Inspection on 12/12/05 for St Augustines Court Care Home

This inspection was carried out on 12th December 2005.

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 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 Augustines Court Care Home 16/02/09

St Augustines Court Care Home 15/05/07

St Augustines Court Care Home 19/04/06

St Augustines Court Care Home 21/06/05

St Augustines Court Care Home 06/01/05

St Augustines Court Care Home 20/09/04

Similar services:

Trevayler Residential Care Home

Thornham Grove

Thistle Hill Hall

Conifer Lodge

Westwood Lodge

Egerton Lodge Care Home

Alfred Minto House Care Home

St Matthews Unit

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

CARE HOMES FOR OLDER PEOPLE St Augustines Court Care Home 105 - 113 Wells Road Nottingham Nottinghamshire NG3 3AP Lead Inspector Steve Keeling Unannounced Inspection 12th December 2005 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 St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 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. St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Augustines Court Care Home Address 105 - 113 Wells Road Nottingham Nottinghamshire NG3 3AP 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) 0115 9590473 0115 9412079 Southern Cross Care Homes No 2 Limited Vacant Care Home 40 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (40), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (40) St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the total number of 40 beds 3 beds maybe used for clients under the age of 65 years in the category of DE St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over a 4 hour period and involved one inspector. The main method of inspection was case note tracking, this is a method of selecting service users within the home and discussing with them their expectations and experiences of living within the home environment. The case tracking method also analyses the records of the service users to ascertain if the service users identified needs are being addressed appropriately within the care home setting and that their safety and well being is being maintained. On this occasion two residents notes were case tracked. Also as part of the case tracking process, staff members within the home are informally interviewed to further evidence the quality of care afforded to the service users. At the time of the inspection a total of 35 residents were accommodated at the home. It was evident that the management and staff within the home are very committed to providing a high standard of care for the service users. The manager and staff within the unit were very helpful and cooperative thus ensuring that the inspection process progressed in a professional and efficient manner. The report indicates minimal comments from the residents, primarily due to the nature of the illness of those accommodated although relatives were interviewed at this inspection to glean further information as to the quality of care afforded to the service users. Whilst the inspector acknowledges progress has been made in some areas the registered provider must address the serious concerns identified in the report to ensure the safety of the service users. What the service does well: The home provides care for people with enduring mental illness and dementia, most residents exhibit difficult behaviours that cannot be managed in a residential environment. The committed care staff have worked at the home for a long time and provide good support for the residents. St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 Page 6 The home has benefited from the replacement of carpets and flooring in the bathroom areas and on the whole the home is clean, homely, safe and fit for purpose. 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. St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 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 St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 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 The case tracked service users were admitted to the home after having a thorough needs assessment performed by a suitably qualified nurse. EVIDENCE: The pre-admittance assessments within the two case tracked notes were detailed in identifying the specific needs of the service users to maintain optimum independence within the home. The assessment documentation is clear, concise, signed and dated by a suitably qualified assessor. St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 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. 10. Individual care plans do not reflect the identified needs of the service user. As such the care planning process is ineffective in meeting the holistic needs of the service users. No service users are currently responsible for self-medication but is was established that this process could be facilitated if after assessment the service user were deemed safe. It was evident that staff at the home maintains respect and dignity for the service users EVIDENCE: The documentation of two service users was case tracked at the time of the inspection. The two case tracked evaluation and care-planning documentation did not contain effective care plans to address all the identified needs within the pre-admittance assessment. St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 Page 10 A service user who had been assessed as high risk of absconding; at risk of pressure ulcer formation and requiring nutritional monitoring had no care plans formulated to effectively manage these identified needs. Another service user who had also been identified as “at risk” of pressure ulcer formation had no care plan to manage this element of care. It was identified that a service users would require podiatry interventions on a six weekly basis, the professional visits record within the case tracked service users documentation was totally blank and as such this element of care could not be evidenced effectively. The acting manager of the home confirmed that elements within the care planning and assessment process requires further development and it was established that the acting manager would be addressing the shortfalls in the near future. The Commission for Social Care Inspection issued a requirement to address the identified shortfall and will be monitoring the manager’s progress at the next inspection. At the time of the inspection no service users were responsible for the selfadministration of medicines. It was established that should a service user wish to be independent in the administration of medicines the manager in conjunction with the multidisciplinary team, would perform a risk assessment, if the service users was deemed as being safe, self-medication would be facilitated if at all possible. At a previous inspection it was established that Lancet devices used for monitor blood sugar levels were not being used as per the manufacturers instructions and the guidance from the medical devices agency. It was the practice to use individual devices for multiple residents, posing a serious risk of cross infection. This practice has now ceased and Lancet devices are now service user specific. At the time of the inspection, service users were clean, presentable and dressed in appropriate clothing for the season. A relative who was visiting her father at the home was positive about the way staff spoke to her father and all the service users within the home. The inspector witnessed many interactions between staff and service users and it was evident that staff respected and promoted the service users dignity and appeared to have a genuine concern for the wellbeing of the service users who appeared comfortable and very happy within the home environment and with the staff employed at the home. St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 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): 12. 