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 November 2005 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.V270937.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 Bartholomews Court Nursing Home DS0000005469.V270937.R01.S.doc Version 5.0 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.V270937.R01.S.doc Version 5.0 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 21/02/05 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 requires 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.V270937.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was an unannounced inspection. During the visit discussions were held with four residents, two relatives, a member of staff and the manager. Their views have been reflected within the report. A variety of documentation was viewed which will be referred to in the evidence section of the report. All area of the home were viewed. What the service does well:
The service ensures it gains as much information as possible about a prospective resident before they are admitted to the home. This means that staff are able to plan the residents care before hand and that the risk of a resident living somewhere that cannot meet their needs is greatly reduced. The home provides a separate intermediate care service. This is well run with correct support and care being provided seven days a week. The team is lead by appropriate health care professionals (physiotherapist, occupational therapist). Staff carry out their instructions in their absence. An occupational therapist commented, “ The staff are great, they do what we ask and write everything down so we know what progress has been made”. It was evidenced that all staff keep clear daily records and that each resident has their own individual plan according to their rehabilitation needs. This is important, as staff need clear written instructions to follow so that the resident’s progress is consistent and is not hindered in any way. Two residents who were receiving rehabilitation support commented very positively on the service. One had never received care before and made the following comment:” I was dreading coming, my son didn’t want me to come, but its marvellous and my son is really surprised by how good it is and the progress I have made”. Both residents agreed that they were getting better and were hoping to go home in the near future. Another resident who was using the service said: “ Staff are so patient” – “`as soon as they know what you want and need its there- they’re great” It was evidenced that staff are patient and supportive and have a good understanding of the individual needs of each resident. Residents can receive a mixture of nursing and rehabilitation if needed as the home provides nursing care also. This works well as it means that the home can be flexible towards a residents needs. St Bartholomews Court Nursing Home DS0000005469.V270937.R01.S.doc Version 5.0 Page 6 Residents who are living at the home long-term also have an individual plan of care. This is reviewed monthly, which shows that staff understand the need to keep records up to date. Staff are quick to respond to changes in a residents health. Examples of this include contacting a dietician if a resident looses weight and requesting doctor’s visits if deterioration is identified. All residents and relatives spoken with commented positively on the staff’s ability to meet their needs. Comments included “ even those (staff) that are not good are marvellous”, and “ the qualified staff are extremely competent and understand the nature of disease, the care staff are excellent and are `extremely patient and kind, we were very lucky to come here. Staff always answer my questions ”and “No, I don’t worry about my (loved one) when I’m not here, I know she’s in good hands”. All spoken with confirmed that staff respect their privacy and dignity. One resident commented that they never” feel embarrassed” another confirmed that even” the young ones understand what its like to be old”. The home ensures that the residents are offered a nutritious variety of home cooked food. Staff understand how to support the residents to eat meals in a dignified manner. The dining rooms are pleasant and tables are dressed with tablecloths and condiments. The meal is taken in a relaxed manner and on the day of the visit lasted 50 minutes. Residents stated that the chef tries hard to please everyone. Residents commented, “ The food is marvellous” and “ yes we are always offered a choice- nothing is too much trouble”. The fabric of the building is well maintained. Although the home is purpose built staff have tried hard to promote individuality by ensuring bedrooms have different colour schemes with matching duvets and curtains. This all helps to promote a homely feel. Residents are encouraged to personalise their rooms according to their personality and lifestyle. One resident particularly enjoys tapestry and the tools required are kept in the bedroom. Completed works are displayed on the walls of her room. All areas of the home were viewed. Everywhere appeared clean and tidy and smelt pleasant. Residents commented on the cleanliness of the home by saying” they keep my room lovely for me” and “ the girls work really hard”. This is important as living in a clean comfortable environment helps to promote self-esteem. What has improved since the last inspection?
The intermediate care service is well established and is fulfilling its aims and objectives. This is a much needed service in the borough and has raised the profile of the home further. Residents who are receiving the service stated that they no longer felt afraid if they required residential care later in their lives. Therefore not only is the service ensuring people remain in their homes for longer it is also providing reassurance of a fear of what may come later in their lives.
