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Inspection on 09/04/08 for St Bartholomews Court Nursing Home

Also see our care home review for St Bartholomews Court Nursing Home for more information

This inspection was carried out on 9th April 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.

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

What the care home does well

What has improved since the last inspection?

We saw that procedures have been changed to ensure that medications are managed more safely within the home. This has included ensuring all staff have had refresher training on this subject. We saw that people and their families have been consulted on changes in the mental health capacity act and that staff have received training on this subject. This means that people are being consulted about how they would like to live rather than staff relying on families to provide this information. An example of this is that many of the people have chosen to keep their bedroom doors closed when they are in the bedrooms. This shows that the staff team also understand the importance of supporting people to have privacy. We found that three people who live in the home smoke. Money has been made available to convert a bedroom into a smoking room, which is safe for people to use and staff to acess. People told us " I`m really grateful- I hated going outside" Each unit of the home has been assigned to a senior qualified nurse. This has strengthened the management structure of the home and is good staff development. Several sections of this report have been judged as being "excellent". These areas include, the provision of health and personal care, the management of complaints, the overall standard of management and the provision of food. This is an improvement since the last visit. Details on these areas can be found within the evidence sections of the report. The home have reviewed how they reduce the risk of infection spreading. This has included nominating a named nurse and carrying out monthly audits on how infection is reduced within the home. This is very good practise and is in line with NHS guidelines. Which shows that the home is keeping up to date with good practice. The manager has developed and introduced a new quality audit tool. This means that all areas of the care and support received by the people who live at the home is reviewed on a monthly basis. This helps to ensure that standards are maintained and that the home meets people`s expectations.

What the care home could do better:

We identified some good practice recommendations, which should be considered. The manager told us that she intended to carry through her intention to provide information in different formats for new people. E.g. large print. This means that information will be available to everyone to enable people to make a decision about whether they want to move into the home. Each person has a key worker. This is a carer who is employed at the home who acts as a "link person". We found that these staff are keeping records of the time they have spent with their designated people but that this time seems to be focused on carrying out tasks. For example some records viewed said" Helped him have a bath or " helped him to get washed and dressed rather than maybe spending the time talking or helping the person to achieve something which is above the usual care and support provided. The manager intends to give staff training on this subject and this should be carried through so that " key worker" time is a meaningful experience for people who live at the home. The deputy manager oversees staff training at the home. She has been absent for some time and despite this staff training has continued. However no overall training plan was in place to show what training has been planned for which staff through the year. Having a plan reduces the risk of a member of staff0missing essential training and helps to ensure that staff have the skills to care for the people who live in the home.

CARE HOMES FOR OLDER PEOPLE St Bartholomews Court Nursing Home Woodfield Road Roby Huyton Merseyside L36 4PJ Lead Inspector Mrs Joanne Revie Unannounced Inspection 8th April 2008 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.V358453.R01.S.doc Version 5.2 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.V358453.R01.S.doc Version 5.2 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.V358453.R01.S.doc Version 5.2 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.V358453.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes We had not old the manager of the home that the visit was going to take place. Prior to the visit the manager was asked to complete a document called an AQAA. This document provides information on the services strengths and weaknesses and any future plans to develop the home. We found that the AQAA was completed to a very good standard and that it gave us lots of information about the home, the staff team and the standard of care and support that people could expect. We also sent out surveys to people who live at the home, their relatives and friends and the staff team. We received 15 surveys from these groups, which were all complimentary about the ability of the service to meet people’s needs. We spent two days at the home (in total 14 hours) talking to the people who live there and their visitors. Time was also spent reviewing a variety of records. We sampled the food and spent time observing a mealtime, activities and how staff interact with people. Comments from the discussions held have been included in the summary section of the report. In total discussions were held with eight people who live at the home four visitors, and six members of staff. The records viewed related to people’s care, how risk was managed, the service provided by the home and how peoples health and safety was promoted. We looked at the environment and how the service maintains this and we also looked at personal information relating to staff as well as staff training was also viewed. The manager understands how to promote equality and diversity by ensuring people receive individualised care and support according to their personal preferences. Examples of this are highlighted within the report. The cost of living at the home ranges from £525.00 to £555.00 per week. This includes the provision of all activities and outings. St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 6 What the service does well: We found that the home runs and provides successful rehabilitation care for people who have recently been in hospital (intermediate care.) A health care professional who is not employed