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Inspection on 23/09/09 for St Edmund`s Nursing Home

Also see our care home review for St Edmund`s Nursing Home for more information

This is the latest available inspection report for this service, carried out on 23rd September 2009.

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

St Edmund`s provides a homely, comfortable and caring environment to the people who live there. We gained a lot of feedback from the residents who were very complimentary about the service. One person said `yes, it`s really nice here, the carers are very good, it`s a nice atmosphere.` Another resident said `The staff are kind and caring, I am very comfortable, I don`t have any complaints.` Comments received in residents surveys included `the general care and food is excellent` and `very good, caring staff. Everything meets my needs, there is nothing to fault.` A relative stated `we are very happy with the care here, Mum has not been well recently so the staff have made sure that they call in regularly to give her drinks and make sure she is ok. She`s not eating very well at the moment but she fancied some grapefruit the other day which they provided immediately.` The feedback we received from the visiting General practitioner was good. They said that the care service always respects peoples privacy and dignity and that the staff liaise well with the GP. The hairdresser said `I have been coming here for twenty years, it`s a nice place, I don`t hear many complaints about the service from the residents.` The Expert by Experience said `In summary, this home came across as a warm, happy and friendly place to live, where caring staff were dedicated to the welfare and dignity of the residents.`

What has improved since the last inspection?

On entry to the home we noticed vast improvements to the environment and atmosphere. There were fresh flowers and plants in the reception area and staff walking around were observed to be relaxed and friendly towards all residents and visitors. The communal areas looked more homely and welcoming. We saw that people`s health care needs were being much more closely monitored and residents were able to make choices about the care they receive. The new manager has implemented a lot of new auditing systems and seems to be aware of any issues and has taken action to rectify them. The staff team appeared to be more confident and were fully aware of how to protect the people living in the home.

What the care home could do better:

