Inspection on 26/08/09 for St Johns Court Nursing Home

This is the latest available inspection report for this service, carried out on 26th August 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.

Other inspections for this house

St Johns Court Nursing Home 24/10/06

St Johns Court Nursing Home 09/02/06

St Johns Court Nursing Home 08/06/05

St Johns Court Nursing Home 09/11/04

St Johns Court Nursing Home 02/06/04

St Johns Court Nursing Home 22/12/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

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Inspirations

Ashcroft Hollow Nursing Home

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 Johns Court Nursing Home St Johns Street Bromsgrove Worcestershire B61 8QT Lead Inspector Andrew Spearing-Brown Unannounced Inspection 09:00 26 and 27 August 2009 th th DS0000004139.V376133.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 Johns Court Nursing Home DS0000004139.V376133.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 Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Johns Court Nursing Home Address St Johns Street Bromsgrove Worcestershire B61 8QT 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) 01527 575070 01527 576246 Somerset Redstone Trust Mrs Karen Jayne Bevis Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42), Physical disability (42) of places St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users 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 (OP) 42 Physical disability (PD) 42 The maximum number of service users who can be accommodated is: 42 8th May 2008. 2. Date of last inspection Brief Description of the Service: St Johns Court is a care home providing both nursing and personal care for up to forty-four older people of either sex. People using the service reside primarily on the ground and first floor. Three bedrooms are provided on the second floor. The home is located in the centre of Bromsgrove, close to shops, pubs and other community amenities. The building was originally the Vicarage to the nearby St John’s church. The building became a care home during the 1980’s and was purchased by the present owners in 1995. The home was extensively refurbished in 2002. Car parking is available to the front of the home. Local bus services stop near to the home. There is a passenger lift providing access to all floors of the home. Handrails are fitted where necessary. The home has thirty-six single and two shared bedrooms. All the bedrooms have en-suite facilities. The single rooms all measure in excess of ten square metres and the shared rooms in excess of sixteen square metres. Communal facilities include lounges, a conservatory, dining room, toilets, and bathrooms with special aids. Information regarding the current level of fees was included within the Service Users Guide. Information is given regarding what is and what is not included St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 5 within the fees. The reader may however wish to contact the service directly for further information. St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We, the commission, carried out this key inspection without telling the home we were going. A key inspection is one in which we look at aspects of the service that are important to people using it and check the quality of the care provided. The last key inspection at St Johns Court was during May 2008. This inspection was carried out by one inspector over the period of two days. Prior to our visit we looked at the information that we have received since our last inspection. We requested an Annual Quality Assurance Assessment (AQAA) from the home prior to our visit. The AQAA is a document completed by the service and provides us with information about the home and how they believe they are meeting the needs of people living there. Some comments from the AQAA are included within this report We sent out some questionnaires to a sample number of people living in the home. We also sent out questionnaires to some members of staff. We received a small number of surveys back. We looked around the home. We viewed records held within the home in relation to some people living in the home such as care records, risk assessments and medication records. We also viewed records relating to some members of staff and other records regarding health and safety matters. We checked that the requirements from our last inspection had been addressed. We spoke to the registered manager, the head of care, some nursing staff including one from an agency, care staff and domestic staff. We also spoke to people residing within the home and some visitors. What the service does well: Information about the home and the service provided to people is available within the home. Prior to an admission into the home people’s care needs are assessed to ensure that they are able to be met. Potential residents and their representatives are able to visit the home prior to admission to have a look around. Care plans are in place and set out how individuals’ needs can be met in a person centred way. The personal care needs of people are generally met well. St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 7 A choice of menu is provided. People are able to take meals either in the dining room or their own bedroom. People are aware of how to make a complaint should they wish to do so and they can be confident that they will be listened to. Staff are aware of their responsibility to report any concerns they have in the event of potential abuse taking place. The home was clean and tidy, people are able to personalise their bedrooms as they wish. Recruitment procedures are in place to ensure that unsuitable staff are not employed. What has improved since the last inspection? 