Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: St Peter`s Court Nursing Home Spital Road Maldon Essex CM9 6LF The quality rating for this care home is:
three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vicky Dutton
Date: 1 5 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home
Name of care home: Address: St Peter`s Court Nursing Home Spital Road Maldon Essex CM9 6LF 01621840466 01621840801 admin.stpeterscourt@careuk.com manager.burroughs@careuk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Care UK Community Partnerships Ltd care home 24 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Persons of either sex, aged 60 years and over, who require nursing care by reason of dementia (not to exceed 24 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of dementia (not to exceed 24 persons) The total number of service users accommodated must not exceed 24 persons Date of last inspection Brief description of the care home St Peters Court is part of Care UK Community Partnerships Limited. St. Peters Court is a care home with nursing for 24 older people with dementia. Care staff and nursing staff provide 24 hour care in a safe and secure environment. The care environment consists of purpose built bungalow style accommodation, situated in the grounds of St. Peters Hospital in Maldon, Essex. There are eight single and eight double rooms. All 24 Over 65 24 Care Homes for Older People Page 4 of 30 Brief description of the care home rooms are on the ground floor, with staff areas only on the first floor. There is a larger dining and seating area with further small lounges available. A statement of Purpose and Service Users Guide are available. Information about the home can be obtained by contacting the manager; inspection reports are available from the home and from the CQC website www.cqc.org.uk Current fees at the home are £679.00 to £800.00 per week depending on individual needs and funding arrangements. Additional costs include chiropody, hairdressing and other personal requirements. Care Homes for Older People Page 5 of 30 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: This was an unannounced key site visit. The previous site visit to the home took place on 7th August 2007. At this visit we (CQC) considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. We spent eight hours at St. Peters Court. We looked around the premises to see if it was pleasant and safe for people. We viewed some care records, staff records, medication records and other documentation to see how well these aspects of care and running the home are managed. Time was spent talking to, observing and interacting with people living at the home, and talking to management and staff. We also spoke to two visitors during the site visit.
Care Homes for Older People Page 6 of 30 The homes Annual Quality Assurance Assessment (AQAA) was sent in to us. The AQAA is a self assessment that providers are required by Law to complete. It was received by the due date, was fully completed, and outlined how management feel they are performing against the National Minimum Standards, and how they can evidence this. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives, involved professionals and staff. People living at St. Peters Court were unable to respond but we did receive responses from four relatives, one visiting professional and three staff. The views expressed at the site visit and in survey responses have been incorporated into this report where appropriate. We were assisted at the site visit by the manager, administrator and other members of the staff team. Feedback on findings was provided throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the staff team, residents, relatives and visiting professionals for their help throughout the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: The AQAA was refreshingly honest in identifying areas where they could do better, and where they hoped to improve over the next twelve months. Much of this was consolidating what has been achieved so far, and continuing with projects such as the sensory garden. Medication at the home is well managed and monitored. However the management of as and when required medicines needs to be improved so that staff use these consistently in accordance with an established protocol. Regular formal staff supervision has been lacking. This needs to be addressed so that staff are well supported in their work, and have opportunities to reflect on their practice. Care Homes for Older People Page 8 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 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. Information available, and assessments undertaken helps people to be confident that the home will be suitable for them. Evidence: We saw that the home had a Statement of Purpose and Service Users Guide in place. It was explained that when people are thinking about moving into St. Peters Court they are given a Welcome Pack. We saw that this contained information about the home and services offered in a user friendly format. The pack also contained other useful information for people such as choosing a care home and information on dementia. The AQAA completed by the manager highlighted that the home has a robust approach to admissions, and have good processes in place to make sure that the home can meet the needs of people who move in. Two visitors spoken with said that their families had helped in finding the home, and had visited St. Peters Court. They
Care Homes for Older People Page 11 of 30 Evidence: confirmed that someone from the home had visited to see if their relatives needs could be met at St. Peters Court. We looked at the files of two people who had recently moved into the home and saw that pre-admission assessment had been undertaken by a trained member of staff at the home. The manager said that the assessment was then discussed and a final decision made. Care Homes for Older People Page 12 of 30 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 receive care and medical support to meet their individual needs. Evidence: People living at St. Peters Court all have dementia so were unable to express their views about the care they received. However everyone looked well cared for. Observations indicated that people liked the staff and were happy in their environment. Relatives said, The nursing care is top rate, I would recommend the home to anyone, They care in so many ways. I appreciate the good level of care, and, Staff at St. Peters Court treat my [relative] as an individual, they are always there for them. A visiting professional said in a letter of compliment, I do not have any concerns about the treatment and care given from the nursing staff or carers. The home uses a computerised system called Saturn for many aspects of managing the home and information, this includes assessing peoples needs and planning their care. To see how well peoples care is planned for and arranged so that staff are aware of peoples needs and meet them in an individual way we looked at two peoples care records in some detail, and others for specific issues. The Saturn system provides a comprehensive package that allows all aspects of peoples personal, health
