Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Saint Elkas Care Home 75 Hill Top, Bolsover, Chesterfield, S44 6NJ Date of Inspection: 12 February 2013 Date of Publication: March 2013 We inspected the following standards as part of a routine inspection. This is what we found: Respecting and involving people who use services Care and welfare of people who use services Management of medicines Requirements relating to workers Assessing and monitoring the quality of service provision Met this standard Met this standard Action needed Met this standard Met this standard Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 1
Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activity Saint Elkas Limited Miss Lisa Ruth Thorneycroft Saint Elkas provides accommodation for up to seven people who have mental health conditions. The home near to the village of Bolsover near Chesterfield in Derbyshire. Care home service without nursing Accommodation for persons who require nursing or personal care Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 2
Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 What we have told the provider to do 4 More information about the provider 5 Our judgements for each standard inspected: Respecting and involving people who use services 6 Care and welfare of people who use services 8 Management of medicines 10 Requirements relating to workers 12 Assessing and monitoring the quality of service provision 13 Information primarily for the provider: Action we have told the provider to take 15 About CQC Inspections 16 How we define our judgements 17 Glossary of terms we use in this report 19 Contact us 21 Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 3
Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 12 February 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with staff, reviewed information we asked the provider to send to us and reviewed information sent to us by commissioners of services. What people told us and what we found There were seven people living in the home at the time of this review. We spoke with three people to gain their views of the service. One person told us "the staff are lovely, I get on well with them", another person told us "I couldn't wish for better". People appeared at ease with the staff and there were lots of chat and positive interactions observed. People were able to make their own drinks and meals when they wished at breakfast and lunch. At the main meal of the day at teatime people and staff ate together. People and told us they were involved in making decisions about their care. The care plans were signed by people to show their involvement and agreement. Staff were suitably trained and had access to information about medicines. We spoke with three people who told us that staff always gave them medicines at regular times. Where appropriate there were systems in place to support people to self medicate. We observed some poor practice during our visit and found that staff were not always following safe administration practices. There were robust recruitment procedures in place. This ensured that staff were suited to work with vulnerable adults. The provider had systems in place to monitor the quality of the service and involve staff and people in the running of the home. You can see our judgements on the front page of this report. What we have told the provider to do We have asked the provider to send us a report by 28 March 2013, setting out the action Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 4
they will take to meet the standards. We will check to make sure that this action is taken. Where providers are not meeting essential standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service (and others, where appropriate). When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take. More information about the provider Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 5
Our judgements for each standard inspected Respecting and involving people who use services Met this standard People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run Our judgement The provider was meeting this standard. People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. Reasons for our judgement People were positive about the amount of independence they had, most people went out alone whenever they wished. Staff told us that if people did need support from staff this was arranged. Two people we spoke told us they felt they had made good progress at the home and were more confident and independent. One person told us that staff always offered choices to them and they said they had "no complaints". Another person told us "its nice here", they said there were few rules but there was one that no alcohol was allowed. People expressed their views and were involved in making decisions about their care. The care records included assessments of people's ability to make decisions and understand information. All of the three people we spoke with knew about the care plans and said they had been asked about them. They could tell us about the reviews that were held and who their key workers were. People's privacy and dignity were respected. People we spoke with told us that staff always knocked before entering bedrooms. One person told us they had a key to their room to maintain privacy. Another person told us they did not want a key but sometimes chose to lock the door of their room when using it to maintain their privacy. People were supported in promoting their independence and community involvement. The people we spoke with told us that they went out independently and took part in a variety of community activities. This included adult learning classes as well as going out to shop or partake in leisure activities such as eating out. People we spoke with told us that they managed their own monies. We saw care plans in place to describe what arrangements were in place regarding people's monies. Information was available to staff on how independent people were. Assessments of people's abilities to manage their finances, some domestic task and management of medicines were in place. This ensured staff knew what level of assistance to provide and they did not increase people's dependence by giving help when it was not needed. The home had a domestic and homely atmosphere and we observed people contributing to the Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 6
running of the home by cleaning their own rooms. Independence was encouraged and people were supported to do their own laundry and meal preparation. People had been asked about their preferences and there was information on file about people's life histories including key dates which were to them. This ensured staff got to know people as individuals. Our discussions with the manager and a staff confirmed that they knew people well and could describe the level of support each person needed Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 7
