Inspection on 04/08/09 for St Catherine`s Nursing Home

Staff make sure that they assess the needs of people before they are admitted to the home. This is to make sure that staff only care for those people whose needs they feel they can meet. The care plans contain a lot of information about how people are to be cared for, what they can do for themselves and what they need help with. The staff make sure that they continually look at anything that may be a risk to the residents. They then make sure that they write down in the resident`s care plan when they have done this, and what action they have taken to reduce the risk. Activities are considered to be a very important part of the residents` day. More activities have been provided and are planned around the individual resident. The meals provided are varied, nutritious and the residents have a good choice of menu. Management continually check out the quality of care and the services provided for the residents.

What has improved since the last inspection?

The way that the residents are cared for has changed. Care is delivered according to the resident`s past and present daily routines, plus their likes and dislikes. This is called "Person Centred Care". Care is given on an individual basis and is according to what the residents want to do at any one time. The home now has 2 kittens and a rabbit for the residents to look after if they wish to. There have been major improvements to the environment throughout the home. Each unit has been decorated and refurbished to a very good standard. 1 of the larger bedrooms on the Nursing Unit has been totally refurbished and is now a designated bedroom for any very ill resident. It has an extra bed in it for any relatives who wish to stay over. A new, very experienced manager is now in post and staff feel she has a very positive outlook and they also feel very supported by her. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2

What the care home could do better:

Medicines must be given to residents as prescribed because receiving medicines at the wrong dose, wrong time or not at all can seriously affect their health and wellbeing. Senior staff must ensure that they keep the records about staff training and recruitment up to date at all times. This is so that everybody involved in the care and welfare of the residents can be assured that the staff are safely recruited and properly trained. This helps keep the residents safe.

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE St Catherine`s Nursing Home Queen Street Horwich Bolton Lancashire BL6 5QU Lead Inspector Grace Tarney Key Unannounced Inspection 09:15 4th August 2009 DS0000005697.V376861.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 2 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 St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Catherine`s Nursing Home Address Queen Street Horwich Bolton Lancashire BL6 5QU 01204 668744 01204 668727 st.catherines@fshc.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Tameng Care Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Manager post vacant Care Home 61 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30), of places Physical disability (1) St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 61 service users to include:Up to 30 service users in the category of DE(E) (Dementia over 65 years of age) Up to 30 service users in the category OP (Old age not falling within any other category) Within these numbers Nursing care can be provided for up to 30 service users One named service user in the category PD (Physical Disability) The registration to revert to the original respective categories should the named service user leave the home. 6th August 2008 2. Date of last inspection Brief Description of the Service: St. Catherines is a purpose built Home with accommodation on the ground and first floors. The home is situated within walking distance of Horwich Town Centre and the local shops. It is close to a main bus route and not too far from the motorway network. Car parking is provided to the front of the home and garden space is provided to the sides and rear. The home is registered to provide accommodation to 61 residents and offers nursing and personal care services. There is a dedicated dementia care unit that is now called Pike View. This unit has its’ own lounges and dining room. All rooms are for single occupancy; one room has en-suite facilities. The bedrooms on the first floor are for the nursing and residential residents and are reached either by stairs or a passenger lift. In addition to the facilities on Pike View there is a lounge and dining room on the first floor and lounges and a dining room on the ground floor for both the residential and nursing residents. The provider informed us that the fees within the home ranged from £416.00 to £636.00 per week. The fees payable depend on the care being provided. Additional charges are made for private chiropody, hairdressing and newspapers. This information was received on the 4th August 2009. