Inspection on 09/10/08 for St Anselm`s Nursing Home

This inspection was carried out on 9th October 2008.

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

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

St Anselm`s Nursing Home 24/10/06

St Anselm`s Nursing Home 15/02/06

St Anselm`s Nursing Home 16/08/05

St Anselm`s Nursing Home 08/12/04

St Anselm`s Nursing Home 21/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Anselm`s Nursing Home St Clare Road Walmer Deal Kent CT14 7QB     The quality rating for this care home is:   three star excellent 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: Christine Lawrence     Date: 0 9 1 0 2 0 0 8 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. the things that people have said are important to them: They reflect 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 23 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: St Anselm`s Nursing Home St Clare Road Walmer Deal Kent CT14 7QB 01304365644 01304380514 stanselms@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Mark Redman,Mrs L A Redman,Mrs Irene Lane,Mrs Aileen Jordan Name of registered manager (if applicable) Mr David Paul Weller Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: Patients detained under Sections of the Mental Health Act may not be admitted to the home Patients must be aged 50 years and over Date of last inspection Brief description of the care home St. Anselms provides care, support and nursing for up to 25 people with mental health needs and dementia. The home is a large detached building set in its own grounds, in a quiet residential area of Walmer. It is near to local shops and facilities, Walmer Castle and the sea. It is within easy reach of the towns of Deal and Dover. It is run by a partnership, with all of the providers actively involved in the running of the home. Care Homes for Older People Page 4 of 23 Over 65 25 25 0 0 Brief description of the care home Accommodation is provided over 4 floors (lower ground, ground, first and second floors), and all floors can be accessed via a passenger lift. The communal areas in the main building consist of a large lounge, conservatory and dining area. There is also another small quiet lounge area for residents. The home has a gatehouse which has been renovated to provide reception and office facilities, minimising disruption to residents in the main building. The grounds are spacious and well kept. The current fees for the service at the time of this visit range from £750 to £850 per week. Information on the services provided for prospective service users will be detailed in the Statement of Purpose and Service User Guide. The e-mail address of the home is stanselms@hotmail.co.uk and the website is www.stanselmsnursinghome.co.uk Care Homes for Older People Page 5 of 23 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: three star excellent 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 inspection visit started at 11:00 and finished at 16:00. We (the Commission for Social Care Inspection, CSCI) looked at various records in the home and also used information sent to us by the manager before the visit. This was the Annual Quality Assurance Assessment (AQAA). Information from the previous inspection of 24 October 2006 and the Annual Service Review of December 2007, was also referred to. We observed the residents who live at the home, noting how they reacted to staff and how relaxed and comfortable they were within the home. A walk round the house was undertaken and this included residents rooms. We made observations of staff interacting with, and supporting residents. We spoke to members of staff, the manager and three of the owners. We also had opportunities to talk to residents and visitors while walking around the building. Care Homes for Older People Page 6 of 23 Care Homes for Older People Page 7 of 23 What the care home does well: What has improved since the last inspection? 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 23 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 9 of 23 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. Residents can be confident that the home judges that it can meet their needs because it assesses their needs before they move in. Evidence: We looked at several individual records and noted that the manager carries out a detailed assessment prior to admitting any new person. He uses a recognised assessment tool (Behavioural Assessment Scale of Later Life) to do this. The records also showed that information is gathered from the prospective resident as well as others involved in their care when appropriate. Information from placing authorities is also used. The information from the assessment is used to compile a care plan. Care Homes for Older People Page 10 of 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from having an individual person centred plan of care which clearly identifies how their health and care needs are to be met. They are protected by the homes procedures for dealing with medication and they can be confident that they will be treated with respect. Evidence: A care plan is drawn up from the detailed and comprehensive assessment noted under standard 3. The home uses a Standex system to note needs and to provide guidelines for staff to meet those needs. This system has lots of supplemental information devised by the manager to ensure that all residents plans reflect their own individual needs and wishes. The Standex system is kept up to date and the home is advised of any changes such as recent ones to do with the Mental Capacity Act. The manager represents the home as a member of the East Kent Practice Development Group and is also involved in the Essence of Care projects which take place regularly, the current one focussing on nutrition. Both the manager and the providers spoken to during this visit demonstrated their knowledge of current practices with regard to providing Care Homes for Older