St Bartholomews Court Nursing Home DS0000005469.V270937.R01.S.doc Version 5.0 Page 7 Activities have been greatly developed since the last inspection. Activities occur in both lounges simultaneously to ensure choice is offered to residents. One resident explained that he receives daily hand massages to help limbs stay supple, enjoys trips out and the visiting cinema but doesn’t particularly enjoy group activities. This shows that residents are free to spend their time how they choose. Individual activities such as building memory boxes have been developed for those residents who are unable to take part in group activities. This is important as it prevents residents from becoming socially isolated. The Home has been commended on the amount and variety of activities offered. These include games such as bingo and reminiscence but also include more unusual activities such as flower arranging, carpet bowls and play your cards right. The garden areas of the home have been remodelled so that they are accessible to all residents and can be enjoyed by all. This is important as it provides the residents with the opportunity to sit outside in nice weather. The dining areas to the home have also been redecorated. This need was identified by the home and not by CSCI, which shows the services commitment to provide a nice place to live. What they could do better:
Although each resident has a clear plan of care these are focused on health care needs. Plans should be developed further to include the resident’s social needs and how these are to be met. Encouraging key workers to discuss social needs with their named resident rather than focusing on care plans could further enhance this. Examples of this could include discussing memory boxes for those residents who have them or discussions around resident’s life biographies once they have been implemented. Although all care plans viewed, had been signed by staff, no evidence could be found of representative/relative involvement. Staff should ensure that providing the resident agrees these groups are involved in their loved ones care. This helps to promote inclusion and gives a much needed insight into a residents wishes if communication is a problem. Although residents confirmed that staff provide effective wound care, little documentary evidence could be found of this. Records must be developed to show the initial assessment and reflect good practise by using mapping tools and photographic evidence. Clear wound care records must be developed showing which dressings have been prescribed and by whom. Wound care charts must be implemented to show the state and progress of the wound. Following the instructions of a health care consultant staff are keeping a diary to monitor a residents progress. This was being completed regularly however staff were writing descriptive words without actually recording the reason for drawing this conclusion. Caution must be exercised when implementing this type of record because there is a danger that a resident can become” labelled” if clear evidence is not recorded.
St Bartholomews Court Nursing Home DS0000005469.V270937.R01.S.doc Version 5.0 Page 8 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.V270937.R01.S.doc Version 5.0 Page 9 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.V270937.R01.S.doc Version 5.0 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 The home gains as much as information as possible about residents needs before they are admitted to the home. The home provides a well run, successful intermediate care service. EVIDENCE: Two care plans, which contained assessment information, were viewed and a discussion was held with the manager. Assessments were viewed that had been completed prior to admission by a health care professional (social worker, district nurse). The homes own assessment was also viewed, which had been undertaken either by the deputy manager or the manager (who are both registered general nurses) prior to admission. This provides essential information only. A second long-term assessment was viewed that had been completed by the home within one week of admission taking place. This gave a more in-depth overview of the residents needs. A tour of the environment was undertaken. Two sets of care records were viewed. Discussions were held with two residents and an occupational therapist. Staff were observed supporting residents. St Bartholomews Court Nursing Home DS0000005469.V270937.R01.S.doc Version 5.0 Page 11 The home provides intermediate care and has dedicated health professionals (Occupation therapy, physiotherapy) five days a week. The occupational therapist confirmed that staff carry out instructions in the absence of OT’s and physiotherapists. Records viewed showed that activities happen on a daily basis and that clear records are kept regarding a resident’s participation and ability. Resident’s rehabilitation needs are clearly documented on a plan of care and activities offered relate to their individual needs. Dedicated space has been provided within the home for this purpose. This includes a large lounge and a separate domestic kitchen. The kitchen is used mainly by the Occupational Therapy staff to carry out assessments for residents who are returning home. Although separate facilities are provided residents are free to socialise with those who are receiving long term care. Discussions were held with two residents who were receiving intermediate care. Both reflected positively on the service provided. Residents have access to a separator dining room from the main lounge The service has a dedicated staff team who have received training to enable them to provide appropriate support. Observation showed that staff provide the right level of support. I.e. gentle encouragement is given to residents to promote independence. St Bartholomews Court Nursing Home DS0000005469.V270937.R01.S.doc Version 5.0 Page 12 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): 7,8,10 Residents have individual plans of care but these are focused on health care needs only. Staff are quick to respond to and get appropriate advice regarding residents health needs. Wound care records are inadequate. Staff respect the residents privacy and dignity. EVIDENCE: Discussions were held with four residents and two relatives. Four care plans were viewed and a diary. Each resident had a clear plan of care, which gave clear instructions of the care required. The plans are being reviewed monthly however no evidence could be found that the resident or a relative had been involved in its formulation. The plans gave clear instructions about a persons health needs but little evidence could be found of how the resident’s social needs were to be met. Each resident has a key worker. Staff are keeping clear records of their involvement with their named resident but these were found to be task orientated. I.e. “ general bath given”. Each plan contained plenty of evidence regarding input from other heath care professionals and all spoken with confirmed that staff are quick to respond to changes and will call for advice as soon as there is a problem. Each resident has risk assessments associated to their health e.g. nutritional risk assessments, pressure sore risk assessments and falls risk assessments.