Care Homes for Older People Page 13 of 30 Evidence: care, social and cultural needs to be assessed, planned for and kept under review. Assessments, care plans, daily notes and other elements were viewed using the system. All staff can access the computerised records so that they know what peoples care needs are and how they like things done. All staff are responsible for keeping the records up to date, overseen by the trained nurse on each shift. We also saw that a hard copy of care plans and essential information, along with a photograph of the person was available to staff. The manager and staff spoken with had a good knowledge of individual peoples needs. They said that because the home was quite small this enabled them to really get to know people and understand their needs. Care plans viewed were person centred and reflected all aspects of peoples needs. They were well maintained and clear. We saw that families are encouraged to be involved through providing information and confirming that the care provided is in accordance with peoples wishes and preferences. The AQAA said, We continue to encourage residents, their relatives or advocates to give input into planning their care. Care is supported by a system of named key workers and named nurse. Each room had a framed notice to let residents know who these people were and explain their role. The home also operate a Resident of the day system, whereby all aspects of the persons wellbeing, care, care planning, assessments and accommodation are reviewed each month. The home promotes Activity Based Care, (ABC.) Staff spoken with understood this concept, and spoke of the importance of maintaining peoples abilities and independence as far as possible. They gave examples of this in practice. Records showed that people access different healthcare professionals to meet their needs, such as doctors, community nurses, psychiatric support, chiropodist, opticians and dentist. The AQAA said, All residents have access to a GP service and other multi disciplinary teams such as Parkinsons nurse, diabetic nurse, speech and language team, dietician, tissue viability nurses, community psychiatric nurses and MacMillan nurses. A visiting professional completed one of our surveys and was happy with the service. They said that the home always sought advice and acted on it to manage and improve individuals health care needs. In a recent letter of compliment to the provider, a Doctor praised the care in the home highlighting good nutrition and lack of pressure sores. they said, I cannot speak highly enough about the staff at St. Peters Court Nursing Home. Care records viewed showed that assessments are undertaken in relation to continence, skin care, nutrition and falls. Good nutrition records are maintained and peoples weight is monitored as far as possible so that any problems are identified. In discussion with the manager it was clear that due to the condition of people living at St. Peters Court, as far as possible hospital admissions are avoided. A GP visits the home on a weekly basis, (and other times as necessary,) to see anyone causing concern and review their care and medication. The home is set within the grounds of a community hospital, whose facilities can sometimes be used to save a Care Homes for Older People Page 14 of 30 Evidence: journey further away. No one living at St. Peters Court is able to manage their own medication. We looked at systems in place to see if this aspect of their care was managed in a safe and effective way. Medication is always administered by trained staff. Staff spoken with confirmed what training they had undertaken. We saw that good records are maintained and that the system is audited between shifts to identify any errors. The system is also periodically audited by the provider and the supplying pharmacy. No anomalies or errors were noted on the records sampled. The home do need however to develop protocols for managing medicines that are prescribed to be used on an as and when basis, (PRN.) This is particularly when such medicines are used to control behaviour, the circumstances of when they are to be used, frequency and quantity need to be clearly identified and described. This is to ensure that medicines are used consistently by all staff. Some people living at the home need to have their medication administered covertly. We saw that this process had been properly assessed and managed through a multi disciplinary approach. Residents profile sheets were clear and highlighted any potential issues. A good practice highlighted was that peoples photographs are dated and renewed every six months to ensure that they reflect how residents currently look. During the day staff were observed to be respectful to people and responsive to their needs. Privacy was maintained when personal care tasks were being carried out. Although not fully assessed we saw that peoples end of life needs had been discussed and their wishes recorded. Care Homes for Older People Page 15 of 30 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 can enjoy a lifestyle that is suited to their needs. Evidence: Management and staff at the home are committed to providing a stimulating environment and opportunities for occupation. The concept of activity based care has already been mentioned. This seeks to involve and engage residents in their care and day to day living tasks. Care records showed us that peoples previous interests and current known likes were recorded and reflected in care planning. Twenty activity coordinator hours are currently provided each week to help in establishing and maintaining good levels of activity. The AQAA and observations on the day highlighted numerous practices and ideas that had the aim of engaging residents. For example since the previous inspection a themed room has been set up. This is initially as a kitchen with a microwave in so that people can make cakes and so on in a safe environment. Future planned themes for the room include a hairdressers salon and a workshop. The home also have regular themed days to provide stimulation and interest. The corridors of the home have been decorated as a street scene with points of interest. The manager hopes to develop this further so that each resident has their own distinctive front door to their room. Although the home does not have much outdoor space this has been made the most of. There is a facility for residents to be