13. 14. 15. A social activities coordinator has been recently employed at the home to ensure a wide range of stimulating activities are provided. Service users maintain contact with family, friends and representatives from the local community. Service users can exercise choice and control over their lives. The service users are given the opportunity to participate in a nutritionally balanced diet but a lack of choice is problematic at the home. EVIDENCE: An activities coordinator has recently been appointed at the home and will be employed for 30 hours per week. The activities coordinator within the home will be responsible for the provision of varied and stimulating social activities such as music appreciation sessions, games, painting, dancing, the provision of guest entertainers and the organisation of trips within the broader community. St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 Page 12 Currently an activities record/log is not maintained for service users although the facility was evident within the service users personal documentation. Given the lack of documentary evidence appertaining to social activities and the service users inability to provide a account of the social activities provided at the home due to reduced cognitive abilities, the inspector was unable to establish what social activities the service users had participated in. It was evident that within the festive period service users will be afforded the opportunity to enjoy a Christmas party. A religious service is also performed at the home on a monthly basis, which the service users can attend if they choose. Service users are also encouraged to interact within the broader community if they choose and are accompanied and the local shops and town centre to shop or browse. It was evident that the newly appointed social activities coordinator is keen to provide transport for the service users to further enhance social interactions within the broader community. It was evidenced on the day of the inspection that only one choice of a main meal was available to the service users and as such the service users choice in relation to the provision of a satisfying meal is compromised. Daily menus are displayed for service users perusal on a menu board within the dining room area. On the day of the inspection it was evident that the food in the home is wholesome and nutritionally appropriate. No restrictions are in place in relation to visiting times. At the time of the inspection relatives and friends were visiting service users. Relatives spoken with confirmed that the home operates an open policy in relation to visiting times. At the time of the inspection service users were very well presented, dressed in appropriate clothing for the season, and were wearing their own shoes or slippers. A relative of a service user spoken with stated that the laundry service is efficient, resulting in her fathers clothing being retuned clean and well ironed condition. St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 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): 16. The relatives and friends of service users are confident that their complaints are listened to, taken seriously and acted upon. EVIDENCE: The home had no outstanding complaints at the time of the inspection. The manager at the unit maintains clear and concise record of any complaints received appertaining to any elements of health care provision within the home. Through discussions with the acting manager it was established that her knowledge of the complaints procedures utilised within the home is appropriate. The complaints procedure was also on display in the reception area of the home. It was agreed that the complaints procedure would be included in the homes statement of purpose and given to the relatives of prospective service users to further promote the safety of residents within the home. Following a discussion with a service users relative it was evident that she felt confident and comfortable to express any concerns or complaints to the care staff or management within the home. It was established that in the past she had made a complaint appertaining to the care her husband received at the home, her complaint had been dealt with effectively and professionally by the acting manager. St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 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. 26. The planned upgrades to the home are now progressing effectively and the home is maintained to appropriate standard of cleanliness. EVIDENCE: The home is benefiting from an ongoing routine maintenance programme, it was established that all the upstairs corridors had been recently re-carpeted and the handyman employed for 20 hours per week was currently in the process of redecorating the bathrooms in the home that have also been recently fitted with non-slip vinyl flooring. Water outlet temperatures are monitored on a monthly basis and emergency lighting and fire alarm checks are performed on a weekly basis. The risk of Legionella contamination is minimised by ensuring that chlorination of the water supply is performed by outside contractors. All mobility equipment within the unit is covered by service contracts to ensure service user safety. To further promote the service users safety, window St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 Page 15 restrictors are in place to prevent intruders gaining access to the unit, radiators in the service users rooms are covered to prevent the risk of burns. The grounds are tidy, well maintained, secure and easily accessible to service users thus providing a very pleasant, safe, area for the service users to utilise as they wish. The communal areas such as the lounges and dining areas smelt fresh and it was obvious that an appropriate standard of cleanliness is maintained within the home. Service users bedrooms are maintained to the same standard of cleanliness, the bedrooms inspected were also very comfortable and homely, some personal possessions are evident. The homes kitchen area was clean but somewhat shabby, areas on the vinyl flooring, which had deteriorated, had been taped over, this type of “make shift” repairs would present a potential hazard in the kitchen areas and as such should be repaired appropriately and given priority within the homes schedule of repairs. St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 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. 