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Inspection on 10/08/06 for St Benedict`s Nursing Home

Also see our care home review for St Benedict`s Nursing Home for more information

This inspection was carried out on 10th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

Service users were well groomed, with attention to detail about their appearance. Staff take time to ensure that service users have their personal needs met in private, and can sit in their rooms or communal areas according to preference. The Provider ensures that there is a good ratio of care/nursing staff to service users, and over 50% of care staff were trained to at least NVQ level 2. The housekeeper and domestic staff work hard to keep the building clean. There are good cleaning schedules in place, and the housekeeping is well organised.

What has improved since the last inspection?

Medication administration records had been completed more carefully. There were no unexplained gaps, and no inconsistencies in the codes used by staff. This was an improvement from the last inspection. The complaints procedure had been amended to show the correct details for CSCI.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE St Benedict`s Nursing Home 22 - 23 St George`s Terrace Herne Bay Kent CT6 8RH Lead Inspector Mrs Susan Hall Unannounced Inspection 10th August 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Benedict`s Nursing Home DS0000026118.V299709.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 Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Benedict`s Nursing Home Address 22 - 23 St George`s Terrace Herne Bay Kent CT6 8RH 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) 01227 362398 Macari Homes Limited Gillian Wren Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Of the 25 nursing beds 8 are also registered for the admission of residential clients 10th February 2006 Date of last inspection Brief Description of the Service: St Benedicts Nursing Home is situated in a residential area of Herne Bay overlooking the sea, and is close to local amenities including local pubs, shops and churches. It is owned by Macari Homes Limited, and the Provider, Mr. Macari is often on the premises, and takes an active role in overseeing the service. The building is a large detached house, which has been extended and converted. There is a car park at the rear of the building, accessed from the front by a driveway to one side of the building, which can accommodate up to eight vehicles. Most bedrooms are for single use, and some have en-suite facilities. There are four communal areas, and the rear lounge leads into a conservatory and on into a paved patio area in the garden. Access to the first floor is facilitated by a passenger lift, and to the garden via a ramp. These provide wheelchair access to most areas in the home. Each bedroom is fitted with a call bell and a TV point. While the home is primarily for nursing clients, 8 beds can be used for residential service users. This can enable married service users to stay in the same home, where one needs nursing care but the other does not. Fees for the service are set at £300 - £310 for residential service users, and £460 - £560 for nursing service users. The exact amount depends on the needs of the service user, and the rooms available. This information was included on pre-inspection documentation in June 2006, and was supplied by the Manager. St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was the culmination of an ongoing assessment of the home since the last inspection in February 2006. The assessment included written pre-inspection and notification documents supplied by the home; survey forms; information supplied to the Inspector during the past 5 months, and the visit to the home. Completed CSCI survey forms were received from a GP and a care manager. Both contained positive comments, and one had written “ a thoroughly efficient home with dedicated staff.” The Inspector talked with 5 service users, 2 relatives and 6 staff as well as with the Manager. Service users said they were well cared for, and staff were seen to interact well with them, and to attend to their needs promptly and with respect. The home was clean throughout, but is in need of much refurbishment to provide a high standard of accommodation. CSCI has received no complaints about the home since the last inspection. Some of the requirements given in February 2006 have not been met, and reflect on the lack of dedicated management to administration issues. What the service does well: What has improved since the last inspection? St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 6 Medication administration records had been completed more carefully. There were no unexplained gaps, and no inconsistencies in the codes used by staff. This was an improvement from the last inspection. The complaints procedure had been amended to show the correct details for CSCI. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 The quality for this outcome area is good. Service users are properly assessed prior to admission, to ensure that the home can meet their needs. EVIDENCE: The Manager informed the Inspector that the Statement of Purpose and the Service Users’ Guide had been amended in response to previous inspection requirements. These had both been revised in April 2006. The Statement of Purpose has clear details, and includes all the information required by Standard 1, and Schedule 1 of the Care Homes Regulations. The Service Users’ Guide is set out in large print, and contains a précis of the statement of purpose and terms and conditions of residency – such as arrangements for contact with family and friends, smoking and alcohol, pets, medication, and use of telephones. A list of residents’ rights is included. Fees are specified, and the details of what is included in the fees and what is not. A sample contract is included, and shows St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 9 the allocated room number, and whether the room is for single or shared use. A copy of the complaints procedure is included in both documents. This had been revised to include updated details for CSCI, and specifies