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Inspection on 12/01/06 for Risedale At St George`s Nursing Home

Also see our care home review for Risedale At St George`s Nursing Home for more information

This inspection was carried out on 12th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

At Risedale St George`s the manager and staff pride themselves on "taking on board the whole family" not just the resident. There was obviously good communication and trust between visitors and staff. Visitors said they felt "at home", could make themselves drinks, assist with personal care if they wished to, and were welcome to stay and have meals with their resident. The home had a strong focus on providing quality nursing care; the registered nurses were encouraged to attend advanced training, and the company promoted the use of nurse specialists. The manager was able to adjust staffing levels according to residents` needs, this was particularly so for those people in receipt of continuing health care funding, who may at times need one to one care.

What has improved since the last inspection?

There were no requirements or recommendations following the last inspection, and none made at this inspection. The home has continued with its own improvement plan, which covers all aspects of the home. Since the last inspection four ceiling hoists have been fitted, following a successful trial in one bedroom. Residents and staff felt this was a great improvement. There is also a plan to replace the floor coverings in the lounge areas. A recent innovation is the appointment a Risedale Clinical Nurse Manager. Her role is to oversee the care of those residents with the most complex needs, across the Risedale group. Staff at St Georges felt this was proving to be beneficial in supporting them to give quality care to their most needy residents.

What the care home could do better:

The company and the manager are continually monitoring the quality of their service. They are also pro-active in looking for ways to improve on their good practice, in order to provide a better service to residents.

