Inspection on 09/02/06 for Nazareth House Nursing Home

This inspection was carried out on 9th February 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Nazareth House Nursing Home 15/05/07

Nazareth House Nursing Home 02/08/05

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 Nazareth House Scholes Lane Prestwich Manchester Lancashire M25 0NU Lead Inspector Grace Tarney Unannounced Inspection 9th February 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Nazareth House Nursing Home DS0000017331.V277625.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nazareth House Nursing Home DS0000017331.V277625.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Nazareth House Nursing Home Address Nazareth House Scholes Lane Prestwich Manchester Lancashire M25 0NU 0161 773 2111 0161 773 4847 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Congregation of the Sisters of Nazareth Miss Barbara Mary Lupton Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Nazareth House Nursing Home DS0000017331.V277625.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. 2nd August 2005 Date of last inspection 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 en-suite 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 that 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 DS0000017331.V277625.R01.S.doc Version 5.1 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 7 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. To make sure that the home and the equipment in it was safe, the Inspector looked at the maintenance and service records. She also looked at how the management recruit their staff and how they handle the residents’ spending money. The Inspector then looked around the building at the bedrooms, bathrooms toilets and sitting areas to check if they were clean and well decorated. She then visited residents in their own bedrooms to check out the care that was being provided for them. In order to get some information about the home the Inspector also spent time speaking to 5 residents,2 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: Before residents went into the home, the nurse manager or one of the senior nurses visited them in their own homes or in hospital to make sure that the care they needed could be provided by the home. 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 live in a very pleasant, safe environment. The residents said that they liked the staff and felt safe in the home. One resident told the Inspector that the staff were “wonderful”. Another resident said that he was “ very happy living here.” The home has a commitment to ongoing staff training. Management continually look at how they can improve the service that they provide. Nazareth House Nursing Home DS0000017331.V277625.R01.S.doc Version 5.1 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 DS0000017331.V277625.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nazareth House Nursing Home DS0000017331.V277625.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6. 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. Standard 6 does not apply. The home does not provide Intermediate Care. Nazareth House Nursing Home DS0000017331.V277625.R01.S.doc Version 5.1 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 the following standard(s): 7 8 & 9. The care plans did not fully reflect the support needs of the residents on the residential unit. Although some improvements still need to be made, the medication system in place ensured that the residents received their medicines safely. EVIDENCE: Only the care files on the residential unit were inspected. This was because the Inspector was checking compliance in relation to a requirement made following the last inspection. The care plans of 2 of the residents were examined. One of the residents was receiving care from the district nurse in relation to the treatment of pressure sores. This resident however, did not have a care plan in place for the prevention of pressure sores. Both the district nurses and the residential care staff have a responsibility to ensure that a pressure sore prevention plan is in place. The other residents’ care plan showed that the staff had identified that she was losing weight. Staff had referred this resident to her GP who had prescribed supplementary drinks. The resident had been refusing these. There was no care plan however in relation to eating and drinking and her refusal to take supplementary drinks. Nazareth House Nursing Home DS0000017331.V277625.R01.S.doc Version 5.1 Page 10 There was evidence of resident/relative involvement in drawing up the care plan. It was noted that the care plan files on both the nursing and residential units remain on the workstations. 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. Risk assessments were in place and covered such areas as moving and handling, nutrition, pressure sores, the use of bed rails and falls. Risk assessments and the care plans were evaluated as and when required but at least on a monthly basis. The residents were weighed in accordance with their nutritional risk assessment but at least on a monthly basis and the weight recorded on a chart kept in their care plan Inspection of the care files identified that the residents had access to health care professionals, such as dentists, opticians, chiropodists and district nurses. Equipment necessary for the prevention and treatment of pressure sores was readily available within the home. Continence aids were in use and the staff were aware of how to contact the continence nurse advisor for advice, if deemed necessary. The Inspector did not look the medication system in detail during this visit. Overall the medication system on both units was safe Compliance was checked with the following: Previous requirements: These were: Staff must document the actual amount/number of tablets being given. This had been complied with on the nursing unit but not on the residential unit The administration of medications must be signed for on the MAR sheet once they have been given. This had not been complied with on the residential unit. Previous recommendations: To ensure the safety of the resident, transcriptions of medications should be checked, signed and countersigned by another member of the nursing staff. This had not been complied with on the residential unit. Consideration should be given to devising a specimen signature and initials list. This had not been instigated. Nazareth House Nursing Home DS0000017331.V277625.