Inspection on 02/08/05 for Nazareth House Nursing Home

This inspection was carried out on 2nd August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Nazareth House Nursing Home 15/05/07

Nazareth House Nursing Home 09/02/06

Nazareth House Nursing Home 18/02/05

Nazareth House Nursing Home 05/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE NAZARETH HOUSE NURSING HOME Scholes Lane Prestwich Manchester M25 0NU Lead Inspector Grace Tarney Unannounced 2 August 2005 nd 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 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 NURSING HOME F56 F06 S17331 Nazareth House V221952 020805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Nazareth House Nursing Home Address Scholes Lane Prestwich Manchester M25 0NU 0161 773 2111 0161 773 4847 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Congregation of the Sisters of Nazareth Miss Barbara Lupton CRH N Care Home with Nursing 60 Category(ies) of OP Older People - 60 registration, with number of places NAZARETH HOUSE NURSING HOME F56 F06 S17331 Nazareth House V221952 020805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The Home is registered for a maximum of 60 service-users to include: Up to 60 service-users in the category of OP (Older People) The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. Date of last inspection 18th February 2005 Brief Description of the Service: Nazareth house is owned and managed by the Sisters of Nazareth. The care home is purpose built and is attached to the convent. It is situated in its own large beautiful gardens, quite secluded but within easy reach of public transport and the motorway network. There is plenty of car parking and the home is only a short distance from Prestwich village. There are no steps to the front of the home. This ensures a level access for wheelchair users and people who have mobility problems. The accommodation is in mainly single bed rooms with shared ensuite toilet facilities. The bedrooms are on the ground and lower ground floor and are reached either by stairs or a passenger lift. The home is divided into nursing and residential areas. The residential area has two lounges and a dining room plus a kitchenette. The nursing unit is divided into two floors and has lounges and dining rooms with a kitchenette on either floor. There is a designated smoking lounge and a large lounge to the front of the home which is used for activities and functions. The toilets and bathrooms have aids to assist any resident with a disability or mobility problem. The home is registered to care for people who require nursing or residential care and people of all religious faiths are accepted. NAZARETH HOUSE NURSING HOME F56 F06 S17331 Nazareth House V221952 020805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home was not told that this inspection was to take place. This was an unannounced inspection. The Inspector spent 6 hours in the home and visited the nursing and residential units. During this time she looked at care and medicine records to ensure that the health and care needs of the residents were being met. The Inspector then visited many of the residents in their own bedrooms to check out the care that was being provided for them. She also looked at records about the handling of complaints. In order to get some information about the home the Inspector also spent time speaking to 4 residents, 4 relatives, 3 care assistants, 1 of the qualified nurses and the Nurse Manager. Not all the National Minimum Standards were looked at on this visit. During the next inspection the Inspector will look at the rest of the Standards that are considered to be important for residents safety and well-being. These are the Standards that have to be inspected at least once a year. What the service does well: The qualified nurses and care staff were extremely good at caring for the residents who were very ill and needed lots of specialised care. The staff made sure that all the necessary equipment needed for their care was available. The residents’ care plans contained a lot of important information about what they needed help with, and how they were to be cared for. Many of the staff had worked at the home for a long time and the residents said that they liked the staff and felt safe in the home. Comments such as “they are lovely girls”, “I am very happy here” “I am glad I moved here” were made to the inspector. One relative said that the staff “were very good indeed” Activities that kept the residents interested and busy were considered to be an important part of how they spent their day. A lot of activities were arranged and the staff knew what each resident liked, and was able, to do. NAZARETH HOUSE NURSING HOME F56 F06 S17331 Nazareth House V221952 020805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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 NURSING HOME F56 F06 S17331 Nazareth House V221952 020805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection NAZARETH HOUSE NURSING HOME F56 F06 S17331 Nazareth House V221952 020805 Stage 4.doc Version 1.40 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 standard(s) 3. The system for ensuring that all prospective residents had a detailed assessment undertaken prior to admission to the home gave an assurance both to residents, relatives and staff that a resident was only admitted if the home could meet their needs. EVIDENCE: Before any resident was admitted to the home an assessment of their needs was undertaken, either by a senior