CARE HOMES FOR OLDER PEOPLE Risedale At St George`s Nursing Home Albert Street Barrow In Furness Cumbria LA14 2JB Lead Inspector Jenny Donnelly Unannounced Inspection 12th January 2006 11:30 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 Risedale At St George`s Nursing Home DS0000006152.V271313.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. Risedale At St George`s Nursing Home DS0000006152.V271313.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Risedale At St George`s Nursing Home Address Albert Street Barrow In Furness Cumbria LA14 2JB 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) 01229 870050 01229 822955 Risedale Estates Limited Ms Joanne Robinson Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47), Physical disability (3), Terminally ill (2) of places Risedale At St George`s Nursing Home DS0000006152.V271313.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home is registered for a maximum of 47 service users to include: up to 3 service users in the category PD (physical disability) up to 2 service users in the category TI (terminally ill) One service user under the age of 65 years may be accommodated in an intermediate nursing bed within the overall number of registered places. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 26th September 2005 Date of last inspection Brief Description of the Service: Risedale Estates Ltd runs Risedale St George’s, and the registered manager is Joanne Robinson. The home is situated in the town of Barrow-in-Furness, a short distance from the shops and amenities. The home is purpose built with accommodation on two floors served by a passenger lift. All bedrooms are single with en-suite toilets. There is plenty of lounge and dining space and there are six bathrooms with specialist equipment. There is a pleasant garden area, with seating and a water feature. The home is twinned with Risedale at Lonsdale, and they share kitchen and laundry facilities, although the homes are managed separately. St Georges provides general nursing care, has three beds dedicated to intermediate nursing care assessment, and also cares for up to eight people in receipt of continuing health care funding. Risedale At St George`s Nursing Home DS0000006152.V271313.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection began at 11.30 am. The majority of residents were up and in the lounges. Some residents had chosen to stay in their bedrooms, and others were too poorly to get up. The registered manager was on duty at the time of inspection. I toured the home and spoke with residents, visitors and staff. I inspected records relating to residents and staff, and observed lunch being served. Those standards not inspected at this time, where inspected and met at the last inspection in September 2005. What the service does well: What has improved since the last inspection? There were no requirements or recommendations following the last inspection, and none made at this inspection. The home has continued with its own improvement plan, which covers all aspects of the home. Since the last inspection four ceiling hoists have been fitted, following a successful trial in one bedroom. Residents and staff felt this was a great improvement. There is also a plan to replace the floor coverings in the lounge areas. A recent innovation is the appointment a Risedale Clinical Nurse Manager. Her role is to oversee the care of those residents with the most complex needs, across the Risedale group. Staff at St Georges felt this was proving to be beneficial in supporting them to give quality care to their most needy residents. Risedale At St George`s Nursing Home DS0000006152.V271313.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Risedale At St George`s Nursing Home DS0000006152.V271313.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 Risedale At St George`s Nursing Home DS0000006152.V271313.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): 2 Residents or their families had signed a contract of residency with the home, and through this were informed of the terms and conditions of their stay. EVIDENCE: Risedale issued contracts to all residents. Signed copies of these were kept on file. The contract stated the type of placement, either short or long term, the bedroom to be occupied, and stated the fees and who was responsible for the payment. There were slightly different contracts for residents occupying a dedicated continuing healthcare bedroom. This made it clear that should a resident no longer be awarded continuing healthcare funding, they would have to move to a different bedroom within the home. The resident files also contained signed copies of laundry and television licence agreements, and information on how to make a complaint. There was sufficient evidence to judge that residents, and their families were well informed about the terms and conditions of their stay at Risedale St George’s. Risedale At St George`s Nursing Home DS0000006152.V271313.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 and 10 Health and personal care needs had been clearly recorded, and residents’ benefited from a very good standard of general and specialised nursing care. Residents felt they were treated with dignity and respect. EVIDENCE: Care plans gave clear and up to date information on all personal and health care needs. There were clear instructions for staff on who required what level of input and when. The home kept detailed health records, which showed that residents had been able to see their doctor, dentist, chiropodist and optician as required. Input from other professionals such as the tissue viability nurse specialist (wound care) and dietician had also been recorded. The home advertised a local private physiotherapist, who residents could access if they wished to. Health needs, including records of wound care, dressings, catheter or feed tube care, were detailed and up to date, ensuring staff gave consistent and correct care at all times. Visitors said they had been kept well informed of any changes in their relatives care. Residents said they felt well cared for, and a visitor said “the staff do everything little thing, they cream his skin and keep his feet warm”. Risedale At St George`s Nursing Home DS0000006152.V271313.R01.S.doc Version 5.1 Page 10 The home had some bedrooms dedicated to continuing health care, and was caring for eight people under continuing healthcare contracts. The people in receipt of continuing healthcare funding had been allocated specific staff hours, according to their assessed needs. Some of these residents required a very high level of intensive nursing care, and the home was managing this very well. Risedale Estates employ a number of specialist nurses with additional qualifications, these include wound care, terminal care, continence management and health and safety. The company keeps a Skills Register, recording which specialist nurse works in which Risedale home, so the managers can easily access them for advice. A new role is the recent appointment of a Clinical Nurse Manager, who oversees the care of those residents with the most complex needs, across the Risedale group. Staff felt this was beneficial, as in addition to giving advice and support, the clinical nurse manager followed up referrals to outside agencies/specialists, allowing the staff to get on with providing hands on care. Risedale had developed criteria to assess which residents would benefit from the involvement of the Clinical Nurse Manager. All staff had received training on maintaining residents’ privacy and dignity. This had been absorbed into the everyday practice in the home, and could be heard in the language used. Staff talked about covering people with “dignity blankets” whilst being hoisted. Staff knocked on bedroom doors before entering, and spoke politely to residents and visitors. Residents confirmed that staff “treated us very well”. All bathrooms and toilets had door locks fitted and there were also engaged signs for use on the doors. Staff had also started using a “personal care in progress” notice on bedroom doors when attending to residents in bed. Risedale At St George`s Nursing Home DS0000006152.V271313.