Inspection on 05/03/09 for Nazareth House

This inspection was carried out on 5th March 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nazareth House 26/04/10

Nazareth House 25/10/06

Nazareth House 24/01/06

Nazareth House 27/07/05

Nazareth House 24/02/05

Nazareth House 21/09/04

Nazareth House 18/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

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Didsbury Court Rest Home

Belma

Hunters Care Centre

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Nazareth House Durnford Street Stonehouse Plymouth Devon PL1 3QR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Antonia Reynolds     Date: 1 9 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Nazareth House Durnford Street Stonehouse Plymouth Devon PL1 3QR 01752660943 01752256842 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Congregation of the Sisters of Nazareth care home 42 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Service users may include up to 17 older people with nursing needs, accommodated in designated rooms. Date of last inspection Brief description of the care home Nazareth House is a care home providing accommodation, nursing and personal care for a maximum of forty-two older people, seventeen of whom need nursing care. The home is owned by The Congregation of the Sisters of Nazareth. In March 2009 the fee levels ranged from 440 pounds to 610 pounds per week, however these may vary depending on the individual needs of each person. The home is a purpose-built, twostorey, detached building situated in large grounds in the residential area of Stonehouse, approximately a mile from Plymouth city centre. The home is within Care Homes for Older People Page 4 of 29 Over 65 42 0 Brief description of the care home walking distance of local shops, a church, the bus stop and the railway station is easily reached by public transport. The home has thirty-nine single bedrooms, thirty-five of which have en suite toilets; there is a one-person flat with a bedroom, lounge room and bathroom; and one shared room with an en-suite toilet. The 1st floor of the home can be reached by stairs or by using the shaft lift. Communal rooms are on both floors and consist of two lounges and two dining rooms, as well as a large reception area and a chapel. The home has extensive grounds and gardens with access to the sea front and many rooms in the home have good views over Plymouth Sound. The home has its own transport so is able to offer trips into town, as well as further afield, and a small shop is open daily within the foyer of the home. The home has plenty of parking space inside the grounds and there is on street parking available outside, although a permit is required to park there at certain times. Information about the home, including copies of inspection reports, can be obtained from the Registered Manager, Alison Hart. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection consisted of an unannounced visit to the home by one inspector between 10am and 4.30pm on Thursday, 5th March 2009, and the inspector was accompanied by an Expert by Experience. A further announced visit took place between 11.55am and 1.15pm on Thursday, 19th March 2009. We last inspected this service on the 25th October 2006. A thematic inspection focussing on the protection of vulnerable people took place on 13th May 2008. Throughout this report, the term we will be used as the report is written on behalf of the Commission for Social Care Inspection. An Annual Quality Assurance Assessment (AQAA) was completed by the home prior to the inspection. The AQAA is a self-assessment that focusses on how well outcomes are met for the people who live in the home. A tour of the premises took place and records relating to care, staff and the home were inspected. Care Homes for Older People Page 6 of 29 Ten people living in the home were spoken with during the visit and twelve surveys were returned from them. Three survey forms were received from relatives. Six staff members were spoken with and ten surveys were received from staff. Two surveys were received from health and social care professionals. The Registered Manager was available for consultation and discussion during the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: The records in the home showed that, when medication has been administered, or not administered, to the people who live there, they are not always being completed accurately. Staff are meant to sign the medication administration records on every occasion when medication is administered to the people who live in the home, or Care Homes for Older People Page 8 of 29 document a reason as to why it has not been administered, but this was not happening and needs to be improved. This is so that there is an accurate record of when people have their medication, or when it has not been administered for any reason, to ensure that people are given the correct medication at the required times. Each person living in the home has a care plan saying what their care needs are, however these were not always being updated as peoples needs changed. To ensure that all care needs are met in a consistent way by the staff team, the care plans should be updated when changes occur. Appropriate action should be taken whenever a significant weight loss is recorded, even if that action is to re-weigh the person concerned, to ensure that appropriate action is taken to address any health needs. Also, all records should contain the actual date that events take place, rather than just the