by the home but works on this unit told us that “ This is the way it should be done” and “we have a “95 ” success rate”. A team of therapists and staff are employed by the NHS but are based at the home. This includes a daily visit from a local G.P. This team work alongside a designated staff team employed by the home. One person told us that they were “ amazed” at how good communication was between the staff team as a whole. They said” The staff team are really gelled – everyone knows “ persons name” and knows what “ persons name” needs- its amazing”. This means that people can feel confident that they will receive consistent care and that staff know what they are doing. One person who was staying on the intermediate care unit told us ““ I couldn’t ask for better staff- I’m very well cared for – Id talk to any of them about anything- they’re really good”. Relatives praised the management of the home and the staff team for the level of support they receive. They told us” He could not be in a better care home” and that they were informed of any changes in their relatives care. They said” They keep in touch for him as his mind wasn’t what it used to be- I feel involved in everything” and” We are always told about any problems or changes” and “ yes we receive very good support as relatives”. One person said “I visit regularly and staff always come and find me if anything has changed.” And another said” I get feedback almost every time I visit on how my mother has been” This group also told us that the staff team are “ very experienced and care about all the needs of all the residents” and that “The care home meets my mothers needs better than expected.” And” All the nursing staff are excellent and I know that matron would not be employing them if she’s didn’t believe they were up to the job- she has very high standards. We saw that staff are keeping clear records on the care that they are giving to people. These showed that in some cases peoples health had improved since thyme moved into the home. One person who has lived at the home for a short while told us that ““ the staff are marvellous- I was at deaths door when I came here- now I can walk again”. We saw that the home provides individualised care and support and tries to match people’s expectations. For example one person has been supported to use an electric wheelchair by widening doorways so that this person can move freely around the home. Another person has been supported to watch personal St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 7 films which other people may find offensive. Procedures have been put in place so that this person’s wishes are fulfilled whilst not encroaching on the privacy of the other people who live at the home. This is very good practise. We found that the manager regularly consults people who live at the home and their relatives and seeks their opinion of the service. This is done through regular meetings, activities meetings and three monthly surveys. We found that people are involved in all major developments at the home. For example the kitchen is going to be retiled in the near future. This means that the home will be relying on an outside caterer to provide the majority of the meals. Some of the people who live at the home have volunteered to test a selection of meals from several caterers so that they can decide who will provide the nicest food. The overall winner will be offered the contract for the provision of meals. This shows that the manager (Matron) of the home understands that the service must be lead by the people who live there which is very good practise. People told us that they enjoyed the food that is offered in the home. We found that a range of home cooked meals is on offer at every mealtime and that mealtimes are a relaxed pleasant experience. We found that the chef tries very hard to ensure people are offered five portions of fruit and vegetables per day in line with government guidelines on healthy eating. For example homemade soup is made fresh every day which contains lots of vegetables. Deserts are made with fresh fruit. We saw that small plates of a variety of freshly prepared fruit were given out to people during the visit. The chef has time set aside each week to talk to people who live at the home to make sure that they are happy with the food on offer. This is excellent practise. People told us that they thought the food was”` excellent” and “ Its always fresh, hot and tasty – what more could you want”. One visitor told us “ My husband was told on the first night that he came here that it was “ steak and chips for tea”we thought they were having a laugh so we said “ okay that would be nice”we nearly died when the staff turned up with it”. We found that staff have the skills and understanding to ensure that small concerns are quickly addressed. People told us” it doesn’t matter who I tellMatron always gets to know somehow and comes to see me- she’s very good”. We saw that the home is very clean and appeared a comfortable place to live. The home is maintained to a very good standard and employs a maintenance team who carry put everyday work to maintain standards. People told us “ the staff work very hard” and visitor commented” no matter what time of day I come – its always spotless” People are encouraged to make their bedrooms their own by adding personal items. For example we visited one person who has not lived in the home very long. We saw that this person’s bedroom had lots of family photos and contained a fridge for personal sundries. This is good practice and helps people to settle into the home. St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 8 Staff told us that they believed that they had received a good induction and had “ more than enough” training to do their role. Staff told us “The service provides good support and care for the clients” “The service is very good as its gives residents respect, meets all care needs, and meets the special individual needs for residents who need extra help.” This shows that staff like working at the home and understand the importance of providing individualised care. We found that the home is very well staffed and that staffing levels are increased if people need extra support rather than providing numbers of staff according to numbers of people living in the home. This is very good practise. We found that the board of trustees and the manager (matron) continue to develop the home in line with changes in best practice. This means that they keep themselves up to date with legislation and pass this information onto the staff team, the people who live at the home and their relatives. This