Care and welfare of people who use services Met this standard People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. People experienced care, treatment and support that met their needs and protected their rights. Reasons for our judgement People's needs were assessed. We saw that an assessment of each persons needs was carried out before they started using the service. Information was also obtained about people's needs from social services or any other agencies involved in people's care. All three people we spoke told us they had visited the home before they moved in. One person told us they had also stayed overnight before making the decision to move in. People's needs were assessed and care was planned and delivered in line with their individual care plan. Each care plan had also had a risk assessment in place to identify any particular risk factors and assess the extent of these. For example if a person was self caring but had the potential when unwell to neglect themselves this was a potential risk. Each care plan was individual and described the person's needs. The provider may find it useful to note that for person there was not a clear plan and risk assessment in place on how one person's medication was to be managed. Each care plan and risk assessment was reviewed monthly and updated if this required. Changes were recording and plans updated if required. One review form we looked at confirmed the person had been involved in this. The manager also undertook reviews for each person on a six monthly basis. Ongoing records were written by staff twice daily. These were well detailed and gave a good account of people, what they done and how they had presented. There were risk assessments in place for specific circumstances for example fire risk if a person smoked as well as a risk assessment which took into account the person's history and previous behaviours. There were arrangements in place to deal with foreseeable emergencies. This included personal emergency evacuation plans should a fire occur. The records indicted people were given information and instructions on what to do should a fire occur. Arrangements were in place to meet people's healthcare needs. The care plans we looked Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 8
at detailed where people had seen their GP or other healthcare professionals. Where people had identified healthcare needs we saw care plans in place to describe what support was needed. People's weight were routinely monitored each month to check if there were any significant changes. Where there were concerns re dietary intake we saw that fluid and dietary intake records were kept. Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 9
Management of medicines Action needed People should be given the medicines they need when they need them, and in a safe way Our judgement The provider was not meeting this standard. Suitable storage and recording systems were for the handling of medications. However poor administration practices had the potential to place people at risk We have judged that this has a moderate impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement We spoke to three people during our visit. All confirmed that they always received their medicines at the correct times. We observed staff giving medicines to people. This was done on an individual basis and in an unhurried manner. During our visit we observed one staff member give out medications to a person without referring to their medication administration record. This increased the potential for errors to be made and was not in keeping with the medication procedure that was in place. During our visit and discussions with staff we found that there were occasions where staff left medications with people to take as they wished. Staff told us they did not observe the person take the medications and could not always get confirmation from the person that they had taken the medications. Staff signed the medication administration record when the medication was missing from the pot. Therefore staff were signing to medication administration record when they could not be assured that the person had taken the medicines. There is the risk evident with this practice that people may discard or stockpile medicines without staff being aware of this. Additionally the medicine may be potentially accessed by people for whom they were not intended. There were systems in place to support people to self medicate. We saw risk assessments were put in place and graduated programmes to enable people's confidence to grow was commenced. This ensured that people's right to handle their own medicines if they were able was respected. Where staff handled medication on behalf of people there were consent forms in place to record they had been consulted about this. The forms also considered if people had an understanding of their medicines. In one care file we saw that a medication for one person had been changed at an outpatient appointment but the GP had not been informed of this. Staff at the home had ensured this was rectified quickly so that the person received the correct medication. Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 10
Medicines were stored securely in suitable cupboards. Whilst there was no controlled drug currently prescribed for people, should these be required suitable recording and storage facilities were in place. A fridge was available for medicines where they required this. There were suitable recording systems in place for medicines. This included staff recording in the quantity of medications received. Where existing stocks of medicines were held these were added to the new stocks that were delivered. We found medication administration records were fully completed to record people were receiving their medications and any returns to pharmacy were documented. This ensured there was an audit trail of medicines in place. We viewed medication administration sheets and these showed that medication was being signed for appropriately and relevant codes were being used to show why a particular medicine had not been given. Where people self medicated, they signed the medication administration records. Whilst medications stocks were replaced on regular intervals the provider may find it useful to note that the urine testing sticks were found to be out of date. Six monthly audits and checks of medication management were completed by the manager. Audits were also completed by the supplying pharmacists. These did not record that there were any issues found. All staff who gave medications to people had received training. This was followed up with assessments of staff competence to give medicines. Staff had access to up to date information on medications and to the policies and procedures in place. Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 11
