Inspection on 30/07/07 for Catherine House General Nursing Home

This inspection was carried out on 30th July 2007.

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... 02/11/06

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

Catherine House General Nursing... 21/06/05

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

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

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Fairfields Country Rest Home

Poldhu

Queensmount

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Didsbury Court Rest Home

Belma

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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 Sue Burn Unannounced Inspection 30th July 2007 09:30 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 Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 2 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 DS0000003248.V342300.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Catherine House General Nursing Home Address Cork Street Frome Somerset BA11 1BR Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01373 451455 01373 455177 catherinehouse@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Limited Mrs Ann Rhoda Mary Dawes Care Home 67 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (43) of places Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. A named RMN shall be employed to manage the dementia care floor. The first floor shall accommodate exclusively people with dementia care needs. The top floor shall provide accommodation for eleven service users with personal care needs, up to five of whom may have nursing needs. No ground floor bedroom shall be used for service users whilst any of them are being used to accommodate nurses working for the company. There will be no less than two trained nurses covering the second and third floors throughout the day and evening shifts and further nurse 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. 16 February 2007 Date of last inspection Brief Description of the Service: Catherine House is a purpose built care home located in the centre of the town of Frome. The home supports three groups of service users; those needing personal care, general nursing and those with dementia care nursing needs. The first floor provides accommodation for people with dementia care needs and the second for those with general nursing needs. The third floor accommodates some people with general nursing needs and others receiving support with personal care only. All rooms are single occupancy with en-suite facilities. Each floor has its own communal space including sitting rooms, dining areas, one smoking room and adapted bathrooms. The dementia care floor has direct access to an outdoor courtyard with seating and raised beds. There is also garden access to the rear of the home that has a ramp and seating. 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, kitchen and offices are also found on this floor. The service provides an in-house laundry service. The lower floor of the service is currently used at times as staff accommodation and is not occupied by service users. Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out the inspection over 8 hours on one day. The Registered Manager provided the Commission with the required preinspection information about the home and surveys were sent to service users, relatives and visiting professionals. 17 relative surveys, 3 service users surveys and 8 professional surveys were received. This information has been included in the relevant areas of the report. On the day of the inspection 62 people were living in the home. 24 people were receiving dementia care, 32 ‘general’ nursing and 6 receiving personal care only. The current fee rates are: £440 for personal care only and £590 for nursing care. Free Nursing Care payments are charged in addition to the nursing fees. This is detailed in the home’s Statement of Purpose. The inspector spent time during the visit observing care and daily life at Catherine House, toured the building and spoke to staff, service users, relatives and a visiting professional. A range of records was inspected and the care of a selection of individuals examined in detail. Throughout the visit the atmosphere in the home was calm and relaxed. Staff interactions with service users were respectful, clear and appropriate. The activities organiser was not available but staff, particularly on the dementia care floor, spent some time during the afternoon engaging service users in social activities and conversation. Feedback received during the visit and through the surveys was positive about the home, including comments such as ‘staff are impressively gentle’ and ‘they care for me well’. An anonymised summary of the survey results was provided for the home. The Registered Manager, Ann Dawes, was available throughout the inspection and was given feedback at the end of the day. The inspector would like to thank the service users and staff for their welcome and assistance during the inspection. Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? All requirements from the last Key Inspection were met. A more specific assessment tool has been introduced for people with dementia care needs. Where call bell leads are not available a rationale is available regarding this, although needs further development (see below). All clinical rooms are now suitable for the safe storage of medicines and identified care staff have been trained to administer medicines under the supervision of the registered nurses. Menus are more readily available in written and picture form. All dining rooms tables are laid and made attractive with small flower vases. Choice is offered to all. Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 7 The malodour problem has been resolved and many areas have been, or are due to be, re-carpeted. The Registered Mental Nurse (RMN) has now completed her Preceptorship and is taking the clinical lead role for dementia care. Service users have benefited from an increase in the number of nurses on duty during the day for people with ‘general’ nursing needs. Sufficient staff have been trained in first aid. All potentially hazardous chemicals are now stored securely. 