Although the care plans had been reviewed regularly, some of the documentation had not been fully updated. The deputy managers said that they are aware of this and were planning to complete audits on care records to make sure that all records are up to date. Some of the bathrooms were being used to store equipment such as hoists which meant that people could not gain access to the toilet or sink had they wished to do so.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Edmund`s Nursing Home Worcester Road Off Barrowby Gate Grantham Lincs NG31 8SA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alison Jessop     Date: 2 3 0 9 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 Edmund`s Nursing Home Worcester Road Off Barrowby Gate Grantham Lincs NG31 8SA 01476576811 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Patricia Taylor Type of registration: Number of places registered: Lifeline Nursing Services Limited care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only - Care Home with Nursing - Code N to people of the following gender - either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability, not falling within any other category - Code PD The maximum number of people who can be accommodated is 49. Date of last inspection 1 7 0 9 2 0 0 8 0 49 Over 65 49 0 Care Homes for Older People Page 4 of 24 Brief description of the care home St Edmunds is situated in a residential area on the outskirts of Grantham and is approximately two miles from the town centre. Grantham is a market town, and contains a wide range of amenities. The home is close to a bus route; local shops and taxis are used to access the town centre. The home is a single story facility, arranged in four wings. Each wing has its own lounge and dining area, and there is a communal room at one end of the home, which is used for activities and entertainment. The home is built around a courtyard, which is fully enclosed, and laid to lawns, shrubs and patios with garden furniture. The home is registered for forty-nine residents. Lifeline Nursing Services Ltd operates the home, and it is one of three homes operated by the company. There are adjoining warden controlled bungalows operated by the same company. A copy of the Service User Guide and Statement of Purpose can be obtained from the Registered Manager. On the day of the inspection the current fees ranged from £545 to £650. This does not include fees for hairdressing, chiropody, newspapers and toilettries. 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: This was an unannounced visit which formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of the people who use the service. Throughout this report the terms we and us refer to The Care Quality Commission. The visit lasted approximately four and a half hours and we took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. Before we made our visit the provider had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting the standards and their plans to improve aspects of the service. We sent out surveys to a sample of fifteen residents and received a response from six Care Homes for Older People Page 6 of 24 people. We also sent surveys to ten staff but did not receive any responses. We also sent surveys to two health care professionals who work closely with the service. We received a response from a General Practitioner. The feedback we gained is included in the main body of this report. The commission are trying to improve the way we engage with people who use services, so that we can gain a real understanding of their views and experiences of social care services. During this inspection we used a method of working where an Expert by Experience visited the home as part of the inspection. An Expert by Experience is a person who because of their shared experience of using services, visits the service to help us get a picture of what it is like to use a service. The expert met and talked to eight residents, three members of staff and two relatives. Their views are included in the main body of this report. The main method used to carry out the inspection is called case tracking, this includes following the care of a sample of three people through their care records and assessing their care. We spoke to six people who use the service, two relatives and three members of staff. We also gained feedback from the visiting hairdresser who has been providing hairdressing services to residents who live in the home for twenty years. The Registered Manager was on annual leave on the day of the inspection, however the two Deputy Managers were present throughout the visit and the general outcomes of the visit were discussed with them both at the end of the inspection. We asked some of the people who live at St Edmunds what they would like to be referred to in this report. They said that they would like to be referred to as residents. What the care home does well: What has improved since the last inspection? What they could do better: Although the care plans had been reviewed regularly, some of the documentation had not been fully updated. The deputy managers said that they are aware of this and were planning to complete audits on care records to make sure that all records are up to date. Some of the bathrooms were being used to store equipment such as hoists which meant that people could not gain access to the toilet or sink had they wished to do so. Care Homes for Older People Page 8 of 24 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The thorough assessment process ensures that peoples needs can be before they move into the home. Evidence: We looked at the care records for three residents and saw that a care needs assessment had been completed before the person moved into the home. The assessments had been completed by the manager of the service and the file also contained a copy of the social services care needs assessment. 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. Peoples health and personal care needs are fully met and care is provided in a way that is sensitive and dignified. Evidence: We looked at the care plans for three residents. They contained information on areas of care such as personal safety and falls, nutrition, continence, personal care, mobility, pressure area care and prevention, body maps, resting and sleeping, religious and cultural beliefs, socialisation and medication. Each resident had agreed and signed their care plan and we saw evidence that they are reviewed every month. We saw that the residents have access to various health care services and notes were kept on file when GPs and other health care professionals had visited. Everyone who completed surveys said that they always get the medical care that they need. We looked closely at the care of people who were being nursed in bed. People looked and said that they were comfortable. Records showed that staff had provided regular care and offered fluid and had documented when personal care had been given. People who are at risk of pressure sores had been provided with pressure relieving Care Homes for Older People Page 12 of 24 Evidence: equipment and regular fluids were being provided. We looked at the medication systems. We saw that records were accurately maintained. The deputy manager told us that medication systems are audited regularly by the local pharmacist. We saw on care plans that where people prefer to administer their own medication a risk assessment had been completed by a trained nurse. One resident said medication is administered on time. We spoke with residents about the care they receive and they said the staff are very kind and caring. Another said they treat me gently and with great kindness. 