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): 14 Residents were being enabled to exercise choice and control over their lives, and were not being restricted because they lived in care home. EVIDENCE: Residents were able to exercise choice and control over their lives. This could be seen in the care plans, where people had stated their preferences for how their care was to be delivered. This included basic choices such as preferring a bath to a shower, and liking to go to bed and get up at certain times. There was also evidence of residents stating their preference on bigger issues, such as whether to accept certain health treatments or medications. Residents said they could spend their days, as they liked, either in the communal rooms or in their bedroom. Any activities and entertainment were optional, and residents said they did not feel pressured to attend. There was information on the notice boards about support groups and independent sources of information, including Age Concern and mental health forums. Some residents had solicitors who looked after their interests, and safeguarded their finances. Residents were able to receive post unopened and many had a private telephone from which they could conduct their business affairs. In reality the majority of residents were not well enough to do this, and received help from their family. Risedale At St George`s Nursing Home DS0000006152.V271313.R01.S.doc Version 5.1 Page 12 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): 16 and 17 Residents and their relatives were able to voice any concerns or complaints, and have them listed to and acted on. Residents were able to maintain their human and legal rights whilst living at St Georges. EVIDENCE: The homes’ complaints procedure was on display and a copy had been issued to each resident/relatives. The procedure was clear and simple to follow. The residents and visitors spoken to say they would raise any concerns with the manager, and felt confident that she would act on the matter. The home had not received any complaints since the last inspection, and none had been made directly to the inspector. The home ensured that residents were named on the electoral role, and were able to take part in political process if they wished to. Residents could access solicitors or advocates for advice and support. The manager was aware of those residents whose finances were solely managed by a solicitor, as she had to request money from the solicitor on the residents behalf, for clothing and so on, and return the receipts to the solicitor. Risedale At St George`s Nursing Home DS0000006152.V271313.R01.S.doc Version 5.1 Page 13 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): 22, 23 and 24 Residents benefited from having spacious and comfortably furnished bedrooms. St Georges was also very well equipped to safely meet the needs of older people with infirmities. EVIDENCE: The home was well designed and suitably equipped to assist frail older people. There were passenger lifts to the first floor, and there was good wheelchair access throughout the building. There were plenty of mobility aids including overhead tracked hoists, freestanding mobile hoists and a variety of slings. There were also moving and handling belts for aiding residents to stand, and slide sheets for moving residents in bed. All beds were electric profiling nursing beds, fitted with low-grade pressure reducing mattresses. The home also had a good supply of higher grade alternating air mattresses. There was a specialist bed for very heavy residents, and the manager had ordered another specialist bed for a trial. The intermediate care unit accessed equipment as required from NHS loans. Risedale At St George`s Nursing Home DS0000006152.V271313.R01.S.doc Version 5.1 Page 14 All bedrooms were single with en-suite toilets. Some ground floor rooms had patio doors leading into the garden. The furniture and furnishings provided was of good quality, and residents had been able to bring in their own possessions to make the room homely. Bedroom doors had a lock fitted, and there was a lockable storage space within the room. Residents said their bedrooms were warm and comfortable, and were treated as their private space. Risedale At St George`s Nursing Home DS0000006152.V271313.R01.S.doc Version 5.1 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 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 The number and skills of staff ensured that residents were well cared for at all times. EVIDENCE: The number and skills of staff on duty were appropriate to meet the needs of the residents. During the inspection there were 3 registered nurses and 10 healthcare assistants on duty. In addition to this were the manager, domestic, catering, administrative and maintenance staff. The home only had one vacant bedroom, which was already booked. The two floors of the home, the intermediate and the continuing healthcare beds were staffed separately. This meant residents knew who was caring for them, and staff were not being called from one area of the home to another during the course of the day. Staff said they did move around the different areas of the home periodically, and as such had some knowledge of all residents. The manager was able to adjust staffing levels according to changes in residents needs, especially for the continuing healthcare beds. St Georges had 8 residents in receipt of continuing healthcare funding, and was looking to increase this to 10. In preparation, additional staff hours had been agreed to commence at the end of the month. Risedale At St George`s Nursing Home DS0000006152.V271313.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 38 Residents were able to comment on, and affect the way the home was run, through the manager’s regular quality surveys. There were adequate systems in place to promote the health, safety and welfare of residents and staff. EVIDENCE: The home operated a quality assurance programme. This included satisfaction surveys for residents and relatives, and internal audits by the manager. Satisfaction survey questionnaires were sent out in batches periodically throughout the year. The last batch was collected in September 2005. Eighteen questionnaires had been completed and these gave mostly “good” to “excellent” responses to all the services provided. There were many positive and praiseworthy comments about the helpfulness and politeness of staff. There were two suggestions for additional equipment people thought would be beneficial, and the manager was discussing these with the company directors. There were two negative comments, which the manager was addressing. Risedale At St George`s Nursing Home DS0000006152.V271313.R01.S.doc Version 5.1 Page 17 It was clear that the manager was acting on suggestions and comments raised in these surveys, so this was a good way of enabling residents to shape the service. The manager’s internal audits checked the quality of care planning and accidents (monthly), and the condition of the kitchen (weekly). The accident record audit showed that there had been very few accidents in recent months, for the number of residents in the home. Through this audit the manager was able to monitor those residents who had frequent, or an increasing number of falls, so that any necessary intervention could be planned. The fire log showed that all checks on the fire alarm system and fire safety equipment were regularly undertaken. Staff had received training in fire safety, and moving and handling, from a qualified instructor at the appropriate intervals. Risedale At St George`s Nursing Home DS0000006152.V271313.R01.S.doc Version 5.1 Page 18 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 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 X 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 X X X X 4 3 3 X X STAFFING Standard No Score 27 4 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X 3 Risedale At St George`s Nursing Home DS0000006152.V271313.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? N/A 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Risedale At St George`s Nursing Home DS0000006152.V271313.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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. 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