Inspection on 21/01/10 for St Peter`s Convent

This is the latest available inspection report for this service, carried out on 21st January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Peter`s Convent 22/02/06

St Peter`s Convent 16/11/05

St Peter`s Convent 12/01/05

St Peter`s Convent 20/07/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Key inspection report Care homes for older people Name: Address: St Peter`s Convent George Lane Plympton St. Maurice Plymouth Devon PL7 2LL     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Megan Walker     Date: 2 2 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: St Peter`s Convent George Lane Plympton St. Maurice Plymouth Devon PL7 2LL 01752337202 01752348804 stpeter@anh.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Trustees Augustinian Sisters Name of registered manager (if applicable) Ms Veronica Bray Type of registration: Number of places registered: care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: Registered for a maximum of 50 DE(E) Registered for a maximum of 50 MD(E) Date of last inspection Brief description of the care home St Peters Convent is a Care Home with Nursing that is registered to accommodate up to 50 people over the age of 65, of either gender, to provide care for people with a significant dementia or mental frailty or a mental disorder. It is not registered to provide intermediate care. The home is owned by Augustinian Care. It is divided into three separate units and a qualified nurse is responsible for each unit. The home has one registered manager who has overall responsibility for running the home. Care is provided by a team of Registered Nurses supported by trained care staff and a variety Care Homes for Older People Page 4 of 35 0 0 Over 65 50 50 Brief description of the care home of ancillary workers. Weekly fees range from £577.50 to £650.00 and are according to assessment of the persons personal and nursing care needs. Additional charges include hairdressing, chiropody, toiletries, newspapers, magazines, journals etc, all charged at commercial rates, and escort for hospital/GP appointments. All charges information was provided to the CQC in January 2010. The home is a listed building, situated in the village of Plympton St Maurice. The home is a large property with extensive, secluded and attractive grounds. There is a variety of equipment to support peoples physical needs and specific individual equipment is available following an assessment of need. In addition to separate communal rooms, a chapel is available for use by everyone using this service, the staff and the local community. The services provided are non-denominational. The latest inspection report is displayed in the entrance foyer. The contracts issued include name and date of admission and who pays the fee, how the fee is broken down and the total fee, plus the homes terms and conditions of residency. Care Homes for Older People Page 5 of 35 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three star. This means the people who use this service experience excellent quality outcomes. This was a Key Inspection undertaken by one regulation inspector. The fieldwork part of this inspection was unannounced. It took place on Thursday 21st January 2010 between 07:20 and 16:20 and on Friday 22nd January 2010 between 10:00 and 18:45. An Expert by Experience joined the inspection on the first day and joined the morning activity group, visited individuals in their rooms during the rest of the morning, and ate lunch with the people eating in the main dining room. The Care Quality Commission (CQC) considers an Expert by Experience as a person who either has a shared experience of using services or understands how people in this service communicate. The registered manager whom we met at our last key and random inspections resigned at the beginning of 2009. A new manager was appointed at the same time and she was successful in being approved by the CQC as the registered manager in August 2009. Care Homes for Older People Page 6 of 35 This person was available throughout our visit for consultation and information such as the day to day routines as well as the management of the home. She was also able to give us an update on things that have happened at St Peters Convent over the past twelve months. This inspection included talking to and observing a number of the people who live at the home. We also spoke to three relatives of people who live at the home. We spoke to care staff working at the time of this visit as well as observing interactions between the staff and the people using this service. We conducted a tour of the premises, inspected six care plans, three staff files, medication and other records and documentation. Eight surveys were returned from people living in the home. We did not receive any completed surveys back from staff or from health and social care professionals. An Annual Quality Assurance Assessment (AQAA) was completed by the Registered Manager prior to the inspection. The AQAA is a selfassessment that focuses on how well outcomes are met for the people who live in the home. In addition we used the last Key Inspection report, the random inspection report, and all other information relating to St Peters Convent received by the CQC since the last inspection to inform this inspection. Throughout this report, the term we will be used as the report is written on behalf of the Care Quality Commission (CQC). There are one requirement and three good practice recommendations made as a consequence of this inspection. Care Homes for Older People Page 7 of 35 What the care home does well: 