Inspection on 21/06/05 for Catherine House General Nursing Home

This inspection was carried out on 21st June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Catherine House General Nursing... 30/07/07

Catherine House General Nursing... 02/11/06

Catherine House General Nursing... 13/12/05

Catherine House General Nursing... 18/01/05

Catherine House General Nursing... 05/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Catherine House General Nursing Home Cork Street Frome Somerset BA11 1BR Lead Inspector Justine Button Unannounced 21 June 2005 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Catherine House General Nursing Home D53 - D02 S3248 Catherine House V230890 210605 Stage 2.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Catherine House General Nursing Home Address Cork Street Frome Somerset BA11 1BR 01373 451455 01373 455177 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Healthcare Services Limited Mrs Ann Rhoda Mary Dawes Care home with nursing 67 Category(ies) of Dementia - over 65 (24) registration, with number Old Age (43) of places Catherine House General Nursing Home D53 - D02 S3248 Catherine House V230890 210605 Stage 2.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. A named RMN shall be employed to manage the dementia care floor. The first floor shall accommodate exclusively people with dementia care needs. 2. The top floor shall provide accommodation for eleven service users with personal care needs, up to 5 of whom may have nursing needs. 3. No ground floor bedroom shall be used for service users whilst any of them are being used to accommodate nurses working for the company. 4. There will be no less than two trained nurses covering the second and third floors throughout the day and evening shifts and a further nurse on duty on the dementia care floor. There will be no less than two trained nurses on the night shifts, one on the dementia care floor and one on floors two/three. Date of last inspection 18 January 2005 Brief Description of the Service: Catherine House is a purpose built service located in the centre of the town of Frome. The service supports three groups of service users; those needing personal care, general nursing and those with dementia care nursing needs. These three groups are accommodated in separate units although Southern Cross Healthcare has recently increased the number of service users who require nursing care. These service users will be accommodated on the upper floor thus reducing the number of service users with personal care needs. All rooms are single occupancy with en-suite facilities. Each floor has it’s own communal space including sitting, dining and adapted bathrooms. In addition to this there is a large room on the ground floor, which is used, for social events, meetings and staff training. The reception and office are also found on this floor. The service provides in house laundry. The lower floor of the service is currently used as staff accommodation. Catherine House General Nursing Home D53 - D02 S3248 Catherine House V230890 210605 Stage 2.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector conducted this unannounced inspection over the course of one day. The inspector was able to speak with a large number of the residents as well as staff on duty. The manager Mrs Ann Dawes was available on the day of inspection. The inspector would like to thank the residents and staff for their time and hospitality shown to the inspector during their visit. This is the first inspection using the new CSCI reporting format, which focuses on outcome statements for National Minimum Standards. The inspector’s aim on this inspection visit was to seek views on the quality of the service from as many service users as possible and to speak to staff. A number of requirements were made at the last inspection. The inspection also focused on the work completed in achieving these shortfalls. Records examined were care plans, medication records, staff training & recruitment files. Other records will be examined at subsequent inspection visits. A tour of the building was carried out on this visit. What the service does well: What has improved since the last inspection? The provision of activities has improved since the last inspection with people who were able to give an opinion stating that there is more to do than previously. Catherine House General Nursing Home D53 - D02 S3248 Catherine House V230890 210605 Stage 2.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Catherine House General Nursing Home D53 - D02 S3248 Catherine House V230890 210605 Stage 2.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Catherine House General Nursing Home D53 - D02 S3248 Catherine House V230890 210605 Stage 0.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed on this occasion. EVIDENCE: Catherine House General Nursing Home D53 - D02 S3248 Catherine House V230890 210605 Stage 0.