28. 29. 30. The quantity and skills mix of staff employed at the home on the day of the inspection was sufficient to meet the needs of 35 the service users. The recruitment practices at the homed had not been followed which could result in the safety of the service users being compromised. Staff at the home have received some training but shortfalls were evidenced in the provision of core training elements. EVIDENCE: Staff files examined evidenced shortfalls in the appropriate documentation to ensure the vulnerable service users are protected. It is a requirement that all staff have a POVA first check followed by a Criminal Records Bureau checks (CRB) and two satisfactory references, it was established that the personal files of two resent employees employed at the home did not have all the aforementioned checks and references undertaken prior to employment. The acting manager of the unit confirmed that the oversight was primarily her responsibility and it was agreed that all staff file would be checked to ensure appropriate documentation is evident. The Commission for Social Care Inspection issued a requirement to address the identified shortfall and will be monitoring the manager’s progress at the next inspection Staff employed at the home is sufficient to meet the needs of the service users and an appropriate skill mix was evidenced. It was evidenced that the manager St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 Page 17 is not included in the nursing rota so as to allow her time to effectively manage the unit. On the morning of the inspection five carers, and two qualified nurses were on duty. Throughout the afternoon period, five carers and two qualified member of staff were on duty and three carers and one qualified nurse covered the night period. An examination of staff files identified minor shortfalls in the provision of refresher courses for statutory training. It was established that the manager of the unit is in the process of addressing these shortfalls and “in-house” training opportunities will commence in the New Year. The acting manager of the unit stated that she has experienced difficulty in persuading some staff members employed at the home to attend statutory training, but she would address this issue in the New Year with the staff involved. The Commission for Social Care Inspection issued a requirement to address the identified shortfall and will be monitoring the manager’s progress at the next inspection. St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 Page 18 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. It was evident that the acting manager at the home is professional, fit to be in charge, of good character although the acting manager stated that in the absence of a deputy manager she is not able to discharge her responsibilities fully. The home is run in the best interests of the service users. EVIDENCE: The acting manager at the home is currently in the process of registering with the Commission for Social Care Inspection as the registered manager. It was established that her application is not progressing in a satisfactory manner as the required references have not been supplied to the commission, as such the acting manager will be required to forward the references as soon as possible to progress her application. St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 Page 19 The acting manager has dual qualifications as a registered general nurse and is also in possession of an appropriate qualification in psychiatric nursing. It is evident that the acting manager would benefit by the support of a deputy manager but having advertised the post for several months it is only recently that a suitable candidate may have been identified. Once all the appropriate checks and references have been performed the candidate will be employed, initially as a senior nurse, to progress to the deputy managers post if deemed appropriate. Currently in the absence of the acting manager of the home, the company’s regional manager can provide support but this arrangement could compromise the continuity of care within the home. It was established that residents are not afforded the opportunity to express opinions and concerns within an open forum such as a residents meeting due to their impaired cognitive abilities. The manager of the unit confirmed that the consultation process is somewhat lacking at the moment but states that the staff meetings performed at the home provides a forum for discussions appertaining the elements care provided at the home and that staff would be given the opportunity to express any concerns at these times. St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 Page 20 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 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x x x x x St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No 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 8 Regulation 15 (1) Requirement The registered person shall ensure after consultation with the service user, or a representative of his, prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. The registered person shall ensure that were assessments of residents condition indicates referral to specialists that this referral is undertaken The registered person must ensure that having regard to the size of the care home and the number and needs of the service users, provide in adequate quantities, suitable wholesome and nutritious food which is varied and properly prepared and available as such times as may be reasonable required by the service users. The registered person must ensure that the premises to be used as a care home are of sound construction and kept in a good state of repair externally DS0000058342.V270083.R01.S.doc Timescale for action 16/12/05 2 7 8 13 16/12/05 3 15 16 (2) 16/12/05 4 19 23 (2) (b) 16/12/05 St Augustines Court Care Home Version 5.0 Page 22 5 29 19 (4)(b) 6 30 18 (1) (c) 7 31 12 (1) and internally. The registered person must 16/12/05 ensure that the staff recruitment practices meet the national Minimum standards and that staff files contain all the required documents. Outstanding Requirement from 21/22 June 2005 The registered person must 16/12/05 ensure that persons employed by the registered person at the care home receive training appropriate to the work they are to perform. The registered person must 16/12/05 ensure that the home is conducted so as to promote and make proper provision for the health and welfare of the service users. 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 St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 St Augustines Court Care Home DS0000058342.V270083.R01.S.doc Version 5.0 Page 24 - 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!