care homes for older people - care quality commission...ct5 4ls the quality rating for this care...

Key inspection report

Care homes for older people

Name: St Martins

Address: 3 Joy Lane WhitstableKentCT5 4LS

The quality rating for this care home is: two star good 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: Date:

Nicki Dawson 1 0 0 7 2 0 0 9

Care Homes for Older People of 26

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 stars - excellent• 2 stars - good• 1 star - adequate• 0 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. They reflect the things that people have said are important to them:

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.


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 Inspection report

Author Care Quality Commission

Audience General public

Further copies from 0870 240 7535 (telephone order line)

Copyright 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.

Internet address www.cqc.org.uk

http://www.tso.co.uk/bookshop


Information about the care home

Name of care home: St Martins

Address: 3 Joy Lane WhitstableKentCT5 4LS

Telephone number: 01227261340

Fax number: 01227281131

Email address: [email protected]

Provider web address:

Name of registered provider(s): H U Investments Limited

Type of registration: care home

Number of places registered: 23

Conditions of registration:

Category(ies) : Number of places (if applicable):

Under 65 Over 65

dementia 23 0

old age, not falling within any other category

0 23

Additional conditions:

The maximum number of service users to be accommodated is 23.

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: Dementia (DE) Old age, not falling within any other category (OP).

Date of last inspection

Brief description of the care home

St Martins is registered to provide accommodation and personal care for up to twenty three older people who have special mental health needs known as dementia. This means that the people living in the home experience difficulty with recalling some events and with organising some of their thoughts. The premises are an extended, older detached two-storey property. There are seventeen single and three double occupancy bedrooms. There is no shaft lift available, but people who live at the home can use a stair lift to gain access to the first


Brief description of the care homefloor bedrooms. St. Martins is set back a little from one of the main roads into Whitstable. To the rear of the property, there is an enclosed garden. The nearest shops are about one quarter of a mile away. The company that operates the home has a number of other residential care services in the south east of the country. Information about the services and facilities available at the home are contained in the Statement of Purpose and Service User Guide and from a brochure which are available from the home. The range of fees charged currently for residence in St Martins, runs from £328.65 to £575.00 per week, depending on the individual needs of the person requiring care. The last key unnannounced inspection to the home took place on 11th July 2007.


SummaryThis is an overview of what we found during the inspection.

The quality rating for this care home is: two star good service

Our judgement for each outcome:

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:

The inspection was unannounced, which means that the service users, staff and registered home manager did not know that the inspector or 'expert by experience' were calling at the home. An 'expert by experience' is a person who, because of their shared experience of using services, helps the inspector to get a picture of what it is like to use the service. Key unannounced inspections are aimed at making sure that the individual service is meeting the National Minimum Standards and that the outcomes for people using the service promote their best interests. The inspection started at 9.55 am and took just over 5 hours. Eight service users, five staff, the registered home manager, five relatives and one social care professional were involved in the inspection to gain their views and knowledge of the level of care, provided by the service. The expert by experience joined some service users for lunch and observations were made of the support that staff offer service users. A number of communal rooms and service users' bedrooms were entered. A number of records to


do with service users' care and safety were looked at. It is now a legal requirement for services to complete and return an annual quality assurance assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The service returned their AQAA to us within the timescale requested and it contains all the information that we asked for. Survey questionnaires ("Have Your Say About") were sent by the commission to the home before the inspection visit. These comment cards are useful in gaining the views of the people who live, work and visit the home about the quality of care that is provided by the service. Comment cards were returned from five service users, five staff and two health care professionals. Comments were mainly positive about the support that is provided by the home and include the following: "Generally the staff are excellent and have a good knowledge about residents". "All the staff are very caring and there is a good atmosphere". "Very welcoming with visitors"


What the care home does well:

The home undertakes detailed assessments of people before they come to stay at the home so that staff have a good understanding of each person's individual care needs. The staff team knows each service user well and responds to each person in an individual way. "This is my home" commented one service user. Service users are offered a range of activities which can be flexible according to each person's needs. For example, the day of the week that the singer visits was changed to accommodate people's preferences. The training of the staff team is a priority in this home and all members of staff are up to date with training in all the areas necessary to perform their role.

What has improved since the last inspection?

