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Inspection on 25/01/10 for St Augustines Court Care Home

Also see our care home review for St Augustines Court Care Home for more information

This is the latest available inspection report for this service, carried out on 25th January 2010.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Assessment processes are comprehensive so that people considering moving to the home are assured that staff will have full information about how to meet their needs. Care is well planned and there is always a registered nurse on the premises to meet health needs. Some outside entertainers come to the home and there is an activities worker who works with people individually. Two people have additional individual attention to meet their needs and another person told us about regular trips out with one of the care staff. People enjoyed the food provided and it was adequately nutritious. Drinks and finger snacks were plentiful throughout the day. People told us they felt safe in the home. People are being cared for by sufficient staff who have been safely recruited and receive training to meet care needs.

What has improved since the last inspection?

The number of shared rooms has been considerably decreased, so that most people have total privacy in their bedrooms. Our Expert by Experience spoke with some people living in the home and a visitor. She noted a general improvement in the care given to people since the previous inspection and specifically commented "The residents` clothes were all clean." and "There was noticeable difference with regard to the interaction of staff to residents. The staff were conversing with the residents in a way that was meaningful to them." The manager has produced a new poster including her photograph. This encourages people to speak to a member of staff or the manager if they have any concerns and it has been displayed around the home. We found that the premises have received appropriate attention. Previously damaged ceiling tiles and bedroom furniture have been replaced. Various areas have been redecorated and the home was clean and odour free throughout. We have assessed the manager since the last inspection and found her to be fit to manage this service. At inspection she demonstrated how previous requirements had been met and the home is now run in the interests of people that live there.

What the care home could do better:

The manager is continually making improvements within the home and should continue with current plans to develop suitable activities for people with needs relating to Dementia. One idea that is developing is to use one of the lounges as cinema room. Staff already have some regular individual meetings with the manager or senior staff, but these should be increased to at least six times each year so that they are fully supported in their work in caring for people at the home.

