CARE HOMES FOR OLDER PEOPLE
Nazareth House Liverpool Road Crosby Liverpool Merseyside L23 0QT Lead Inspector
Mrs Trish Thomas and Lorraine Farrar Unannounced Inspection 22nd February 2006 10:10 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 Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 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. Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Nazareth House Address Liverpool Road Crosby Liverpool Merseyside L23 0QT 0151 928 3254 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) Sisters of Nazareth Sister Joseph Veronica Crowe Care Home 66 Category(ies) of Old age, not falling within any other category registration, with number (66) of places Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 66 OP. The service should, at all times, employ a suitably qualified and experienced Manager who is registered with the CSCI. 30/09/05 Date of last inspection Brief Description of the Service: Nazareth House is a care home for older people owned by the Sisters of Nazareth. The ethos of the home is rooted in Catholicism and there is an integral chapel with daily Mass, which residents may choose to attend. The religious beliefs of service users of all denominations are respected and supported in the home. The manager is Sister Joseph, who has many years experience in health care and service to the community. The home accommodates 66 residents and to ensure a homely and personalised service, the accommodation is divided into three self-contained floors or units. Each unit is individually managed by nominated senior staff, under the supervision of Sister Joseph, who has ultimate responsibility for the day-to-day management of the home. Residents are provided with home cooked meals, accommodation and personal care. The service provides residential care and is supported by visiting general practitioners, community nurses and paramedical services. Nazareth House was built at the beginning of the last century and the general style of the interior reflects this period. Nazareth House is furnished in a homely and comfortable way and there was a relaxed atmosphere during the inspection. Meals are cooked on the premises and served in one of the dining rooms on each unit, or in residents’ bedrooms, if they prefer. The home also provides a laundry service, carried out on the premises. To accommodate the home’s purpose and function, there are two passenger lifts, a nurse call system throughout, a ramp and individual adaptations in accordance with the needs of service users. The home is situated on the main Liverpool to Southport Road with close links by public transport and nearby shops, a cinema, local churches, and a wealth of local community amenities. A number of in-house social events take place, and day-to-day activities. Outings are arranged when Service Users are escorted by staff, or some prefer to go out alone or with family and friends. The home is set in extensive grounds with car park. The gardens are pleasant and well maintained, and views of the garden from the house enhance the general environment and character of the premises. Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was carried out by two inspectors. The methods used included discussion with residents and staff. Also, tours of the top and ground floors were carried out, and records relating to care, medication, health & safety and staffing were read. What the service does well: What has improved since the last inspection?
Care plans were written in appropriate language, respectful of residents’ dignity. To protect residents from risk of scalding, submersible water temperatures are maintained at 43 degrees. An electrical fault on fire doors has been repaired Measures have been taken to ensure that residents do not become mal nourished or dehydrated, and that their health and welfare is monitored. Food and fluid intake is recorded for residents who are frail and have weight loss, and the G.P. referred to, if weight loss continues. Staff training is in accordance with the presenting needs of those in residence and some staff have received training in dementia care. Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 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. Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 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 Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 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): 3,4 The home has an admissions procedure, which includes an assessment of needs being carried out prior to admission. Variations were not in place for residents who have dementia. EVIDENCE: The unit manager of the ground floor explained that prospective residents (or their representatives) complete an application form. A Senior member of staff will visit and carry out an assessment of their needs. If the person does not move in within the next two of months then an updated assessment is carried out. Records for a recently admitted resident contained a copy of the application and a detailed assessment, completed before moving into the home. This stated support needs and preferences. This resident confirmed that staff had visited her at home before she moved in to Nazareth House. Standard 4 was not fully assessed during this inspection. However the home is registered to provide care for older people, not falling within any other category of care needs. The home is currently supporting two people (on the
Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 Page 9 ground floor), who require additional care as they have dementia. Records were read, and some staff have received training in this area. A clear care plan was in place for one resident who has dementia. The manager should apply to the Commission for Social Care Inspection (CSCI) to vary their conditions of registration for these residents. Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 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 10 Residents are satisfied with the care and support provided by the staff team and staff were seen to respond quickly and positively to requests for assistance. Some care plans did not fully evidence the care and support required for the individual. The home supports residents to access medical and paramedical services. Some health care assessments were out of date. The home has a procedure for management of prescribed medication. Variations to the system were observed between the two floors. In general, residents’ rights to privacy and dignity are respected by staff in their approach and care giving. A shortfall was noted regarding support for continence. EVIDENCE: Individual care files are in place for all residents. On the ground floor, the care plan for one resident who has a high level of care needs was read. This was written in appropriate language and gave some detailed information about the resident’s needs and personal preferences. The plan recorded that the resident likes to listen to classical music and prefers brown sauce with meals. On a visit to the resident’s bedroom, it was observed that staff are following this plan of care by providing both of these preferences. Care plans were also in place for meeting the residents’ safety, personal care, health, medication,
Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 Page 11 communication, daily living, religious and mobility needs. The home uses some ‘core-care plans’ these are pre-printed documents, which identify a need and list the care that should be provided. The manager should ensure that all of the information in these plans is relevant to the individual, and updated as needed. This will ensure that the resident is receiving the care needed, based on individual circumstances. Records showed that staff work well with healthcare professionals and make referrals for residents when needed. These include regular health checks such as access to an optician and district nurse / GP, when required. Clear records are kept of dressings and checks on skin breaks. Some assessments are in place for monitoring the residents’ health, including pressure area assessments and monthly weight monitoring. Not all had been reviewed and updated monthly, which could lead to a change in health needs being over-looked. Good practice was noted in that a key-worker is assigned to each resident and they carry out an overall review of the care plan monthly. There is space in the plan for residents or their representatives to sign their agreement to their plan however not all of these had been completed. The home should offer all residents regular opportunities to discuss and agree their plan of care. Not all plans, which were read, contained a consistent level of detail. Some plans, particularly for more independent residents, did not contain the level of detail needed to support the resident effectively. The manager should arrange for a review of the format in use for more independent residents, to ensure it contains plans towards meeting all assessed needs. Medication is stored on each of the three floors, and was checked on the ground floor and the top floor. There is an established medication policy and records show that staff who administer medication, have received training. Medication on the ground floor was stored correctly and records were, in general, well maintained. A member of staff spoken with advised that when medication is received into the home, it is checked and counted, but no record is maintained. In order to provide a clear system for checking and auditing medication, the home must set up a system for recording all medication, including that in blister packs, which is received into the home. On the top floor, gaps were observed on medication administration records, and staff were advised that in instances such as, refusal of medication, or if the resident is in hospital/on holiday, the relevant code must be inserted for the time of the non-administered dose. In this way, an accurate audit of medication administered/returned to the pharmacy, will be maintained. A storage system, consisting of plastic boxes, for individual residents’ medication, has been set up on the top floor. Because, in some instances, the pharmacy containers did not fit into the relevant plastic box, blisters (strips of
Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 Page 12 tablets) had been removed from their original pharmacy containers. Medication must be administered only from the pharmacy container, which provides details of the drug, the dose, the time and the resident’s full name. Residents spoken with said they are happy with the care they receive with one stating, “If I had to choose where to spend the last years of my life it would be here”. Throughout the inspection staff were seen to talk quietly and respectfully to residents and take the time to listen to them. One resident confirmed that they never have to wait to long when they ask for help and explained, “I can find no faults, we are waited on hand and foot”. Personal care was provided in private with staff seen to knock on residents’ doors before entering. On the top floor, continence covers were observed on some of the residents’ chairs. Staff were advised that support for continence should be provided discreetly and in a way which respects the individual’s privacy and dignity. Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 Page 13 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): 12,13,14,15 The home provides arranged activities each day and ensures that meal times are sociable occasions with discreet support provided where needed. Residents maintain contact with family, friends and the local community and are supported in exercising choice and control over their lives. EVIDENCE: A resident explained, “There is some kind of activity every morning”, and that this includes, painting and quizzes. For those of the catholic faith, there is the opportunity to attend Mass every day in the home’s chapel. There is a wellstocked library with large print books and communal areas and bedrooms on each floor, have televisions and music systems as preferred. Three residents said that their families visit them. “No-one bothers you, staff leave you in peace when visitors come and I do as I please. If I don’t want to join in, I just say ‘No’.” Students from a nearby college call in regularly to chat with residents and play the piano. The home has a main kitchen and each unit has a serving area, stocked with drinks and snacks. A resident said, The food is very good, there is always a choice”. Each unit has a member of staff employed to work in the serving area at busy times. The dining areas are pleasantly decorated and staff take time to prepare the room with well presented tables, drinks, menus and
Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 Page 14 condiments. On the day of the inspection the lunchtime meal being served, homemade leek soup, roast chicken or minced beef, assorted vegetables and two choices of potatoes, with rice or fruit for dessert. In the evening there is a choice of a hot meal, salad or sandwiches, which are freshly made on each of the three units. Staff are assigned to support people who need help with their meals and this is provided discreetly and in accordance with their persons choices. The kitchen and food storage areas were visited. Five members of staff were assisting the chef. Their duties include food preparation and cleaning. Food stocks were high and storage of fresh, dry, frozen and chilled foods was satisfactory. There are choices of hot and cold drinks and cereals for residents. Fresh fruit and vegetables were in evidence. Menus are regularly reviewed and residents said the food is, ”Always good with plenty of variety.” The chef said that menus are taken to the dining rooms daily and alternatives are offered, as residents prefer. Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 Page 15 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): Not assessed EVIDENCE: Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 Page 16 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): 19,26 The building is vast and maintenance and refurbishment programmes are ongoing. The home is maintained to very good standards of hygiene and systems for infection control are in place. EVIDENCE: The top and ground floors were visited by inspectors. Office spaces on all floors have been improved. New furnishings have been provided in lounges. A new call system has recently been fitted throughout the home for residents’ convenience and safety. Care staff carry a pager which displays the number of the room calling. Staff said that he two main advantages to the system are, it is a lot quieter than the previous system, (which could be heard throughout the home) and a print out is given, of all the calls made, and the time taken to answer them. The home employs domestic staff, who are provided with protective clothing. The building is very clean and well organised whilst maintaining a homely atmosphere on each unit. The laundry is carried out in a separate building.
Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 Page 17 The kitchen and storage areas were visited and were well equipped and maintained to a very good standard of hygiene. Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 Page 18 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, 29 The numbers of staff on duty were meeting the needs of residents and they are skilled in their roles, due to levels of training available. The home’s recruitment procedure, policies and practices are aimed at protecting residents. EVIDENCE: The staff roster for the ground floor was read and demonstrated that staffing levels are maintained in that area. Two residents on the ground floor said that they feel there are enough staff working in the home. They explained that when they press for assistance, they never have to wait long and described the staff team as “smashing”. Each unit has a unit manager a deputy unit manager and care staff. In addition to which extra staff are employed to work in the unit kitchens to help out at busy time. The home also employs staff for the main kitchen, laundry, administration, maintenance, and to support residents with activities. During the inspection staff, although busy, were not rushed and always took the time to talk with residents and respond to requests positively. The home has a recruitment procedure which is based on protection of residents through staff vetting. Two staff files were inspected and contained the information required under schedule 2 Care Home Regulations. In accordance with confidentiality procedures, staff files are secured in the main office and were made available on request.
Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 Page 19 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): 33, 35, 38 The home has a quality assurance system, and residents are consulted as to decisions, which will affect them. Residents’ financial interests are safeguarded through the home’s policies. The home has systems in place to promote and protect the health, safety and welfare of residents. Procedures had not been followed with regards to the requirement for weekly fire alarm systems tests. EVIDENCE: The home has established an annual quality assurance assessment carried out by an external organisation. The exercise involves obtaining the opinions of residents against a range of service indicators. Staff said that the home does not become involved in residents’ personal finances. Records of personal allowances are maintained and receipts retained for purchases.
Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 Page 20 Records of fire safety checks were read. There had been a fairly recent fire drill, (on 17/11/05) and fire safety training had been attended on 1/2/06. The weekly alarm systems tests were last recorded on 2/2/06, three weeks previously. These tests are required to be carried out at weekly intervals. Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 Page 21 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 X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 2 Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 Page 22 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 Requirement The manager must arrange for all core-care plans to be reviewed and altered as needed, to reflect the individuals support needs. The manager must instruct staff that all care plan assessments are updated at least once a month. The manager must arrange for residents or their representatives to have the opportunity to read, agree and sign their care plan. The manager must introduce a system for recording all medication received into the home. The manager must ensure that a record is maintained of all unused medication, prior to disposal. The manager must instruct staff that they are to administer prescribed medication only from pharmacy containers. The manager must arrange training updates for staff in medication management. The manager must instruct staff
DS0000005384.V285084.R01.S.doc Timescale for action 22/05/06 2. OP7 15 22/05/06 3. OP7 15 22/05/06 4. OP9 13 22/05/06 5. OP9 13 22/05/06 6. OP9 13 22/05/06 7. 8. OP9 OP9 13 13 22/05/06 22/05/06
Page 23 Nazareth House Version 5.1 9. OP38 23 that they are not to leave gaps in medication administration records. Codes must be inserted as needed. The manager must ensure that fire alarm systems tests are carried out weekly. 23/03/06 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. Refer to Standard OP4 OP10 OP7 Good Practice Recommendations The manager should apply for Variations to registration for two named residents. The manager should ensure that support for residents’ continence is provided discreetly. The manager should arrange for a review of the care plan system in use for more independent residents. Nazareth House DS0000005384.V285084.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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