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 Care Homes for Older People Page 8 of 35 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 35 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 35 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. Anyone considering moving into St Peters Convent can be confident that their needs will be assessed to ensure that these can be met when they move into the home. Evidence: Five out of eight people living at St Peters Convent who completed and returned a survey about the care home, told us that they had received enough information before they moved in that helped them to decide if it was the right place for them. Four of these people also told us that they had received written information about the terms and conditions of the home. One person said they had not, and two others said they did not know if they had received this information. The registered manager will offer an appointment to visit the person wherever they are in order to complete a pre-assessment. This is to gain as much information as possible. The registered manager told us that people are encouraged to visit and spend time at the home with the other people who live there. She explained that Care Homes for Older People Page 11 of 35 Evidence: during this time she will also try to glean as much information as possible about the person wishing to move in. She told us her main question for consideration is Are we able to care for this person? Once someone has decided they wish to move into St Peters Convent, there is at present a verbal agreement offering a place and then confirming fees and a date to move in. We suggested that it would be prudent to put this information in a letter to the prospective resident and/or their family. This would ensure that there were no misunderstandings and also confirm that St Peters Convent could meet the persons care needs. On arrival at the home, the newcomer is given a copy of the homes Statement of Purpose and Service Users Guide, and a contract. A copy is also made available to the family or representative if this is appropriate. We were shown a Statement of Purpose and a Residents Handbook. Neither has a satisfactory description about how to make a complaint or the homes complaints procedure. There is no information at all about contacting the CQC other than guiding people to look at the notice board. Both these booklets are provided by Augustinian Care, the registered provider, and are general information covering all their services rather than home specific about St Peters Convent. We looked at four care plans. They all had pre-assessments of care needs. The contracts are kept separately in a lockable filing cabinet. Care Homes for Older People Page 12 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are involved in their individual plan of care and are supported and encouraged to make decisions as part of an independent lifestyle. The practice regarding the planning and delivery of care means that people can be sure that their health and personal care needs will be always be met. Evidence: The comments we received in surveys returned by people using this service included: I am assisted in buying beautiful clothes Advised with selected clothes to wear Hair styled the way I like it I always like the way the homes hairdresser does hair I am treated with respect I am offered a choice in anything. The AQAA told us Care plans are discussed with relatives and their views are encouraged and incorporated where appropriate into residents care. Relatives read and sign the care plan. Relatives are invited to attend review meetings held by health care professionals. We hold residents meetings and residents are encouraged to discuss their feelings and how the home meets their needs and also if they have any Care Homes for Older People Page 13 of 35 Evidence: worries or issues. As we toured the premises we observed daily life at St Peters Convent. People were well dressed, appropriate for the time of year, wearing stockings and well fitting slippers or shoes, with blankets to give extra warmth where needed. Some people were wearing makeup, jewellery and had their nails varnished. Most people had their hair well groomed and we were told that there were opportunities for them to have their hair done by the visiting hairdresser when they wished. We asked a member of staff about facilities for personal hygiene and baths and showers and were told We usually do two baths a day, but we give other baths to people if they want one, or if we feel it is needed. Staff were seen to be courteous and sensitive with people. In the communal areas in St Ritas, people seemed to be very happy and there was lots of interaction with the staff. People were treated with respect and there was good communication. We observed two members of staff using a hoist to move a very frail lady. When they approached her, their rapport was very good, they advised her about what they needed to do, gained her co-operation and then gave very clear information about what was happening as they hoisted her. The staff we saw working with people in St Ritas appeared to be very kind, caring and respectful to everyone. There was a calmness and homely atmosphere. St Josephs and St Francis sitting rooms are much smaller. It was evident that the people living in these parts of the home have more advanced memory problems. Many were asleep in their chairs and there was less interaction and activity. We saw several people in reclining chairs which for some may have been a restriction of their liberty. We spoke to the registered manager about this and she assured us that individual assessment and risk assessments