that complaints will be responded to within 7 working days. Pre-admission assessments had been carried out by the Manager, and 3 were viewed by the Inspector. These were sufficiently detailed to show that all aspects of service users’ daily living needs had been assessed. The assessments showed that any special equipment needed was identified prior to admission, and obtained before the service user came into the home (e.g. airflow mattress, nursing beds). Mobility needs are assessed to ensure that the service user can access the allocated bedroom, and can reach all required areas of the home in a wheelchair if necessary. Joint assessments from hospital staff/social services had been obtained and were filed in the records. St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 The quality for this outcome area is good. Attention is paid to meeting individual health care needs, and good nursing care is maintained. Lack of management is evident in regards to out of date paper work, and lack of audits for medication. EVIDENCE: The Inspector viewed 3 care plans in detail, and looked at specific sections in another. Service users’ plans are set out in individual folders, with different sections for easy access of information. Admission details at the front include personal data, (next of kin, recent medical history, religion, GP etc.), and a photograph of the service user. The nursing admission sheet is in the format of a tick list, and these had been well completed. Admission details include specific data about history of falls, diet, likes/dislikes, sleep pattern, continence care, communication needs etc. Mobility details show if a service user needs the use of a hoist, and if one or two staff are needed for transfers. St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 11 Care plans are hand written, and set out according to the initial assessments. Assistance with personal hygiene needs are clearly specified, and show if the service user needs help with washing/bathing/dressing/shave/denture care etc. and there is a daily tick list completed by care staff to show what assistance was given. Details are recorded for the service user’s mental state, (e.g. quiet and withdrawn, anxious or confused), and if they are able to specify their own needs clearly. Risk assessments are carried out for dependency needs – mobility, nutrition, personal hygiene care, elimination, vision, communication, cognitive needs and any nursing procedures. General risks are assessed for items such as scalding, leaving the building unaccompanied, and choking. Nutrition screening includes monthly weights and BMI. Wound care pathways are followed, with each dressing documented. The nurses use a daily diary as a reminder for any dressings due. The nurses carry out a detailed monthly check of each care plan by reviewing a different one each day. Assessments are re-evaluated, and the nurse talks through any changes in the care plan with the service user where possible. Records showed that appropriate referrals are made to GPs and other health professionals. A service user with continued weight loss had been referred to the dietician via the GP; and a service user with anxiety problems was referred for psychiatric input. This service user had shown an improvement after assessment by the Community Psychiatric Nurse. Records showed evidence of optician, chiropody and dentist visits. Daily records are completed by the nurse on duty for nursing needs and professional visits. Care staff write separate daily records for the service users they care for on that day. There is a system for carers to have responsibility for a different group of service users each day, so that they get to know all of the service users well. Medication is stored in a small room which had an air-conditioning unit in it. The room temperature was controlled to 24-25 degrees in hot weather, and was therefore just satisfactory, but needs to be kept under review. The drugs fridge temperature had been maintained satisfactorily. Controlled drugs were appropriately stored and entered in a controlled drugs register. No out of date medication was found, and there was good evidence of stock rotation. Homely remedies are stored in the medicine trolley, and included a bottle of simple linctus which had not been dated on opening. As this only has a month shelf life after opening, it should be considered as out of date. Senna tablets for homely remedies were not in their box, so the date for use could not be verified. Medication Administration Records (MAR charts) include a photograph of the service user, and details of any allergies. Medication had been receipted into a book, but should be recorded on the MAR charts, as this provides an ongoing record for each service user, and is easier for managing drug audits. As St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 12 necessary (“PRN”) medication had “o” entered on the chart when not given. This is unnecessary as it is PRN anyway, and makes auditing more difficult. There were no records of drug audits being carried out, and it is a recommendation that at least controlled drugs and PRN analgesia are audited on a regular basis (e.g. monthly). The MAR charts contained an out of date list of nurses in the home, and PIN numbers which had gone past their expiry dates. Updating this list was a requirement at the last inspection, and this had not been done. Service users were observed as being treated with respect to their privacy and dignity, and said that they were well cared for. Two relatives said they were “very happy” with the care given here. The Manager ensures that service users who are dying are kept as comfortable and pain free as possible. Relatives/friends can visit at any time if the service user wants them to. Staff will sit with service users if relatives are not available. Additional visits from church/religious leaders will be arranged if requested. St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 13 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): 12-15 The quality for this outcome area is adequate. Some improvements have been made with trying to increase activities. Nutritional needs are met, but some changes