People Page 11 of 23 Evidence: nursing care. The care plans viewed for this inspection were up to date, reflecting that they are looked at on a monthly basis or changed when required. Staff record daily notes to inform the review process. Some examples were noted of residents being involved in this process but David Weller said that some people choose not be involved. There are various tools in place for monitoring residents health care such as weight records, risk assessments for skin, nutrition and for falls. Some people living at St Anselms have quite complex health care needs and there was evidence within the care plans seen to show that other health care professionals are involved as required. The home uses a monitored dosage system for medication. Residents medication is reviewed every six months by a GP or psychiatrist or changed and reviewed as required. The storage and administration records were satisfactory and only trained and competent staff give out medications. Risk assessments are in place for injectable medication. The home has applied to become a champion within the Dignity in Care scheme and as such they receive regular information including a newsletter. The induction training emphasizes the importance of privacy and dignity and the manager said that feedback from residents is positive. How people wish to be addressed is recorded and known by staff. We observed staff to be polite and discreet when offering support and to knock on doors before entering rooms. Care Homes for Older People Page 12 of 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their preferences will be identified and responded to and that they will be enabled to maintain contact with friends and family. Residents will be enabled to make choices and they will benefit from healthy, well-presented food at a time and place to suit them. Evidence: The home has individual profiles for each person identifying preferences for activities etc. These are compiled by a designated member of staff (activities coordinator) who keeps them relevant and up to date through discussions with residents and others where appropriate. Those seen for this inspection were person centred and included a variety of activities and stimulation including knitting, colouring, gardening, watching TV, games such as big Connect 4, one to one visits to rooms, having nails painted, aromatherapy, chair exercises, listening to music, visiting entertainers, DVD sessions, going to the pub, shopping, attending communion. A daily record is maintained. Staff spoken to were knowledgeable about residents preferences and wishes and also about providing activities and stimulation. Some staff have attended a conference run by Age Concern relating to activities and older people. Residents are given opportunities and encouragement to enjoy a full lifestyle based on their own preferences. Care Homes for Older People Page 13 of 23 Evidence: One resident said there was always something going on but you didnt have to join in. We noted that people made choices about various things including their daily routines, activities, where to eat and whether to observe their religious beliefs. We were informed that there are no restrictions on residents receiving visitors. There was a particular example of the home supporting a resident to maintain a relationship and the home helped two people to celebrate their 40th wedding anniversary. The home has facilitated two people to take a holiday this year to visit with a relative and there are plans to support another person to make a trip reflecting a wish to go back and see old haunts. Residents spoken to said they were very satisfied with the food. There were choices available and wine or beer to drink if a resident wished. The chef spoke knowledgeably about residents needs and preferences and he operates a Safer Food, Better Business system of food safety. Mealtimes are not rushed. One resident said how much he enjoyed the food and the social occasion it is. Special occasions are catered for such as birthdays and anniversaries. The gardens will also be used for picnics or barbeques on occasions. An allotment created within the grounds, and maintained with the involvement of residents, provided some fresh produce for residents meals this past summer. Care Homes for Older People Page 14 of 23 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints would be handled objectively and in keeping with the homes appropriate procedures and residents or their representatives can be confident that any concerns will be listened to, taken seriously and responded to. Staff are aware of adult protection issues and there are systems in place which create an atmosphere for protecting residents from abuse. Evidence: There is a clearly written complaints procedure available within the home. Information about how to make a complaint is included within the initial information given to new residents and is also on display in the entranceway of the home. Staff, residents and visitors spoken with during this inspection said they were aware of the procedures. Records are maintained of any complaints and the manager said they would respond to any complaints as quickly as they can. Training regarding the protection of vulnerable adults is provided for everyone who works at St Anselms as is training in understanding how, if at all, any restraint should be used. There are policies and procedures in place relating to concerns and complaints, disclosure of abuse and bad practice (whistle blowing), residents finances and safeguarding and protection of residents. Care Homes for Older People Page 15 of 23 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. Residents benefit from living in a safe, well-maintained home which is homely, clean, comfortable, pleasant and hygienic. Evidence: The home is sutable for its purpose and has attractive gardens which are used for both social occasions and for growing vegetables. A