are carried out before anyone has a reclining chair to use. Some people spent the day in their bedrooms and we did not see any evidence of call bell systems. The registered manager advised us that due to their dementia, people could not use bells however staff visited them at regular intervals in their rooms to ensure that they were alright. We also noted on our visit the following day that in St Josephs everyone was sitting out in the lounge for some part of the day. The Activities Co-ordinator was spending 1:1 time with people. We observed that the staff were softly spoken and calm in their manner. Even when they spoke to each other it was done so in a quiet, gentle way so no-one was alarmed or unsettled by raised or loud voices. We also witnessed some exceptionally sensitive giving of care to people who are more mentally frail. There was never any sign of impatience or frustration by Care Homes for Older People Page 14 of 35 Evidence: any staff member and they were respectful at all times with everyone. We asked a senior member of staff if they had developed individual Life Story books to help get to know and understand people and their life before they had developed dementia. We were told that this was something that they were planning to do. We spoke to three relatives. They each told us that in their opinion, the staff provided the care and support and the medical support that was needed. They felt that the staff listened and acted on what was said to them, and that the staff were available when they were needed. Feedback from relatives and staff, as well as information contained in personal files, confirmed that people living in the home have access to health care services such as doctors, the tissue viability nurse, dentists, chiropodists, opticians and hospital consultants. The registered manager told us that registration with a General Practitioner (GP) is dependent on where the person lived prior to moving into St Peters Convent. The majority of people are registered with a local medical centre and a doctor from this practice visits twice weekly. We chose six people, both men and women, to look at their care files and care generally. Each care file seen stated the name by which the person preferred to be called. Each had a full assessment of care needs that was focused on the person. The care plan included daily life activities such as communication, eating and drinking, expressing sexuality, washing and dressing, and sleeping. For example, X is very attractive and enjoys wearing jewelry and looking smart. She enjoys wearing bright colours. Involve X in choosing her clothing, ask her do you like this and encourage her interest. We saw evidence of care planning that enables a pro-active approach by staff to provide suitable care for individual health care needs. Daily records showed that any medical condition was monitored and recorded. There was evidence of recording of nutritional assessments, tissue viability, skin integrity, breathing, controlling body temperatures, challenging behaviour, moving around, weight checks, medications, and personal preferences. Examples we saw included: Xs skin is very fragile and will mark easily ie bruise. Staff to use open hand technique and not to apply any pressure to skin. Ensure sheets are wrinkle free. Skin very soft and all pressure points are at risk. People are able to choose to have dental checks, eye-sight checks and chiropody services and these can be provided at the care home by visiting contractors. Each care plan is reviewed monthly with the individual. If the persons health deteriorated so they were limited in their ability to be involved with their care planning, then a family member/representatives would be invited to become involved (if not already). We saw care plans and reviews that were signed as agreed. One Care Homes for Older People Page 15 of 35 Evidence: nurse told us that relatives are invited to read the care plans. They are asked to sign if they agree with the proposed plan of care or to raise any issues of concern or questions about the care plan. We asked each nurse on duty on each unit about medication. We were told that it is ordered monthly and comes in prepared blister packs. Anyone given a new medication or dressings mid- month has this recorded separately from the monthly medications. Each nurse showed us the medications stored on their unit. All the medication is kept in a lockable medication trolley. At the time of our visit these were all kept securely tethered when it was not in use. Only one unit has a prescribed controlled drugs cupboard and this is used to store all the controlled drugs for the whole home. We saw the prescribed drugs securely stored in a separate controlled drugs lockable cupboard that was inside a lockable cupboard. All controlled drugs records had double signatures. Each dressings cupboard and supplies seen were up to date. There was minimal stock so lessened the likelihood of things going out of date before they were used. Each nurse told us that everyone has a medication review within one month of moving into St Peters Convent with a view to cut down medications as soon as it is practicably feasible. They are then reviewed approximately every six months by a GP. We saw that relatively few people have medication at teatime and night time. Most people had medication at mealtimes however for anyone requiring specific times, these were adhered to. The medication sheets have photographs of the individuals to identify them. Allergies are recorded on the persons blister packs and on the care plan. There are reminder cards in the medication records if someone has medication that