month, so that the timescales between events happening are clear. At the time of inspection the staff in the home were using two different sets of records for recording daily events. It would be useful to amalgamate these daily records so that there is a continuous, chronological history of the persons care rather than information being contained in two different documents. The Registered Manager needs to review the staffing arrangements when staff go on holiday or are off sick because there should be enough staff on duty at all times to meet the physical, psychological, emotional and social needs of the people who live in the home. Consideration should be given to providing staff with training in end of life care as this would expand the knowledge and skills of the staff team who provide this care. Whilst individal and group meetings with all staff were taking place regularly, these were not always being documented. Recording these meetings would be useful so that it is clear when they take place and the areas/issues that are discussed as well as recording peoples personal development needs in relation to the work they do. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes Statement of Purpose and Service User Guide give people sufficient information about the services the home provides to decide whether this home is the right place for them. Pre-admission processes are in place to ensure that peoples needs are properly identified and planned for before they move into the home. Evidence: Discussions with people living at the home confirmed that they had chosen to live in this home. One person said I dont know how my daughter found this home but it is wonderful here. The home has a Statement of Purpose and Service User Guide, which contain details of the services available in the home, to help people decide if they want to live in this home. The Registered Manager confirmed that each person living in the home has been given a copy of the Service User Guide. Discussion with the Registered Manager confirmed that, before people come to live in the home, an assessment is carried out to determine what support people need in Care Homes for Older People Page 11 of 29 Evidence: relation to their physical, psychological and social care needs. Wherever possible, people planning to live in the home are visited in their current place of residence, to enable the management team in the home to make a judgement about how needs will be met before offering the person the opportunity to live in the home. The files of three people were inspected and these contained pre-admission assessments of their needs. Surveys from staff members also confirmed that they have enough information about peoples needs to provide the care required. The admission process includes visits to the home to meet the other people who live there and staff, so that people have a chance to assess the quality, facilities and suitability of the home. The AQAA says that the home offers a monthly trial period for people to decide whether they wish to remain living at Nazareth House. Nazareth House does not provide intermediate care. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are treated with respect and personal support is offered in a way that promotes peoples privacy and dignity. There are arrangements in place to ensure that medication is administered in a safe way. Evidence: The files of three people who lived in the home were inspected and these contained individual care plans with information on physical, psychological and social care needs and how staff at the home would meet those needs. Where possible care plans were signed by people who lived in the home and/or relatives/representatives to show that they have been involved in drawing up the plan and were aware of the content. Peoples files contained the names and addresses of their relatives and representatives so that staff would know who to contact should they need to. Each file contained recently reviewed and updated risk assessments relating to falls, skin/pressure area care, moving and handling and nutrition. However two of these care plans had not been updated recently, for example, one persons file contained information referring to the recent development of a pressure area on her skin, and appropriate action had been taken, but this was not reflected in the care plan. Also, one person had been Care Homes for Older People Page 13 of 29 Evidence: weighed in January 2009 and the records showed she had lost a significant amuont of weight since December 2008. No action was taken regarding this except that the records said to re-weigh the person in two weeks time, but that did not take place. Discussion with the Registered Manager and staff confirmed that they did not think the person had lost such a large amount of weight and the next time she was weighed confirmed this. However no-one could explain why the person was not weighed again if the staff believed the weight to be incorrect or why she was not re-weighed two weeks later as the records requested. Also the weight records only recorded the month the person was weighed and not the actual date therefore it was not clear how long a period of time had elapsed between weighings. Information about each person living in the home was recorded on a daily basis although there were two sets of daily records - one completed by the nursing staff and one completed by the care staff. A discussion took place about amalgamating this information so that everything was recorded chronologically in one record. People who