includes talking to people about inspection reports and talking to relatives about training staff have had and how this could impact on their relative’s care. This is excellent practise. One health care professional who is not employed by the home told us that “ The matron is excellent – I am amazed at how open to change her and the board are- they are really forward thinking- it’s a pleasure to come to work” We found that people are supported to manage their finances safely. Staff monitor what people are being charged for to ensure they are not being overcharged. For example paper bills from the local newsagents are checked to make sure people have actually received the paper before they are supported to pay their bill. This is good practise. We found that the home has a robust attitude to ensuring people live in safe home and staff have a safe place to work by ensuring health and safety legislation is followed. What has improved since the last inspection? We saw that procedures have been changed to ensure that medications are managed more safely within the home. This has included ensuring all staff have had refresher training on this subject. We saw that people and their families have been consulted on changes in the mental health capacity act and that staff have received training on this subject. This means that people are being consulted about how they would like to live rather than staff relying on families to provide this information. An example of this is that many of the people have chosen to keep their bedroom doors closed when they are in the bedrooms. This shows that the staff team also understand the importance of supporting people to have privacy. St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 9 We found that three people who live in the home smoke. Money has been made available to convert a bedroom into a smoking room, which is safe for people to use and staff to acess. People told us “ I’m really grateful- I hated going outside” Each unit of the home has been assigned to a senior qualified nurse. This has strengthened the management structure of the home and is good staff development. Several sections of this report have been judged as being “excellent”. These areas include, the provision of health and personal care, the management of complaints, the overall standard of management and the provision of food. This is an improvement since the last visit. Details on these areas can be found within the evidence sections of the report. The home have reviewed how they reduce the risk of infection spreading. This has included nominating a named nurse and carrying out monthly audits on how infection is reduced within the home. This is very good practise and is in line with NHS guidelines. Which shows that the home is keeping up to date with good practice. The manager has developed and introduced a new quality audit tool. This means that all areas of the care and support received by the people who live at the home is reviewed on a monthly basis. This helps to ensure that standards are maintained and that the home meets people’s expectations. What they could do better: We identified some good practice recommendations, which should be considered. The manager told us that she intended to carry through her intention to provide information in different formats for new people. E.g. large print. This means that information will be available to everyone to enable people to make a decision about whether they want to move into the home. Each person has a key worker. This is a carer who is employed at the home who acts as a “link person”. We found that these staff are keeping records of the time they have spent with their designated people but that this time seems to be focused on carrying out tasks. For example some records viewed said” Helped him have a bath or “ helped him to get washed and dressed rather than maybe spending the time talking or helping the person to achieve something which is above the usual care and support provided. The manager intends to give staff training on this subject and this should be carried through so that “ key worker” time is a meaningful experience for people who live at the home. The deputy manager oversees staff training at the home. She has been absent for some time and despite this staff training has continued. However no overall training plan was in place to show what training has been planned for which staff through the year. Having a plan reduces the risk of a member of staff St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 10 missing essential training and helps to ensure that staff have the skills to care for the people who live in the home. 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. The summary of this inspection report can be made available in other formats on request. St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 11 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.V358453.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive lots of information to enable them to make a decision about moving into the home. The home has an intermediate care unit, which gives people the opportunity to receive the right support to enable them to live independently again. EVIDENCE: We looked at the surveys people had sent us and had discussions with people who had recently moved into the home and the manager. We also spoke with members of the intermediate care team who are employed by the NHS but based at the home and had discussions with people who are receiving intermediate care. Everyone told us that they had received enough information to decide whether they wanted to move into the home. We looked at care records, which showed St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 13 us that senior staff from the home had met with people to talk about their needs and expectations before they moved in. The manager told us that staff take a variety of information with them to these meetings. This includes a brochure of the home, photographs of recent activities and a copy of the homes most recent inspection report. This is very good practise. The manager explained that she was considering producing this information in different formats so that all people could use it. For example producing this information in large print may help someone who is visually impaired. The manager should follow this through so that everyone who may wish to move into the home is provided with the same opportunities and given the same information to make a decision about whether they want to live there. People told us that staff had been very welcoming and that nothing was too much trouble to ensure that they settled into the