Due to the limitations of the current laundry room service users' clothes are now laundered by an external agency. A fire risk assessment has been submitted to Kent Fire and Rescue Service to ensure that the home is doing all that it can to minimise the probability of a fire occurring in the home. At the last inspection service users were asked informally about how things were for them at the home. This is now complemented by a formal system whereby service users' views are regularly sought and their feedback is acted upon.

What they could do better:

Information that people receive before they move to the home needs to be regularly reviewed to make sure that it is correct. Particular attention should be paid to the 'Statement of Purpose'. The Service User Guide is not currently written in a format that is easily understood by people who use the service. The registered home manager has said that a new brochure is being produced with pictures which people who live in the home should find more easy to understand. Some service users have 'life histories' which give a good picture of the important events and interests in their life. Every service user would benefit from having a life history since it would mean that the care staff have a greater understanding of their past lives and things that are important to them. There are a number of areas in the environment of the home that are not ideal for people who live there. These are the garden which is not currently accessible, a bathroom that is too small for adequate moving and handling, a laundry room that is not fit for its purpose and a kitchen that is separated into two areas. We were advised that building plans are in place to address all of these identified areas.

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 [email protected] or by telephoning our

order line 0870 240 7535.


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


Choice of home


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.


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.

People considering moving to St.Martins are given most of the information they need to help them decide whether or not to it is the right place for them to live. Peoples' needs are fully assessed before they move into the home so that they can be sure that they will receive the right type of care.

Evidence:

The aims and objectives of the home are clearly set out in the home's 'Statement of Purpose'. The services and facilities that are available to people living in the home are detailed in the 'Service User Guide'. The Statement of Purpose needs some updating since the names of staff working in the home are not correct. It would be useful to include the areas in which staff are trained and how to contact the local authority and health authority. The registered home manager said that soon a brochure for service users will be available that includes pictures. It is envisaged that people who use the


Evidence:

service will find this document easier to understand. Before new service users are admitted to the home a full needs assessment should be carried out to decide whether or not the home is a suitable place for the person to live. The assessments of three service users, including one person that has recently moved to the home were looked at. They all gave good information on which to base an assessment as to whether the home could meet these people's needs. This information is used to start the development of an individual plan of care. If the person is funded by the local social services, then a copy of the social services assessment is obtained. The main aim of the home is to care for the needs of older people with dementia. Evidence was seen that the whole staff team have received training in how to care for people with dementia. Some staff have also received training in how to care for people with behaviours that challenge. The registered home manager was observed talking to one service user in an individual way. The conversation quickly changed from talking about the present to the past and the registered manager responded immediately without any break in the flow of the conversation.


Health and personal care


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.


Judgement:


Service users benefit from having a plan of care that gives clear guidance to staff as to how to meet their assessed needs. Service users' access to health care services is fully met. Service users are treated with dignity and respect and their privacy is maintained.

Evidence:

Each service user should have an individual plan of care that clearly sets out their health, personal and social care needs, together with the staff support that is required to meet these assessed needs. Three service users' care plans were examined and found to contain all of this necessary information. Where a 'life history' of the service user is included, this gives a clear picture of the most important events in that person's life. Evidence was seen that each plan is regularly viewed. All care plans should have written plans in place to minimise the effect of any potential


Evidence:

risks. Assessments are undertaken in key areas such as nutrition, risk of falls and moving and handling. In the three care plans that were examined clear plans were seen to reduce any potential risks identified. Evidence was seen in care plans that service users regularly receive visits from the dentist, chiropodist and GP. The district nurse visited an individual service user on the day of the inspection. The home uses a pre-dispensed system for administration of medicines. This system is used to reduce the risk of service users receiving incorrect doses or incorrect medication. The person that is giving out the medicine records on a pre printed form the medicine has been given or, if it hasn't been given, the reason why. On examination of this record it was found that there were no gaps in recording medicines, showing that service users had received their medication as intended by their GP. All staff who give medicines to service users have been trained in how to do so safely and their competency in this task is regularly assessed. During the visit staff were observed talking with service users in a respectful and individual way. The expert by experience, "observed the staff giving out tea, coffee and biscuits, where they spoke to all residents to check they were well with little gestures like an arm around shoulders or a pat of the hand which the residents responded to". Staff were observed knocking on bedroom doors before entering and staying in their bedrooms if they wished.


Daily life and social activities


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.