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 Johns Court Nursing Home DS0000004139.V376133.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 Johns Court Nursing Home DS0000004139.V376133.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): Standards 1, 3, 4 and 5. Standard 6 is not applicable to this service. People using the service experience good quality outcomes in this area. Information is available to help people make a choice about whether they would like to live in the home. The needs of people who may use the service are assessed so that individuals and their relatives can be assured that staff have the ability to meet these. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Prior to our inspection we were sent a copy of the home’s Statement of Purpose and Service User’s Guide. Both these documents were reviewed earlier this year. We saw a copy of the summary document plus a supply of a leaflet in the entrance / reception area of the home. The manager told us that a copy of the document is given to each person or their relative on admission to the St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 10 home. We were also informed that a copy in larger print could be printed off a computer if required by a potential resident or their advocate. The manager informed us that consideration has been given to providing the guide in other formats such as audio tape. One person who we spoke to was able to confirm that they had received adequate information about the home when they made their initial enquiry. The leaflet makes reference to the Commission for Social Care Inspection who were the former regulator. The summary of the Service User’s Guide states that ‘the home will aim to fulfil the following criteria’ and then includes ‘assess the individual prior to admission, in relation to their needs, suitability with the other service users will be a major factor.’ We asked to see the assessment of a recently admitted person into the care home. The person’s file contained a document which was an initial care plan. The head of care confirmed that this document was completed on the day of admission. We saw an assessment completed by the local authority. The local authority assessment was detailed and gave a good account of the individual’s care needs. We were told that the manager did see the prospective resident in hospital but no formal assessment was written following this visit, having already seen the social worker’s document. The summary of the Service User’s Guide states that ‘the home will aim to fulfil the following criteria’ and then includes ‘assess the individual prior to admission, in relation to their needs, suitability with the other service users will be a major factor.’ We were told that the person’s family had visited the home prior to the admission. During the inspection we were able to speak to some people who had come into the home over the past year. People confirmed that needs were assessed prior to the admission taking place. At the time of our inspection the home had no vacancies. The registered manager informed us that a waiting list existed. A copy of our previous inspection report was not available within the reception area for people to view as part of their initial enquires about the home. The availability of inspection reports would afford people further information to assist them in their decision making process. St Johns Court Nursing Home DS0000004139.V376133.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): Standards 7, 8, 9 and 10. People using the service experience good quality outcomes in this area. Staff have an understanding of people’s care needs and have written care plans available to them to ensure consistency in the care provided. Further improvements in recording systems will help to ensure that medication is managed safely. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: During our previous inspection the manager informed us of her desire to develop person centred care planning. We viewed a sample number of care plans and risk assessments as part of this visit to the service. St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 12 Care plans had significantly improved in the style in which they are written. They were person centred and do not focus on ‘problems’ that need staff intervention. Care plans were written as if the individual concerned is requesting assistance in order for them to have needs met for example ‘I have my own teeth and I like them brushed morning and night I can hold a toothbrush but I need help to apply toothpaste’ and ‘I need lots of encouragement to drink as I can forget that my drinks are there in particular any hot drinks.’ Care plans contained information regarding the need to use equipment such as a hoist and details of the sling to be used. The care plan also gave instructions regarding individuals getting up, standing from a chair, toileting and bathing. We saw risk assessments in relation to falls, skin care and oral hygiene. Daily records and turning charts were in place. We noted a number of gaps in records such as turning charts whereby staff had not signed to demonstrate that this had taken place. The daily records did not support these gaps therefore some improvement is necessary. The head of care informed us that it is her intention to improve all the care plans within the home. The plans we saw were being regularly reviewed and up dated taking into account changing needs and circumstances. We saw one care plan whereby community nursing services are assisting in the care of somebody requiring considerable input. An agency nurse was complementary regarding the care she believed staff at the home were offering to this person. We found that nursing staff were operating a care regime recommended by community nursing staff although this had not initially the case. We spoke to staff about the care certain people needed. Staff we spoke to had a good understanding of people’s needs. Prior to this inspection we were informed about problems securing the correct sized pads for people who have continence issues. We discussed this with the registered manager who assured us that the situation had improved. Residents have access to supplies via the local health authority as well as the registered manager having a budget to purchase additional supplies as needed to meet individual care needs. We were told about training undertaken to assess needs correctly and systems in place to ensure that pads are available. We saw supplies of pads differing in size within communal bathrooms. Following the previous inspection we made a requirement that the medication records must be completed both accurately and fully to ensure that people receive medication as prescribed. As part of this inspection we viewed a St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 13 sample of the current month’s medication records and the medication held within two trolleys. On the first day of this inspection we noticed a health care assistant administering breakfast medication at 10.45 am. We were informed that breakfast medication is, at times, not completed until this time. Not completing medication until this time could be of concern if people were then receiving further medication at lunch time as the gap between medication administrations may not be sufficient. We were informed that although one part of the home is still referred to as ‘residential’ this is no longer the case. People assessed as needing nursing care residing within all parts of the home. The National Minimum Standard states that ‘Medicines, including Controlled Drugs, for service user receiving nursing care, are administered by a medical practitioner or registered nurse’. The registered manager confirmed that health care assistants are administering medication throughout St John’s Court. Following this inspection advice was sought from pharmacy inspectors within the commission. It was felt that if there is delegation of medication administration then this must be by the individual nurse on duty at the time who must be satisfied that the carer concerned is trained and competent for the task. Therefore neither the registered manager nor the registered provider is able to delegate the administration of medication as part of a blanket policy. The vast majority of the Medication Administration Record (MAR) sheets were completed satisfactorily. We saw a daily signing off sheet to state that MAR sheets were completed. A photograph of each resident was in place prior to their individual MAR sheets. We carried out an audit of some medication. One person’s medication was not booked in correctly however we were able to balance the medication. Other audits were carried out and these also balanced. We did note a small number of gaps on MAR sheets whereby staff had failed to either sign for medication administered or record a code for why it was not administered. We saw one occasion when an agency nurse did not sign the MAR sheet for a controlled drug (CD) however the CD register was signed correctly. We observed that staff did not always knock on bedroom doors prior to entering however generally staff closed bedroom doors when personal care was going to be carried out. St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 14 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): Standards 12, 13, 14 and 15. People using the service experience adequate quality outcomes in this area. Activities are provided both within the home and outside the home if people wish to join in with them. Nutritious meals are available for people to enjoy. However, there is sometimes insufficient attention to individual needs in these areas. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: On the day of our second visit we arrived at the home at 7.20 am. We saw that the vast majority of residents were still in bed; therefore night staff had not got people up early. We were able to see some people in their room while we walked along the corridors. Everybody appeared comfortable lying in bed. During the time we spent in the home we noted that people looked well St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 15 groomed and appropriately dressed taking into account gender and weather conditions. We saw that people in bed had a nurse call bell easily assessable to them. Throughout our visit we heard the nurse call system sound on numerous occasions. On a couple of these occasions we viewed the display panel to see where it was activated from. At times the calls were stacking up showing that more than one resident was calling for assistance at the same time. At times the call system was sounding for a period of time prior to a member of staff attending to the call. We asked a small number of people using the service about their experience of staff answering the call system. People informed us that at times they do have to wait for about 15 – 20 minutes before it is answered. Generally people did not mind this delay as they acknowledged that staff are usually busy attending to other people. On one occasion we viewed staff and their practice while the system was sounding. Initially we saw staff walking past the bedroom where the bell was activated. A few moments later a member of staff cancelled the call without going to the bedroom. As this places the call into a ‘snooze position’ it reactivates itself after a relatively short period of time. Once the call system was reactivated staff did attend to the call promptly. Prior to our visit we received a number of comments about the service in our questionnaires. One person told us that their relative had ‘acquired a range of interests inside and outside the home and has a number of hobbies and interests and is helped to achieve these by staff.’ By contrast somebody else commented that ‘Better organisation of activities would benefit residents’ while somebody else wrote under what the service could do better ‘more activities for residents needs and physo is needed to meet stroke / residents needs.’ The results of a survey of residents and relatives carried out by the manager dated July 2009 states that the main area of dissatisfaction within the daily living section was in relation to the activities that are provided or arranged. In response to the comments received the manager stated in her response that she had spoken to the activities co-ordinator and that it had been agreed that she was going to talk to residents both individually and as a group to establish more details about activities that people would like. An activities organiser is employed for 5 hours Monday to Friday each week. During our visit we saw the activities coordinator preparing for a game of bingo. We also saw a small group of people getting ready to go on a small trip on a mini bus. We saw records showing trips out to local garden centres and of celebrations within the home such as the Queen’s Birthday. We were told that people from a local Methodist church were due to visit on the Sunday following our visit to carry out a multi denominational service. The food available was also an area of dissatisfaction within the survey carried out by the registered manager earlier this year. Within that survey people St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 16 stated that they were ‘quite satisfied’ or ‘not very satisfied’ with the choice and the variety of food given. In response to these comments the manager wrote that she would ensure that the cook spoke to people to discover likes and dislikes. We were told that meetings had taken place following the comments received and that one request acted upon was for fish and chips to be purchased from a local take away and that more fresh fruit salad is now provided. During our visit we took the opportunity to have lunch with a small group of residents. The main meal on offer was roast chicken, stuffing, roast and boiled potatoes, cabbage and gravy. The alternative was faggotts. For sweet people could choose from jam rolly poly and custard or peaches and cream. The tea menu offered leek soup, sandwiches, crisps, artic roll and fresh fruit. The mid day meal we were served was well presented and pleasant. We spoke to people during the meal and they told us that they were satisfied with the food provided. One resident said ‘I had stew yesterday, very very nice I cleared my plate.’ We were also told that people ‘can have a salad.’ We viewed the new kitchen area which is in the basement of the home. The temperature in the kitchen is now much reduced as an air conditioning system is in place. The dry store contained small tins of items such as baked beans and macaroni cheese which suggests that these would be made available if people requested them. The home was awaiting a delivery of fresh vegetables however fresh fruit was seen. We saw staff serving meals to people in their bedrooms. One person did not appear to have eaten much of their mid day meal before the tray was taken away. When we initially enquired about this none of the staff could recall having taken the tray away. It was later established that the person concerned had stated that they had eaten sufficient however the care plan stated that staff should report to the trained nurse if meal not eaten. Staff had not reported this event on this occasion. St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 17 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): Standards 16, 17 and 18. People using the service experience good quality outcomes in this area. People using the service are aware of how to make a complaint and they can be confident that any concerns will be listened to. People are safeguarded from the risk of harm or abuse because staff have sufficient knowledge about the procedures they should follow. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A complaints procedure is included within the ‘Summary of the Service User’s Guide’ document. The procedure states that all comments, compliments, suggestions and complaints should be made to the manager. The procedure gives details of the Care Quality Commission (CQC) and gives details of our regional office in Birmingham. The procedure states that if complaints cannot be satisfactorily resolved within the home that they will be referred to us. The procedures states that ‘service users’ may complain directly to us. The wording within the procedure is not totally in line with the National Minimum Standard and therefore should be reviewed to reflect that anybody can make a complaint to us about the service provided at any time. St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 18 The procedure states that the organisation views complaints as an opportunity to identify anything that is going wrong and make it right. It continues to say that comments and suggestions for improvement are always welcome. The AQAA stated that the complaints procedure ‘is shown on display in reception. It shows staged (sic) and time scales for the complaint process and explains how the complaints are dealt with and by whom.’ We enquired about this as we were unable to see a procedure on display. The manager believed that this document was displayed however it became apparent that it was not. A laminated copy was later found which is believed to have been previously displayed. It was however pleasing to note that the procedure had been amended to reflect that contact with us is now handled by staff in Newcastle Upon Tyne. The AQAA stated ‘We have not received any formal written complaints in the last 12 months.’ The manager confirmed this during our visit. We have not received any complaints about the service provided since our last inspection. As a result we did not request sight of the complaints records during this visit. We received a small number of surveys back prior to this inspection. Staff confirmed that they know what to do if somebody does make a complaint about the service provided. One resident told us that she had ‘nothing to complain about’ and that she would ‘speak to head carer’ if she did have any concerns. We saw a folder containing a number of cards and letters complimenting the service. As the majority of these were not dated it was difficult to ascertain when they were written and sent to the service. The manager informed us that she has knowledge of a local advocacy service if needed. We saw evidence of a referral under the Deprivation of Liberty Standards whereby assistance was sought to assess an individual’s capacity to make an informed decision. We were told that systems are in place to ensure that people retain their right to vote. The AQAA stated that ‘it is vital that the service users are protected against neglect and abuse. POVA (Protection of Vulnerable Adults otherwise known as safeguarding) training and staff awareness continues over the next 12 months.’ The AQAA confirmed that the home has policies and procedures in relation to safeguarding adults and the prevention of abuse. These documents were not viewed as part of our inspection. The manager confirmed that she has a copy of the Worcestershire Adult Services procedures on safeguarding and was aware of a booklet recently published by the local authority. St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 19 Since the last inspection the manager has informed us of one potential safeguarding matter. The matter was referred to social services and investigated as appropriate. The manager was aware of who to contact within Worcestershire Adult service in the event of actual or suspected abuse. We also spoke to some members of staff who were aware of their responsibility to report any suspicions they may have. One member of staff said she would speak to an agency such as Age Concern if necessary. We asked residents whether they feel safe in the home; everybody we asked confirmed that they do. We viewed the recruitment records of two members of staff appointed earlier this year. These records confirmed that appropriate checks were made prior to them commencing work to ensure they were suitable to work with vulnerable people. St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 20 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): Standards 19, 20, 22 and 26 People using the service experience good quality outcomes in this area. The home is a well maintained, clean and comfortable place in which to live. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: St John’s Court is a grade 2 building located close to Bromsgrove town centre and therefore near to shops and other local services. As part of this inspection visit we viewed communal areas of the home and a sample number of bedrooms. St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 21 Corridors are wide and bright. We have previously reported that the fire doors at the end of each corridor have plain glass within them in order to enhance the overall appearance of the home. Due to the plain glass we previously recommended that more noticeable motifs were stuck to the glass to prevent people accidentally walking into it. On one of each of the double doors is a sticker warning about the glass, a small motif is affixed to some of the other doors. It would appear that some motifs have been picked off. A further review as to whether the motifs are fully sufficient should be undertaken to ensure accidents are prevented. The top floor of the home has 3 bedrooms, a small lounge and a kitchenette. The remaining bedrooms are on the first and ground floor. All the bedrooms have en-suite facilities. All bedrooms with the exception of two are single. A passenger lift is provided to provide ease of access to the ground and first floor, with a small lift in place to gain access to some other bedrooms on the first floor. We saw evidence that people are able to bring their own possessions and belongings into the home to make the room both more personal and comfortable. People told us that they found their bedrooms to be comfortable. We saw that wardrobes are secured to the wall to prevent accidental toppling. Some bedrooms have secondary glazing. Many bedrooms have special beds that are able to be raised and lowered. We saw aids