home well. We` saw that one person who has lived in the home for a short while had a fridge in their bedroom and lots of family photographs and pictures which gave the room a very homely feel. This person told us that “ The home has an intermediate care unit, which provides rehabilitation therapies to 14 people. These people have usually been in hospital and come to the home to re learn vital skills to enable them to live at home again. Everyone we spoke with were complimentary about staffs ability to care and help them get better. One person told us that “ I couldn’t ask for better staffI’m very well cared for – Id talk to any of them about anything- they’re really good”. We saw that the home is equipped to enable people to undertake specific exercises to enable them to get well again. We met with health care professionals who told us “ This is the way it should be done” and we have a “95 ” success rate. A team of dedicated therapists (Occupational therapist, physiotherapist and support workers) who are employed by the NHS work at the home each day. The home provides a further staff team who they employ which includes qualified nurse and carers. A health care professional who is not employed by the home told us that the homes staff had been welcoming and were open to change which meant that it felt like one big team. One person told us that she couldn’t believe the care and support that her relative had received and that this had resulted in a huge improvement in this person’s health. This meant they were able to live together at home again. St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 14 The home has a small domestic style kitchen with cooker fridge freezer and microwave. People who live on the intermediate care unit use this so that they can practise cooking before they return home. We looked at records and observed people taking part in specific exercise to help them improve. The home is supported by a G.P. who visits daily to ensure that people are improving. A community pharmacist visits the home weekly to ensure that staff are managing medications in the right way. A full team meeting is held once a week so that all the members of this team can meet to discuss people’s progress and to decide what care and support is needed next. St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People receive quality care to meet their individual needs and wishes. Medications management has been improved so that the risk of a mistake occurring has been reduced. EVIDENCE: We met with people and looked at the surveys that people had sent us. The surveys showed us that people were very pleased with staff ability to care and support them. We looked at care records and observed how staff interacted and cared and supported people. We saw that each person has a care plan, which provides instructions to staff on their care and support that they need. The records showed us that people had been involved in deciding how they would like to be cared for and staff had reviewed the instructions to ensure that the plans were up to date. The St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 16 instructions had been written in a personal way, which is good practise as it gave an insight into the person’s personality. We saw staff of all levels reading and using these plans. This is good practise and shows that people can expect to receive consistent care. We looked at two plans this showed us that peoples care needs had decreased since moving into the home. This shows that staff had the skills to help people improve and that staff understand the importance of helping people become as independent as possible. For example one person couldn’t walk when they moved into the home. We saw this person walking with a walking frame without staff support. Another persons has been supported with a night time continence problem. This person wants to go home and staff believe that if this problem can be eradicated they could return home to live with their family again. The family agree with this. Specialist products have been sourced and bought on several occasions with little effect. We observed staff discussing this problem with this persons G.P. to see if extra expert help was available. This shows that staff try hard to support people to achieve their wishes. Records that we looked at showed us that staff are quick to respond if a persons health care needs change. For example one person had a chesty cough during the evening and staff contacted the G.P. the next morning to request a visit. Records showed us that a variety of health care professions such as specialist nurse visits the home regularly to monitor peoples progress. Staff carry out assessments to identify whether peoples health care needs could deteriorate and take action to try to stop this occurring. We saw one-person fall and we rang the call bell. Care staff arrived within seconds and pressed the emergency bell. Two qualified nurses arrived seconds later. This shows that staff respond quickly to peoples requests for help. We saw that one person who can no longer walk has been supported to use an electric wheelchair. The home have responded to this by widening the doorways to the communal lounge/dining room and this persons bedroom to ensure that they can use their wheelchair independently without injuring their hands. This is excellent practise and shows a commitment by the service to provide individualised care and support. Two different family members told us that they were very pleased with how staff communicate. They told us that they are kept informed of all changes in their relative’s care and needs. The surveys we received also reflected this. People told us that no matter which member of staff they talked to they knew all about their relatives needs and were impressed with this. This shows that the staff team communicates well which reduces the risk of someone’s care needs being forgotten or missed. People told us that they had been given a key worker. This is a member of staff whom they can develop a closer relationship with. We looked at records, St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 17 which showed us that that key workers are in place but that the support they give people is task orientated rather than personal. For example staff were writing comments such as” assisted with bath”, “helped to dress”. The manager told us that she was aware of this and intended to arrange training so that staff understood their role better. The manager has recently undertaken training on this subject herself so understands what is expected. We looked at how staff manage medications. Improvements have been made