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The staff at the home were not told that this inspection was to take place although many weeks before the inspection questionnaires (comment cards) were sent out to some of the residents and to the staff. The questionnaires asked what people thought about the care and quality of the service provided. We have not yet received any comment cards back from residents but we received 7 back from the staff. What they felt about the care and services provided is written in different sections throughout this report. Also before the inspection we (The Care Quality Commission) asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they did at present, what they felt they did well and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we do. We made 2 visits to the home within the week. The first visit to the home by 2 inspectors and 1 pharmacist inspector took place over 9 hours. During this time we examined care and medicine records to make sure that the health and care needs of the residents were being met. In addition we looked at what activities were available for the residents and whether they were given choices about how they spent their day. We looked at what the residents were having for their meals, to make sure that there was a choice of meals and that they were varied and wholesome. We also looked around the building at some of the bedrooms, bathrooms, toilets and sitting areas to check if they were clean, warm and well decorated. We checked how many staff were provided on each shift to make sure that the residents needs were being met. We then looked to see if management recruited and trained the staff properly and safely. This is so the staff can do their jobs properly and the residents are protected from being cared for by unsuitable people. The records were not as up to date as they should have been so 1 inspector went back a few days later to check that they were now in order. We also looked at how management check that the care and services they provide is what the residents and their relatives want, or expect. How the residents spending money is managed was also checked. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 6 In order to obtain further information about the home we spent time talking to 3 residents, 1 visitor, a visiting nurse, 3 care assistants, the cook, the administrator, a unit manager and the home manager. What the service does well: Staff make sure that they assess the needs of people before they are admitted to the home. This is to make sure that staff only care for those people whose needs they feel they can meet. The care plans contain a lot of information about how people are to be cared for, what they can do for themselves and what they need help with. The staff make sure that they continually look at anything that may be a risk to the residents. They then make sure that they write down in the resident’s care plan when they have done this, and what action they have taken to reduce the risk. Activities are considered to be a very important part of the residents day. More activities have been provided and are planned around the individual resident. The meals provided are varied, nutritious and the residents have a good choice of menu. Management continually check out the quality of care and the services provided for the residents. What has improved since the last inspection? The way that the residents are cared for has changed. Care is delivered according to the resident’s past and present daily routines, plus their likes and dislikes. This is called “Person Centred Care”. Care is given on an individual basis and is according to what the residents want to do at any one time. The home now has 2 kittens and a rabbit for the residents to look after if they wish to. There have been major improvements to the environment throughout the home. Each unit has been decorated and refurbished to a very good standard. 1 of the larger bedrooms on the Nursing Unit has been totally refurbished and is now a designated bedroom for any very ill resident. It has an extra bed in it for any relatives who wish to stay over. A new, very experienced manager is now in post and staff feel she has a very positive outlook and they also feel very supported by her. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 7 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3. People using the 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 properly assessed before they are admitted to the home and this gives an assurance to everybody, that a person is only admitted if the staff at the home feel they can meet their needs. EVIDENCE: Before any resident was admitted to the home a senior member of staff from the home undertook an assessment of their needs. The assessment looks at what help and support the prospective resident needs in all aspects of daily life. The 1 assessment that we looked at was detailed and gave a clear indication of the resident’s needs and what she could and could not do for herself. Based on this information it was decided that the staff at the home could meet the resident’s needs and therefore her admission to the home was possible. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 10 The AQAA document sent to us told us that the new resident’s proposed key worker accompanies the senior staff member who is undertaking the assessment. This is so that when a resident comes into the home they recognise their key worker and hopefully this will help them to settle in more easily. A key worker is a staff member who has certain responsibilities around an individual resident’s care. Standard 6 does not apply. The home does not provide Intermediate Care. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 &10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans reflect the needs of the residents and care practices ensure the resident’s needs are met in an individual and caring way. The majority of residents are given their medicine as prescribed, however because we found that some people could not have their medication because it had run out or not been ordered we still have concerns that residents health and well being may sometimes be at risk of harm. EVIDENCE: Individual care plans were in place for each resident. A care plan details the care and support needs that a resident may have and also shows how those needs are to be met by staff. The care plans of 3 residents were looked at, 1 on the Dementia Unit (Pike View) and 2 on the Nursing Unit. They were very detailed and gave clear instruction and guidance on how the care needs of the residents were to be St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 12 met. They also provided information about the resident’s daily routines, their past life and their interests. This helps the staff and the resident plan for their daily activities so that they can get as much enjoyment out of their lives as possible. On Pike View we saw that the staff had identified that 1 of the residents was at risk of developing pressure sores. There was a good plan of care to show how she was to be cared for to prevent pressure sores developing. Staff had not, however written down in the care plan that she was being cared for on a pressure relieving mattress. We visited this resident in her room. She was being cared for properly and a pressure relieving mattress was in place. It is important to write down exactly how a resident is being cared for so that there is a clear record of care in place for everybody involved. We also saw that a positional change chart was in place for this resident. A positional change or turn chart is there for staff to record when a residents position has been changed, either whilst in bed or in a chair. This is to ease pressure on parts of the body and prevent pressure sores. The chart however had not always been filled in. It was not as up to date as it should have been. It was up to date on the day of our visit but had not always been filled in on previous days. Staff should ensure that the charts are filled when positional changes have been made. The charts should give an accurate record of the care delivered at any one time. The care plans were checked regularly by the staff so that any change in the resident’s condition could be identified and action taken if necessary. In the care plans that we checked we saw that the staff looked at whether or not there was any risk in relation to the residents developing pressure sores. They also looked at whether there was any risk of the resident falling and also if a resident was at risk due to problems with their food and fluid intake. Staff also looked at and wrote down how any resident was to be assisted with being moved around and by how many members of staff and what equipment if any, was to be used to assist in safe moving and handling. We saw that residents were weighed regularly and their weight was recorded in their care notes. We saw that staff wrote in the care notes when the residents had received visits from health care professionals, such as dentists, opticians, district nurses and chiropodists. We spoke to a visiting nurse whilst we were at the home. She told us that she had seen very big improvements in the care and care planning. She said “All credit to them”. Equipment necessary for the prevention and treatment of pressure sores was available and in use throughout the home. In the AQAA document sent us and in the surveys received from staff there was lots of information about how the staff now deliver “Person Centred Care”. As the name suggests, it basically means that care is delivered and centres on the individual. Care is delivered according to the resident’s past and present daily routines and their likes and dislikes. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 13 We saw lots of evidence of person centred care. Residents stayed in bed until they felt ready to get up. They had their meals at a time that more or less, suited them and they were free to move around the unit as they pleased. Some residents sat in the lounges, others in the dining room and others in the conservatory. The staff that we spoke to said they found that the way care was being delivered now was so much better. They told us that the residents seemed a lot more relaxed. We spoke to a visitor who told us that she felt her relative was well looked after. We also spent some time talking to 2 residents who had been living at the home for some time. They told us that they were “very happy” and had no complaints. One of the residents told us “the girls here are smashing”. As part of the visit a specialist pharmacist inspector looked at how medicines were handled because a previous pharmacist inspection had found mistakes in medicines handling. We also checked to see if the requirements made at the previous inspection regarding medicines had been met. We looked at a sample of medicines stocks, medicines records and care plans in all three units. We found that the significant improvements which had been made in the recording and general organisation of the medicines after the last inspection had continued. Records of medicines receipt, administration and disposal were still usually clear and accurate. When records about medicines are kept well they can show if residents are being given their medication properly. The records can also show if medication is all accounted for. However the records about creams were poor and did not show that creams were being applied properly. When we looked at the records about medicines together with the stock of medication we found that most medicines were administered to residents as prescribed and most medication could be accounted for. However we did find that some residents were not given some of their medication because it had run out. One resident had not had her medicine to help her sleep for 5 days because it had run out. Another resident could not have some heart medication for 5 days because it had run out too. During the inspection the