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. The summary of this inspection report can be made available in other formats on request. Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5. Standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their families are provided with sufficient information to make a choice about moving into the home. All service users are appropriately assessed before moving in to ensure that they home can meet their needs. Service users benefit from living in a purpose built home that is taking steps to meet specialist needs. EVIDENCE: The home has a comprehensive written Statement of Purpose and Service User Guide. The Service User Guide is also available in audio format, if needed. Both these documents are written in the corporate style but have been adjusted to Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 10 reflect the particular service at Catherine House. Both have recently been updated and provide all the relevant information. The home encourages people to visit the home before making any decision and move in on a trial basis of 4 weeks. The surveys sent to service users and relatives asked if they received enough information to make decisions. 2 service users said they did receive enough information and one did not. 65 of relatives always received enough information and 30 usually received enough information. All service users are assessed prior to moving into the home to ensure that their needs can be met. This information was seen on the files examined during the inspection, which also included a pre-admission draft care plan for each person. The home is purpose built, has sufficient equipment and employs adequate numbers of appropriately trained staff to provide the service detailed in the Statement of Purpose. Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are sufficiently detailed to provided staff with the necessary information to deliver the care and support needed. Service users would benefit from the further development of the care plans for person-centred social and psychological care. Service users can be assured that their healthcare needs will be met through visiting professional input and regular monitoring by staff. Medication procedures and storage are well managed. Staff provide care and support that is respectful and sensitive to the needs of the individual. Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 12 EVIDENCE: 6 care plans (2 from each floor) were examined in detail and compared with the care observed during the inspection. Each service user has a named nurse who carries out the assessments and develops and reviews the care plans. All files examined had a wide range of health needs and risk assessments documented that had been carried out and reviewed each month. Care plans were also all reviewed each month. There is a ‘client review’ sheet, which was completed for some of the service users; this should be implemented for all service users who are able and representatives where they are not. All files contained information about reviews held with relevant professionals. All service users had nutrition assessments and all records examined showed that services users had either gained weight or remained stable. Additional snacks were available and supplements were provided where required and recorded on the Medication Administration Record. All service users had pressure risk assessments and appropriate plans. These plans should include the detail of which type of hoist, sling and air mattress is to be used, where indicated. People nursed in bed had their positions changed regularly. The care plans on the dementia care floor evidenced development over the past 2 years toward a more person-centred approach, including a more detailed assessment and social profiles. They would benefit from continued development to more accurately reflect the uniqueness of the individuals, for example statements seen such as, ‘orientate him within limitations’ and ‘aggressive’ needs to have further detail to enable staff to provide an individualised and consistent approach. Information about specific triggers and therapeutic approaches for service users should be included. Generally plans contained sufficient detail to enable staff to provide an appropriate level of care. Staff spoken to understood the needs of the service user group and the care observed was consistent with the care plans seen. The documentation has a ‘terminal illness assessment’. This was not completed for all service users and the manager explained that due to the sensitivity of this further information is sought as needed. Some care plans documented decisions made about resuscitation. Both these documents should be reviewed to take account of the new legislation, the Mental Capacity Act 2005, to ensure that the individual’s wishes are accounted for and sought wherever possible. The files examined confirmed that relevant healthcare professionals were involved with service users and the GP and dentist visited during the inspection. The home has a retained GP who specialises in the care of older people and visits twice a week. Professional feedback received was positive Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 13 and included the comments ‘cope well with complex needs’ and ‘staff are very caring’. The medication records on 2 floors were sampled and the storage arrangements on all the floors were inspected. These all complied with the requirements made at the last Key Inspection. New drug fridges have been installed and a new clinical room created on the dementia care floor. Clinical rooms were clean and tidy and administration and returned medication records and storage temperature records were well maintained and reflected best practice. A list of care staff was submitted to confirm those that had now been trained and deemed competent to administered medication when delegated to do so by the registered nurses. Staff spoken to confirmed these arrangements. Creams seen in rooms had been dated on opening and the administration was recorded. Prescribed nutritional supplements were also recorded when given. 