and adaptations fitted in bathrooms and communal toilets to meet differing care needs of people living there. One person had an oxygen cylinder in his bedroom which was not secured to prevent accidental toppling over. A large lounge on the first floor was pleasant; the carpet is however stained in a number of places. Sitting provision on the ground floor was welcoming. A smaller lounge is available on the ground floor if people wish to use it. A lounge area on the top floor has no furniture within it and therefore not able to be used by the three people who have their bedroom on this floor. The dining room is on the ground floor. We were told that new units are to be fitted in the kitchenette area of this room in the near future. The carpet was clean but is stained in many places. A ‘fridge is provided within the kitchenette for items such as milk and fruit juice. We viewed the records of the temperature of the ‘fridge and found that on occasions they were excessively high. We asked a member of staff who fills out this form what the ideal temperature should be. The member of staff was unsure but felt that at times the temperature reading was artificially high if it was taken after the door had been opened frequently such as during breakfast. No written procedure was in place regarding the temperature taking or the action to be taken if the readings were either too high or low. St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 22 During our previous inspection it was evident that the home had experienced difficulties following having devices fitted designed to ensure that doors close in the event of the fire alarm sounded. As many of these were not working correctly we previously saw doors held open by wooden wedges. We were informed that these problems were now sorted although one bedroom door still had to be wedged open. People confirmed that they had to wedge open this door. In addition fire records confirmed that the holding device was not working correctly. We saw that one of the double fire doors at the end of the corridor on the ground floor did not always close fully into its rebate. We later saw some reference to this door in the fire records. We brought this door to the attention of the manager. Some combustible material was seen underneath one staircase which could pose a risk if there was an emergency. During a tour of the home we commented to the manager that the picture quality on some television sets in bedrooms as well as the lounge was ‘snowy’. We later saw that this was raised as part of a recent customer satisfaction survey. In a response to the survey the manager had acknowledged the issue and stated that she was awaiting proposals from a contractor. During our visit the manager informed us that the handy person was aware of the problem and was working on addressing it throughout the home. The AQAA completed by the manager stated that during the last 12 months a new front door device has been fitted. Staff can now only enter the building with a fob rather than having a key code. A loud alarm is set off when somebody opens the front door to alert people that somebody is leaving. The locking device would be overridden in case of emergency. All areas of the home that we saw were clean and tidy. A bottle of washroom cleaner was found in the hairdressing room, this could have been potentially dangerous if a resident had accessed it. All cleaning materials need to be stored securely to prevent such an occurrence. The lighting throughout the home is domestic in appearance. Radiator covers are provided but we saw one which was broken which was mentioned to the manager. We were told by staff that water temperatures are recorded when people have a bath. These records were not seen however our observations regarding other records including water temperatures are included under the management section of this report. The kitchen and laundry are located on a lower ground floor. Since our last inspection work to improve working conditions have taken place. The air conditioning has made this area much cooler. We saw a certificate showing that the local Environmental Health Department awarded the home a rating of ‘very good’ or 4 stars in relation to food hygiene St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 23 standards. We viewed the temperature records relating to the ‘fridge in the dining room. During August the records showed temperatures such as 10 and 11°C. These temperatures were in excess of safe limits. At the time of our visit there was no food within the fridge and therefore posed no risk at that time. The registered manager undertook to change the routine and ensure that staff reported any excess temperatures. The laundry is suitable equipment. Colour coding systems are in place to ensuring laundry is washed correctly and in line with infection control procedures. People living within the home told us that they are satisfied with the laundry service provided. On one survey somebody commented ‘The home is very clean and never smells unpleasant’ ‘The laundry system is excellent.’ Gloves and aprons were available for staff to us. The laundry is staffed each morning seven days per week. We were told by a carer and the manager that antibacterial hand gel was available in the home. We checked three locations and found no gel to be in place. Liquid soap and paper towels were however available within communal toilets. Some members of staff were carrying their own personal supply of hand gel. A delivery of protective gloves and aprons were in a corridor waiting to be put away. The home has its own generator. Two sockets within each bedroom are able to be powered using the generator. For some people this would mean that they could continue to watch television or listen to their radio in the event of a power cut. The plugs would however mean that in other rooms the power supply to pressure relieving mattresses or peg feeds would not be affected therefore providing consistent care delivery. St Johns Court Nursing Home DS0000004139.V376133.