in some cases the people or representative/relative has agreed with the plan. The Registered Manager told us that a new clinical/medication room is part of the plans to improve the management of the medication. It is hoped that this will be implemented within the next two months. The home is aware that the temperature in the current storage of medication fluctuates and has provided a fan to maintain the correct temperature. A random check of the blister packs showed that there were no gaps or medication left unaccounted for. The home has improved the recording of the controlled drugs and each person has their own controlled drugs record in place. They are introducing a new audit system. The senior staff will audit the medication weekly and the Registered Manager will conduct an audit on a monthly basis. This will make sure that any errors or admissions will be identified and appropriate action can be taken. All staff administering medication have received training. There have been incidents in the home where people are going into other peoples rooms. The temporary Assistant Manager told us that staff are aware of this issue and guide and support people away from other peoples possessions and room. Staff were seen talking to the people respectfully and in a manner which promoted their dignity and independence. This was observed when a member of staff was supporting a person to make up their mind where to sit and where to go in the home. She spoke to the person, softly, with reassurance and patience to make sure that she was given the time to decide Care Homes for Older People Page 4 of 9 as to what she wanted to do. People were seen freely moving around the home, going to their rooms or sitting in the lounges. People in the small lounge told us that they liked living at St Winifreds and the staff are polite and kind. Carers were seen knocking on doors and pausing before entering, assisting people to eat in a sensitive manner and encouraging them to finish their lunch. One person was being supported to choose anything she wanted to eat. She had refused her lunch and said that she did not want anything to eat. The staff patiently offered her a choice of a sandwich and other snacks to make sure that her nutritional needs were met. The Registered Manager told us that there are eight staff remaining who require safeguarding training and a course will be held within the next two weeks. The service has introduced clear guidelines for staff of what they should do if they suspect abuse or have any concerns and all staff have received this information. The Registered Manager is completing an Independent Safeguarding Authority course in the near future to update her practice. The home was clean and had a pleasant odour throughout. A member of the domestic staff told us that there is a cleaning plan to make sure that carpets are cleaned on a regular basis. The Registered Manager told us that the laundry room is being refurbished. There will be new flooring and changes to the layout to improve efficiency, including an in and out door to make sure that soiled and dirty linen are kept separate. At the last inspection the home was not given a requirement to improve staffing levels as the Registered Manager told us that staffing levels were under review. On arrival in the home it was found that staffing levels had not changed since the previous inspection. The Registered Manager told us that staffing levels had been reviewed and the home was waiting for approval from their head office. We requested a timescale as to when this would happen and the owners responded by increasing staffing levels by one member of staff for the dementia unit with immediate effect. The service has recently appointed two new members of staff who are in the process of recruitment and completing trial and induction days. The home is still using agency staff to cover night duties, however there is one night worker scheduled to commence in the near future. The Registered Manager told us that changes in the way they use the lounges and dining rooms have been made which has benefited the people living in the home and staff deployment. There have also reviewed night staff domestic duties to make sure that night staff can concentrate fully on the care for the people. The owners of the home have employed a consultant Registered General Nurse for three months to identify areas of concern and improve the service. The Registered Manager told us that they are still reviewing the Assistant Manager role and continuing to try to recruit a permanent person. The structure of the home is to have a Registered Manager, Assistant Manager, Head of Care, with senior cares, and carers on each unit. Key workers will also be identified for individual people. It is hoped that this will be implemented within eight weeks. There are still some staff vacancies and recruitment will be ongoing until all vacancies have been filled. The Registered Manger said that she will be advertising for more staff as soon as possible, however in the mean time staff will be able to cover most of the additional shifts. Care Homes for Older People Page 5 of 9 The owners are making sure that the improvements in the service are being implemented and the home is making progress to achieve the improvement plan. The Registered Manager is aware of what still needs to be improved and we are confident that these areas will now be addressed. There is evidence that a full supervision programme is now in place and staff told us that they are supported by the management team. Work has been carried out to improve the quality assurance programme and questionnaires have been sent to relatives, staff and other stakeholders. They are in the process of summarising the details and addressing any outcomes identified for action. There have been substantial incidents in the home with regard to accidents, including falls. There was a high number of falls which occurred in the dementia unit. The Registered Manager told us that the additional member of staff for this unit will reduce the risk to the people falling. A sample of accident recording was seen and tracked through to the persons individual care plan. This makes sure that appropriate recording and monitoring of health care needs is in place. There was evidence that the home have improved the way they record this information with clear details of what action has been taken. For example one person had his medication changed and this was clearly detailed in the care plan and on the medical administration sheets. They are also in the process of introducing a new format of accident recording which includes a falls pathway, pain charts and check list to make sure person is monitored and health care needs are met. 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 9 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 9 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 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 Care Homes for Older People Page 8 of 9 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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