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 Care planning has improved; care must be taken to ensure clear guidance is given to staff on all occasions. The home must continue trying to achieve more service user involvement. Medications management was safe and well organised. Service users are treated thoughtfully, with respect and are well cared for if very frail or very ill. EVIDENCE: Care plans were sampled, personal details and contacts were recorded. Service users had recorded care needs assessments and subsequent reviews of care. The plans of care related to the care given for people who live at the service (case tracking) There was evidence in the care plans of input by the community health care professionals such as the chiropodist, dentist, optician and continence advisor. Out patient appointments and GP visits were recorded and care plans had been reviewed. Staff need to avoid ambiguous statements in the care plans. Statements seen included “ensure adequate fluids or turn regularly”. The plans of care need to be specific e.g. how much fluid or how frequently the person needs support to change position. The registered nurses Catherine House General Nursing Home D53 - D02 S3248 Catherine House V230890 210605 Stage 0.doc Version 1.30 Page 10 need to ensure that the use of medical terminology is avoided. Both of these measures will ensure that clear guidance is given to care staff. Pressure relieving equipment was seen in use and all manual handling was risk assessed for the individual service users in their care plans. Medications management was sampled on the middle floor, these were of a good standard. The home is using a community based pharmacy service, which was reported to be very helpful. Specific conditions where blood tests are required are monitored by the pharmacy service and tests are prompted. Service users all spoke positively of the care they receive from the staff at the home. Staff were seen knocking on bedroom doors. Catherine House General Nursing Home D53 - D02 S3248 Catherine House V230890 210605 Stage 0.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 The inspectors observed good practice and visitors were made welcome. The home’s ethos supports choice, independence and values the individual. The catering was good. EVIDENCE: Service users spoke highly of their freedom and choices in daily life. One person reported that they sometimes feel bored. Activities are offered and are led by the activities coordinator. The range of activities on offer appears to have improved since previous inspections. Activities for the week were on display in the hallway. These included games bingo, Holy Communion; sing along, domino club and listening to classical music. As the activities programme is on display in the hallway it could not be evidenced how people who spend time in their bedrooms or are immobile are informed of the opportunities that are on offer. Activities for people with dementia need to be developed further. Visitors were seen and all said that they felt welcomed. Satisfaction with the care of their relatives was expressed. Comments about the food from those who were asked included ‘food is good’. Lunch was observed and was seen nicely served at well-presented tables. The menu looked appetising, lamb hotpot or baked ham served with parsley Catherine House General Nursing Home D53 - D02 S3248 Catherine House V230890 210605 Stage 0.doc Version 1.30 Page 12 potatoes and a choice of vegetables was served. A choice of desserts was then offered. Hot drinks are served between meals with biscuits; homemade cakes are served with afternoon tea although on the day of inspection ice cream cones were offered, as the weather was warm. The people who had them enjoyed these. A choice of fish pie or sandwiches were available in the evening. Catherine House General Nursing Home D53 - D02 S3248 Catherine House V230890 210605 Stage 0.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Complaints are dealt with appropriately. Although no incidents of abuse have been reported. It could not be confirmed if service users are protected to the fullest extent. EVIDENCE: The complaints log was viewed during the inspection. No complaints has been received since the last inspection. Service users are not protected from abuse to the fullest extent as staff recruitment is not robust (see standards on staffing). Catherine House General Nursing Home D53 - D02 S3248 Catherine House V230890 210605 Stage 0.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25, 26. The service is well maintained. The environment is clean, tidy and odour free in most areas. The service is appropriate for it’s purpose with the majority of specialist equipment available. All of rooms are single occupancy. There are adequate bathing and toilet facilities. EVIDENCE: A tour of the building was conducted. The majority of areas were clean, tidy and smelt fresh. The bedrooms are for single occupancy all having en-suite facilities. People spoken to during the inspection stated that they were happy with their rooms and that they were able to bring in personal possessions if they wished. Specialist equipment is available with the exception of adjustable beds. This may compromise the flexibility for the service user and the safety for staff in terms of moving & handling practices. Following requirements from previous inspection an action plan was developed to replace the existing beds with Catherine House General Nursing Home D53 - D02 S3248 Catherine House V230890 210605 Stage 0.doc Version 1.30 Page 15 those, which are more suitable. This agreement has not been adhered to. Southern Cross intended to replace the beds at a frequency of one per month. Given the number of service users accommodated at Catherine House this will take a period of approximately four years. It is recommended that the frequency that the beds are purchased be reviewed. There are adequate numbers of bathrooms all of which are adapted for the needs of the people who live at the service. There is a lounge/dining area on each floor and also a large room on the ground floor, which is used, for social events, meetings and staff training. These rooms are appropriately furnished and decorated. They were well lit. Some carpets are in need of replacement. The manager stated that there was a planned programme of replacement. Adequate systems are in place for the control of infection. Catherine House General Nursing Home D53 - D02 S3248 Catherine House V230890 210605 Stage 0.