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,14 &15. The home enables residents to exercise as much personal freedom and choice as possible. The residents’ dietary needs were met. EVIDENCE: The visiting policy is outlined in the Statement of Purpose. A discussion with the residents and care staff confirmed that the residents were able to receive visitors in private and that they were able to choose whom they see and do not see. Visitors can be seen in the privacy of the residents’ bedroom although many choose to sit in one of the communal areas. Visitors are a very welcome to use the chapel and attend services with or without their relative. Residents are encouraged to bring personal possessions into the home. Many of their bedrooms were highly personalised with small pieces of their own furniture, pictures, photographs and ornaments etc. The Inspector did not dine with the residents but observed lunch being served. The lunch was served from a heated trolley in the servery area of the dining room. The meals served were of ample portion and looked appetising. The tables were nicely set with napkins, cruets and cold drinks. Staff discreetly assisted some residents to eat. Nazareth House Nursing Home DS0000017331.V277625.R01.S.doc Version 5.1 Page 12 There was always a choice of meal at lunchtime and evening. The menus were inspected and they looked varied and nutritious. Mid-morning and midafternoon drinks were served and milky drinks were provided at suppertime. A discussion with the residents showed that they were very happy with the choice and quality of the food provided. Nazareth House Nursing Home DS0000017331.V277625.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: Not looked at during this inspection. These Standards were examined during the inspection of the 2nd of August 2005. There were no requirements. Nazareth House Nursing Home DS0000017331.V277625.R01.S.doc Version 5.1 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 the following standard(s): 19 20 21 24 25 & 26. The residents live in suitably adapted, clean, safe, comfortable and very pleasant surroundings. EVIDENCE: The secured entrance hall is very welcoming. The use of a CCTV camera is restricted to the outer door only to ensure the security of both staff and residents. The entrance hall is a large area with seating, a very attractive display of plants and relaxing piped music. There is a reception area, a small interview room, the tuck shop and visitors toilets. To the left of the reception area is the residential unit and to the right, the nursing units. The nursing units are situated on two floors. The residential unit has two lounges, a dining room plus a kitchenette. The nursing units have lounges and dining rooms with kitchenette on either floor. There is also a separate dining room for the priests who live at Nazareth House. Nazareth House Nursing Home DS0000017331.V277625.R01.S.doc Version 5.1 Page 15 There is a designated smoking lounge but the Inspector was informed that mainly staff use this room. As expected, this wasnt a very pleasant room. The walls were smoke stained. There is a large lounge to the front of the home that is used for functions. Adjacent to this is a very pleasant conservatory area. The home also has a well-stocked library a hairdressing room and a sensory room. All the communal rooms were very well decorated and furnished to a high standard. There are nine assisted bathrooms throughout the home in addition to each bedroom sharing an en-suite toilet and wash hand basin. Each bathroom has a toilet and wash hand basin and the bathrooms were decorated to a high standard. Toilets are within close proximity of communal spaces. Each toilet and bathroom has a lock on the door to ensure privacy and the facilities were all clearly marked. The bedrooms were decorated and furnished to a good standard. They were clean and odour free. The majority were highly personalised. The bedroom floors had a non-slip vinyl covering. The residents spoken to said they were happy with the flooring provided. A lockable facility was provided in the bedrooms and the doors had an over riding door lock to ensure privacy. Comfortable seating and writing tables were supplied on assessed need. Screening was provided in double rooms to ensure that privacy and dignity are maintained. The heating within the home was adequate. All the rooms were centrally heated and the radiators and pipe work were suitably protected. Thermostatic control valves were in place on immersion baths and showers. Ventilation was either natural or mechanical. The home was clean and free from odours. Hand washing facilities were in place in each resident’s room, in bathrooms, toilets and sluices. The laundry was very spacious, well equipped and well organised. The floors and walls were tiled and therefore easily cleaned. Protective clothing and staff hand washing facilities were in place. Clinical waste was handled appropriately and infection control procedures were adhered to for all areas of the home. Staff who handle food undertake basic food hygiene training. Nazareth House Nursing Home DS0000017331.V277625.