37.5 of professional surveys confirmed that the support for selfadministration of medicines or the correct administration of medication was always given, 25 stated usually and 37.5 gave no answer. None of the service users currently manage their own medication. All staff seen and heard were respectful and spoke appropriately to service users. Help was provided promptly and discreetly in a kindly manner. The 3 service user surveys received confirmed that they received the care they need and all comments received during the visit were complimentary about the staff attitudes. Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a flexible routine and social opportunities both in and outside of the home. Visitors are welcomed into the home and service users are supported to maintain contact with the local community. The opportunities for choice and control have increased and systems are being developed to support this further. Meals provided are wholesome and reflect the preferences and needs of service users. Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 15 EVIDENCE: The Activities Organiser was off sick during the inspection. The manager and a visitor commented on how much his enthusiasm was missed. It was evident from the various display boards around the home that there were regular outings into Frome and visitors confirmed that these took place. Each floor had it’s own activities programme and photo board of the trips out. Some of the service user files examined had completed social profiles, which included information from families. This is an area that the home is currently developing, supported by planned training. The manager identified this as an area for further development in the pre-inspection information as the home introduces a more individualised approach to activity. The RMN on the dementia floor confirmed that part of her role is to support carers to spend social time with service users. During the inspection staff were seen socialising with service users during the afternoon. On the dementia care floor 4 of the care staff were in the lounge discussing a magazine, offering manicures reminiscing and playing cards. The gardens were accessible and being used and all service users have access to all parts of the home, as appropriate. The atmosphere was calm and friendly throughout the home and visitors spoken to felt welcomed. One survey stated that the home is ‘welcoming to visitors’. The service user surveys confirmed that all 3 respondents could usually take part in activities. A professional survey stated that there is a ‘good activities programme’ and staff are ‘good at maintaining identity and space’. The care records examined on the dementia care floor contained a rationale for the removal of the call bell lead in bedrooms and that regular checks are made when people are in their rooms. The assessment did not reflect the individual and was based on the medical diagnosis. These should be developed to reflect the individual’s capability and take account of the Mental Capacity Act 2005. The outcome must be to promote independence and ensure safety. The mealtime experience has been improved. All dining areas were clean and pleasant set with tablecloths and small flower vases. Menus were displayed, including a pictorial menu for service users on the dementia care floor. Choices of drinks were available and jugs of water were available in all bedrooms. Lunchtime was relaxed and unhurried and those who needed it were help discreetly. Biscuits were available and homemade cake is offered in the afternoon. The cook had a good knowledge of service user preferences and was able to offer the soft and vegetarian diets needed and fresh fruit. Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 16 Consideration should be given to providing snacks that are suited to people needing a soft diet who cannot manage biscuits. The kitchen was clean and all required records were completed. The home has a corporate menu that it is altered to reflect the preferences of the service user group, who the cook stated enjoyed traditional home cooking. The company is introducing the ‘NUTMEG’ system to ensure that each person has food provided that is nutritionally balanced to their individual needs. The manager and cook have been trained in this system. The service user surveys indicated that 2 people always liked the meals and the other usually liked the meals. One relative survey commented – ‘the food looks good and is homemade’. Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and relatives can be assured that complaints are acted upon Robust systems are in place to ensure that service users are protected from the risk of abuse. EVIDENCE: The home has clear policies for whistle blowing (staff disclosures), safeguarding and complaints. The complaints procedure is detailed in The Statement of Purpose, Service User Guide and displayed in the entrance to the home. The manager was advised to get a copy of the Somerset Safeguarding policy that has been revised and issued in May 2007. CSCI have not received any complaints regarding the home since the last inspection. The home’s complaints file was examined and no recent complaints have been received by the home. The recruitment procedure is robust and staff do not start work until a POVA 1st check/Enhanced CRB check is received – staff files were seen to confirm this. Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 18 The service users’ surveys indicated that 2 people knew how to make a complaint and one person did not know. The relatives’ surveys confirmed that 76 knew how to make a complaint and 12 did not. 6 could not remember. The professional surveys stated that 87.5 felt that the home always responds appropriately to concerns raised. 