since the last inspection, which means that medications are managed more safely. Staff wear a red tabard when giving out medications. We looked at minutes of meetings which showed us that meetings have been held with the people who live at the home and their relatives so that they understand that this staff member should not be disturbed when doing this task. This is good practise and reduces the risk of a mistake occurring. We looked at records and storage systems which showed us that all medications are accounted for when they arrive at the home and when they leave or are taken. Staff are keeping clear records of when medication is administered and different coloured records are being used for different medications so that they stand out. This is good practise. The manager explained that since the last inspection a quality audit tool has been introduced which includes observing how staff administer medication. We looked at training records, which showed us that all staff that administer medications have received refresher training on this subject. A copy of this tool was viewed which confirmed what had been said. Records for the disposal of medications showed that only one member of staff was signing to show this had occurred. This should include two staff members to ensure medications are disposed of safely. We looked at how people’s privacy and dignity is maintained. We saw that all bathroom doors and toilets have signs on the outside of them stating whether the room is occupied or not. This means that people who may be receiving staff support can receive this support in privacy without the risk of someone else entering the room. We looked at staff training records and had a discussion with the manager. This showed us that staff have recently had training on the changes in the mental health capacity act. The manager has explained these changes to the people who live at the home and their families and friends, which is very good, practise. St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 18 Changes have been made to how people are living at the home. Each of them has been consulted about whether they would prefer their bedroom door closed when they are in their bedroom. Some people have decided that they feel safer with their bedroom door open and this is clearly written in their plan of care. This is excellent practise and shows that the home continues to develop in line with current legislation. St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People are encouraged to lead individual lifestyles and the home lives up to their expectations. People are consulted about all areas of their life at the home and are supported to achieve their choices. People are offered a variety of home cooked nutritional food which they enjoy. EVIDENCE: We looked at records and the surveys people had sent us. We spoke with people about their expectations and had a discussion with the manager and activities staff. We observed group activities happening in the home. People told us that they can take parts in activities if they choose. We saw people taking part in a quiz, playing hoopla, taking part in crafts and carrying out chair exercises. People are offered the opportunity to go out on trips such as pub lunches, places of local interest. We looked at minutes of a recent meeting, which showed us that people are consulted about what activities they would like to do. A ladies lunch had been requested and this was set up in a St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 20 quiet area of the home. A choice of three course restaurant type food was provided with wine. This was a different menu to that offered to the other people who live at the home on that day. Gentleman have requested the same activity and this is occurring soon. This is good practise and meets the latest recommendations for some single sex activities to occur. People are supported to carry out indivual activities of their own choice. One person is supported to watch films, which some people may find offensive. This person has hearing difficulties so the home have purchased a specialised head set so that the movie can be enjoyed without causing offence to others. This person is supported to watch films in the privacy of their own room and have been provided with a “do not disturb sign” for this purpose. Since the last visit the home has provided a smoking lounge for the people who live at the home. This has been provided at great expense to the home as it has involved changing the use of a bedroom, supplying a powerful extractor fan and an intercom system so staff can enter the room safely. Three people who smoke were living at the home and told us that they appreciated this facility. The manager told us that links have been made with a smoking cessation nurse for those people who wish to stop smoking. This was provided as the board of trustees were concerned about people smoking outside in cold weather. This shows that the home supports peoples indivual needs and wishes and reflects very good practise. Visitors told us that they were free to visit the home whenever they chose. We looked at the visitors book which showed us that people do visit at a variety of times throughout the day. The home is situated close to a local church. People visit from the church weekly and other church visitors from another denomination also visit. We looked at menus, observed a meal time and held discussions with the chef and people who live at the home. We tasted the food during the two days. On both days nutritious home made soup was served with a selection of sandwiches or a salad as well as a hot meal such as bacon and egg or cauliflower cheese. Fresh deserts with fresh fruit were available as well as afternoon tea, which also contained fresh fruit- pastries with cream and fresh strawberries. The main meal is served in the evening. Choices are available at all meal times as well as hot snacks such as cheese on toast. The chef is provided with a day away from the kitchen so that he can discuss menus with the people who live at the home. This is very good practise. Everybody spoken with felt the food was of a very high standard and that staff tried hard to please if they felt like eating something different. We were told that the kitchen tiling is about to be replaced which will mean that meals will be prepared of site by a catering company. The manager has selected three companies and a selection of meals are to be provided to the people who live at the home so that they can choose St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 21 which food they would prefer. This is very good practice and shows that