member of the nursing staff from the home or from the professional i.e. care manager requesting their admission. The assessment documents of residents on the residential and nursing units were looked at. The assessments were detailed and gave a clear indication of the residents’ needs and their capabilities. The assessments looked at the physical, mental and social care needs of the residents as well as the involvement if any, of their relatives. The Inspector spoke with the relative of a resident who had been admitted from home the previous day. The relative stated that the manager had been out to the residents’ home to undertake an assessment of her needs. NAZARETH HOUSE NURSING HOME F56 F06 S17331 Nazareth House V221952 020805 Stage 4.doc Version 1.40 Page 9 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 standard(s) 7,8,9,10 &11. The care plans reflected the support needs of the residents. Care practices ensured that the residents health care needs were met, that they were treated with respect and their dignity was upheld. Although some improvements could be made, the medication system in place ensured that the residents received their medicines safely. EVIDENCE: Individual care plans were in place for each resident. The care plans of 2 of the residents on the residential unit and 2 on the nursing unit were looked at. All of the care plans gave clear instructions and guidance on how the care needs of the residents were to be met. They were reviewed monthly and any changes were noted and acted upon. Risk assessments were in place and covered such areas as moving and handling, nutrition, pressure sores, the use of bed rails and falls. It was identified that the document used for the risk assessments for pressure sores on the residential unit, was different from the document used on the nursing units. The assessments on the residential unit did not have any code to identify the scoring, making it therefore, a meaningless exercise. NAZARETH HOUSE NURSING HOME F56 F06 S17331 Nazareth House V221952 020805 Stage 4.doc Version 1.40 Page 10 A discussion with the staff showed that, whilst they understood the reasons for the assessments, they didnt always fully understand the outcome of the scoring and what it meant for care practice. It was noted that the care plan files on both the nursing and residential units were left on the workstations. Staff told the Inspector that there is nearly always somebody working in the vicinity of the workstations. However, to ensure that the care records are kept safe and there is no breach of confidentiality they should be kept in a less accessible place. A discussion with the residents and relatives identified that the residents had access to other health care services including hearing, sight tests and a visiting chiropodist. Evidence of these visits was kept in the residents’ individual files. Equipment necessary for the prevention and treatment of pressure sores was available on all the units. Continence aids were in use and the staff were aware of how to contact the continence nurse advisor for advice if deemed necessary. The medication systems on the residential unit and the lower ground, nursing unit were inspected during this visit. The medication system on the nursing unit was safe. Medications were securely stored and were administered by the qualified nursing staff only. Some issues were identified however, in relation to the actual signing of the medication administration sheets. The administration sheet for one resident who was prescribed Paracetamol 1or 2, 4 times a day was not being completed accurately. Staff were not documenting the actual number of tablets being given. Inspection of the controlled drug book showed that one resident had been given Temazepam and that there were 15 Temazepam tablets left. The actual number of tablets left was 16. Inspection of this residents’ medication administration sheet showed that the Temazepam had not been given. This indicated that the nursing staff were signing the controlled drug book before medications were actually administered. Overall the medication system on the residential unit was safe. Some areas of concern however, were identified. The medication of one resident had, on three separate occasions, not been signed for even though it had been given. Staff were not always checking, signing and countersigning handwritten transcriptions on the medication administration sheets. The date of opening was not written on a bottle of eye drops that were in use. Eye drops have to be disposed of 28 days after opening. There was no specimen signature and initial list in use on either unit. It would be good practice to implement such a list to make it easier to know who had signed for medications. A discussion with the residents and relatives identified that they feel their privacy is respected and that they are treated with great kindness. One relative stated that the staff always make sure that her relative has a bubble NAZARETH HOUSE NURSING HOME F56 F06 S17331 Nazareth House V221952 020805 Stage 4.doc Version 1.40 Page 11 bath and that “this makes her feel like Joan Collins”. Staff spoken to gave examples of how privacy and dignity were promoted. They also gave good practice examples of how they would care for a resident who was terminally ill. Great emphasis was placed on the spiritual support offered to residents and their family. The home has its own chapel for the use of residents, relatives and staff. Funeral services can be held from the chapel. NAZARETH