Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Nazareth House 118 Harlestone Road Northampton Northants NN5 6AD The quality rating for this care home is:
zero star poor 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: Keith Williamson
Date: 0 6 0 4 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 26 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 26 Information about the care home
Name of care home: Address: Nazareth House 118 Harlestone Road Northampton Northants NN5 6AD 01604751385 01604580435 sheila@naznptn.plus.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Congregation of the Sisters of Nazareth care home 50 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: Between the dates of 23.04.05 to 03.05.05 - 53 service users within the category OP can be accommodated within the home Between the dates of 23.04.05 to 03.05.05 a named service user can be accommodated in Room 6 of Zone 3 of the home. Between the dates of 23.04.05 to 03.05.05 no one falling within the category of OP may be admitted into the home where there are 53 service users who fall within the category of OPalready accommodated within the home That the home limits its services to the following service user categories:- Care Home personal care only - up to 52 service users within the OP over 65 years category Date of last inspection 0 Over 65 50 Care Homes for Older People Page 4 of 26 Brief description of the care home Nazareth House is a care home providing personal care for Older People, it is a large home located on the outskirts of Northampton. The home has been established for many years and is run by The Congregation of the Sisters of Nazareth who also offer a comprehensive range of spiritual support and guidance to meet the individual religious needs and preferences of people living within the home. Mass and The Rosary are celebrated on a daily basis, in the Church which is attached to the home . Accommodation is provided over the ground and first floor, with access to the first floor being via a passenger lift, the ground floor provides all the communal amenities, along with bedroom and bathing facilities, whilst the first floor provides additional bathing facilities and bedrooms. Bedrooms in some instances include an en-suite facility, some of these being added recently. Nazareth House has a large and very well maintained garden, with mature trees, shrubs and plants and benefits from a large water fountain. Information about Nazareth House is provided in the form of a Service Users Guide and a Statement of Purpose. The Manager provided information on the day of the site visit with regards to fees. Fees range from £469.00 to £539.00 per week; the fee charged is dependent upon the specification and amenities of the personal accommodation. Care Homes for Older People Page 5 of 26 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: zero star poor 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: The focus of the inspection is on outcomes for Service Users and their views of the service provided. The main method of Inspection used was case tracking which involves selecting a sample number of people and tracking the care they received through talking with them where possible, and looking at their records and accommodation, in this case three Service Users were chosen. This visit took place over one day, commencing at 9.30am and took six hours to complete. An opportunity was taken to talk with Service Users, manager and staff, look around the home, view records, policies and care plans. Service Users made some comments that have been included in this report. Information was obtained from the Annual Quality Assurance Assessment, which gives information about the home, and is filled in by the registered manager. A copy of the last Care Quality Commission (formerly the CSCI Commission For Social Care Inspection) report is displayed at the homes office, and copies of this report are available from the registered manager. The quality rating for this service is 0
Care Homes for Older People Page 6 of 26 star. This means the people who use this service experience poor quality outcomes. What the care home does well: What has improved since the last inspection? There were a number of requirements made at the last visit, that have been dealt with appropriately. These included residents care plans, staff recruitment and training. Blinds have been fitted in the dining room and lounges as the glare form the sun was an issue. The manager has now arranged multi - denominational religious services. Large print books are now available in the home. Care Homes for Older People Page 8 of 26 What they could do better: 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 26 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 26 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. Prospective residents receive information on the home and have their needs assessed before moving into the home. Evidence: Prospective residents can expect to have their needs assessed before they move into the home this should ensure that staff have the experience and numbers to meet peoples needs. All the residents files were found to include an assessment of their needs, completed by a social worker or the senior staff member from the home. Care