manager told us that she would arrange a meeting with the community pharmacist to try to prevent this happening in the future. At the last inspection we were told that a meeting with the community pharmacist had highlighted this problem and that action had been taken to help prevent this happening again. It is of serious concern that the actions taken did not St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 14 prevent residents from running out of medication. Going without prescribed medicines could harm the health and wellbeing of people who live in the home. During the inspection we found some prescriptions pinned on a notice board in a public area. These prescriptions were dated 9th July 2009 and when we looked at these residents medication records we found that the medication had not been started. The staff told us that the prescriptions had not been dispensed for these residents. No one, including the manager, could explain why these prescriptions had not been dispensed or why the residents were not being given their new medication. Going without prescribed medicines could harm the health and wellbeing of people who live in the home. At the last inspection we looked at the times medicines were given and found they were not always given at the correct and best time for individuals. We found some medicines used for bone problems were given after food instead of before for three different people. At this inspection we found identical concerns. We also found that doses of paracetamol containing medicines were given with only a three hour gap between the morning and lunchtime doses. The minimum recommended safe time interval is four hours. Taking medicines at the wrong time can stop them working properly or cause unnecessary side effects, which could affect the health and wellbeing of the person taking them. At the last inspection we also looked at how ‘when required’ medicines were being used. Care plans had been developed for most of these and some lacked enough detail to help make sure the medication was given correctly. At the last inspection we found that one person that was prescribed ‘when required’ medicine for agitation did not have a clear written care plan for this. During this inspection we found identical concerns. We also found that when people were prescribed more than one cream there was not always a care plan for each cream, which could lead to the wrong cream being applied to the wrong area. Having detailed care plans helps make sure people get their medicines when and how they need them. Sometimes care plans for medication were kept in residents care file where the information was inaccessible to staff who needed the information. Some residents needed to have a prescribed thickening powder added to all their fluid to prevent them from choking. We found that staff did not know what consistency drinks and soups should be thickened to and there were no records that staff who made drinks made sure that they were thickened. If people are not given thickened drinks or drinks thickened to the wrong consistency their health could be at risk. We looked at how medicines were stored and found the trolleys, rooms, fridges and cupboards to be tidy and secure, this helps make sure medicines are kept safely. However the room in which medicines was kept in was not clean, the floor and bench tops were sticky and there were two bin liners of rubbish in the clinic room, one of which was leaking. The manager told us that the condition St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 15 of the room was an improvement on how it had been. If medicines are not kept in a clean and hygienic environment residents health may be put at risk. We also found that creams were kept in residents bedrooms but staff had not checked or recorded that they were stored safely and that residents were not at risk. All prescribed medication should be stored securely and safely at all times. We looked at the arrangements for handling controlled drugs (medicines that can be misused). We found that these medicines were being handled safely and were recorded and given correctly. We looked at records about training and found that not all staff who had responsibility for handling medication had had up to date training. Staff told us that they had not had any medicines training for a long time. It is important that all staff, including nurses have up to date training so that medicines are handled safely and residents health is not placed at risk. It is also important that staff are formally assessed as competent, to handle medicines safely. In light of the concerns we found during the inspection we asked if the manager checked, audited, the way medicines were handled. The manager produced a recent audit to show that all areas of medicines handling were looked at. We found that a number of areas for concern had been highlighted. When concerns are found it is important that action is taken to prevent them from happening again. A record of these actions should be made. The manager said she had made a record of her actions but when asked to provide us with the information did not do so. Throughout the day we saw that the staff spoke to the residents in a respectful way. The staff seemed to have a natural and comfortable understanding with the residents and they found time to sit and talk with them. They were discreet and understanding when providing assistance to the residents. The residents looked clean and comfortable and were suitably dressed. Their hair was neat and tidy and the men were cleanly shaved. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 & 15. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are supported and encouraged by staff to make choices about what they do so that they can find enjoyment and satisfaction in their daily life. EVIDENCE: The residents routines of daily living, such as when they go to bed and when they get up, plus their present and past social interests, are recorded in their care plans. The home employs an activities person who works full time. Information in the AQAA document sent to us showed that the activities person has spent time developing life histories for the residents with dementia. This should help all people involved in their care to have a better understanding of how the resident liked to spend their day and also plan for their daily activities so that they can get as much enjoyment out of their lives as possible. During our visit on Pike View we saw that the care staff were baking with the residents. They were making Choc Chip cookies. One carer was sat quietly reading to a resident and we also saw later on in the day that the carer was playing a reminiscence game with the same resident. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 17 The care staff that we spoke to told us that the activities person works between each unit and tells the care staff what the theme for activities is that day. The care staff told us that this ensures that the residents on each unit get the chance of enjoying some activity. We also saw that the home now has two kittens and a rabbit. The staff felt that the introduction of the pets had been a great success. The staff take it in turns to look after the pets and they involve the residents in this when they can and if they wish to. We spoke to 1 carer who told us that he regularly takes 1 of the residents out to the local pub and also regularly takes 1 of the ladies shopping. Staff told us in the surveys and on the day of the visit that they felt that more trips out would be beneficial. We were told in the AQAA document that the home does have the use of the company mini bus. We were also shown the plans in place for the introduction of a sensory garden for the residents of Pike View. Staff, relatives and residents have been involved in the planning. The AQAA document sent to us stated that all of the residents were of the Christian Faith. Staff told us that the Roman Catholic residents, if they wish, are visited by members of their church and are able to receive Holy Communion. We saw that the residents are encouraged to bring personal possessions into the home. Most of the bedrooms that we looked at were personalised with the residents pictures, photographs and ornaments. The home has an open visiting policy. There are no unreasonable restrictions on the time people visit. The 1 relative that we spoke to told us that she is always made to feel welcome. We saw what the residents were having for their lunch whilst we were on the residential unit. The conservatory, that was previously the lounge area, is now the dining room. The tables were very nicely set with tablecloths, napkins, condiments and a jug of ice water. We spoke to 2 of the residents who told us the “Yes, the food is very good”. Both these residents asked for a glass of wine whilst we were there and both received a glass of rosé. They told us that they can have a drink whenever they want one. Breakfast is whatever the resident wants and is given whenever they get up. The menus showed that the lighter meal is served at lunchtime and the main meal in the evening. The exception to this is Friday lunch when the residents have fish and chips and Sunday when they have a traditional roast dinner. When we were on Pike View we saw that snacks were left out for the residents to help themselves. We were told that these snacks were available on a 24 St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 18 hour basis. Things like fresh fruit, savoury snacks and biscuits were freely available. Later on in the day we saw the sweet trolley that had been prepared for the evening meal. It was very nicely presented and contained a variety of cakes and desserts. We were told that it is wheeled around to the residents so that they can choose what they want. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People using the 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 given information on how to complain. Staff have a good knowledge and understanding of what abuse is and know what to do if it happens. This helps reduce the possible risk of harm to the residents. EVIDENCE: The complaints procedure is enclosed in the Service User Guide that is given out to every resident or relative. It explains to people how and to whom they can complain and how their complaint will be dealt with. On the last inspection we saw that the complaints procedure was displayed in the reception area. It was not displayed on this visit. We were told this was because of the recent redecoration of the reception area. The manager agreed to put it back as soon as she could. We saw that a record is kept of any complaint made. 3 complaints have been made to the home since the last inspection. No complaints have been made to us. From the complaints log we saw however that the following information was missing from 1 of the files: • The name of the resident involved was not on the file. • There was no explanation regarding the steps taken in investigating the complaint. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 20 • There was no evidence to suggest that a response letter had been sent to the complainant, nor was it evident that the relatives had been informed of the complaint. We spoke to some of the staff and asked them to tell us what they would do if they felt that a resident had been mistreated in any way. They were very aware of what to do and how to report it. They told us that they had been trained so that they could, as far as possible, protect the residents from harm. We saw evidence of this training in their individual training files. We also spoke to the manager who told us what her responsibilities were in relation to dealing with any incident of alleged abuse. A copy of the Bolton Local Authority procedures for the protection of vulnerable adults was in place. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 24 25 & 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents live in a very pleasant, safe and suitably adapted environment. EVIDENCE: The home is purpose built and the accommodation is provided on 2 floors that can be reached either by a lift or stairs. The home is divided into 3 units. On the ground floor there is the Dementia Unit, now called Pike View, and the Residential Unit. On the first floor is the Nursing Unit. There is a secure garden area for the residents where they can walk around safely and enjoy the gardens. We looked at all the units, some in more detail than others. Each unit has been totally refurbished since the last inspection. They have been decorated and furnished to a high standard. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 22 Pike View 1 of the lounges and the dining room have been redecorated and refurnished. They were clean, warm and welcoming. The corridors have been redecorated and each corridor has a themed decor. Themes such as pets, the seaside and old films are in place. Grab rails to aid mobility are in place along the corridor walls. The toilets are easy to get to, as they are close by to bedrooms, lounges and dining rooms. The bathrooms and toilets have a lock on the door to ensure privacy and have suitable aids on them so that the residents can use them safely The toilets are identified by large pictures of toilets. This is for ease of identification by the residents. They also have a blue wall and blue toilet seat to help the residents identify or associate the colour blue with the toilet. We looked at some of the bedrooms. They were furnished and decorated to a good standard. Each bedroom door has a safety overriding lock and each bedroom has a lockable space to store anything that is of value or importance to the resident. Nursing and Residential Units. We did not look in detail around these units but we could see that both units have been refurbished to a good standard. The layout of the dining and sitting areas for the Residential Unit had been changed and it was a big improvement. The conservatory is now the dining room and what was the dining room is now divided into small lounge areas. New dining furniture had also been provided. On the Nursing Unit the corridors, lounges and dining room had been redecorated and re-carpeted. Most of the bedrooms had also been redecorated and refurnished. We also saw that 1 of the larger bedrooms had been totally refurbished and it also had 2 beds in it. We were told that this bedroom can be used for people who are very ill and the 2nd bed is for relatives to stay with the resident if they wish to. The rooms throughout the home were centrally heated by wall and ceiling heating panels. We were told that thermostatic control valves were fitted to baths, sinks and showers. This reduces the risk of residents being harmed by protecting them from accidental scalding. The home was clean and there were no unpleasant smells. Disposable hand washing equipment (liquid soap and paper towels) was in place in bathrooms, toilets and bedrooms and disposable gloves and aprons were provided for the staff to wear. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 23 Providing this equipment helps to reduce the spread of infection and therefore helps to protect the residents health and wellbeing. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 & 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are cared for by sufficient numbers of suitably trained staff. EVIDENCE: A check of the duty rotas and inspection of the training files showed that there was enough suitably trained staff on duty throughout the day and night to care for the residents. The information that we looked at in the training files and the information given to us in the AQAA document showed that 23 of the staff had obtained their NVQ (National Vocational Qualification) level 2 or level 3 in care. We were told that some staff have not yet finished the training and that some are waiting to start. We looked at how the management recruit their staff. The personnel files of 3 staff members were looked at. On our first visit we saw that the files did not contain enough information to prove to us that the staff had been properly and safely employed. Some references were missing and a Criminal Records Bureau (CRB) check was not in place for 1 of the staff. The Manager told us she would ensure that all the information was in place as soon as possible. On our second visit a few days St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 25 later we saw that the new references had been requested and received for 2 of the staff. We also saw that the CRB check had been undertaken previously and was now in the file. The information received from the AQAA form showed that management provide a staff induction programme for all newly employed staff. This is to make sure that they understand what is expected of them and that people are cared for properly and safely. On our first visit we found it difficult to establish just what training had been undertaken by the staff. When the training records were compared with the training plan it was evident that the training plan