Key inspection report Care homes for older people Name: Address: St Augustines Court Care Home 105 - 113 Wells Road Nottingham Nottinghamshire NG3 3AP     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: Meryl Bailey     Date: 2 5 0 1 2 0 1 0 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 2 1 0 stars - excellent stars - good star - adequate 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. that people have said are important to them: They reflect the things 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. Care Homes for Older People Page 2 of 24 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 Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: St Augustines Court Care Home 105 - 113 Wells Road Nottingham Nottinghamshire NG3 3AP 01159590473 01159412079 staugustines@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Care Homes Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Elaine McAdams Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: Within the total number of 40 beds 3 beds maybe used for clients under the age of 65 years in the category of DE Date of last inspection Brief description of the care home St Augustines Care Home care for older people with Dementia who require nursing care. Accommodation is provided in mainly single rooms, but double rooms are available for those that choose to share. A passenger lift is installed to provide access to the first floor. All areas are accessible for people in wheelchairs. The home is two miles north of the centre of Nottingham and there are a regular buses to the city centre. There is also a range of local stores close by. The fees at the home range Care Homes for Older People Page 4 of 24 Over 65 40 40 3 0 1 6 0 2 2 0 0 9 Brief description of the care home from £326.00 to £500.00 per week according to needs. . Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service 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 focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice. In planning our visit we reviewed all of the information we have received about the home since we last visited and we considered this in planning the visit and deciding what areas to look at. We did this inspection with one inspector and an expert by experience who observed and spoke with people who are using this service. An expert by experience is a person who either has a shared experience of using services, has specialist knowledge or understands how people in this service communicate. The expert visited the service with us to help us get a picture of what it is like to live in or use the service. This is Care Homes for Older People Page 6 of 24 important because the views and experiences of people who use services are central to helping us make a judgement about the quality of care. Another method of inspection we use is called case tracking which involves us choosing people who live at the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We observed staff working with people, spoke to some members of staff, six individual people who live at the service and a visiting relative to form an opinion about the quality of the service being provided. We read documents and records as part of this visit and observed how nurses handle medication to help us form an opinion about the health and safety of people who live at the service. We also sent survey forms to staff before our visit and ten of them completed and returned forms to us. Care Homes for Older People Page 7 of 24 What the care home does well: What has improved since the last inspection? What they could do better: The manager is continually making improvements within the home and should continue with current plans to develop suitable activities for people with needs relating to Dementia. One idea that is developing is to use one of the lounges as cinema room. Staff already have some regular individual meetings with the manager or senior staff, but these should be increased to at least six times each year so that they are fully Care Homes for Older People Page 8 of 24 supported in their work in caring for people at the home. 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 enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 24 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 Care Homes for Older People Page 10 of 24 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: 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. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessment processes are comprehensive so that people considering moving to the home are assured that staff will have full information about how to meet their needs. Evidence: We looked at the files of four people and found evidence that the registered manager or other nursing staff had visited each person before they were admitted. They had undertaken a comprehensive pre-admission assessments that included all areas relating to personal and social care as well as nursing. A draft care plan was in place immediately so that staff were informed of how to meet the peoples needs as soon as they were admitted. All pre-admission documents had been signed by the person admitted or a representative showing they had been fully consulted on all aspects of the care required. Care Homes for Older People Page 11 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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. This is what people staying in this care home experience: 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. Personal and health care is individually planned so that staff meet peoples needs appropriately. Action is taken to ensure people receive their medicines as prescribed by a doctor. Peoples rights to privacy and dignity are upheld. Evidence: As at the previous inspection, the written plans of care were comprehensive and specified action needed to meet needs and reduce or eliminate risks. There were clear risk assessments for each person regarding moving and handling, nutrition, falls and possibility of developing pressure sores. Specific risks were also assessed for individuals affected by other risks due to diabetes or their behaviour. There were daily notes written by staff, weekly progress reports and each plan had been fully reviewed at least monthly. There was evidence of signatures of people themselves or their relatives showing they agreed to the way care was provided. There was a nurse always on duty during the day and night. There were records of visits from doctors and other health professionals. It was clear that individual work had been carried out with people. We saw that one person, that previously remained Care Homes for Older People Page 12 of 24 Evidence: alone in their own room, was enjoying the company of others in one of the lounges. Two other people each had a dedicated member of staff to meet needs relating to behaviour and dementia care. The nurse on duty was in full control of medication, which was held securely in a dedicated room. Since the last inspection a window in medication room has been secured. The nurse used a locked trolley to transport medication to people around the home. There was a photograph of each person for identification purposes and the current Medicine Administration Records that we examined were well completed. The manager told us that audits were carried out on a monthly basis and each nurse was responsible for rechecking the records before the end of their shift to ensure all medicines had been given as prescribed. We observed some of the medication being given to people and the nurse was following correct procedures. Our Expert by Experience spoke with some people living in the home and a visitor. She noted a general improvement in the care given to people since the previous inspection and specifically commented The residents clothes were all clean. and There was noticeable difference with regard to the interaction of staff to residents. The staff were conversing with the residents in a way that was meaningful to them. The number of shared rooms has been considerably decreased, so that most people have total privacy in their bedrooms. In the remaining three double rooms there were curtains that could be drawn between the beds. Care Homes for Older People Page 13 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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. This is what people staying in this care home experience: 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 are stimulated with appropriate activities and enjoy varied nutritious meals and snacks. Evidence: An activities worker is provided at the home and a new worker started in this role three weeks before the inspection. There were photographs of people engaged in activities and a bright display advertising the planned party for Valentines Day. We saw a new activity kitchen, which is available for people to be supported with household tasks. It had bright red cupboards and there were spaces for a cooker and washing machine yet to be installed. The room was not in use during our visit but staff told us it had been used and there was a photo album there for staff to use in reminiscence work. There were other old photos all around the home. We also saw various other pictures, street signs and sensory boards specifically placed to stimulate ideas and help people locate rooms. In the Annual Quality Assurance Assessment the manager told us over the last twelve months there had been lots of trips out and there was an activities plan available on a weekly basis. There was a file with records of all activities. Two people told us that they had been assisted on individual trips out for a few hours by care workers. One Care Homes for Older People Page 14 of 24 Evidence: person accessed the community