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. Residents have access to a stimulating programme of activities to suit their individual needs. Evidence: On the day of the inspection there were a lot of visitors around the home and some activities were taking part in the activities room. The service employs two part time activity co-ordinators who provide a printed schedule of activities to all residents. The Expert by Experience spoke with people about the range of activities available. This included baking, dominoes, scrabble, bingo, crafts, plant potting, quizzes, films and one to one sessions. There are planned future outings to town including a meal and entertainment, a fire work display, harvest festival, supper and carol service. A holy communion service is held at the home once a month. One person concluded we are very lucky with activities. We looked at three care plans and saw that peoples personal preferences and choices had been documented. We saw that where people had made requests these had been granted. One resident asked late one evening if she could see her priest. The staff had documented this and the priest was called in very early the next morning. Care Homes for Older People Page 14 of 24 Evidence: The Expert by Experience gained some feedback about the food. One person said the food is very good, home prepared and appetising. Another said the food is very, very good. I have no grumbles about the food. Theres always a choice every day and a sweet. You can have omlette, soup or a salad if you dont want the choice given. The Expert by Experience said in her report While only one of five at the lunch table was seated on a dining chair, the others being in wheelchairs, pushing people up to the table would have been made easier had the chairs been on gliders. There were no table decorations, but the attractive wooden table was laid with place mats, cutlery, serviettes and drinking glasses, and there was a large display of artificial flowers and stems on a dresser. The room was light, bright and cheerful and the residents chatted to each other praising the food. Kitchen staff checked that everyone was managing, which was clearly evident, with the help of special cutlery and plate guards for those who needed them. 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. The people who live in the home are safeguarded from abuse and neglect as staff are fully aware of procedures. Evidence: The manager keeps a record of all complaints received along with a copy of the response. We saw that all complaints received had been fully resolved however we could not see the timescales on all of them as they were not all dated. Everyone that we spoke to and all the surveys received from people said that they know how to make a complaint or raise a concern. We also saw evidence that where complaints had been received, where appropriate they had been discussed with staff during team meetings to make staff aware of any issues that needed to be resolved. We saw that there was a copy of the Adult Safeguarding policy on display in the entrance hall to the home. All staff that we spoke with said that they have received training and are fully aware of how to recognise and report suspicions of abuse or neglect. We also saw training certificates to evidence this on staffing files. 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. St Edmunds provides a comfortable, homely and clean environment to the people who live there. Evidence: The Expert by Experience said that the home environment was clean, bright, tidy and free of offensive odours. There were pleasant, low maintenance garden areas where residents could sit in fine weather. It was good to note that bedrooms were individually decorated and furnished with plentiful use of of residents own furniture adding to the homely feel. There were two lounges both attractive and welcoming but neither very much used at the time of the visit. Several large pieces of lifting and hoisting equipment were being stored in one of the bathrooms. The toilet was inaccessible and the equipment needed to be relocated in order for someone to have a bath. We observed staff following good infection control procedures. 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. There is a competent and caring team of staff working in the home. Evidence: The staffing levels have been increased since our last inspection and generally people said that they receive their care in a timely manner although some said they have to wait for their call bells to be answered. The deputy manager said that an extra carer has been added onto the morning shift to try to alleviate this problem. One person said they do the best they can, but more staff are needed. We did not see any evidence that peoples needs are not being met due to low staffing levels and everyone who completed a survey said that they always receive the care and support they need and that staff are usually available when they need them. We gained a lot of feedback about the staffing team from the residents. One person said the staff are wonderful, they are very caring. Another person told us that the manager tends to recruit experienced staff which gave them confidence in the carers, whom she highly commended for their care. We gained feedback from two nurses and one care worker who said that they receive the training they need to be able to carry out their role effectively. One person said we get lots of training and support from the manager and deputy managers. We also have team meetings and supervision regularly. We saw minutes of the team meetings Care Homes for Older People Page 18 of 24 Evidence: and training certificates held on staffing files. We looked at the staff recruitment files for three staff. We saw that a Criminal Record Disclosure had been obtained before commencing employment along with the receipt of two satisfactory references. 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. The home is run in a safe way by a competent management team. Evidence: On the day of the inspection visit the Registered Manager was on annual leave. The service now employs two deputy managers who are both registered nurses. The deputy managers said that they are currently implementing new systems for sharing responsibilities. Feedback about the manager was good. One resident said since the new manager has been in post things are much better. Another person said that they consider the manager to be a kind and understanding person who listens. There are several systems in place to measure quality in the service. We saw that surveys are sent out annually to the residents to gain their views and make comments or suggestions. We saw that regular meetings are held for residents and relatives. Staff meetings are also held regularly and visits from one of the company directors are carried out each month with a report written about the outcomes of the visit. Care Homes for Older People Page 20 of 24 Evidence: The only issue that was identified was that although peoples care plans had been reviewed, some of the records on file had not been kept up to date and did not always reflect the current information. We saw that residents have access to lockable facilities in their bedrooms. If they prefer their personal finance and valuables can be stored in a secure place, however on the day of the inspection no one had anything valuable being stored for them. We saw that regular health and safety audits are carried out within the home, this included fire safety checks, inspections of equipment such as hoists, wheelchairs and bed rails. We did not see any chemicals or hazardous substances left around the home. 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 2 19 37 Bathrooms should not used to store equipment and should be fully accessible to the residents at all times. It is recommended that audits are made of care records to ensure that these are regularly kept up to date. Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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