cannot be supplied in a blister pack. There are specimen signatures on the front of each medication record chart of each staff member who is responsible for handling and administering medication. This provides a quick glance way to audit who has signed as having given medication. There are clear procedures for staff to follow regarding refused medication, spoilt medication and medication for return to the dispensing pharmacist. There was a clear audit for all drug disposals. Care Homes for Older People Page 16 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at St Peters Convent are encouraged to exercise choice and control over their lives. People are supported to continue to enjoy familiar supportive relationships with family and friends, and within the local community. Evidence: People who returned a survey told us I always enjoy the activities organised in the home. [I am] Taken out to shops and outings; Take me out evenings to see concerts. I am treated with respect. I am offered a choice in anything. When we arrived on the first day of our visit a few people were up by choice although most people were still in bed asleep. Breakfast is at 09:00 and people can choose to have it either in their bedroom or in the dining room. Most people need assistance with eating and those who are able to eat independently need prompting and encouragement with their meals and drinks. Our observation at breakfast, and with all meals, was staff that were gentle, giving people support and encouragement to eat their meal. The people who needed assistance with eating had one to one time that was unhurried and at a pace suited to the person. The meal for those who needed assistance was left in the heated food trolley to keep warm until it was brought to Care Homes for Older People Page 17 of 35 Evidence: them to be eaten. This means that people are being given food that is still hot. It has not been placed in front of them to go cold whilst they wait for a staff member to be available to assist them. During the morning of our first day the Activity Co-ordinator had arranged a morning activity group, in the sitting room in St Ritas. The group was well organised with lots of colourful materials ready to make Valentine and Easter Cards. The session was very lively with lots of chat and interaction. People sat at the tables in small groups, and help, encouragement and praise was given to individuals. Other members of staff joined the group to help from time to time. Before making their cards, people decided who they were to be given to and it was very evident that the staff knew about families and friends of individuals and made suggestions about what would be suitable. A Music and Movement session was arranged for the afternoon and people told us they were looking forward to this. They also said that they were looking forward to a birthday party that was being organised for someone who lived at the home. We saw a table being prepared in the sitting room with things ready for the party. Some people were able tell us about the skittles games they had and we saw posters on the wall showing scores of individuals who had taken part. During the snowy weather, the staff built a snowman outside the dining room window while the people living in the home watched (and supervised!) them through the windows. We were told that people had enjoyed the snow without having to risk going out in the cold and icy conditions. The Activity Co-ordinator told us that she had been a member of the care staff for number of years, she had always enjoyed activities and crafts and was now employed five days a week to focus on providing activities and group craft work for people living at St Peters Convent. The registered manager later confirmed this and re-iterated how beneficial it was having an Activities Co-ordinator who was previously employed as a member of the care staff so knew and was known by the people living in the home well. As we toured the premises we visited individuals in their rooms. In some rooms we saw members of staff sitting with people, engaged in a range of one to one activities, reading, sitting and chatting. Some people were watching television and others listening to music. We met one member of the care staff in a bedroom, she was helping the person to fold towels, and she told me the lady gets very anxious and she likes to use her hands, we sit with her and she enjoys folding the towels and doing other small tasks, it seems to help her. Some of the people were able to tell us that they had recently been to Plymouth to see a pantomime and how much they had enjoyed it. Someone else we spoke who has been living in the home for several years Care Homes for Older People Page 18 of 35 Evidence: told us I am settled here, the Sisters are very good I am very happy. I like to do jobs around the home, I like setting the tables and helping with the washing up. They take me out to visit my elderly relative and I have also been on holiday it was very nice. Lunch is served at 12:00. We were concerned that this was too soon after breakfast as some people were still eating their breakfast up to 10:00 -10:30. Although lunch like breakfast was unhurried and at peoples individual pace, we were aware that supper is served at 17:30, and homemade cakes and biscuits are served mid morning and mid afternoon. It is a lot of food in a short period of time. For the people who need time to eat well or who may benefit from little and often this current meal times regime is not flexible because of the times the catering staff are employed to work. The catering staff also told us that they had become aware that more food was coming back at