St Bartholomews Court Nursing Home DS0000005469.V270937.R01.S.doc Version 5.0 Page 13 Residents who had wounds stated that they believed they were getting better but there was little documentation to support these statements. Residents have access to opticians, dentists and chiropody as required. This was evidenced in the plans of care and confirmed by those spoken with. All residents and relatives confirmed that staff respected their dignity and privacy and were kind and patient. All agreed that staff have the necessary skills to meet their needs. A diary was viewed which had been implemented following a request by a health care consultant. Staff were following instructions but were writing their interpretation of the event rather than the actual event, which occurred. Adjectives and descriptions of “ bad mood” and “ aggressive” behaviour were recorded with no evidence of how this conclusion had been reached. St Bartholomews Court Nursing Home DS0000005469.V270937.R01.S.doc Version 5.0 Page 14 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): 12,13,15 Residents are offered a range of fulfilling activities. Visitors are welcomed into the home. Resident’s receive a choice of appetising home cooked food. EVIDENCE: Copies of activities rotas and records were viewed. Discussions were held with four residents. Staff were observed supporting residents with activities and the lunchtime meal. Activities have been greatly developed since the last inspection. The home has two communal lounges therefore a choice of activities has been provided in each lounge at different times during the day. Two activities organisers are employed who both keep records of which activities are being delivered. Examples of activities include flower arranging; play your cards right, bingo etc. Two residents were observed playing carpet bowls. Staff have recognised that some residents are unable to take part in group activities and individual activities such as massages and building of memory boxes have been developed to address this. The home is close to a local church and residents are supported to attend services. A discussion with a resident confirmed that taking part in activities is a choice and staff support the residents to take part in those that they enjoy. For example one resident was looking forward to viewing the film “ white Christmas” on the visiting cinema screen and this resident receives daily hand massages through choice to ensure limbs stay supple.
St Bartholomews Court Nursing Home DS0000005469.V270937.R01.S.doc Version 5.0 Page 15 Personal shopping trips are arranged with the activities organiser to support residents to Christmas shop. Trips also occur according to the weather to places of local interest. Viewing the visitor’s book showed that visitors are free to visit when they choose. One relative visits his loved one daily and keeps carpet slippers in the bedroom for this purpose. Viistors are welcome to take meals at the home by prior arrangement. Menus and serving of the lunchtime meal was observed. All residents spoken with stated that the chef tried very hard to please everyone. Three residents commented very positively on the standard of food provided. The menus showed that a variety and choice of nutritious home cooked meals are offered. The home tends to serve the main meal of the day in the evening. The kitchen was recently inspected by the Environmental Health Officer who made no recommendations. One resident confirmed that staff understood his needs by ensuring sandwiches were made with sliced cheese rather than grated. This resident experiences difficulties holding sandwiches securely and therefore tends to drop particles of food. The meal served on the day of the visit was home cooked Pea and Ham soup with sandwiches. Other choices were available for those who preferred. Staff were seen and heard to support resident to make choices and to eat in a dignified manner. The meal took 50 minutes and was relaxed and calm. The dining room tables were nicely set with cloths and condiments. St Bartholomews Court Nursing Home DS0000005469.V270937.R01.S.doc Version 5.0 Page 16 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): No standards were assessed from this section on this occasion EVIDENCE: St Bartholomews Court Nursing Home DS0000005469.V270937.R01.S.doc Version 5.0 Page 17 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 home is a well-maintained, comfortable and clean place to live EVIDENCE: A tour of the environment was undertaken. The dining room has been redecorated since the last inspection and the gardens have been developed further so that they are accessible to all. All bedrooms viewed were individual in appearance with plenty of personal possessions. All corridors and communal areas were nicely decorated and well maintained. All bathrooms were clean tidy and safe. The laundry has been equipped with new washing machines and dryers since the last visit and looked clean and well organised. The home smelt pleasant and all areas viewed were clean and tidy. St Bartholomews Court Nursing Home DS0000005469.V270937.R01.S.doc Version 5.0 Page 18 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): No standards were assessed from this section on this occasion EVIDENCE: St Bartholomews Court Nursing Home DS0000005469.V270937.R01.S.doc Version 5.0 Page 19 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): No standards were assessed from this section on this occasion EVIDENCE: St Bartholomews Court Nursing Home DS0000005469.V270937.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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X 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.V270937.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 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 St Bartholomews Court Nursing Home DS0000005469.V270937.R01.S.doc Version 5.0 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP7 OP7 OP8 OP8 OP12 Good Practice Recommendations Staff should ensure that relatives and representatives were appropriate are involved in the formulation and reviewing of care plans. Keyworkers should be encouraged to discuss and address social needs rather than focusing on personal care tasks. Wound mapping tools and photographic evidence should be included to evidence healing or deterioration of wounds. Staff should use caution when recording descriptive words in the diary, which has been implemented to record one resident’s mood/behaviour. The activities staff should carry through their intention to develop life biographies for all residents. St Bartholomews Court Nursing Home DS0000005469.V270937.R01.S.doc Version 5.0 Page 23 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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