was not an accurate reflection of the training files and vice versa. On a number of occasions the training plan stated that training had taken place but no certificate or note was made within the staff member’s file, and similarly training certificates or notes were present in the file but not recorded on the training plan. On our second visit a few days later we saw that the training plan and the individual files had been updated. We saw that training has been provided for the staff. They have had training in Person Centred Care, 1st Aid, Moving and Handling, Basic Food Hygiene, Fire Safety, Health and Safety, Medicine Management, Dementia Care and other subjects connected to their jobs. From the training plan that we looked at we saw that some staff needed further updating on training in certain subjects. The Manager told us that the new computer system in place alerts management to what training needs to be done by individual staff members. In the staff surveys returned to us we were told that the induction training was: “Good”. “It covered everything I needed to know very well”. Staff also told us that they felt the training was very good. 1 staff member said “I would like to say how impressed I am with all the support and training I have been given since I have started. This makes me better and happier in my job”. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 & 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is safe and well managed. EVIDENCE: The Manager is a Registered General Nurse who has extensive experience in caring for elderly people. She has recently obtained a management qualification. She keeps herself regularly updated with training, both in management and care issues. Staff told us in the surveys that they felt the Manager was an “enthusiastic caring person who has had a huge impact on the home”. They also told us that she is “approachable, positive and listens to the opinions of the staff”. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 27 The Manager has to do regular checks on lots of things in the home to make sure that the staff get things right for the residents. Some of the things that she has to do are to check the records about care, medicines and any accidents that have happened. Management also send out comment cards to residents and relatives asking what they think of the quality of the care and the facilities that are provided. In addition, regular relative and resident meetings are held. These meetings enable the residents and their relatives to have a say on how they think things are being run and what they would like to see changed. The system in place for the management of residents money was safe. We were told that they mainly handle money brought in for residents expenses. We saw that receipts were given for any money received and receipts were kept for any money that was spent on behalf of the residents. Individual computer records are made of all transactions and balances. We saw that regular weekly checking and testing of the fire detection system, fire exits and emergency lights was undertaken and documented. Information from the AQAA document showed us that the equipment and services within the home were serviced on a regular basis. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 3 3 x x 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 29 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement Medicines must be given to residents as prescribed because receiving medicines at the wrong dose, wrong time or not at all can seriously affect their health and wellbeing. OUTSTANDING FROM 06/08/08 (Previous requirement of 3/04/08 not fully met. Whilst the requirement in relation to certain medicines from the last inspection was met staff had either given other medicines out at the wrong times or not given them for several days. ) Timescale for action 05/08/09 2 OP9 13(2) 3 OP9 13(2) 01/09/09 Risk assessments regarding the safe storage of creams must be made and recorded so that residents health and wellbeing is protected. All staff must have medication 01/09/09 training and have assessments of competency to ensure that they handle medicines safely and that residents health and wellbeing is protected. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations To ensure that there is always a clear record in place to show how a resident is being cared for, staff should make sure that they write down in a resident’s care plan if any pressure relieving equipment is being used.. To ensure that everybody is aware of what care has been delivered and at what time, staff should ensure that the charts are always filled in when positional changes to a resident have been made. Further review and updating of peoples’ care plans should be made to help make sure ‘when required’ medicines are handled safely The complaints log should be filled in accurately so that there is a true record of what action has been taken to address the concerns raised. The recruitment files need to be kept up to date at all times. This is so that everybody involved in the care and welfare of the residents can be assured that the staff are safely recruited. This helps keep the residents safe The training files need to be kept up to date at all times. This is so that everybody involved in the care and welfare of the residents can be assured that the staff are properly trained. This helps keep the residents safe. 2 OP8 3 OP9 4 OP16 5 OP29 6 OP30 St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 31 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. St Catherine`s Nursing Home DS0000005697.V376861.R01.S.doc Version 5.2 Page 32 - 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!