Care Homes for Older People Page 16 of 30 Evidence: involved in gardening, and a sensory garden is being developed. Outside entertainers visit the home and residents are encouraged to go out. We saw photographs of trips out and while we were there a resident was being taken to the shops. Other activities, such as having an ice cream van call at the home on a regular basis provide additional interest for residents. As highlighted in the service users pack and AQAA visitors are free to come whenever they wish. We observed that management and staff had a good rapport with peoples families. The AQAA said Relatives and friends do not have restricted visiting hours, and can join their loved ones for meals and drinks if they wish. Two visitors spoken with on the day said that they were always made welcome. During the day people went where they wished, and were supported by staff who knew their preferred routines. Information was available on a local advocacy service, so that people could know where to go for independent support and advice if they wished. One visitor also told us that they and other relatives found the support offered by the local Alzheimers Society group to be very good. Management and staff at the home are aware of recent Legislation relating to mental capacity and deprivation of liberty. We saw that they were using the systems in place to safeguard residents interests. The AQAA said, All service users have been assessed as to the requirement for a Deprivation of Liberty order and this is recorded on Saturn. The menus viewed showed that residents are offered a good range and choice of food. Visitors said that the food given to residents was very good. At lunchtime we saw that residents were offered a visual choice of what meal they wanted. The portions were plentiful. Residents ate well and there was little waste. Where people needed assistance this was done sensitively. Care Homes for Older People Page 17 of 30 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for safely through practice in the home. Evidence: The home has a good complaints procedure in place that is easy to understand. The complaints procedure is on display for people and a suggestions box is also available. The complaints procedure could be improved by making people aware of our (CQCs) role in complaints management, and letting people know that they can also raise any concerns through their local authority. The home records any complaints or concerns through the Saturn system. We saw from old complaints recorded that this allowed for investigations and outcomes to be suitably identified. On surveys people said that they knew how to raise any concerns. One person said, If you are not happy you can go straight to the manager or medical RGN. They will listen and deal with it straight away. The home had not recorded any complaints over the last year. One that we were aware of, that had also been referred under safeguarding, had not been recorded. The manager said that this had been an oversight. As the issues raised had been referred under safeguarding social services are still looking into the matter and had just visited the home. The manager had however already been very proactive in addressing the issues raised by retraining staff, purchasing more moving and handling equipment and reviewing practice. Two other safeguarding referrals had been made over the last year. These related to resident to resident incidents. Again the manager had been very proactive in letting us know about the incidents and what had been done about them. Actions taken were appropriate. Staff training records and staff
Care Homes for Older People Page 18 of 30 Evidence: spoken with confirmed that training in safeguarding had been undertaken. We saw that good information was available so that staff knew all the contact details necessary, and had access to the appropriate forms to use if an incident occurred. The home have their own policies and procedures in place relating to safeguarding vulnerable adults. We saw that a training pack produced by the local authority was also available. However the Local Guidelines produced by Southend/Essex/Thurrock were not available. The manager undertook to get a copy of these. A number of people living at St. Peters Court may exhibit behaviour that can challenge staff. We saw that the care recording system fully recognised these issues. Peoples behavioural needs were assessed and reflected in care planning. Any incidents were recorded and monitored in a way that would provide useful information for involved professionals, and that may help to identify any patterns that could then be worked with/avoided. Staff spoken with said that they had undertaken training in managing challenging behaviour. Some evidence of this was seen in training records available. The AQAA identified that it was hoped to provide further training in this area. Care Homes for Older People Page 19 of 30 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is comfortable and suited to meeting their needs. Evidence: St. Peters Court Nursing Home is a purpose built home that, for residents, is all on one level. There is a staff area on the first floor. Residents have a choice of small lounge areas that they can use, but as there are a number of easy chairs placed in the central dining area this is where a number of people tend to remain. This practice needs to be monitored as it means that people who are immobile may be spending all day in the same place with no change of scene or movement. Since the previous inspection the home has been completely redecorated. On a survey someone said, The refurbishment is wonderful and cleanliness is very good. The home have two general hands who manage repairs and decoration. This ensures that the home is kept in a well maintained state. Suitable bathrooms were available. These have been made welcoming and attractive through the use of murals. Since the previous inspection two wet rooms have also been created to provide further options for bathing. We saw that suitable equipment to meet peoples needs is available, with new moving and handling equipment and a number of specialist beds having recently been purchased. Signage in the home is good to assist people who have cognitive