every day with an additional care worker. We observed staff encouraging people to sing along in the lounge and some were dancing. We saw several visitors during the day and observed that they were welcome at all times and were invited to join in activities. There was a choice of food given at each meal. We observed that during the morning each person was asked prior to the meal which menu they preferred. Our Expert by Experience ate a meal with people and observed that they enjoyed the food provided and it was adequately nutritious. Those who needed help to eat were assisted by a care worker sitting next to them. Drinks and finger snacks were plentiful throughout the day. Care Homes for Older People Page 15 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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. This is what people staying in this care home experience: 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 are assured that any complaints are listened to and action is taken to keep people safe at all times. Evidence: There was a full complaints procedure on the wall in the entrance to the home. It was also contained in the Service User Guide and we saw a comments form on the reception desk for people to write their views of the home and care given. However, our expert by experience found that a visitor did not how to make a complaint if it was needed. The manager immediately arranged to produce a new poster including her photograph. This encourages people to speak to a member of staff or the manager if they have any concerns and it has been displayed around the home. The manager had told us in the Annual Quality Assurance Assessment that there had been nine complaints received in a 12 month period. There was a file containing full records of complaints received with details of investigations and outcomes. There had been some situations that needed to be dealt with by the local authority safeguarding team and the manager had made appropriate referrals. Records of these showed that action had been taken to keep people safe. Additional one to one staffing for some people had improved overall safety. In discussions with our expert by experience people indicated that they felt safe in the home. Records showed that all staff had received training in Safeguarding Adults. Care Homes for Older People Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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. This is what people staying in this care home experience: 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 live in premises that are fit for purpose. Evidence: At the last inspection visit we found that some areas had not been fully maintained or kept clean. The manager sent us an improvement plan which informed us that an additional weekend cleaner has been employed to ensure the continuity of high standards of cleaning and a through cleaning schedule has been implemented on a daily basis. Also in the Annual Quality Assurance Assessment form the manager told us, Both the bedroom and communal areas are part of a redecorating programme. The bedrooms have been personalised and we have reduced some of the companion rooms to single and this will continue as the residents prefer. We found that the premises had indeed received appropriate attention. Previously damaged ceiling tiles and bedroom furniture had been replaced. Various areas had been redecorated and the home was clean and odour free throughout. The laundry was well organised and the manager told us that an additional member of staff has been employed to undertake the laundering of clothing at weekends and this has enabled clothing to be returned quickly. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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. This is what people staying in this care home experience: 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 are cared for by sufficient numbers of staff who have been safely recruited and receive training to meet care needs. Evidence: The acting manager told us that the standard formula was still used to calculate the number of staff needed to meet peoples assessed needs. As the number of people accommodated has decreased to 29, there has also been a decrease in staffing. There was always one nurse on duty and during the day there were five other care staff, including at least on senior care assistant. In addition to this two people had dedicated workers with them for five to six hours each day. At night there was one nurse and two care assistants. The manager, administrative worker, domestic and kitchen staff, a maintenance person and activities worker were employed in addition. Staff that returned completed survey forms told us there were usually enough staff to meet peoples needs and they felt supported by additional staff being supplied for those that needed more attention. All nurses were experienced and registered with the Nursing and Midwifery Council. Records confirmed registrations were current. Senior care workers had achieved level 3 of the National Vocational Qualification (NVQ) in Care and all other care staff held level 2. There was clear induction training for new staff. Care Homes for Older People Page 18 of 24 Evidence: We checked records of a sample of four staff including one that had started within the last few months. There were records that showed that staff had been checked through the Criminal Records Bureau and two written references had been provided for each person to ensure all staff were fit to care for vulnerable adults. Records of continuous staff training clearly showed the extent of training given to staff during the last 12 months and this included Dementia Care. Ten staff returned survey forms to us and were satisfied with the quality of the training they received. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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. This is what people staying in this care home experience: 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 benefit from efficient management of the home and it is run in the interests of those that live there. Peoples health and safety are promoted and protected at all times Evidence: We have assessed the manager since the last inspection and found her to be fit to manage this service. The manager sent us the Annual Quality Assurance Assessment (AQAA) when we asked for it in December 2009. It was very comprehensive and gave us all the information we needed. It demonstrated that the manager knows what action is needed to maintain and improve the quality of the service. At inspection she demonstrated how previous requirements had been met and used a management file that clearly set out the improvement plan with all actions recorded. The manager told us in the AQAA that staff assist with the meetings with people that live in the home on a monthly basis. The views were recorded and placed on the notice board. There were also Relatives meetings held every three months to discuss Care Homes for Older People Page 20 of 24 Evidence: issues, concerns, or suggestions. These minutes were also on the notice board. A Southern Cross satisfaction survey was conducted regarding the home in July 2009 and the results of this were available in the reception area. The manager told us that from listening to people, particularly those that requested more activities, they have made the following changes: Our activity co ordinator ensures that our residents have a variety of activities and this includes trips out, entertainers, hobbies and interests.... A Pat the dog comes with its owner every Tuesday. They have also installed a radio and compact disc facility in the main corridor. This enables people to hear music and other stimulating atmospheric sounds such as walking in a woodland and bird sounds. A senior manager form Southern Cross visited each month to speak to people living there, their families and staff and reports were available of what was found at these visits. The management of peoples money was examined and there were appropriate safeguards are in place for people who were unable to manage their own money. The acting manager demonstrated an understanding of the Mental Capacity Act. Some cash was held securely for people and we saw that there were suitable signed records of all transactions, with receipts issued. There were recent records of staff supervision meetings with the manager or senior care staff and all staff had up to four such meetings during the last year. Staff told us they could discuss any concerns with the manager as needed. Since the last inspection a new system for recording incidents and accidents has been used so that the manager was fully aware of them all and could ensure appropriate action was taken. Records showed that staff had refresher training in safe working practices. There were records of weekly fire alarm testing and monthly checks on emergency lighting. During the tour of the premises we noticed that the assisted bath was last serviced during 2009 and the manager had told us within the AQAA form that all other equipment had also been serviced within the last year. Care Homes for Older People Page 21 of 24 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 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 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 36 Arrange 1:1 supervision meetings with each staff member at least six times each year so that they are fully supported in their work in caring for people at the home. Care Homes for Older People Page 23 of 24 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. 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. Care Homes for Older People Page 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!