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 The home has a dedicated core staff team. There are sufficient numbers of staff on duty. It could not be confirmed if all staff have undertaken the necessary training in order to meet the needs of the people who live at the service. The homes recruitment practises are not robust. EVIDENCE: Rotas were examined for the 2 weeks worked prior to the inspection. This has been compared with the previous Somerset Health Authority staffing requirements. The rotas showed that Catherine House currently provides an adequate amount of staff hours to meet the needs of the service user group including domestic staff. Staff stated that they felt that the dependency levels within the home were currently high. Service users confirmed that staff were often very busy but they received good care and support. The management stated that only a small amount of agency staff have recently been used to supplement the existing staff group since staff have been recruited from overseas. It is advised that recruitment efforts continue particularly with regard to Registered mental health nurses for the dementia care floor to support the named RMN who leads the team. The staff-training matrix was viewed on the day of inspection. This demonstrated that all staff had received all mandatory training. The training files for the registered nurses were not viewed on this occasion so it was not confirmed what additional training they had been undertaken. This is required for them to maintain their registration as specified by the Nursing and Catherine House General Nursing Home D53 - D02 S3248 Catherine House V230890 210605 Stage 0.doc Version 1.30 Page 17 Midwifery Council (NMC). A staff induction programme is available which meets good practise guidelines. This programme is not always used in the first instance. A Shorter induction is used initially. It could not be confirmed if staff received adequate supernumerary time prior to commencing “hands on work”. This time remains at two days and this may not be adequate particularly for those staff who have no prior knowledge or experience of working within the care industry or for those staff who have been recruited from overseas were there may be cultural or language differences. Staff recruitment files for new staff were viewed. It could not be confirmed if two people out of the four files viewed had received Criminal Record Bureau or POVA checks prior to commencing work. Catherine House General Nursing Home D53 - D02 S3248 Catherine House V230890 210605 Stage 0.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35 This home generally has good occupancy rates. Service users speak well of the care and service they receive. Records are well managed and are stored securely. The home is well managed. EVIDENCE: Staff and people who live at the service all stated that they thought the service was well managed. Staff stated that they were well supported. All parties stated that they would feel confident in taking any concerns to Mrs Dawes. People who live at the service are able to keep small amounts of money in the office for safe keeping if they wish. The systems for managing this aspect were viewed. The monies are kept individually. The documentation supporting these monies is in line with good practise and was well managed. The fire safety log and hoist servicing records were viewed. These were in line with good practise. Catherine House General Nursing Home D53 - D02 S3248 Catherine House V230890 210605 Stage 0.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 3 2 3 3 3 1 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 X 3 3 3 3 x 3 x x x Catherine House General Nursing Home D53 - D02 S3248 Catherine House V230890 210605 Stage 0.doc Version 1.30 Page 20 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP24 Regulation 16(2)(c) Requirement The Registered Person must undertake a risk assessment for the provision of adjustable beds and devise an action plan as to how these are to be provided. It is required that all new staff have a Criminal Records Bureau and POVA check prior to commencing employment Timescale for action 30/08/05 2 OP29 Schedule 2 For all new staff with immediate effect. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that the service user plans be reviewed to ensure that clear guidance is given to the care staff. Ambiguous and medically based terminology should be removed. Staff need to ensure that people are supported to make choices particularly with regard to TV and radio programmes. That the activities programme continues to be developed particularly for those people with dementia. That some of the carpets are replaced particularly those which are stained and cannot be cleaned adequately. D53 - D02 S3248 Catherine House V230890 210605 Stage 0.doc Version 1.30 Page 21 2 3 4 OP14 OP12 OP20 Catherine House General Nursing Home 5 OP28 That the supernumerary time given to staff on induction be increased from the current two days. Catherine House General Nursing Home D53 - D02 S3248 Catherine House V230890 210605 Stage 0.doc Version 1.30 Page 22 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Catherine House General Nursing Home D53 - D02 S3248 Catherine House V230890 210605 Stage 0.doc Version 1.30 Page 23 - 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. 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