were able to comment, feedback from relatives and staff, as well as information contained in personal files, confirmed that people living in the home have access to health care services such as doctors, the tissue viability nurse, dentists, chiropodists, opticians and hospital consultants. Comments in surveys from people who lived in the home included we have a doctor of our own choice on call when required and care staff are always very supportive and caring and always ready to listen should any difficulties arise. Information in a survey from a healthcare professional said that staff work well with them, provide a very good standard of end of life care and act promptly to meet peoples needs, such as obtaining prescribed medication. This person also said: Staff endeavour to provide dignity at end of life. Residents are not admitted to hospital if their preferred priority of care is this home, when dying. Equipment to promote peoples health and well being was provided including specialist baths and equipment for promoting pressure area care and to prevent skin breakdown. Those people able to comment, as well as surveys from people who lived in the home and their relatives, confirmed that the staff treated them with respect and preserved their privacy and dignity at all times. Staff were observed knocking on doors before entering private rooms. Medication was stored securely and most of it was administered from blister packs prepared by a local pharmacist. Records relating to the administration of medication were up-to-date although there were gaps where there was no signature to say medication had been administered, but the medication was not in the container. This issue had also been identified during a pharmacy inspection in January 2009. The only Care Homes for Older People Page 14 of 29 Evidence: staff who administer medication are qualified nurses therefore have been trained in the administration of medication. There were procedures and documentation in place for the removal of unused medication by a licensed contractor. The home had a refrigerator specifically for storing medicines that needed to be kept cold. A member of staff was observed whilst administering medication and this was done in a safe, respectful and individual way for each person. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines in the home are relaxed, relatives and friends can be confident that they are welcomed, and social activities are arranged. The dietary needs of the people who live in the home are catered for with a balanced and varied selection of food that reflects their tastes and choices. Evidence: The people who lived in the home said that they were free to come and go away from the home as they wished. They were encouraged to maintain interests and friendships outside of the home and confirmed that friends and relatives were welcomed. Visitors in the home said that they were always made very welcome by the staff and felt that they could visit at any time. The home has a designated staff member to co-ordinate activities and information about what was happening was displayed on a notice board. There was an ongoing activity programme giving people the opportunity to take part in a variety of activities. People said they enjoyed quizzes, craftwork, films, bingo, discussing the contents of newspapers and having their hair done. Two people said that they have the day off on Wednesdays, thus implying that, on other days, they are busy. The weekend film show on a large screen when people choose the film and tea is served seemed Care Homes for Older People Page 16 of 29 Evidence: particularly popular. Although people did not recall going on any trips outside the home, apart from with family members, the Registered Manager listed several trips out that had been undertaken over recent months in the minibus belonging to the home. People do not have to pay for the use of this transport. People said they can choose to use the lounge, join in the activities, remain in their bedrooms reading, watching television, doing jigsaw puzzles and enjoying the views across Plymouth Sound watching the shipping come and go. Some people were able to walk into town or catch the bus as there is a bus stop very close to the entrance to the homes large garden. A survey from a person who lives in the home said: A variety of activities are arranged such as craft work, current affairs and the news are discussed. A great favourite is recollection of the past, especially the war years, so many had served in the forces. We also have trips in the minibus out to the moor or other places of interest. Discussions with, and information in surveys from, the people who lived in the home showed that peoples different religious and cultural faiths and beliefs are respected. Whilst the home is owned by a Christian organisation, people who have other faiths and beliefs are also welcome to live in the home. The AQAA said that Religious needs can be met either here in the home in our own chapel or through visits from clergy of other faiths and peoples religious interests were documented in their personal files. A survey from a relative said: At Nazareth House everyone is treated with respect and understanding of their individual needs. There is a chapel on the premises for anyone, of any faith, to visit at any time. The menus were displayed on a notice board in the dining room and showed that there was a three course meal served every lunchtime with a choice of two hot meals, although people could choose an alternative to these. People