HOUSE NURSING HOME F56 F06 S17331 Nazareth House V221952 020805 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 &13. The home enabled residents to exercise as much personal freedom and choice as possible and find enjoyment with the wide range of activities available. EVIDENCE: The residents spoken to said that they were very satisfied with how they were allowed to spend their day, more or less as they pleased. One of the Sisters organises events and activities within the home as well as trips out to various places of interest. The programme of activities was displayed on each unit so that residents were aware of what was “going on”. Apart from details about games and activities it gave information about how often religious services would be held. Mass and the Rosary were held daily. The programme of activities was varied and appropriate for the resident group. The Inspector sat with some of the residents whilst they were at the “Tuesday Club”. The Tuesday Club is held in the afternoon and this where small-groups of residents meet to do arts and crafts, games, simple cooking, bingo, scrabble and jigsaws. The residents spoken to clearly enjoyed themselves. The staff who were assisting the residents seemed to have a lot of patience and an understanding of the residents’ needs. Residents told the Inspector that they are able to have visitors at any reasonable time and they can see their visitors in private. One relative told the Inspector that the staff at the home always made her very welcome. NAZARETH HOUSE NURSING HOME F56 F06 S17331 Nazareth House V221952 020805 Stage 4.doc Version 1.40 Page 13 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 standard(s) 16 &18. The complaint system in place enabled the residents to feel that their views were listened to and acted upon. Staff had a good knowledge and understanding of adult protection procedures thereby reducing the possible risk of harm or abuse EVIDENCE: A discussion with residents and relatives indicated that there was a general awareness of how to make a complaint. The complaints procedure was displayed in the reception area. It was easy to understand and gave an assurance that complaints would be responded to within 28 days. The complaints procedure had also been given out to each resident. A copy of the Local Authorities Vulnerable Adults Procedure was in place and a discussion with the senior staff identified that they were very aware of the procedure to follow in the event of any allegation of abuse. Training in the protection of vulnerable adults has been undertaken by some staff and is ongoing. NAZARETH HOUSE NURSING HOME F56 F06 S17331 Nazareth House V221952 020805 Stage 4.doc Version 1.40 Page 14 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 standard(s) EVIDENCE: Standards 19 and 26 will be looked at during the next inspection. NAZARETH HOUSE NURSING HOME F56 F06 S17331 Nazareth House V221952 020805 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The residents were cared for by sufficient numbers of staff that were suitably qualified and trained and therefore had the knowledge and skills to meet the residents’ needs. EVIDENCE: Examination of the duty rotas and a discussion with staff and residents showed that there was enough staff on duty to meet the care needs of the residents. On the nursing units 24-hour nursing care continues to be provided by qualified nurses. Suitably trained care assistants support them. Senior care assistants who have achieved their NVQ level 3 in Care manage the residential unit and suitably trained care assistants support them. The overall management of both units remains the responsibility of the Registered Nurse Manager. NAZARETH HOUSE NURSING HOME F56 F06 S17331 Nazareth House V221952 020805 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: Standards 33,35 and 38 will be looked at during the next inspection. NAZARETH HOUSE NURSING HOME F56 F06 S17331 Nazareth House V221952 020805 Stage 4.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x x NAZARETH HOUSE NURSING HOME F56 F06 S17331 Nazareth House V221952 020805 Stage 4.doc Version 1.40 Page 18 No. Are there any outstanding requirements from the last inspection? 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 7 Regulation 13(4)(a) Requirement For a pressure sore risk assessment to be meaningful a scoring code must be in place. Staff must be trained to understand the importance of the risk assessment outcome. Staff must document the actual amount/number of tablets being given. Staff must not sign for the administation of controlled drugs until they have actually been given. The administration of medications must be signed for on the MAR sheet once they have been given. Timescale for action 31/8/05 2. 3. 9 9 13(2) 13(2) 2/8/05 2/8/05 4. 9 13(2) 2/8/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 9 9 Good Practice Recommendations To ensure the safety of the resident, transcriptions of medications should be checked, signed and countersigned by another member of the nursing staff To ensure that the medication is not out of date, the date F56 F06 S17331 Nazareth House V221952 020805 Stage 4.doc Version 1.40 Page 19 NAZARETH HOUSE NURSING HOME 3. 4. 9 9 of opening should be written on the bottle of eye drops. Consideration should be given to devising a specimen signature and initials list. The care staff on the residential unit should receive regular supervision or furher training in relation to medication maangement. 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