Judgement:


The people who use the service have things to do and they keep in touch with members of their families. Service users enjoy mealtimes and receive a healthy and varied diet.

Evidence:

The home gave us a lot of detailed information in the annual quality assurance assessment (AQAA) about the range of activities that take place in the home. In the AQAA it is stated that the activities on offer include aromatherapy, music and movement, clothes parties and games. Activities are changed on a monthly basis, taking into consideration the service users hobbies, interests and past interests. This can be evidenced by the purchasing of a piano at the request of some service users who enjoy playing the piano. Also, at the request of families, the day that the singer visits the home was changed so that relatives can join in this activity with their relative. A local vicar visits the home on a regular basis and Holy Communion is provided within the home each month. There are a number of events organised to celebrate special occasions and events, for example on fireworks night, service users, relatives, and staff joined in a party.


Evidence:

The expert by experience said, "I looked at the activities board in the foyer which had a good mix of activities although I did not see anything taking place on my visit. I was assured by relatives that musical movement (although restricted by the residents ability), card games, and singing did certainly take place regularly". Four out of five service users who completed a survey stated that there are 'usually' activities arranged by the home and the other service user stated that there 'always' are. During the inspection it was observed that a large number of visitors came to the home. The expert by experience commented that, "I spoke to several visitors who without exception said they were happy with the home". Evidence was seen in care plans that service users' individual choices and preferences are taken into consideration. For example, in one care plan it was noted that the service user liked to have a small plate at mealtimes. Observations were made that some service users chose to eat in their rooms and others in the dining room. Visiting relatives said that the food at the home was good and that there is always enough of it. The expert by experience joined some service users for lunch. She observed that service users are encouraged to be as independent as possible and that assistance with eating is given discretely. "There was little waste and dessert was also served which looked appetising and was eaten by everyone. Staff took the time not to hurry the residents. Menus for the week offered a good variety. One visitor told me that they had complained about the food and this had been dealt with promptly by Joanne(registered home manager) ".


Complaints and protection


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.


Judgement:


Service users are confident that any concern or compliant they make will be listened to and resolved to their satisfaction. Staff feel confident to speak out and take action to protect service users, if they have any concerns about their care.

Evidence:

Neither the home nor the commission have received any formal complaints about the service in the last year. Evidence was found during the inspection that any concerns are dealt with immediately and therefore do not escalate to formal complaints. Staff demonstrated that they know what to do if a service user made a complaint. Details of how service users or their relatives can make a compliant about the service are readily available in the home. Staff demonstrated that they know what to do if they observe any potential abuse. They said that they feel confident to speak out in such a situation. The staff team has received formal training in how to safeguard vulnerable adults. The expert by experience was told by one service user that they felt, "safe and happy" living at St.Martins.


Environment


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.


Judgement:


Services users benefit from living in a home that meets their expectations of being safe, clean, comfortable and well-maintained.

Evidence:

Service users have use of a two communal lounges and it was observed that they are able to move freely between them. There is a separate dining area. There is a garden to the rear of the property with a patio area and seating area. Part of the garden is currently inaccessible to service users as it is overgrown. We were advised that there are plans to extend the home into part of the garden and this is the reason for the garden being neglected. It was found that there was a bucket full of cigarette ends in the patio area which looked unpleasant. It is recommended that an area for staff smoking is designated separately from that used by the people who live in the home to avoid this in future. Service users are able to personalise their rooms and have done so according to their individual choices and tastes. The expert by experience observed that in one service user's bedroom there were, "many photographs of their family and some ornaments which had been brought from home ". Some areas were identified at the last inspection where improvements could be made to the environment. The first is the kitchen where there is a separate kitchen and


Evidence:

preparation area. We were advised that in the proposed building plans the kitchen will be large enough to include both these areas. The second area identified was a bathroom in which it is difficult to move and handle service users. We were advised that in the proposed building plans this bathroom will be made larger. Thirdly, the laundry room is unreasonably small. Although it has the basic items needed such as washing machine and drier, there is simply no room for care workers to move around and to organise their work. This problem has been alleviated by the home sending away laundry to be laundered. The home was clean and free from unpleasant odours on the day of the inspection. People who live in the home and completed a survey stated that the home is 'always' or 'usually' clean and fresh. The staff team have been trained in how to minimise the spread of infection and the proposed building plans include the installation of a sluice room to aid this.