who lived in the home expressed mixed views over the quality of the meals provided. Comments from people during the inspection and in surveys included excellent food, although I do not eat red meat there is always something I can eat; the food is fresh and beautifully cooked; a very good variety of well cooked meals three times a day; food not marvellous, but OK and the food is not well cooked, especially meat and vegetables. Often only just warm. Same old repetitive menus. A survey from a relative said: The meals are home cooked and are very good and nourishing. There is always a bowl of fresh fruit on each table in the dining room. Anyone can help themselves to tea or coffee. Special diets, such as diabetic, were catered for and dietary needs were documented in peoples personal files. If anyone needed their food liquidised, each item was liquidised separately so that it was easy to differentiate between the food items, for example, meat and vegetables, on the plate. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home can be confident that any complaints or concerns will be listened to and acted upon by the home. Evidence: The home has a written complaints procedure and this was displayed on notice boards in the home. Discussions with people living in the home and their relatives, as well as information contained in surveys, confirmed that all the staff were very approachable and people had confidence in bringing concerns to them. Everybody spoken with said they felt safe living in the home. Comments included The nursing staff and the sisters (nuns) always listen and act. Couldnt be better; We have frequent meetings to have our say and Staff are always ready to listen and ready to discuss any complaints. A relative commented that The managers and nursing staff are always available to listen to concerns and worries that I may have and will take appropriate action if necessary. The staff training records in the home showed that all staff are expected to complete in-house training related to the safeguarding of vulnerable adults, as well as safeguarding training provided by the Local Authority. This is also included in formal qualifications such as National Vocational Qualifications (NVQs). Discussion with staff and the Registered Manager confirmed that they were knowledgeable about the local processes in place to safeguard vulnerable people. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from a very high standard of accommodation in a house with extensive views and large, accessible gardens. The home is clean, comfortable, warm, safe and well maintained providing people with a pleasant environment in which to live. Evidence: We looked all round the home and found it was warm, comfortable, clean and free from offensive odours. The home was easy to get into for people who have mobility difficultes or use wheelchairs because it has automatically opening doors at the front and wide corridors. People who lived in the home, as well as their relatives, commented on the homely, welcoming feel that they experience whilst in the home. The shared rooms consist of lounge and dining rooms on each floor, with a variety of seating for people to use. There is a large reception area and there is a chapel for people to use whenever they would like to. There are extensive views across Plymouth Sound from the rooms on the 1st floor described as beautiful and wonderful by the people who live there. The bedrooms are located on the ground and 1st floors and there is a shaft lift to the 1st floor. The home had one bedroom that could be shared if people chose to do so; a flat consisting of a bedroom, sitting room and bathroom; and all the other bedrooms were for single occupancy. Most of the bedrooms had en suite toilets. All bedrooms doors were fitted with locks to protect peoples privacy and the security of their belongings and people said they had keys to their bedrooms. The Care Homes for Older People Page 19 of 29 Evidence: bedrooms visited were well decorated, contained many personal possessions and people said they were comfortable in them. Some rooms have had the flooring replaced with a vinyl flooring but the Registered Manager said this would be changed to carpet if people wanted it. There was a call bell system throughout the home and portable hand sets had been purchased for people who were immobile so they could summon assistance when they needed anyone. The laundry facilities were clean with sufficient equipment to meet the needs of the people who lived in the home. People spoken with said that the laundry was done efficiently and it was rare for anything to go missing. Appropriate arrangements for controlling the spread of infection were seen including gloves and aprons. Radiators were covered to prevent the risk of burns should anyone come into contact with them when they were on. The Registered Manager confirmed that thermostatic valves, to prevent the risk of scalding, controlled the hot water temperature to the baths. Toilets and bathrooms were clean and bath hoists were available to assist people with restricted mobility. Whilst most people had en suite toilets in their bedrooms, there were also shared toilets close to the lounge and dining rooms. Toilet and bathroom doors were fitted with appropriate locks that could be opened from the outside by staff in an emergency. The home stands in large grounds and gardens that were safe and accessible to the people who lived in the home. People told us how much they liked living so close to the seafront and how much they enjoyed the views. In a survey one person said: I have a lovely room with a beautiful view over the Atlantic. Couldnt look for anything better. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are usually sufficient numbers of caring staff, with appropriate qualifications, skills and knowledge to support the people who live in the home. Recruitment practices are robust and protect the people who live in the home from risk of harm. Evidence: Information contained in staffing rotas, as well as discussion with the Registered Manager, showed that, on the nursing (ground) floor, there was always one qualified nurse on duty at all times during the day and night. There were four care staff during the day and one waking member of care staff at night. On the residential (1st) floor there were usually four care staff in the morning and three or four in the afternoon, with one waking member of staff on duty at night. People raised this as a concern with us during the inspection however discussion with the Registered Manager confirmed that she had already addressed this and that there would be another member of care staff on duty at night from 1st April 2009. In addition to the care staff there was a deputy manager for each floor. The care staff were supported by administrative, catering, domestic and laundry staff. Whilst information from most people who lived in the home showed that there were usually enough staff on duty to meet their needs, three people said there were sometimes staff shortages caused by people being on holiday or off sick. One person who lived in the home commented that this makes life difficult for all at these times. Care Homes for Older People Page 21 of 29 Evidence: Also, one person commented: Depending on the time of day it can take several minutes for the call bell to be answered. Surveys returned from five staff members and one relative also said that there were sometimes staff shortages usually caused by people being on holiday or off sick. People living in the home told us that the staff were excellent, caring and gentle. I get on with them very well and I have never heard a cross word from anyone. The staff were observed being helpful and gentle when assisting people and engaging with them as they went about their tasks. Information in surveys from relatives indicated that the staff were kind, respectful, polite, considerate and caring towards the people who live in the home. One person commented that the staff are very kind and caring and treat all the people with dignity and another relative said All the care staff are very kind and considerate ... and I feel they treat [people in the home] as they would their own family. The files of three recently recruited staff members were inspected. All of these showed that the required checks and references were obtained before people started working in the home. Information contained in surveys from staff also confirmed that they could not start work until the proper process had been followed. Comments in surveys from staff included: Staff are looked after ... Nazareth House is a good place to ... work and I am very happy in my place of work and would not want to be anywhere else. The Registered Manager confirmed that all new staff, including qualified nurses, are expected to complete a structured induction programme within the first few weeks of appointment. Discussions with staff members, as well as information contained in surveys, confirmed that the induction training was comprehensive and covered everything they needed to know to do their job. One staff member said that new staff shadow more experienced staff until they are competent and feel confident to do the job. Information obtained from staff, both verbally and in surveys, said that the staff worked well as a team and that Nazareth House was a good place to work. In particular they praised the training available to them and the support they receive, from both peers and management, to do their job. Information in a survey from a healthcare professional commented on how welcoming and receptive the staff were to feedback and advice but commented that they may benefit from access to training in end of life care for example, symptom control management and advanced communication skills. Information in the AQAA, as well as discussion with the Registered Manager, confirmed that approximately two thirds of the the care staff have achieved a professional qualification in caring for older people, usually a level 2 or 3 National Vocational Qualification (NVQ) and nine staff were in the process of completing a level Care Homes for Older People Page 22 of 29 Evidence: 2 NVQ in health and social care. When these staff members have completed the course, 96 of care staff will have a formal qualification demonstrating an excellent level of training. In addition staff are expected to complete training in moving and handling, emergency first aid, health and safety, food hygiene, infection control, safeguarding vulnerable adults and an awareness and understanding of relevant legislation, for example, the Mental Capacity Act. The homes training records also showed that staff have opportunities to participate in specialised training such as epilepsy, continence care and palliative care. Surveys from ten staff members confirmed that they have good training opportunities and consider that they have enough training to do their jobs well. Comments from staff included: There are plenty of training sessions that I am encouraged to attend and training has meant I have been shown new skills which have helped me understand my role and do my job effectively. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that it is well managed. The health, safety and welfare of the people living in the home are promoted and protected. Evidence: The Registered Manager, Ms Hart, is a qualified nurse and has several years experience of managing care homes. She has also completed a management qualification, the Registered Managers Award, and is in the process of completing an advanced qualification in management. She undertakes periodic training to update her knowledge, skills and competence, for example, knowledge of the Mental Capacity Act and how that may affect people who live in the home as well as how the home is run. Ms Hart operates an open door policy and feedback from staff included comments such as management are available at all times and I am supported and listened to. I feel I can approach management when I feel the need to. A survey from a relative said that the home provides excellent care and two relatives commented that the management and staff team liaise well with families. Care Homes for Older People Page 24 of 29 Evidence: Discussion with the Registered Manager, as well as documentation and surveys from staff, showed that the staff have regular staff meetings and 1:1 supervision meetings with a member of the management team. Training records showed that care staff are expected to participate in training that will give them the knowledge and skills to keep people safe, such as emergency first aid, food safety/hygiene, moving and handling, infection control and health and safety practices. Discussions with the Registered Manager and one of the administrators, as well as documentation, confirmed that the financial affairs of the people who live in the home are managed by themselves, their families or representatives. The home did administer spending money on behalf of some people who lived in the home. The money held at the home for three of the people who live there was checked and found to be correct. All transactions required the signature of the administrator and the signature of another member of staff. The fire safety equipment records showed that checks and tests of the fire safety equipment were carried out regularly and a local contractor serviced the fire alarm system and fire extinguishers at least annually. Information contained in the staff training records showed that staff had received training in fire safety awareness and/or had attended a fire drill. Newly appointed staff had received training in fire safety procedures on the first day of employment as part of the induction process. Whilst walking around the home all the radiators we saw were guarded to prevent the risk of burns to the people who live in the home. The Registered Manager confirmed that thermostatic valves, to prevent the risk of scalding, controlled the hot water temperature to the baths. There was documentation in the home to show that the gas system and appliances were checked and serviced regularly; the electrical wiring had been checked in May 2007 and all portable electrical appliances in the home had been checked for safety. Servicing records showed that the shaft lift and hoists were serviced regularly to make sure they were working properly and were safe for the people who used them. The home had a quality assurance system in place and questionnaires were distributed to people living in the home and their relatives on a regular basis. A sample of completed surveys were seen during the inspection. The results were collated and any points for improvement noted and acted upon. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 17 Medication administration records must be signed when medication is administered. If medication is not administered for any reason, this reason must be documented on the medication administration record. This is so that it is clear that medication has been administered or, if it has not been administered, the reason is clear. 05/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The daily records should be amalgamated so that there is a continuous, chronological history of the persons care rather than information being contained in two different documents. Care plans should be updated as peoples needs change and all records should contain the actual date that events Page 27 of 29 2 7 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations take place, rather than just the month. This is to ensure that all care needs are met in a consistent way by the staff team. 3 8 Appropriate action should be taken whenever a significant weight loss is recorded, even if that action is to re-weigh the person concerned. Weight records should contain dates rather than just the month in which the person was weighed. This is to ensure that correct records are maintained and that any health needs are addressed immediately. There should be enough staff on duty at all times to meet the physical, psychological, emotional and social needs of the people who live in the home. Consideration should be given to providing staff with training in end of life care for example, symptom control management and advanced communication skills, as this would expand the knowledge and skills of the staff team who provide this care. All supervision meetings with staff should be documented so that it is clear when they take place and the areas/issues that are discussed. 4 27 5 30 6 36 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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