CARE HOMES FOR OLDER PEOPLE
St Bartholomews Court Nursing Home Woodfield Road Roby Huyton Merseyside L36 4PJ Lead Inspector
Mrs Joanne Revie Unannounced Inspection 30th January 2006 10:00 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 Bartholomews Court Nursing Home DS0000005469.V281730.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. St Bartholomews Court Nursing Home DS0000005469.V281730.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service St Bartholomews Court Nursing Home Address Woodfield Road Roby Huyton Merseyside L36 4PJ 0151 480 9997 0151 480 5505 saintbarts@btconnect.com 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) St Helens & Knowsley Caring Association Mrs Elaine Marie Allison Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (47), Terminally ill (3) of places St Bartholomews Court Nursing Home DS0000005469.V281730.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Service Users to Include up to 47 (OP) and up to 3 (TI) Service users to include up to 14 (OP) for rehabilitation, 5 of which may be aged 50 - 65 The service should at all times have a suitably qualified and experienced manager who has been approved by the CSCI Date of last inspection Brief Description of the Service: St Bartholomew’s is a purpose built Nursing Home. It provides nursing care for the long-term needs of 47 elderly people. It has three bedrooms set aside for people who require palliative care during the last stages of life. St. Bartholomew’s also has an agreement with the Local Authority to admit people from hospital that require rehabilitation care so that they eventually may return to their own homes. The home currently has fourteen beds set aside for this purpose and has a dedicated staff team to provide support. The service is a non-profit making organisation and has registered charity status. St. Bartholomew’s is situated in a quiet residential area of Roby-with-Huyton, Merseyside. It has landscaped gardens, which are accessible to everyone. All areas of the home are adapted to meet the needs of those residents who use wheel chairs. The home has two large dining rooms and separate lounges which benefit from a loop system for those who have hearing impairments. A local shopping centre can be accessed by a short bus ride or car journey. St Bartholomews Court Nursing Home DS0000005469.V281730.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The purpose of this visit was to assess the remaining core standards, which were not assessed during the last visit in November 2005. The reader should therefore read both reports top gain a full overview of the service. The inspection was unannounced. What the service does well:
The staff at the home manage medication safely. Examples of good practise were viewed which showed that staff were aware of the importance of managing medication correctly. This shows that the staff try hard to ensure that a medication error does not occur. Complaints are minimal about the service however any concerns raised are investigated and acted upon as though a formal complaint has been made. This means that any actions taken are written down and available for the complainant to see. This reflects good practise. The environment of the home is well maintained and appears clean, homely and comfortable. There are several seating/ lounge areas, which are used for a variety of purposes. One resident who was sitting in one of the lounges revealed that they would give” 10 out of 10 for everything” and “ I heard about this place, - thought Id give it a try and its been brilliant!” Duties and areas of expertise are delegated amongst the staff. There is a clear staffing structure in place. This means that each staff member knows who is responsible for what and what their role is. Individual Senior staff are responsible for overseeing areas of care such as medications, wound care etc. The home is managed as three separate wings each has its own staff team. This means that the residents receive care from staff who they know. The units are consistently staffed above the minimum level expected. The manager should be commended for the opportunities available for staff development. NVQ training is a strong focus in the home. 75 of staff employed have achieved this qualification, which is greater than the recommended level of 50 . As well as`NVQ training staff have undertaken other training which is relevant to the residents needs and helps to promote their Health and Safety.
St Bartholomews Court Nursing Home DS0000005469.V281730.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
Although medication is managed safely this could be further enhanced by offering the opportunity of self-medication to the residents who are receiving intermediate care. The home is aware of this and is waiting for approval from the Primary Care Trust before this can be implemented, however this should be pursued so that residents can manage their own medication and therefore further promote their independence. The service puts a great deal of effort into staff training, which includes training for new staff. The deputy manager is attending a meeting in the near future, which will discuss the national training standards for new staff in care homes. Following the meeting it is expected that a comparison will take place to ensure the homes induction is in line with the national standards. This should be followed through to reflect good practise. St Bartholomews Court Nursing Home DS0000005469.V281730.R01.S.doc Version 5.1 Page 7 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 Bartholomews Court Nursing Home DS0000005469.V281730.R01.S.doc Version 5.1 Page 8 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 Bartholomews Court Nursing Home DS0000005469.V281730.R01.S.doc Version 5.1 Page 9 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): EVIDENCE: No standards were assessed from this section on this occasion. St Bartholomews Court Nursing Home DS0000005469.V281730.R01.S.doc Version 5.1 Page 10 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): 9 Medicines are managed safely. EVIDENCE: Medication administration records, three medicine trolleys, medication storage cupboards, fridge and records and the Controlled drugs register were viewed. A discussion was held with the manager. All medications and associated equipment are stored in a locked room that is accessible by Keypad. The room has been fitted with cupboards designed to store medication. Oxygen cylinders were viewed that were all appropriately stored and had the prescription instructions attached. . A separate trolley exists for those residents who are receiving intermediate care and require support with medication. A member of staff is allocated to take responsibility for this. The manager stated that the home us unable to support these residents with self-medication yet as the policy, which covers this, is awaiting approval from the Primary Care trust. However a sample of bedrooms were viewed which had lockable facilities for this purpose. North and South corridor each has its own separate medicine trolley with a Venalink dosage system in place. A random stock check was carried out on Warfarin and was found to be correct.