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 29. The residents were cared for by sufficient numbers of staff that are suitably qualified, trained and recruited and therefore have 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. In addition to the qualified nurses on the unit the manager has appointed 2 nurses to the position of senior nurses. These senior nurses are mainly supernumerary and in addition to their own clinical practice undertake supervision in relation to clinical issues. 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 The personnel files of three staff members were inspected. These contained all the requirements of Schedule 2. They had a completed application form, 2 professional references, an enhanced CRB disclosure check and health status declaration. Nazareth House Nursing Home DS0000017331.V277625.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38. The experience and qualifications of the manager ensures there is effective leadership and guidance to the staff thereby ensuring that the residents receive consistent quality care. The arrangements in place for the reviewing of the service provisions ensure that the home delivers a quality service. A satisfactory accounting system was in place that ensured the residents’ interests were protected. Current practices within the home in relation to the maintenance of a safe environment, promoted and safeguarded the health, safety and welfare of the people using the service. EVIDENCE: The registered manager is a Registered General Nurse with extensive experience of nursing both within the NHS and the private sector. She has just completed the modules for the registered managers award and is awaiting accreditation. She has undertaken training in bereavement counselling, is a moving and handling facilitator and has experience in palliative care nursing. Nazareth House Nursing Home DS0000017331.V277625.R01.S.doc Version 5.1 Page 18 Staff spoke very positively about the managers attitude, knowledge and experience. They said that she was very approachable and listens to any concerns that they have. One staff member said that it is “onwards and upwards” with their manager. Another staff member said “ things have certainly improved since Barbara came into post”. The home has recently achieved the Investors in People award. They have an annual development and business plan and there was evidence of continuous self-monitoring using an objective method. The home also has a quality assurance team. They look at various issues within the home such as food, health and safety, care plans, the laundry service and wheelchair provision. Following the audit on wheelchairs the home has devised a system whereby each resident has their own named wheelchair. The Inspector saw evidence of this while she was walking around the building. The home also sends out questionnaires to the residents/relatives requesting their views on the service provision. The systems in place for the management of residents’ money were good. The home had a satisfactory accounting system in place. Receipts were retained for all financial transactions. The equipment and services within the home were serviced on a regular basis in accordance with the individual requirements. The home had a detailed Health & Safety Policy. Fire risk assessments and risk assessments for all safe working practices were performed and outcomes recorded. The fire logbook was up-to-date. All staff received Induction Training with regard to food hygiene, fire safety, moving and handling and infection control. Fire training was undertaken on an annual basis. Nazareth House Nursing Home DS0000017331.V277625.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 3 3 3 x x 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Nazareth House Nursing Home DS0000017331.V277625.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Residential unit. When a resident has been identified as being at risk of developing pressure sores then a plan of care for prevention must be in place. Residential unit. When a problem has been identified, i.e. weight loss, then a plan of care to address the problem must be in place. Residential unit. Staff must document the actual amount/number of tablets being given. Residential unit. The administration of medications must be signed for on the MAR sheet once they have been given (Previous requirement of the 02/08/05 not complied with.) Timescale for action 10/02/06 2 OP7 15 10/02/06 3. OP9 13 10/02/06 4a OP9 13 09/02/06 Nazareth House Nursing Home DS0000017331.V277625.R01.S.doc Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 4 Refer to Standard OP7 OP9 OP9 OP37 Good Practice Recommendations The care staff on the residential unit should receive regular supervision or further training in relation to care planning Consideration should be given to devising a specimen signature and initials list. To ensure the safety of the resident, transcriptions of medications should be checked, signed and countersigned by another member of the care staff. 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. Nazareth House Nursing Home DS0000017331.V277625.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Nazareth House Nursing Home DS0000017331.V277625.R01.S.doc Version 5.1 Page 23 - 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. 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