Staffing


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.


Judgement:


Service users benefit from their individual needs being met by a competent and trained staff team. Service users are fully protected by the home's recruitment practices.

Evidence:

There are four care workers on duty to respond to people's needs for assistance from early in the morning until 8pm, when two night staff arrive. The care workers are supported in their work by other people, who undertake catering and housekeeping tasks. The expert by experience observed that, "Staffing levels were tight and staff themselves felt they were under some pressure to get everything done in the time limits, although appreciating that this was the start of the holiday season, which would always be difficult. However, no resident was ignored and the staff were aware when residents needed the toilet". Four staff who completed surveys agreed that there is 'usually' enough staff on duty to meet the individual needs of service users and one staff felt that there is 'always' enough staff available. People were complimentary about the support that they receive from the staff team. "The staff are so kind and I feel they are my friends", and "I am happy here the staff are so nice" were comments made by the people who live at the home.


Evidence:

National Vocational Qualifications (NVQ) are useful awards because they help staff develop good care practices and their skills in working with people who live in a residential care home. 85% of staff are trained to NVQ level 2 which exceeds the National Minimum Standards of 50% of staff. Before new members of staff are employed at the home a number of checks need to be carried out to make sure that all members of staff working at the home are suitable to care for vulnerable service users. Files were seen for three new members of staff. All the relevant checks and documentation were included showing that the recruitment process followed protects service users. The registered home manager is responsible for making sure that care staff have the skills they need to support the residents who live in the home. The registered home manager made a declaration on annual quality assurance assessment (AQAA) that all new care staff receive the appropriate introductory training, which gives them the basic competencies they need to be able to work without direct supervision. In addition to the introductory training, care workers undertake a number of training courses that develop their skills in caring for the people that live in the home. The registered home manager has completed a comprehensive staff training matrix, which lists the training that each member of staff has undertaken, together with the dates on which they need to renew this training. The training matrix evidences that all care staff are kept up to date with current care practices. In addition, the adequacy of the skills and knowledge of each of the existing care workers is being assessed to ensure that they have the competencies they need to perform their role as care workers. This is a good piece of work.


Management and administration


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.


Judgement:


Service users benefit from the management approach of the home, which is individual and open. The views of the people living in the home are regularly sought so that the home can be certain that it is run in their best interests. The health, safety and welfare of service users is promoted at all times.

Evidence:

The registered home manager has held a management position at the home for five years and was appointed as the registered home manager in August 2007. She has an NVQ 4 in management. This award is recognised by the commission to be usefulbecause it helps to make sure that people who manage residential care services havethe competencies that are necessary to do so. The expert, "observed that Joanne (registered home manager) was available to all the


Evidence:

residents throughout the visit and had a good rapport with them, as she did with staff". Staff said that there is a good atmosphere in the home and that they like the way that the registered home manager consults with them. "People want to help each other. Things are really open", commented one member of staff. For the home to run in the best interests of the service users it is important to have a system in place which regularly obtains the views of service users and visitors about the standard of care that they receive at the home. Evidence was seen that the views of people who live in the home were last sought in October 2008 and that overall people were happy with the quality of care that they receive. In addition, a representative of the company visits the home monthly to undertake a comprehensive review of the service, which includes talking to service users and staff. The registered manager monitors systems used in the home to make sure that they are effective, such as complaints, staff competencies and medication. The registered manager has told us that there are no people living at the home subject to a deprivation of liberty authorisation under the Mental Capacity Act 2005. Where monies are kept on behalf of people who live in the home, evidence was seen that they are well organised to ensure that monies are spent in the best interests of each individual service user. Care staff have the opportunity to discuss care practice, the philosophy of the home and their own development needs at meetings with the registered manager. Staff who completed surveys all agreed that they regularly meet with the registered home manager to discuss how they are working. The registered home manager made a declaration in the AQAA that all items of equipment in use in the home remain in good working order. Certificates were looked at for moving and handling equipment and confirmed that these had been serviced at the correct intervals. As mentioned previously, the registered home manager has developed a staff training matrix which ensures that all staff are kept up to date with current care practices.


Are there any outstanding requirements from the last inspection?

Yes £ No R

Outstanding statutory requirementsThese 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


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

RecommendationsThese 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


Helpline:

Telephone: 03000 616161

Email: [email protected]

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). 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.

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