Requirements relating to workers Met this standard People should be cared for by staff who are properly qualified and able to do their job Our judgement The provider was meeting this standard. Robust recruitment procedures were in place. This ensured that the staff recruited were suited to work with vulnerable adults. Reasons for our judgement We spoke to people using the services but their feedback did not relate to this standard. However people told us about their experience of the care delivered by staff. One person told us "the staff are lovely, I get on well with them", another person told us "I couldn't wish for better". Our review of two out of the six staff files found that robust recruitment procedures were in place. Each staff file contained completed application forms which documented the employment history of staff. Prior to commencing in post the manager had ensured that Criminal Records Bureau checks and two references for each staff member were assessed. In both of the staff files we looked there was proof of the staff member's identity available. This ensured that only suitable staff were employed to work with vulnerable people. The application forms included questions to enquire about the health of staff. This ensured staff were fit to work. Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 12
Assessing and monitoring the quality of service provision Met this standard The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system to regularly assess and monitor the quality of service that people received. Reasons for our judgement People who used the service, their representatives and staff were asked for their views about their care and they were acted on. Ongoing quality surveys were given out to people and their relatives and positive feedback was seen on these forms. However there was no collation of the findings from these so the views given were not analysed or shared with stakeholders. Staff had commented on the surveys that they felt the home was "run to a high standard". Regular monthly meetings were held for people living in the home and staff. The staff meetings considered areas of good practice and where there scope to improve. The minutes of residents meetings informed us that people were asked about activities, food and reminded people of health and safety aspects and how to raise concerns if they had any. This ensured systems were in place to enable people and staff to share their views about how the home was run. There were regular internal audits of systems and practices in the home. This included health and safety audits, care plan audits and medications audits. We saw that where actions had been identified a plan had been put in place and they had signed off when completed. The provider may find it useful to note that whilst some audits considered aspects of infection control as this was a small part of the audit, and as such may not identify all potential areas of risk. A managers audit was also completed the last one being done on 31 December 2012. This considered a wide range of areas to enable the manager to assess quality over a number of areas. Derbyshire County Council undertook a quality monitoring visit of the service in June 2012. An action plan was produced to identify where improvements were required. The provider was considered to have addressed the findings and all actions confirmed as complete on 22 January 2013. The manager provided us with the dates of service checks and installations in the building. Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 13
These were found to be in date. There was evidence that learning from incidents took place and appropriate changes were implemented. Whilst few accidents had occurred there was a record in place to collate information about the accidents. The manager told us that no complaints had been received about the service in the past 12 months. A comments box was in the reception hallway if people or visitors wished to use this. The three people we spoke with all said they would readily approach staff if they had any concerns. Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 14
This section is primarily information for the provider Action we have told the provider to take Compliance actions The table below shows the essential standards of quality and safety that were not being met. The provider must send CQC a report that says what action they are going to take to meet these essential standards. Regulated activity Accommodation for persons who require nursing or personal care Regulation Regulation 13 HSCA 2008 (Regulated Activities) Regulations 2010 Management of medicines How the regulation was not being met: The provider is not ensuring that safe admistration practices are followed, this may place people at risk. Regulation 13 HSCA 2008 (Regulated Activities) Regulations 2010 This report is requested under regulation 10(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The provider's report should be sent to us by 28 March 2013. CQC should be informed when compliance actions are complete. We will check to make sure that action has been taken to meet the standards and will report on our judgements. Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 15
About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of dentists and other services at least once every two years. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times but we always inspect at least one standard from each of the five key areas every year. We may check fewer key areas in the case of dentists and some other services. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 16
How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. Met this standard This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 17
How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. We make a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation) from the breach. This could be a minor, moderate or major impact. Minor impact people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 18
Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 19
Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 20
Contact us Phone: 03000 616161 Email: enquiries@cqc.org.uk Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: www.cqc.org.uk Copyright Copyright (2011) 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. Inspection Report Saint Elkas Care Home March 2013 www.cqc.org.uk 21