the manager understands the importance of involving everyone in decisions, which affect their lives. We observed the lunchtime meal. This was relaxed and quiet with staff supporting people in the right way. Some people were provided with specialised cutlery and aids so that they could eat their food independently. Tables were set with linen tablecloths, fresh flowers and serviettes. People were offered cups of tea as well as a cold drink Those people that needed extra support were sat at a discreet distance, which promoted their dignity. The home employs staff that act as “ breakfast servers”. These staff work from 8 am until 11 am so that people can eat breakfast when they choose rather than having to wait for care staff to be vaibale. This is very good practice and reflects the choice available at the home. St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People know how to complain and are confident that their concerns will be listened to. Staff have the skills to protect people from abuse. EVIDENCE: We talked to people who told us that they knew how to complain and that they would talk to any member of staff about their concerns. One person told us that as soon as they said they were unhappy with something the manager came to see him to put things right. People told us that they were very confident that staff would ensure they were happy with the care that they received and were happy living at the home. The manager explained that two senior sisters are now in charge of the two nursing units within the home and that they have been provided free time to spend talking to people and their families. This is excellent practise. We looked at complaints records that the manager had kept. One complaint has been made since the last inspection, which was unfounded. The manager had kept clear written records of any investigation she has undertaken and copies of any letters, which she had sent to complainants. St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 23 Due to the management structure of the home people told us that there was no need to formally complain (complain in writing) as staff were very quick to put things right if they said they were unhappy. We saw that lots of consultation takes place with the people who live at the home so people have the opportunity to be involved in decisions that affect their lives. We saw that the home s complaints policy was displayed in the reception area of the home and that this included the contact details for the commission and who the lead inspector for the service was. No complaints have been made to the commission about the service. We looked at the surveys people had sent us. All stated that they knew how to complain (“ not that there is anything to complain about”) We looked at staff records which showed us that all staff have had training in abuse awareness, how to prevent it and what to do if they suspect abuse has occurred. This training is refreshed yearly to ensure staff have up to date skills. This is very good practise. St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,23,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained, comfortable and safe. Management of the home adapt the building to meet the individual needs of the people who live there. People’s health is maintained by ensuring stringent cleaning routines are carried out. EVIDENCE: We walked around the home and looked at some people bedrooms, the laundry room and the kitchen. We looked at duty rotas, which showed us how many staff were on duty to staff these areas. We spoke with the manager and spoke with people who live at the home. We also looked at the surveys that people had sent us. St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 25 We saw that the home has two large bright lounges and two separate dining rooms. The home has two nursing units known as the south and North wing. A quiet area is available at the end of each of these areas, which is furnished with tables, chairs and comfortable seating. Both of these areas contain drinks machines for people and their visitors to use. This is good practise as it enables people to get drinks when they choose. The home has a number of toilets, which are accessible, and bathrooms and shower rooms. All of theses areas have been adapted to meet the needs of people with physical disabilities. The manager explained that hoists have recently been purchased to enable people who are over a certain weight to be moved safely. The home is purpose built with all accommodation being on the ground floor. The second floor of the building is used as office space and storage. We saw that the home is a clean comfortable place to live. People told us that they believed this to be true and that staff worked very hard to keep it this way. The manager told us that two maintenance staff are employed who decorate bedrooms and ensure that they remain safe places to live by carrying out weekly checks. We saw maintenance staff at work during out visit redecorating one bedroom. We saw that people are encouraged to make their bedrooms their own by furnishing them with personal effects, pictures etc. We saw that one person had their own fridge so that they could access small sundries. This is good practise. The manager explained that redecoration to bedrooms occurs at a rate of one to two rooms per month. Staff agreed with this. The manager also told us that bedrooms are recarpeted once the room has been redecorated if needed. The manager also explained that the corridors to the home are to be redecorated during summer and that quotes have been obtained for this work to take place. We saw that these areas did have some small tears in the wallpaper in places but that the décor was of an acceptable standard. This shows that the management of the home try to keep the décor of the environment to a high standard. We saw that the home has converted one bedroom into a smoking room and that this room fully complies with legislation regarding smoking. This shows that the management of the home are willing to adapt the environment to meet the needs of the people who live there. We visited the laundry room. We found that this was clean and tidy and organised and that staff ensured clothes were ironed and returned to the people who live at the home. We visited the kitchen and found this to be clean and organised. The chef and other staff told us that the local environmental health department had St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 26 presented the home with an award for the third year running called” eat safe eat well”. This shows that the cleanliness of the kitchen is above the standards expected