Homes for Older People Page 11 of 26 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. Residents are looked after well in a safe and secure environment, are treated with respect, dignity and their right to privacy is upheld. Evidence: Residents have care plans, which details the care they receive whilst in the home. This is important so people know how they will be looked after. These plans were up to date and had been reviewed regularly with the resident or a member of their family. Care plans are also risk assessed, which gives staff vital information how to keep people safe in the home. Again these risk assessments are reviewed periodically. From records kept by the home it was evident that health care services including General Practitioners and community nurses visit on the residents behalf. Staff working at the home are very aware of the individual care needs of the residents, and those spoken with stated that peoples care needs were being met. Care Homes for Older People Page 12 of 26 Evidence: Medication is held securely and administered by senior staff in the home. Staff explained how the system worked showed an good knowledge of the detailed system. This is important as it increases the security for residents around medication administration. All residents and relatives spoken with felt that the care workers treated them with respect and throughout the visit care workers were seen interacting with the residents in a professional and dignified manner. Comments received during the visit, and from comment cards included: you cant fault them (staff), they are all nice. this is the best place for me. when you buzz to get up and there is only two on, you need to wait. (my mother) arrived quite poorly and not very mobile, but is now much better and using a walking aid (instead of a wheelchair permanently) thanks to the staff. Care Homes for Older People Page 13 of 26 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. There is a relaxed and homely atmosphere within the home and social care is encouraged with the residents. Evidence: Residents are offered choices on a daily basis. The residents agreed these included when to get up or go to bed, what to wear, a choice of meals and whether to join in the activities provided. These are important as they ensure residents can retain a good level of control over their lives. The activities offered include armchair exercise, music quizzes, jigsaws and reminiscence. There is an activities organise employed to assist in this area, as staff have a limited time they can spend helping with pastimes. Spiritual comfort is regularly offered to people with the resident group of nuns from the attached convent. Relatives and friends are encouraged to visit the home, one resident explained: my family come to see me regularly. The menu does not offer an alternative choice, but the residents spoken with on the day confirmed that this is not a problem. Most when spoken with agreed the food was good. There is a list of likes and dislikes in place, and the staff are aware of peoples individual preferences. Care Homes for Older People Page 14 of 26 Evidence: Other comments received during the visit, and from comment cards included: I go to the lounge at 3.00 pm today for the exercises you cant fault the cleanliness the foods good, but the steak pie is always tough there are fewer activities and outings in the winter months, but will be starting trips out soon the chips are awful sometimes the care and quality of food is not as good at weekends (possibly due to staffing levels there is a good programme of activities, with visiting entertainers and speakers. We have exercises twice a week with a professional. During the summer we go out in the mini-bus, obviously there are some residents who are too infirm we are very well looked after and our relatives and visitors are made welcome Care Homes for Older People Page 15 of 26 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The failure to recognise safeguarding issues and follow guidelines for reporting these appropriately, results in residents being placed at risk. Evidence: Residents are aware that there is a complaints procedure in place and were aware of who to go to should they have a concern of any kind. One resident stated, if I was not happy I would speak to the manager or one of the sisters. A relative spoken with stated: I would speak to the manager or a senior care worker. The manager has received a number of complaints since the last visit. These were investigated appropriately, within the appropriate time scales. There were no complaints forwarded to the Care Quality Commission (CQC). However there were five issues that were not dealt with appropriately, have been wrongly recorded and were not forwarded to the Local Authority to be investigated under Safeguarding legislation. This is due to the lack of training and insight by the manager, and has resulted in people being abused, and this being managed inappropriately. Care staff spoken with during the inspection were aware of what to do should they suspect any act of abuse. It is clear the manager is not currently aware of the procedure to follow with regard to adult protection. There were no safeguarding issues forwarded to the Care Quality Commission (CQC).