St Bartholomews Court Nursing Home DS0000005469.V281730.R01.S.doc Version 5.1 Page 11 Medication administration records had been completed as required and each had a photograph of the resident attached. A list of staff signatures was available for identification purposes if required. The Deputy manager carries out weekly medication audits to ensure standards don’t slip. A medication fridge is available and staff are recording the temperature correctly on a daily basis. The manager discussed and showed the contract with a waste disposal company, which collects all clinical waste (including medication) three times per week. The home has a destruction kit for the disposal of Controlled Drugs The Controlled drugs register and stock was randomly checked with the manager and was found to be correct. Although not fully assessed a discussion was held with the Nurse who is responsible for developing and managing Wound care within the home. Documentation, which has been developed for this, was viewed. The records shown reflected good practise and the nurse responsible was reminded of the importance of developing similar records for all wounds within the home ASAP. St Bartholomews Court Nursing Home DS0000005469.V281730.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No standards were assessed from this section on this occasion. EVIDENCE: St Bartholomews Court Nursing Home DS0000005469.V281730.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): 16,18 All concerns are responded to swiftly. Staff have the skills to protect residents from Abuse. EVIDENCE: The complaints file was viewed and discussed with the manager. The number of complaints made is minimal. No complaints have been made against the service to CSCI. All concerns however small are treated as a complaint, which reflects good practise. Clear records were viewed which included actions taken and outcomes. A copy of the complaints procedure was displayed within the home. This complies with the Care Home Regulations 2000. Staff files, training records and discussions showed that staff have received training and understand abuse and how to prevent this happening. The home has a canopy of Knowsley’s Adult Protection Procedures. St Bartholomews Court Nursing Home DS0000005469.V281730.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): EVIDENCE: No standards were fully assessed from this section on this occasion, however a tour of the communal areas of the environment was undertaken. Everywhere smelt pleasant and appeared clean and tidy. Residents were utilising various areas of the home according to the activities on offer. St Bartholomews Court Nursing Home DS0000005469.V281730.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): 27,28,29,30 Staff are provided in sufficient numbers to meet the service users needs. Service users are in safe hands. The service has robust recruitment procedures. Staff are offered and undertake a variety of training, which is appropriate to their role. EVIDENCE: Off duty rotas were viewed which showed that the manager and the deputy manager are supernumerary to staffing numbers. Another R.G.N. is also supernumerary two days a week to assist the Deputy manager with staff training. The Intermediate Care Unit, South Side, and North Side are all staffed separately with their own staff team to the other wings. Viewing the off duty showed that it regularly fluctuates according to residents and staff training needs. Senior Health Care Assistants have had their role developed to support the RGNs with nursing duties. Staff files and training records were viewed. A discussion was held with the manager. NVQ training is ongoing within the home. Four staff are work place assessors and currently four staff have almost achieved NVQ Level 3 and eight are undertaking NVQ level 2. 75 of staff have achieved an NVQ in care. Three staff files were viewed. These were much more organised than when first viewed. Each had the required documentation to meet the Care Home regulations 2000.The files showed that two staff had started recently and were
St Bartholomews Court Nursing Home DS0000005469.V281730.R01.S.doc Version 5.1 Page 16 undertaking a two week induction before delivering care. The manager confirmed that they are supervised during this period. The home has developed a list of Induction topics that are relevant to care. The manager stated that the deputy manager was attending a meeting about the National Training Organisations standards in the near future (what was known as TOPPS). A training file was viewed and discussed with the manager. Staff undertake all mandatory training expected to promote Health and Safety. The service has also labelled Abuse awareness as mandatory which reflects good practise. Records are monitored to ensure staff receive refresher training. Training needs and wishes are discussed during supervision. Many of the qualified staff have undertaken specialised training such as wound care, syringe drivers etc. St Bartholomews Court Nursing Home DS0000005469.V281730.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): EVIDENCE: No standards were assessed from this section on this occasion. St Bartholomews Court Nursing Home DS0000005469.V281730.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 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 4 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X St Bartholomews Court Nursing Home DS0000005469.V281730.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 12, (1)(a) Requirement Wound care records must be developed showing the initial assessment, ongoing progress and what dressings have been prescribed and by whom. Resident’s social needs must be documented on their plan of care. Timescale for action 01/03/06 2. OP7 16, (m)(n) 01/03/06 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. Refer to Standard OP7 Good Practice Recommendations Staff should ensure that relatives and representatives were appropriate are involved in the formulation and reviewing of care plans. Key workers should be encouraged to discuss and address social needs rather than focusing on personal care tasks. Wound mapping tools and photographic evidence should
DS0000005469.V281730.R01.S.doc Version 5.1 Page 20 2. 3. OP7 OP8 St Bartholomews Court Nursing Home be included to evidence healing or deterioration of wounds. 4 5. OP9 OP12 The manager should pursue the PCTs response to selfmedication on the intermediate care wing. The activities staff should carry through their intention to develop life biographies for all residents. St Bartholomews Court Nursing Home DS0000005469.V281730.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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