from this department. We saw that some wall tiles were loose in the kitchen. The manager and the chef explained that the kitchen is being fully retiled in the near future rather than patching weak areas. We saw that the home is staffed daily with domestic staff who are responsible for keeping the home clean. We saw that the housekeeper carries out audits to ensure that standards of cleanliness are maintained. The manager told us that since the last inspection she has received a copy of the N.H.S. guidelines on infection control. Staff are following guidelines by ensuring audits are carried out on infection control and one member of staff has been made responsible for feeding back any new information in this area to the staff team. The manager explained monthly infection control meetings had to occur to comply fully with these guidelines and that these were starting in the near future. We saw that the home is equipped to reduce the risk of infection by ensuring that all sinks have a range of hand washing products and alcohol gel to reduce the risk of infection spreading. Staff confirmed that they were provided with aprons and gloves and that they used them frequently. We saw them using these products during our visit. We looked at staff training records, which showed us that all staff receive infection control training every year. St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People are receiving care and support from skilled staff in plentiful numbers who have the qualities expected to work with vulnerable people. EVIDENCE: We looked at the information that the home keeps about the staff. This included staff training records and off duties showing when staff were available. We also looked at the surveys sent to us from staff and from the people who live at the home. We had discussions with the manager and the people who live at the home about this topic. We also observed how staff interact with people who live at the home. People were very complimentary about the staff team. They spoke of the trust that they had in staff and in some cases the close friendships that they had formed. Relatives told us on surveys that they believed that the staff team was “ excellent” and that “nothing was“ too much trouble”. People praised how well the staff team communicates with each other particularly on the intermediate care unit. The surveys that staff completed showed that they are happy in their role and are positive about the service. Two staff surveys (when asked what the home could do better) stated – that “ St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 28 nothing – its great” and another said,” I love my job, enjoy coming to work and I think that St Barts place provides excellent care”. This helps to show that the staff team are motivated and settled which means that people are more likely to receive care and support form staff that they know. When we looked at off duties we found that the service provides a ratio of staff higher than in other nursing homes. For example the home provides care and support to 49 people. Every morning 4 qualified nurses are available plus a team of 11 – 12 care staff, 2 senior care staff and two activities organisers. This does not include domestic staff, kitchen staff, two staff who work as breakfast servers, the manager or deputy manager (who are both qualified nurses) or the therapy team who are supplied by the N.H.S. to support the 14 people who are receiving therapy on the Intermediate Care Unit. We observed staff responding very quickly to an emergency situation as stated in the section “ Health and Personal Care”. People told us that they believed there are enough staff to care for them “ without rushing”. This is excellent practise and shows a commitment from the management of the home to ensure that people receive quality care in an unhurried manner. We looked at staff files for three members of staff who have recently starting working at the home. The files contained information, which showed that the manager had carried out necessary checks to make sure the candidates were suitable to work vulnerable people. The files also contained information, which showed that the new staff member had received a full induction to their job including training, which is relevant to their role. The manager explained that new staff are supernumerary( not counted in the numbers) for the first two weeks so that they have time to learn the job . New care staff will work alongside a qualified nurse. The manager also explained that she prepares a probationary report following the induction after discussing the staff member’s performance with those people concerned. This is used to highlight any difficulties and monitor the new staffs progress. A copy of a probationary report was viewed. The manager explained that some people need longer than others to learn the role and if that is the case supernumerary time will be extended until staff feel confident. This is very good practise. We looked at staff training records. These showed us that every year’s staff recived refresher training in important areas, which could affect the health and safety of the [people living at the home. This includes, moving and handling training, cross infection, abuses awareness, fire safety, food hygiene. A variety of other training has taken place since the last inspection. However the training topic with the biggest impact has been training on the changes in the Mental Heath Capacity Act. All staff have received training on this with further training planned for all staff on the derivation of liberties (taking away peoples rights). As a result of this staff have had to consider whether people St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 29 are naming decisions for themselves or whether staff are consulting relatives about the care and support required instead. We saw during the inspection that a lot of people had chosen to have their bedroom doors closed. This has come about due to the above training. Nursing staff have undertaken a variety of training to ensure that their nursing skills are still up to date. The manager explained that training is discussed during supervision and that staff are supported to undertake training for their personal development as well as for the benefit of the people who live at the home. For example one nurse is being supported to undertake training to achieve a degree and receives an extra day off per week to complete this. This is very good practise. We also looked at whether staff are achieving national vocational qualifications in care. We found that the home has ensured that staff are provided training for this award