lunchtime. They were unaware that it was because people were eating breakfast much later than in the past. We suggested to the registered manager that this may be an example where person centred care has clashed with task focused care, and may benefit from a review. The main dining room of the home was bright and homely, the tables were set with linen cloths and napkins, table mats and cutlery, and there were flowers on the table. At lunch time most people sat at tables for four. There was quiet music playing in the background which people appeared to enjoy and some people were quietly singing. The atmosphere was calm and unhurried and the staffing levels seemed good. Food was served from a heated trolley. The menu consisted of soup, and roast turkey with vegetables, with a choice of two puddings. There was fruit squash to drink. The food looked appetising, colourful and was tasty. Staff serving the food told people what was for lunch and then went through in detail to ask them what they wanted. People were given support and encouragement to eat their meal. We heard staff telling people who needed assistance what the food was. At the time of this visit two people had diabetes managed with insulin injections. The head chef told us suitable meals and snacks can be prepared for anyone who has their diabetes managed by their diet. She also told us menus include fortified and build-up foods for people who have low weight or are identified as being at risk of malnutrition. We found that pureed foods were served separately. The head chef told us she uses food moulds so the pureed foods looked more presentable. We spoke to the head chef. She told us that she works four days a week from 07:00 until 13:00. and the other chef works Saturday to Monday. He also prepares supper on Saturdays and Sundays before he leaves. The care staff collect it from the kitchen and serve it. This is usually a selection of sandwiches, soup, sausage rolls and cakes. There is a supper cook Monday to Friday. Additionally there are five catering Care Homes for Older People Page 19 of 35 Evidence: assistants who cover all seven days of a week between them. On the days of our visit there were three catering assistants and we also met the supper cook. We were told that the home has a four week rolling menu however the head Office is currently revising it to include a choice of main courses at lunch time. At the time of this visit Fridays was traditionally a fish meal. Omelets, soup and sandwiches are offered daily as an alternative to the main dish. There was some concern about the new menu proposals particularly for people who needed their food to be pureed or soft. Salad, for example, we were told is not easily pureed, or easily digestible by everyone. We suggested to the head chef and the registered manager that consideration should be given to individual tastes and preferences, with particular significance on foods that can be pureed and are appetising. All the food is ordered by the head chef, locally sourced and all the meat, fruit and vegetables are bought fresh. Therefore although the Head Office staff make general suggestions for the menus, it is the staff in the local care home who need to ultimately take responsibility for the food they provide to meet individual tastes and preferences. Care Homes for Older People Page 20 of 35 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 living at St Peters Convent and their families and friends can feel confident that any issues of concern or complaints raised by them will be dealt with appropriately. People are protected from abuse, neglect and self harm by the homes policies and procedures, and by a robust recruitment process. Evidence: Seven of the eight people living at St Peters Convent who returned a survey about the home all told us that there is someone to whom they can speak informally if they are unhappy. Five confirmed that they know how to make a formal complaint. Three told they didnt know how to make a formal complaint however one person said that they would ask the nurses. The AQAA states: The home has a complaints procedure. The complaints procedure specifies how complaints can be made and who will deal with them and that they will be dealt with within 28 days . The complaints procedure is displayed in the reception area, on each unit and forms part of the admissions pack. The complaints procedure includes the contact details for the C.Q.C. office. We saw the Complaints procedure displayed on the notice board near the front door. It was clear however the contact details for the CQC were incorrect. The registered manager had updated this by the second day of our visit. We were shown a Statement Care Homes for Older People Page 21 of 35 Evidence: of Purpose and a Residents Handbook. Neither has a satisfactory description about how to make a complaint or the homes complaints procedure. There is no information at all about contacting the CQC other than guiding people to look at the notice board. Both these booklets are provided by Augustinian Care, the registered provider, and are general information covering all their services rather than home specific about St Peters Convent. Since the last inspection there has been one safeguarding referral that the registered manager worked with us and managed well. The registered manager has received two complaints both of which were resolved. She also monitors day to day general grumbles and moans and endeavours to resolved things as quickly as possible. A record is kept of both verbal and written complaints. The AQAA states:The home has a procedure for safeguarding of vulnerable adults and staff receive training