Care Homes for Older People Page 16 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the accommodation within this home is very good, providing residents with an comfortable and homely place to live. Evidence: Residents can enjoy this comfortable and relaxed home. Decoration is of a good standard and furnishings in the communal areas are domestic in character and in good condition. A selection of public and bedrooms was seen during the visit. These were clean, appropriately furnished and included items personal to the people living there. People responded to the comment cards about if the home was fresh and clean? (the home) is spotless always; the staff work very hard. When people were spoken with, they added, I like the cleaner, she does a good job, and makes time for a little chat. There is a secure enclosed garden within the grounds of the home, many of the bedrooms look out to the garden area. Staff have received training in infection control and observations during the inspection confirmed that staff used appropriate protective clothing when carrying out their duties. Care Homes for Older People Page 17 of 26 Evidence: The laundry is well appointed and the floors and walls are easily cleaned. This is important as it helps guard against cross contamination within the home. Care Homes for Older People Page 18 of 26 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. Residents safety is promoted by the recruitment process, and staff employed in sufficient numbers to meet their individual needs. Evidence: There were sufficient numbers of staff on duty on the day of the visit to meet the current needs of the residents. Residents and a relative spoken with felt that there were enough staff on duty to meet residents individual needs at all times. Residents are protected by a thorough recruitment procedure; this involves a detailed process prior to staff being appointed. Four staff files were checked, both were found to include all the necessary information including an application form, two references and Criminal Records Bureau checks. These are compulsory checks to enable the manager to ensure that staff have a fully checkable employment history, and are deemed suitable to work with vulnerable people. Training is recognised as important and courses for staff are arranged from outside trainers and that done by staff in the home. Training courses completed included; first aid, moving and handling, safe handling of medicines and food hygiene. These include courses for new staff and refresher courses for staff employed on a longer term basis. This is good as it shows staff knowledge is being continually updated. One member of staff commented: I had (induction and training) information from all the
Care Homes for Older People Page 19 of 26 Evidence: staff and managers. I was very pleased with my induction Staff meetings are arranged throughout the year. Care Homes for Older People Page 20 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected by the ethos of the management, staff, and detailed policies and procedures of the home. Evidence: The registered manager has previous experience in care, and has completed the NVQ level four. The National Vocational Qualification (a nationally recognised course for staff in caring) and Registered Managers Award. The manager has now commenced the process to become the registered manager of the home. There is clear evidence that the manager has a lack of experience in recognising and dealing with safeguarding issues. This results in people in the home being placed at risk, and been dealt with in an earlier outcome area. Staff spoken with stated that they were well supported and positive relationships between residents; their relatives, management and staff were evident throughout the visit. Care Homes for Older People Page 21 of 26 Evidence: Residents and staff are consulted with regard to how the home is run and residents and staff meetings are held on a regular basis. Quality assurance is performed throughout the year, and questionnaires are given to people in the home, and their relatives. The outcomes from the findings of the completed questionnaires are then given back to interested parties. This process has yet to be completed this year. Some of the policies and procedures required for the safeguarding of residents are in place, though the records seen on this occasion were not accurate. This has been fully dealt with in outcome area four of this report. Residents finances that are held by the home are done so in a safe and efficient manner. Staff supervision which is where the staff are overseen on their ability to do tasks take place regularly. There is an individual training plan for each member of staff, this is put together following an appraisal meeting. There is a programme of maintenance operated by the handy person. This includes a programme of daily, weekly, monthly and annual checks, with individual records kept of the findings. Care Homes for Older People Page 22 of 26 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 23 of 26 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 16 22 The responsible person must 16/06/2009 ensure that complaint recording is accurate and any issues arising are followed up within appropriate timescales, and with the appropriate authorities. This is to protect people in the home. 2 18 13 The responsible person must 16/06/2009 ensure all staff are aware of the adult abuse policies and procedures and are enabled to act on those when needing to do so. This is to protect the people in the home. 3 31 9 the responsible person must ensure that the manager has up to date training and knowledge to ensure that policies and procedures are carried through appropriately. 14/07/2009 Care Homes for Older People Page 24 of 26 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 This is to ensure the safety of people in the home. 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 9 When receiving new medications into the home, it would be useful to use the administration record provided by the chemist. This would enable any medication audit to easily take place. Where medications are carried forward from a medication month to another, the number of tablets or capsules could be marked on the administration sheet. This would enable accurate auditing to take place. A list of alternative foods available at meal times would be an advantage for staff offering meals to those residents not wishing the main meal option. 2 9 3 15 Care Homes for Older People Page 25 of 26 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. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