through an outside training agency. At the time of the visit 81 of staff had achieved this award, which is greater than the national minimum standard recommendation of 50 . Staff told us via surveys that they thought the training offered was” excellent” and agreed that they had had enough training to enable them to do their jobs. We also found that no training plan was in place for the forthcoming year. The manager explained that the deputy manager formulates this but has been absent so it has not occurred. The manager stated that this would be addressed on her return, which is imminent. Training plans help to show the services commitment to ensuring that staff have the necessary skills to care and support the people who live in the home. St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 30 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is managed well and is a safe place for people to live. People are consulted and the management of the home listens to and acts on their opinion. EVIDENCE: We had discussions with the manager, looked at the AQAA, the surveys received and took an overview of our findings of the visit. We know that the manager is registered with the commission, which means that we are satisfied that she is suitable to manage the home. We looked at the managers training records which showed that she has achieved the registered general managers award and has recently undertaken training in staff appraisal and supervision, St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 31 meeting challenges of personalisation, Enteric feeding, Infection prevention, Recruitment and selection, CSCI awareness, Mental health capacity act and deprivation of liberties. People and staff complimented her on her ability to manage. They said they found her to be supportive, kept them up to date and was open and positive to change. Since the last inspection a senior sister being in charge of each unit has strengthened the management structure further. This is good practise as it is likely that s theses staff deliver care to people they will be well known to relatives and visitors who visit the home. We looked at how people are consulted about the service and found that lots of consultation takes place. We saw minutes of meetings, which showed us that meetings are held three monthly with both the people who live at the home and their visitors. Consultation takes place about changes in how staff work and how the commission regulates the service. People are being consulted about daily matters such as which catering company should be used with the forthcoming closure of the kitchen. We read other minutes, which showed us that activities staff hold meetings with the people who live at the home so that people can decide how they would like to spend their time. We also saw service satisfaction surveys. These are surveys, which are sent out to people and their relatives every three months. Their opinion is sought and the results formulated into a graph. This information was displayed in the hallway of the home so people could see the results. This means that the manager can monitor the services strengths and address any weaknesses. When we met with the cook we saw records that showed he meets with people on a weekly basis to ask feedback on the meals that people have received that week. This is very good practise as it enables people to have a say in how the service develops. The home has a board of trustees who meet monthly with the manager to discuss progress and development. One board member is registered with the commission as the “ responsible individual”. This means that this person undertakes monthly checks to ensure that people are still receiving a quality service. A group of volunteers also visit the home monthly. They talk to people about the care and support they receive and look at the environment. Their findings are fed back to the board and the manager. This is very good practise. We saw a Quality audit tool, which has been introduced by the manager since the last visit. This was very detailed and included seeking views from people who live at the home and staff. This means that the manager is able to audit St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 32 all areas including care and support on a monthly basis in a more streamlined way. We looked at how the service promotes the health and safety of the people who live at the home and the staff that work there. We looked at a number of certificates and contracts, which were current and showed us that regular safety checks are carried out on all equipment that is within the home including fire-fighting equipment. We saw staff training records which showed us that staff had the skills to keep people safe including reducing infection, fire safety, moving people safely and health and safety in general. The maintenance staff undertake regular checks on the outside of the home as well as the inside and this includes a weekly health and safety check and testing water temperatures weekly. St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 33 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 4 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 x 18 4 3 X X X 3 X X 4 STAFFING Standard No Score 27 4 28 4 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 4 St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 34 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The manager should carry through her intention to provide information in different formats for new people. E.g large print. This means that information will be available to everyone to enable people to make a decision about whether they want to move into the home. Disposal of medication records should be signed for by two staff to ensure that the management of all medications is safe and also so that a clear audit trail exists of any medications that enter the home. The manager should carry through her intention to ensure that a training plan is completed, which shows what training has been planned for which staff through the year. This reduces the risk of a member of staff missing essential training and helps to ensure that staff have the skills to care for the people who live in the home. 2. OP9 3. OP30 St Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection North West Region CSCI Preston Unit 1 Tustin Court Port Way Preston, PR2 2YQ National Enquiry Line: 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 © 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 Bartholomews Court Nursing Home DS0000005469.V358453.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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