and updated twice a year. The actions to be taken if a case of safe guarding is suspected is displayed on staff notice boards. The home has a whistle blowing procedure. Allegations are followed up promptly and action taken and the relevant organisations advised. Where appropriate staff are referred to the POVA register. Training is given to staff twice a year on types of abuse and the procedures for dealing with any allegations. We saw one Alerters Flowchart for the procedure to follow in the event of making a referral to the Safeguarding of Vulnerable Adults Team. This was in the refectory. We were told that the Safeguarding of Vulnerable Adults policy and procedure has been updated since our last visit. Also that staff have training twice a year about how to recognise the abuse of vulnerable people and how to report it. This included training about whistle blowing. We discussed other training relating to safeguarding vulnerable adults, including the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS), and what it means for staff working with people in registered care services. This is legislation that came into force on 1st April 2009 and applies to people living in services registered under the Care Standards Act 2000, regardless of who funds their place. It was unclear if any staff have had training on these subjects and or if any information has been disseminated to the staff so they are aware of their responsibilities and duty of care under the MCA or DOLS. We spoke to the registered manager about our concerns regarding several people we saw in reclining chairs which for some may have been a restriction of their liberty. The registered manager assured us that individual assessment and risk assessments are carried out before anyone has a reclining chair to use. The care plans we looked at had personalised risk assessments that included mobilising, maintaining a safe environment and safety. There were clear rationales and instructions for staff about why and what they should Care Homes for Older People Page 22 of 35 Evidence: do to ensure the safest outcome for individuals. These included positioning when in bed and chairs, and with attention to protecting pressure points. Care Homes for Older People Page 23 of 35 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. The people living at St Peters Convent have a comfortable and safe environment that is being adapted to promote their independence and meets their needs. Evidence: St Peters Convent is a very large old house, set in extensive well-kept grounds, with walkways and seating areas to promote peoples exercise and with access for anyone using a wheelchair. From inside the home there are good views of the gardens, surrounding fields and farm land. The main entrance to the old house is no longer used as the main access. The home is arranged on four floors divided into three units - St Joseph, St Rita and St Francis. The ground floor rooms are bright and homely with a number of small comfortable seating areas. The dining room is large and there is a spacious sitting room which is also used for activities on the St Ritas unit. The upper two floors (St Joseph and St Francis) are less spacious, less well furnished and in need of some redecoration and refurbishment. We were told by the registered manager work to refurbish parts of the home and provide some new bedrooms is due to take place soon. The person who oversees maintenance and safety of the home confirmed this and gave us more detailed information about the refurbishment plans. The outcome will mean a walk-in shower on each floor with two additional bathrooms with rise and fall baths as well as additional bedrooms with en-suites that will replace the bedrooms now decommissioned on the second floor. There are also plans to provide new furniture in the main hall. This is a large space that will be used as Care Homes for Older People Page 24 of 35 Evidence: another sitting room, and the dining room will extend into this area. During our visit on both days we observed that lunchtime gave some people an opportunity to walk/be assisted to walk to and from the dining room on St Josephs unit. We raised a concern about the loss of this dining room (The dining room on St Josephs unit is to become two bedrooms with en-suite facilities.) We were told that the people who are able to sit at a table for their meals would be able to go downstairs to the dining room on St Ritas unit. We suggested that this should be monitored to ensure that the people who currently have an opportunity to walk to the dining room are still able to do so at least part of the way. It was also unclear how many tables would be available with the proposed changes to change the dining room on St Ritas unit into part dining room and part sitting room. We suggested that this also should be monitored to ensure that the people who use the dining room on St Josephs unit did not lose the opportunity to eat in a dining room. We visited some of the bedrooms in the home. Some are carpeted and others not. Bedrooms look homely and comfortable, and people have small items of furniture, pictures and photographs which they had been able to bring with them. This makes the bedrooms look personal and reflects individual characters. There are nine double bedrooms. The registered manager advised us that individuals and their families are consulted when a room is to be shared to ensure it was acceptable to both the individual and the family, and the other person sharing the room. There are two twin bedrooms that are necessary to walk through in order to gain access to another bedroom. In December 2008 we carried out a random