12.5 felt the home usually responds to concerns. The staff training records were examined and Protection of Vulnerable Adults training is planned for January 2008. The manager confirmed in the AQAA and during the inspection that communication is considered an important issue in the home and this is reinforced in the monthly training sessions through roleplay. Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 25, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from living in a safe purpose built home, with suitable indoor and outdoor spaces. The home has developed an environment more suited to supporting people with dementia. Refurbishment is improving the surroundings. Cleanliness and infection control is well managed. EVIDENCE: All communal areas of the home were seen and a sample of bedrooms. Many areas have been re-carpeted and there is more carpeting to be done. This has had a been effective in improving the appearance of the home and in Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 20 eradicating the malodours. The majority of areas seen were fresh and clean. A number of toilets and bathrooms need new floor coverings where they have become stained and split. One shower room had suffered from leak the day before this inspection and the tiles had come off and many areas are now in need of redecoration. The manager stated that these areas would be addressed as part of the refurbishment programme and the leak had been investigated. More profiling beds have been purchased and the purchasing programme is almost complete. The home has a range of equipment and adaptations to meet service user needs. One of the relatives’ surveys asked that chairs be provided in bedrooms for visitors. Rooms seen provided an armchair for the service user. The manager should consider providing comfortable seating in bedrooms for visitors as described in Standard 24.2. The dementia care floor has been redecorated to enable service users to move around the home, find their own rooms and enjoy the stimulation of a themed room and ‘stop off’ area with seat and mural. The AQAA indicated that further development is planned over the next year. Service users have access to a safe courtyard garden with raised beds. Bedrooms were personalised and pleasant. There is also a garden at the back of the home; this is accessible by a ramp. All areas of the home were clean and staff were seen using protective equipment, as appropriate, when assisting people. Hand washing facilities were available to staff. The laundry was not inspected on this occasion but all linen seen was clean and service users’ clothes looked well cared for. One relative survey indicated that small items do go missing; another confirmed that the home is always clean and tidy. This feedback was provided anonymously for the manager. Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be assured that the home has sufficient numbers of skilled staff to meet their needs. Service users are protected by thorough recruitment procedures. The manager is committed to training and staff are encouraged to keep updated and provided with training opportunities. The induction programme is not sufficiently comprehensive to meet the standards set by ‘Skills for Care’. EVIDENCE: Rotas were examined and confirmed that additional nursing staff have been rostered since the last inspection. The manager is mostly supernumerary and 2 senior nurses have been appointed to support the manager in addition to the administrator. The RMN appointed prior to the last inspection has now completed a period of Preceptorship and is leading and developing the clinical care on the dementia care unit. The provider should consider recruiting a further RMN to support the specialist nature and continuity of this service and ensure that absences of the RMN are covered. Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 22 On the day of inspection there were sufficient staff on duty to deliver the planned care. 2 of the service user surveys stated that there is always staff available and the other stated they are usually available. 59 of the relatives’ surveys stated that the staff always have the rights skills and experience needed and 35 said usually. One comment stated that staff are professional and compassionate.’ 37.5 of the professional surveys stated that staff always have the rights skills and experience and 37.5 said usually. Comments included were that staff ‘cope well with complex needs’ and ‘more staff may enable more social activities’. 2 nurses have completed the trainer’s course for Yesterday, Today and Tomorrow, a course designed to train staff in person-centred dementia care. This training is to be cascaded to all staff starting 1 August 2007 and externally assessed. The RMN and the senior nurse managing the dementia floor are the trainers. The training records were examined and confirmed that monthly training is held for staff after the staff meeting. These are generally well attended and run by the manager. Staff complete an induction programme when they start work, which was seen on the staff files inspected. This covers a range of areas but is not competency based. The company has developed a comprehensive induction programme that is completed over 6 months. When this is implemented it will meet the standards expected. The majority of staff have completed all mandatory training, including moving and handling, food handling, fire and health and safety. 4 staff need updating in moving and handling and 5 staff have not received fire training for a year, this should be updated every 6 months. The home now has an identified trainer for Infection Control who is due to start update training with all staff. One of the senior nurses has taken responsibility for training. 79 of care staff have an NVQ qualification in care or equivalent. This exceeds the minimum standard of 50 . A number of overseas staff qualified as nurses in their country of origin. 3 recent staff records were examined and all were well organised and contained the necessary information and recruitment checks. Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35, 36, 37, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well organised and the manager is competent and pro-active in her management style. Staff are supported and supervised to carry out their work. Service users can be assured of a safe environment and that systems are in place to rectify problems. EVIDENCE: The home does manage any personal finances and makes this clear in the Statement of Purpose. Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 24 The Registered Manager, Ann Dawes has managed the home for over 5 years. The Statement of Purpose confirms that she is a Registered Nurse with qualifications and experience in management. Staff spoken with felt able to approach the manager and felt well supported. The manager also works occasional shifts assisting with nursing care to enable her to keep in touch with the work of the staff. One member of staff stated that the home had a ‘good team’ and the manager is ‘on top of things.’ Staff meetings are held monthly, followed by a training session. Records seen confirmed that these are usually well attended by most staff. Staff are issued with a copy of the General and Social Care Council code of conduct, as seen on staff files. The Statement of Purpose states that the manager sets time aside each month to meet with relatives. All 3 service user surveys answered yes to the question ‘do staff listen and act on what you say’. One professional survey stated that the home could improve some communication with relatives and another stated that the home is ‘well managed.’ A comment in a relatives’ survey stated that ‘the manager and staff are approachable.’ There were comments on both the relatives’ and professional surveys relating to language skills. The manager and staff are aware of the wide cultural experiences of the staff group and a training session was held on 30 May about English culture and language and staff are supported to attend English language classes if needed. All staff spoken to during the inspection had appropriate language skills. Staff receive regular formal supervision. Staff confirmed this and records of supervision were seen. The nurses supervise a group of care staff each and the manager supervises nurses and senior staff. During the inspection 3 sets of bedrails had gaps that could pose an entrapment risk to service users. These rails were examined during the inspection and the maintenance person changed one bed to a profiling bed and made the other sets of rails safe. The home has a policy for the safe management of bedrails and records showed that the rails are checked each month. Care records examined had risk assessments in place for the use of bed rails but did not include the risk assessment, included in the policy, of the risk to service users posed by the use of bedrails. This should be implemented and all staff should check the safety of rails each time they are used. A range of maintenance records were examined including window restrictors gas, hoists and slings, lift, waste disposal, water testing, electrical, wheelchairs and lifts. All records showed that maintenance and testing is carried out to comply with the relevant regulations and requirements. Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 25 Environmental Health inspected the kitchen on 18.1.07 and no requirements/recommendations were made. Kitchen records were up to date and the kitchen was clean and tidy. Accident records were inspected. All records were ‘signed off’ by the manager or senior nurse. The home submits Regulation 37 reports to the Commission as required, with a copy kept at the home. Moving and handling practices observed during the inspection were consistent with best practice. All records seen were very well organised and stored securely. A current Employer’s Liability Insurance certificate is displayed. Fire safety records were examined. All systems and equipment testing had been carried out. All staff have received fire safety training, however 3 staff had not been updated for a year (see Standard 30). This is required and should be carried out at least 6 monthly as recommended in the guidance ‘Fire Safety - An Employers Guide’. Record showed that fire drills are carried out regularly and include night staff. Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 X 3 3 3 4 2 Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15(1) Requirement Care plans must be further developed to provide staff with more detailed information to meet individual social and psychological needs. All staff must have training to update in fire safety and moving and handling. Timescale for action 30/11/07 2. OP30 18(1) (c)(i) 30/10/07 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. 2. 3. 4. Refer to Standard OP7 OP7 OP14 OP24 Good Practice Recommendations Care plans should include detail about the specific type of equipment used for each person. Care plans should be reviewed where decisions are made relating to resuscitation and end of life care to take account of the Mental Capacity Act 2005. The assessments for the removal of call bell leads should be further developed to reflect the individual’s capability and take account of the Mental Capacity Act 2005. The manager should consider providing comfortable DS0000003248.V342300.R01.S.doc Version 5.2 Page 28 Catherine House General Nursing Home 5. OP27 6. OP38 seating in bedrooms for visitors as described in Standard 24.2. The provider should consider recruiting a further RMN to support the specialist nature and continuity of the dementia care service and ensure that absences of the RMN are covered. All risk assessments for bed rails should be implemented as in the home’s policy and staff should check the safety of rails each time they are used. Catherine House General Nursing Home DS0000003248.V342300.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 - 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. 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