maintenance person is employed and staff use a maintenance book to record any issues that need attention. The home is decorated and furnished in a homely way, although in keeping with the atmosphere of a large detached, period house. Original features have been kept. The laundry was satisfactory and we spoke to a laundry assistant who confirmed that she had received training and guidance. The manager takes responsibility for monitoring infection control as he is an infection control link nurse and therefore up to date with knowledge. He has used the Department of Healths Essential Steps tool to identify any areas for improvement. Hand washing facilities were good throughout the building, including anti bacterial sprays in all rooms. Staff have received training provided by the Health Protection Agency. The home was clean and fresh at the time of this visit. Care Homes for Older People Page 16 of 23 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 needs are met by sufficient staff who are competent and well trained. Residents are supported and protected by the homes recruitment procedures. Evidence: There is a mix of staff including registered nurses and registered mental nurses. A rota is used which shows that extra staff are available at lunchtimes to support residents. The manager and owners said that they regularly review staffing levels to make sure that there are sufficient people on duty to meet the changing needs of the people who live at St Anselms. There is a bank of additional staff so flexibility is possible. There are cleaners, laundry assistants, catering staff and a maintenance person. More than half the staff have a national vocational qualification level 2 or above and two people are currently undertaking this. We looked at three staff records for this inspection which reflected that the home has a robust procedure for recruitment which includes an application form, references, criminal record bureau checks, terms and conditions of employment and checks with the appropriate authority regarding nursing registration. Each person has an individual training record and training needs are discussed with staff and reviewed by the manager and owners. The training programme includes mandatory training such as relating to health and safety, as well as more specialised courses such as dementia Care Homes for Older People Page 17 of 23 Evidence: awareness, reminiscence, mental health awareness and managing and responding to difficult behaviour. Induction training is in keeping with the common induction standards and some staff have also been supported to attend conferences relating to the care of older people. Care Homes for Older People Page 18 of 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the home being managed by someone who is competent, experienced and knowledgeable. Residents financial interests are safeguarded and their views are sought. Staff and residents have their health and safety promoted and protected. Evidence: David Weller is a registered nurse who has a Diploma in Care Home Management and Practice. He represents the home in the East Kent Practice Development Group and uses this to keep up to date with current ideas, as well as giving and getting support from professional peers about issues relating to care homes which provide nursing. It was clear from talking to the manager and the owners who were present, that the management structure works well, with different people taking on various designated responsibilities. Both the AQAA completed by David Weller and discussions with him during the inspection reflected his knowledge of and commitment to the ethos of the home. The owners comments about him also confirmed this. One member of staff said Care Homes for Older People Page 19 of 23 Evidence: that he was a good role model and knew the clients well. The owners and manager explained the systems in place which they use to monitor the service provided. This includes staffing and training as well as the environment. The opinions of the people who live in the home are sought through meetings every two months. The results of these meetings are minuted and displayed on a noticeboard in the home. The manager explained that if anyone did not wish to be involved in the residents meetings they would have an opportunity to express opinions on a one to one basis. This often happens with the support of relatives. The owners also meet regularly and the audits feed into a business plan which is monitored and reviewed at these meetings. Satisfaction surveys are sent out yearly and the feedback from them will be considered. The home tries to gain feedback from a variety of people involved with St Anselms not just the people who use the service. Those seen included feedback from healthcare professionals, hairdresser and chiropodist as well as relatives of residents. There are policies and procedures in place regarding residents money. In practice most of this is managed by relatives and we were informed that if required the home will involve a solicitor to help manage peoples finances. The records seen showed that staff have the appropriate health and safety training to keep themselves and residents safe and this includes manual handling, infection control, fire safety, control of substances hazardous to health, food hygiene first aid and general health and safety. There are policies and procedures in place to underpin good practice. A spot check on some of the maintenance and service contracts showed them to be appropriate and up to date. Care Homes for Older People Page 20 of 23 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 21 of 23 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 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 Care Homes for Older People Page 22 of 23 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 23 of 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. 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!