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): Standards 27, 28, 29 and 30. People using the service experience good quality outcomes in this area. Staff on duty are able to ensure that people using the service are able to receive the care they need although this may not always be a prompt as people may wish. Staff are trained to provide them with the skills and knowledge necessary for them to carry out their role. People can be confident in the home’s recruitment processes. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager told us that during the morning shift there are usually 7 care assistants on duty as well as a health care assistant and a trained nurse. The health care assistants are able to support the registered nurses in some of their duties. As a result of the staffing levels, two carers are working on each side of each floor of the home. People generally believed the staffing levels to be sufficient to meet the needs of people living there. We asked on our questionnaires whether people believed that the home has enough staff on duty to meet care needs. Two people answered ‘usually’ while two answered ‘sometimes’. We were told that staffing is at times short especially at night and St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 25 that staff were complaining. We have commented on delays in answering the call bell system within a previous section of this report. We looked at the current night shift rota as well as some previous weeks and found that they consisted of 1 trained nurse and 3 carers. We did not note any occasions when this level of staff were not recorded as in place. We spoke to one night care assistant who informed us that staffing levels do not fall below these levels. On the AQAA we were informed that more staff had been employed over the previous 12 months and that as a result the home has ‘not required to use any agency staff on day shifts’. This statement was confirmed during our time within the home. We were also informed that ‘twilight staff’ have been employed to increase staffing levels at certain parts of the day. One resident stated that ‘Carers couldn’t be any better from top to bottom.’ Another resident said ‘staff very helpful.’ At the time of our last inspection training records for the previous year were not available. Staff confirmed upon questionnaires that they receive training that is relevant to their role and keeps them up to date. The matrix showed that the majority of staff have undertaken the training we would expect people to have. Some gaps were evident such as fire training whereby it appeared that 6 carers, 1 trained nurse and 2 domestic staff had not undertaken any training during 2009. We were told that staff who train colleagues in moving and handling have undertaken training to enable them to train others. One relative commented within a survey ‘The home provides high quality service. All of the staff seem to be very well trained.’ St John’s Court was recognised with the Investors in People award in June 2008. The AQAA stated that 21 permanent care staff out of 38 hold an NVQ (National Vocational Qualification) level 2 or above. This figure represents 55 which is above the associated National Minimum Standard. A similar figure is mentioned within the Service User’s Guide. Staff confirmed, on the surveys returned, that the employer carries out checks, such as CRB (Criminal Records Bureau) and references before people start working within the home. We viewed the file appertaining to 2 recently appointed members of staff. We saw that a CRB was in place prior to the commencing of duty. We also saw 2 written references to be in place. Other documents held included job description, contract of employment, supervision details and training details. St Johns Court Nursing Home DS0000004139.V376133.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): Standards 31, 33, 35, 36 and 38. People using the service experience good quality outcomes in this area. The home is being managed in the best interests of people using the service. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The registered manager, who is experienced and suitably qualified to carry out her role, was on duty throughout our visit to the home. As well as holding a nursing qualification she has also completed the Registered Managers Award (RMA) which is a level 4 NVQ (National Vocational Qualification). St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 27 One relative commented on a survey returned to us that you can talk to ‘any member of staff or management they will all listen.’ Since our previous inspection, changes in the management team have taken place. The home no longer has a deputy manager; this post was replaced with a head of care who has delegated responsibility for care related matters within the home. The registered manager is now based in an office on the ground floor which makes her more accessible to residents, visitors and staff members. Before this inspection we requested an Annual Quality Assurance Assessment (AQAA) from the service. The document was returned to us on the date specified by us. It contained sufficient details to indicate to us what the home believes they do well and their plans for the future. We sought copies of the Regulation 26 reports. These are monthly reports that have to be carried out by either the owner or their representative following visits to the home on a monthly basis. We viewed some of the reports going back to March 2009. The reports were detailed and evidenced discussion held with residents and staff as well as details of other areas discussed with the manager. We noted that issues identified have usually received attention by the manager or others within the home. The recording of ‘fridge temperatures, mentioned earlier in this report, is an exception. During our previous inspection we stated that a commercially produced Quality Assurance System obtained by the provider was not being used. Having such a system enables the service to monitor what is provided and assess the outcomes for people living in the home. We saw a newer document as part of this inspection. The manager has made a start on this document and has recorded a number of ‘standards’ within it thereby she believes the home to be ‘compliant’ or ‘partly compliant’. The manager has previous sent out customer satisfaction questionnaires in order to seek comments about the service provided. Although the questionnaires were not seen we did nevertheless see a response to residents and their relatives dated 31st July 2009. The response indicated that proposed action in relation to the areas identified as needing improvement. A matrix in the manager’s office evidenced the date when staff have received formal supervision. We saw further evidence of staff supervision within the two staff files seen. It was however evident that some staff have not received any formal supervision sessions since the start of the year, however these staff have in many cases received an annual appraisal. Residents or their representatives are able to deposit small amounts of cash for safekeeping. We checked the balances held of a small sample of people and found them to be correct against the written records. We made a St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 28 recommendation regarding the practice of who was able to have sight of people’s balances. We became aware of a person’s bank passbook held in safekeeping however this was not recorded as held. Within our last report we stated that ‘systems are in place to visually check equipment such as window restraints on a periodic basis. The frequency of checks regarding such important pieces of equipment should be reviewed to ensure they are sufficient.’ Prior to looking over the current records of safety checks, we discovered a broken window restrictor; therefore, the window could be fully opened. This was a potential risk to people using the service. The registered manager took immediate action and called into the home a person from another home owned by the same company to make the situation safe. The periodic checking of window restrictors had not changed since our previous inspection. The above example indicates that stringent measures need to be in place to prevent accidental or intentional falling from windows. The records showed a number of areas where action was needed such as securing a wardrobe to the wall. We checked a sample number of these to see if the work had taken place and found that it had however it was not recorded. A label on the hoist on the ground floor showed that it was last serviced during June 2009. We viewed the fire records. We had already noted some fire doors not closing completely into their rebates as well as one bedroom door held open by means of a wedge. On viewing the fire log we discovered that these faults were continually reported within the log going back to April 2009 and, clearly, no action had been taken. The fire alarm is tested most weeks. We were told that 2 emergency lights reported to have failed were replaced, this repair was not documented Within our previous inspection report we commented on the system the registered manager operated to audit falls. Although we did not view these records on this occasion we were assured that the system is still used as a means of highlighting any trends and reducing further occurrences. St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 29 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 3 X 3 3 3 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 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 2 X 2 St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 OP1 Good Practice Recommendations The service user’s guide should include comments from people using the service. A full review of medication procedures should be undertaken. This should include the delegation of responsibility for the administering of medication and systems to ensure that records are completed accurately. A review of the choice of activities should take place to ensure that they meet the needs of people using the service. People should receive the support they need to ensure they received their meals and nutritional needs are met. 2. OP9 3. OP12 4. OP15 St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 31 5. OP19 Further motifs should be fixed to the plain glass doors to act as a visual aid. Robust systems such be in place to ensure the health and safety of residents. 6. OP38 St Johns Court Nursing Home DS0000004139.V376133.R01.S.doc Version 5.2 Page 32 Care Quality Commission West Midlands 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). 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