inspection. Our observation at that time was Due to the layout of the building some bedrooms provide access to other bedrooms. We observed two care assistants wheeling a hoist through such a bedroom. In the corridor bedroom one person was asleep in a bed and another person was dozing in a chair. The care assistants walked through the bedroom chatting as they had been as they came through the lounge. There was no indication they were passing through a bedroom or that there were two people in there asleep. We suggested to the registered manager on this visit that our observations this time still indicate that this arrangement affects privacy and could also be very disruptive if the person needed some quiet time, or had visitors. The registered manager said that this situation was not seen as a problem and that she felt it gave an opportunity for the staff to observe people. She also commented that the families of people who were using these bedrooms and also the individuals themselves had not objected. Our concern was about the people who do not have the capacity to make a decision about sharing a bedroom. There was no clear rationale about the decision making process on these peoples care plans, with clear evidence Care Homes for Older People Page 25 of 35 Evidence: showing who has made the decision, how the decision has been reached and why it is in the best interests of the person to share a room. We found that the bedroom doors are left open when people are in their bedrooms. We were told this is so they can be monitored because they are unable to use a call bell. The home is equipped to meet the needs of the people identified with moving and handling risks and disabilities that affect their ability to bathe. Specialist mattresses and adjustable beds were seen in place for those people requiring them. There is a shaft lift to all floors. The laundry and kitchen are well equipped and large enough to manage the amount of laundry and catering required to meet the needs of the people living in the home. Hand washing facilities were seen throughout the home and provision of protective gloves and aprons. The home was very clean and there were no unpleasant smells at all during our visit. Care Homes for Older People Page 26 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at St Peters Convent are supported by well-motivated and caring staff in sufficient numbers to meet the needs of those currently living at the home. Staff supervision is carried out regularly for all staff to ensure that the assessed needs of the people living at the home are met. Evidence: There is a low turnover of staff at St Peters Convent and this helps care to be consistent. Our observation of the staff during our visit found that they are kind and caring. They talk to the people for whom they care, explain their actions, for example, if they are going to move someone with the use of a hoist, they explain before and during the process. They treat everyone respectfully. We also found that care is much more person-centred than on our visit in December 2008. On St Ritas and St Josephs units particularly the staffs approach was calm and engaging with the people for whom they were caring. On the day of our visit there was a registered nurse on each unit and twelve carers across the three units. Additionally there were housekeeping staff and catering assistants as well as the Head Chef and the Supper Chef, and an administrator. We looked at three staff files. They all had two written references, a police check and Care Homes for Older People Page 27 of 35 Evidence: a staff contract with terms and conditions of employment. Two of the staff files showed they had followed an induction and had comprehensive training and development records. The third person was only starting their induction training, having only recently started working in the home. There is a probationary performance period. We were told that the Human Resources Department is centralised and takes responsibility for seeking references after the homes manager completes the interview process. The manager does not therefore see the references although the Human Resources Department would contact the manager if there were any queries about a reference. Prior to our visit the staff had been informed of proposed improvements to their terms and conditions of employment. Changes to the nurses shifts were also due to take effect from February 2010. This will mean two nurses will start work at 06:45 each day to take handover from the night nurse. The day nurses will handover to the care assistants at 07:00. One day each week one nurse will work from 06:45 until 20:30. Currently they work one day a week from 07:30 until 20:30. We expressed concern about a shift being nearly fourteen hours long. Some care staff already work from 07:00 until 20:30. We asked the manager to monitor that it does not have adverse outcomes for the people using this service because the nurse in charge and care staff are tired. We were unclear if they would be allowed to take a longer break, currently all staff are entitled to a fifteen minute and a thirty minute paid break. We did see evidence on staff files of a form for staff to sign that they agreed to work in excess of the European Working Time Directive of 48 hours including overtime in any seven day period. All the care staff and nurses have taken a dementia awareness course since our last random inspection visit and were waiting for their certificates. We saw certificates for Food Safety in Catering training on display in the kitchen for the catering staff. The manager is currently reviewing all the staff training and putting together a