Care Homes for Older People Page 20 of 30 Evidence: impairments with orientation. The home has eight single and eight shared rooms. Given the client group being cared for this is not ideal. The manager said that generally it was not an issue and people got on well. On the day of the site visit the home generally seemed fresh and clean. There is a suitable laundry area that has recently been re-equipped with new washing machines. Staff have been trained in infection control so that they are aware of good practice that will keep people safe. The laundry person had a good awareness of infection control and correct procedures. Care Homes for Older People Page 21 of 30 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by caring and well trained staff. Evidence: We received positive comments about staff working at St. Peters Court. All staff are special but an extra god star for SRN *** who excels, The staff put themselves out to entertain and look after the inmates, they really do care, and, The staff always have time to chat about *** and how they have been were some comments made. On surveys and in discussion staff were positive about their role. We work well as a team and create a homely environment for our residents, and, St. Peters Court is a warm friendly enjoyable place to work, Due to some members of staff being there a long time residents can have a sense of stability and security, were some comments made. In discussion it was established that 13 staff have left in the last year. This is quite a high turnover. The manager reported that staff had left for various reasons, including furthering their career, moving within the Company and returning to their country of origin. The manager felt that generally staffing at the home was stable with a good group of core staff. From a complaint made and minutes of a team meeting viewed, there have clearly been issues within the staff team earlier in the year that were, and still have the potential to impact on residents care. Conflict within the team was making resident care be based on routines and institutionalised practices, rather than being individual and person centred. The manager has been trying to address these issues and feels that team building events, staff turnover and ongoing practice
Care Homes for Older People Page 22 of 30 Evidence: discussions have had a positive impact, and resolved the issues. On the day of the site visit staff worked well together. Although it was reported that there were few vacancies at the home, the AQAA reported that over the previous three months 40 nursing and 27 care shifts had been covered by agency staff. The manager reported that they do try to use the same staff, but this will not help with the overall team development and stability that management are trying to achieve and maintain. On the day of inspection twenty people were being accommodated. Staffing levels were being maintained at four care staff and a trained nurse during the day and two care staff and a trained nurse at night. The manager hours are supernumerary. Additional support is provided for administration, domestic, laundry, catering, general hand and activity hours. During the site visit there were generally staff around in the communal area to monitor, interact with, and assist people. When we used a call bell to gain assistance for a resident this was responded to promptly. On three staff surveys one felt that there were always enough staff to meet peoples needs, and two that there usually were. When we looked at rotas we saw that care staff tend to work twelve hour shifts from 08:00 to 20:20, over fewer days. The manager said that this is their preference and that it provides good continuity of care. Given the nature of the resident group this practice needs to be monitored to ensure that staff do not become tired or stressed. So that people receive care from a well trained workforce it is recommended that at least 50 of a homes care staff achieve a National Vocational Qualification (NVQ) in care at level two or above. Information provided at the site visit indicated that out of 14 care staff nine currently hold an NVQ with other staff either currently undertaking the qualification or waiting to start. The home have therefore achieved the 50 basic target. The previous inspection found that recruitment procedures and practice at St. Peters Court were satisfactory and protected residents. We looked at the files of two members of staff who had been most recently started work at St. Peters Court to ensure that good practice was being maintained. We saw that all proper checks had been undertaken. POVA first, and Criminal Records Bureau checks had been undertaken, references taken up and proof of identification sought. On three staff surveys people said that their recruitment was carried out fairly and thoroughly. On three staff surveys, the question about their induction covering the things they needed to know provoked a varied response of very well, mostly and partly. A fairly new member of staff spoken with said that their induction had been good. No induction materials were available on staff files, and we were told that these were still being worked on by the staff concerned, and were in their possession. We were given Care Homes for Older People Page 23 of 30 Evidence: a blank copy of the document undertaken by staff, Orientation and Induction Programme. This is based on the Common Induction Standards and provided a detailed induction programme for the first six weeks of a persons employment. The induction programme incorporates training on core subjects via the EL