Inspection on 11/10/05 for Holy Cross Priory Nursing Unit

This inspection was carried out on 11th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Holy Cross Priory Nursing Unit 03/11/08

Holy Cross Priory Nursing Unit 29/11/06

Holy Cross Priory Nursing Unit 23/05/05

Holy Cross Priory Nursing Unit 29/09/04

Holy Cross Priory Nursing Unit 28/04/04

Holy Cross Priory Nursing Unit 30/09/03

Holy Cross Priory Nursing Unit 01/07/03

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Holy Cross Nursing Unit Cross In Hand Heathfield East Sussex TN21 OTS Lead Inspector Niki Palmer Unannounced Inspection 11th October 2005 10:15 X10015.doc Version 1.40 Page 1 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 Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 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. Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Holy Cross Nursing Unit Address Cross In Hand Heathfield East Sussex TN21 OTS 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) 01435 863764 01435 863764 The Grace and Compassion Benedictines Vacant Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That only older people requiring nursing care are to be accommodated Residents should be aged sixty five (65) years or over on admission That no more than twenty one (21) residents are accommodated Date of last inspection 23rd May 2005 Brief Description of the Service: Holy Cross Priory Nursing Unit is a purpose built extension to The Priory residential care home. It is owned by the Grace and Compassion Benedictine Society (Charitable Trust) and run by the Benedictine Sisters of our Lady Grace and Compassion, which is a Catholic order. It is situated in Cross-in-Hand, approximately three miles from Heathfield village. The unit is attached by a corridor to The Priory and is staffed and run as a completely separate home apart from the shared laundry and main kitchen. The residents enjoy a lounge and separate dining area, they can also use the facilities of The Priory if they wish. On site is a hairdressing room as well as a chapel. There are extensive attractive gardens that are accessible to residents and used when the weather permits. The Holy Cross Nursing Unit is registered to provide general nursing care for 21 residents and admits residents who are either privately funded or funded by Social Services. Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Holy Cross Nursing Unit will be referred to as ‘residents’. This unannounced inspection took place on a Tuesday between 10.15am and 4.30pm. The inspection began with discussions with the acting manager (Sister Benedicta) of the care home in respect of progress made since the last inspection, followed by the examination of five care records. In order to gather evidence on how the home is performing, individual discussions took place with four residents, whilst others commented on their care during lunchtime, the Inspector having been invited to join them for a meal. In addition, one Registered Nurse, two care staff and one visiting relative were spoken with during the visit. 20 residents were accommodated at the time of the inspection. Other areas and documentation inspected included: the home’s medication systems, policy in relation to death, dying and bereavement, the provision of food, complaints and adult protection procedures, staffing rotas, quality assurance systems and the systems in place for managing residents’ monies. What the service does well: What has improved since the last inspection? The home has worked hard since the last inspection to ensure that the vast majority of requirements and recommendations have been achieved. Preadmission assessments and care planning procedures have been improved upon to ensure that no resident is admitted to the home whose needs cannot be met and detailed risk assessments are now in place for the prevention of falls in accordance with guidance produced by the Department of Health. Quality assurance systems have been improved upon to ensure that feedback Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 Page 6 from residents, relatives and visitors to the home is sought on a regular basis. Residents confirmed that the temperature and variety of food has improved. 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. Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 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 the following standard(s): 2, 3 and 5. The home has good systems in place to assess all prospective residents to ensure that no one is admitted to the home, whose needs cannot be met. EVIDENCE: All of the residents spoken with confirmed that they had the opportunity to visit the nursing home prior to admission. Many had been admitted from the adjoining residential unit, and were therefore familiar with the surroundings and ethos of the home. In addition, each of the residents said that they had been provided with a terms and conditions of contract. This includes: details of the room to be occupied, the overall care and services that are covered by the fee, insurance arrangements, the initial four week trial period and termination of contract. All of the contracts seen had been signed by either the individual or their representative. Since the last inspection the acting manager has devised a new pre-admission assessment form. Three were seen on the day of inspection all of which were found to be very thorough and detailed. Once the assessment has been completed additional information is recorded to specify how the home intends Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 Page 9 to meet the assessed needs. It is required that this information be shared with / copied to residents prior to admission. Holy Cross Nursing Unit currently has seven prospective residents on the waiting list as priority is always given to residents from The Priory. Although the acting manager reviews the needs of those on the waiting list every three months over the telephone, no written record is kept. This is outstanding from the previous inspection report. Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 7, 8, 9 and 11. The assessed needs of residents are met by the homes care planning procedures. The systems for the administration of medication are good with clear and comprehensive arrangements being in place. EVIDENCE: Three individual care plans were seen on the day of inspection. It was pleasing to note that much time and effort has been spent on improving the care plans to ensure that they provide specific guidance to staff in order to meet the assessed needs of residents. Nursing staff spoken with said that the new preadmission assessment forms were very useful in formulating the plans of care. There was clear evidence that they were updated regularly and shared with residents. In addition, detailed risk assessments are now completed for the prevention of falls in accordance with guidelines produced by the National Institute for Clinical Excellence with preventative measures being incorporated into the care plans. Detailed action for staff to follow is recorded within care plans regarding any specialist needs such as maintaining pressure area care, continence, Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 Page 11 psychological health and nutrition. Professional advice is sought on an individual basis as and when necessary. The home’s medication systems were viewed and found to be in order. The home has updated policies and procedures in place for the use of homely remedies, controlled drugs and self-medicating. The home’s policy regarding death, dying and bereavement states that the home’s aim is to support people to die with dignity. From discussion there is clear evidence that staff support residents who are terminally ill with care and sensitivity with the needs and preferences of residents and their relatives taken into account where possible. A recommendation has been made for the home to consider devising an information leaflet that can be provided to residents / relatives in order to help support them in planning for and dealing with dying and death. Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 14 and 15. The home needs to consider ways in which personal autonomy and choice can be promoted in relation to daily routines within the home. All residents receive a varied, wholesome and nutritious diet. EVIDENCE: All of the residents spoken with said that they felt their views and opinions were respected by the home at all times. During lunchtime however, it emerged through discussion that the home operates a daily bathing rota. This means that each resident has a set day for his or her weekly bath. Although each of the residents spoken with said that this suited them, with one resident saying ‘you fall into the routine’, a recommendation has been made for the home to consider ways in which baths / shower times could be made more flexible. Since the last inspection the home has purchased a new ‘hostess’ trolley to keep the food hot, between it leaving the kitchen and being served. In addition, all of the residents spoken with said that the choice and variety of food has improved. Daily menus are on display in the dining room area. Each day, a vegetarian alternative is offered in addition to the main meat dish. On the day of the inspection, a vegetarian option was provided. It was found to be hot, tasty and nutritious. During the lunchtime, one of the residents Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 Page 13 commented on the fact that only ‘normal’ cutlery was available, which was found quite difficult to use. This was discussed in detail with the acting manager and a requirement made. Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 16 and 18. The home needs to ensure that up to date written policies and procedures are in place to safeguard residents from harm. EVIDENCE: The home has a detailed policy and procedure in place to ensure that all complaints will be dealt with appropriately by the home. It needs to provide details of the how the CSCI can be contacted at anytime during the investigation. No complaints have been made to either the home or the CSCI since the last inspection. The home’s adult protection policy and procedure was updated in August 2005. It provides staff with clear guidance and advice regarding PoVA – the protection of vulnerable adults, however it needs to be amended in accordance with local multi-agency guidelines to state that Social Services are now the lead agency. Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 Page 15 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 the following standard(s): 19, 21 and 26. Holy Cross Nursing Unit provides residents with a warm, comfortable and homely place to live. EVIDENCE: Holy Cross Nursing Unit employs a maintenance person to ensure that all areas of the home are maintained and kept safe. Since the last inspection the home has consulted an Occupational Therapist to carry out a risk assessment of the kitchenette area. New cupboards, work surfaces and units are to be replaced in due course. It is recommended that the dining are be refurnished with domestic style curtains, chairs and tablecloths. The home comprises of 20 wheelchair accessible bedrooms, eight of which, have en-suite facilities. There are six communal toilets, two large bathrooms and two separate sluicing areas. All areas were found to be clean and wellmaintained throughout. Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 28. This home employs adequate numbers of staff to meet the assessed needs of residents. EVIDENCE: The Nursing Unit employs a total of eight Registered Nurses and 13 care assistants, six of which are trained to at least NVQ level 2 in care. Through the examination of staffing rotas and in discussion with residents, staff and visitors it was confirmed that there are usually enough staff on shift to meet the needs of the residents, however many commented that ‘they could always do with an extra pair of hands’. On the day of inspection, one Registered Nurse and care assistant were off work due to ill health. The additional hours were being covered by regular agency staff who are familiar with the home. Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 37. Holy Cross Nursing Unit has made good progress to ensure that adequate management and administration systems are in place. Much work has been carried out to seek the views of residents and relatives. EVIDENCE: Since the last inspection an application for a Registered Manager of the home has been received by the CSCI and is in progress. It was pleasing to note that all of the residents, staff and visitors to the home found the acting manager to be ‘competent’ and have a ‘wonderful rapport with her residents and staff’. This was evident throughout the day of the inspection. In response to a requirement made in the previous inspection report, the home has worked hard to ensure that feedback from residents, relatives and visitors to the home is sought on a regular basis. 30 anonymous questionnaires were given to people, 27 of which were completed and returned to the acting Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 Page 18 manager. The results have been published in an easy to read format-covering areas in choice, meeting needs, staffing, protection, environment and management of the home. All responses were positive. On admission all residents and their relatives are given the choice for the home to hold a ‘pocket money’ account for small day to day items such as: toiletries and hairdressing. All residents have their own account book and all items paid are detailed within the books and covered by receipts. All accounts are audited every six months. Since the last inspection, six Registered Nurses have attended certified training on supervision, which was facilitated by an external training agency. Feedback from nursing staff spoken with on the day of inspection was positive. Clear supervision structures are now in place and happening on a regular basis. Care assistants spoken with, also commented on the fact that they found the allocated time for supervision useful. A recommendation has been made for care staff to contribute towards to the care planning process. This could be achieved during supervision. In response to a recommendation made at the last inspection, the home has removed the list of National Minimum Standards from its business plan. All residents and staff spoken with said that they were aware of their right to access the most recent inspection report in order to see how the home is performing. Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X 3 X X X X 3 STAFFING Standard No Score 27 3 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 X Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? YES 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 OP3 Regulation 14(1)(d) Requirement It is required that the acting manager confirm in writing to prospective residents how their assessed needs can be met by the home. It is required that prospective residents who are placed on the waiting list have their needs reviewed regularly. This must be recorded [OUTSTANDING FROM PREVIOUS INSPECTION]. It is required for the home to purchase additional cutlery / adaptations for residents to use who may have additional needs. It is required that the complaints procedure is amended to include details of how the CSCI can be contacted at anytime during the investigation. It is required that the adult protection procedure is amended in accordance with local multiagency guidelines. This must state that Social Services are now the lead agency and provide contact details. Timescale for action 11/10/05 2. OP3 14(2)(a) (b) 11/10/05 3. OP15 12(1) 23(2)(n) 22(6)(7) (a)(b) 11/12/05 4. OP16 11/12/05 5. OP18 12(1)(a) 13(6) 11/12/05 Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 Page 21 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. Refer to Standard OP9 OP11 Good Practice Recommendations It is recommended that the home consider using a medicines monitored dosage system. It is recommended that the home consider devising an information leaflet that can be provided to residents / relatives in order to help support them in planning for and dealing with death, dying and bereavement. It is recommended that the home consider ways in which bath / shower times could be made more flexible for residents. It is recommended that a copy of the complaints policy and procedure is included within the complaints folder. It is recommended that the dining area be refurnished with domestic style curtains, tablecloths and chairs. It is recommended that 50 of care staff are trained to NVQ level 2 in care by December 2005. It is recommended that allocated time be set-aside during supervision for care staff to contribute towards the care planning process. 3. 4. 5. 6. 7. OP14 OP16 OP19 OP28 OP36 Holy Cross Nursing Unit DS0000014001.V254227.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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. 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