training needs analysis for consideration by the Head Office to ensure all staff are up to date with all mandatory training. Each nurse is responsible for supervision of the care staff on their unit. This will change with the change of nurse responsibility and the nurse on duty will take responsibility for supervision across the three units. One nurse told us that she uses supervision to emphasis with the care staff about the importance of reading and knowing the content of care plans. She told us that she encourages the care staff to ask questions and ensure that they fully understand the care plan so they know what is expected of them in their provision of care. Staff appraisals were expected to be completed by the end of February 2010. Care Homes for Older People Page 28 of 35 Evidence: The staff group at the time of this visit was both female and male, assorted ages, and mixed races and colours. The people using this service are predominantly female, white, British and Christians. The current staff group is able to meet the needs of the people living at St Peters Convent. They provide care that is unprejudiced and recognises peoples differences and values. Throughout this visit our observation of the staff found they were friendly and caring towards everyone. They were gentle and respectful as they assisted people with daily living tasks, and mindful of preserving peoples dignity and self respect. Care Homes for Older People Page 29 of 35 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 registered manager shows a responsible attitude and continues to implement changes and improvements in order to keep improving and achieving positive outcomes for the people using this service and staff working with them. Evidence: Since our last key inspection on 14th March 2007 there has been a change of registered manager at St Peters Convent. On both days of our visit the registered manager was present throughout the day. She was approachable, willing and able to provide information to assist with the inspection. We discussed the impact of a change of manager since our last visit (December 2008) when the change was still in process. The registered manager advised us that there has been a significant amount of change and there still are changes ahead. She spoke positively about the forthcoming building works and felt these would boost and be a morale lifter for all the staff as well as offering a softer living area for the people living at the home. It is also an investment for the future of the home. It will help Care Homes for Older People Page 30 of 35 Evidence: further break down the concept of three units working in isolation to one another because there will be increased shared communal living spaces throughout the home. The registered manager also expressed confidence in the change of hours for the nurses. The registered manager admitted that St Peters Convent now needs to find a happy equilibrium. She confirmed that she will be taking further management training. Also the different key worker system giving a rotation of supervisory practices she hoped would be a move towards finding the right balance. She feels this will help the Head Office to step back and be less hands on allowing the staff to feel they are valued. The manager confirmed that all the necessary maintenance checks as reported in the AQAA were correct and up to date. We inspected the Fire Log and confirmed that the smoke detectors, emergency lighting and fire alarms had been checked regularly, dated and signed. We aalso saw individual fire risk assessments on the care files we inspected. The Accident Book was seen and accidents had been recorded correctly. There is a monthly audit to check any reoccurrence and the registered manager reviews this with the nurses to seek resolution about preventing further accidents. The CQC is notified of any serious incidents affecting the health, safety or well being of any of the people living at St Peters Convent as this has not been happening. On the day of our visit the home was clean and tidy, free from offensive odours throughout. The registered manager knows and is able to communicate her responsibilities to achieve the aims and objectives of providing a homely place where people are treated as individuals, and know their dignity and self respect will be preserved. Care Homes for Older People Page 31 of 35 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 32 of 35 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 1 16 4 The Statement of Purpose must include arrangements for dealing with complaints. This will ensure that people can be confident about how to make a complaint especially if they are unable to access the reception area independently. 15/04/2010 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 1 The Statement of Purpose should be home specific rather than an overview of all the services provided by Augustinian Care. This will ensure that prospective residents have service specific information they may need to make an informed decision about moving into St Peters Convent. The times of meals should be reviewed to ensure that people have the opportunity to enjoy their food and meals within routines that are focused on their needs. All staff should have up to date mandatory training relevant for their job role. This will ensure that the people using this Page 33 of 35 2 15 3 30 Care Homes for Older People 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 service and their families can be confident that staff are trained and competent to do their jobs. Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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