Box. This is a Saturn based staff training package that all staff use for induction and ongoing training. Through this we saw that the two new members of staff whose files we viewed had completed relevant induction training. On surveys and in discussion staff made positive responses to questions about training saying that training offered gave them the skills that they needed. One said, We undergo regular training to keep updated on new procedures and requirements. Because staff training records are held electronically on Saturn, hard copies of staff training files not well maintained, and there was no overall training matrix showing all the El Box and external training undertaken by staff, it was difficult to get a full picture of staff training. Staff confirmed that they had received training in dementia care, and we saw part of the programme offered on El Box, which the manager estimated would take a day to complete. Staff said that they did not always like doing the majority of their training on the El Box, and felt that other methods of training would suit some subjects better. The manager agreed with this and identified additional external training that they hoped to provide such as the Yesterday, Today, Tomorrow dementia care training. They are currently arranging some staff training through the community nursing team to cover areas such as Parkinsons disease and diabetes. Overall from information available it was possible to conclude that St. Peters Court provides a well trained staff group. On surveys and in discussion relatives felt that care staff generally had the right skills. Care Homes for Older People Page 24 of 30 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well managed and safe home. Evidence: St. Peters Court benefits from having a qualified and experienced manager in post. Since the previous inspection they have worked hard to continue to develop St. Peters Court and move the home forward. The home was well organised and information needed to undertake the inspection was readily available. Relatives said, The home has a good manager, and St. Peters Court is a well run home. Since the previous inspection the manager has always been good at keeping us informed of events happening in the home, and letting us know what actions have been taken. Discussion and information viewed at this inspection showed that the manager is aware of things happening in the home and proactive in dealing with issues when they arise. St. Peters Court has a friendly open atmosphere and residents seemed comfortable and at ease with staff. A member of staff said, The home makes you feel welcome and part of the family. Overall its a wonderful place to work with a lovely
Care Homes for Older People Page 25 of 30 Evidence: environment for staff, relatives but most importantly residents. Due to the mental frailty of residents they are not often able to express their views. The AQAA said, We hold regular relatives support meetings. This was confirmed by a visitor, who also said that these were not well attended. The manager agreed with this, but felt that an open door policy gave people the opportunity to talk to the manager or senior staff at any time about any issues or concerns. We saw that regular staff meetings take place where practice and other issues are freely discussed. The provider undertakes quality reviews of their services. At St. Peters Court a quality review last took place in December 2008. This showed that people mostly find the service provided in all areas to be good or excellent. Monthly visits to review the service are required by Regulation. We saw that these are being undertaken by a senior person in the organisation. The visits include talking to people about the service. Other strategies to maintain standards are in place such as audits of various areas such as medication. The AQAA was completed by the manager. Part one was very fully completed, and showed us that management are committed to maintaining a good service. The AQAA showed us that management know what they need to do better, and identified many areas where growth and development are planned to continue to benefit residents. People can feel confident that if they or their families ask the home to help them look after their personal monies, this will be done in a way that safeguards their interests. Monies checked were correct, with receipts in place for all transactions. Management at the home recognise that staff supervision is an area where improvement is needed. The manager said that staff were supervised but that this was not well recorded. Two staff surveys felt that the home could do better in providing supervision. We saw that work is in hand to address this. Staff files viewed showed that supervision agreements were in place. Staff training is planned for senior staff to enable them to provide effective supervision. A mentor tree is planned so that staff always have someone to talk to if they do not wish to go to the manager. The AQAA completed identified that systems and services are monitored and maintained. A sample of records looked at confirmed this. A partial tour of the premises showed that the home seemed well organised, and no particular health and safety issues were identified. The fire service visited the home in February this year and found everything to be in order. A local fire plan was seen to be in place. Fire records were well maintained. Systems are tested weekly, and fire drills are carried out to ensure that staff know what to do in an emergency. Care Homes for Older People Page 26 of 30 Evidence: The last environmental health officers visit in November 2008 found that very good standards of food hygiene were being maintained and awarded the home a four star rating. Some aspects of the kitchen do need improvement and this is planned. Core training is undertaken via El Box. A print out of this showed that good levels are maintained. Two staff at the home are trained to deliver the practical aspects of this training such as moving and handling and first aid. Care Homes for Older People Page 27 of 30 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 28 of 30 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 9 So that peoples medicines are managed consistently protocols for medicines prescribed as PRN should be developed. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!