could be made to facilitate better infection control in the kitchen. EVIDENCE: The home has employed two staff to spend time carrying out activities with service users, and mostly spend time with them on a one to one basis. They will also play card/board games with them – e.g. draughts, dominoes. Service users may be taken out for walks at times. Most service users did not want many joint activities, but the perception was that there is “nothing to do” and so more should be made available. Entertainers are occasionally brought in for shows or singing afternoons. There is a payphone for service users to make telephone calls. Library books are provided. One lady is regularly taken to church, and nuns visit to give communion to service users who are Roman Catholic. Service users are encouraged to retain their independence in all areas for as long as possible. Rooms were seen to be personalised. St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 14 Menus are prepared by the cooks, who work from 08.00 – 2.00pm. Supper cooks are employed from 4.00 –7.00, and a kitchen assistant is employed each day to assist with giving out drinks, laying up trays, clearing tables and helping with cleaning duties. A new kitchen assistant had started work on the day of the inspection, and was working alongside an experienced kitchen assistant as a start to the induction process. The cook keeps a list of likes/dislikes, and provides a choice of two alternatives for each meal. Other dishes will be prepared if requested. She said that “if they’ve got it, she’ll cook it.” Service users liked this attitude, and said that they can always ask for something different. Food was well prepared, and there are always fresh fruit and vegetables. Meat is delivered daily, except at weekends. Cleaning schedules, and a list of food/fridge/freezer temperatures are maintained. The kitchen is quite small, but the cook said that the equipment is satisfactory, and a new fridge and new freezer had been purchased since the last inspection. The Inspector observed lots of staff going in and out of the kitchen, which is not good for infection control. Many were not wearing plastic disposable aprons. There is no provision for staff to make drinks when they have breaks without accessing the kitchen. This is not helpful, as staff are constantly going in and out, and some alternative provision for staff should be considered. Breakfasts are prepared by the care staff and are always the same. Cooked breakfasts are not available except for boiled/scrambled eggs. If breakfasts were prepared by the cooks, this would entail less staff entering the kitchen, and could provide more choice for service users. The cook and kitchen staff had updated their basic food hygiene training every 3 years. St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. The quality for this outcome area is adequate. The complaints procedure and recording processes would benefit from further improvements. Staff recruitment and training records are inadequate to confirm satisfactory procedures and training regarding adult protection. EVIDENCE: The Manager said that there had been no complaints since the last inspection. There was no complaints log, and the Inspector was therefore unable to verify that complaints are handled appropriately by the home. The Manager said that if there were any concerns or complaints, she would document them in the service users’ records. This does not enable any authorised person to check the level of complaints taking place in the home. The complaints procedure was on display, but was incomplete, as it did not include a timescale. Directions were to speak to the Manager or Provider. The procedure does not state that the Provider can be contacted at the same address, and this may not be common knowledge for visitors. There were no details included for Social Services, and it would be helpful for service users and relatives to have those details if they should wish to contact care management. The complaints procedure included in the Statement of Purpose and Service Users’ Guide was more detailed, and showed that complaints would be responded to within 7 working days. St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 16 CSCI details had been amended since the previous inspection. These will need to be altered in September 2006, to reflect the change of local office to Maidstone. There was evidence of some staff training in the Protection of Vulnerable Adults during the past year, but the Inspector was unable to verify if all staff had attended this training. A POVA First check, and applications for a CRB (Criminal Record Bureau) check are carried out before any staff commence work under supervision. The Inspector stressed that 2 satisfactory written references should also be obtained prior to any induction. Employment is not confirmed until a satisfactory CRB check has been received. St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 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 quality for this outcome area is poor. There are many areas of maintenance within the building which require attention. EVIDENCE: The Inspector viewed communal areas, bathrooms, kitchen, laundry, outside patio area, and some bedrooms. The general state of the building was clean throughout, but the decoration and general appearance is worn and tired, and in need of refurbishment. Some decorating had been carried out for corridor walls, but the skirting boards, doors, and other woodwork is damaged and scuffed. This gives the building an unkempt appearance. Some bedrooms viewed would benefit from redecorating, new furniture, and new soft furnishings. Carpets are cleaned as necessary each day. Some of these were worn and badly fitted. Three bedroom carpets were identified by the Inspector as needing urgent replacement. The A St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 18 Manager said that these had already been identified by the Provider, and new carpets had been ordered. The Inspector was informed that the Provider carries out most of the maintenance, and urgent items are always dealt with quickly. However, ongoing items may not get done e.g. skirting boards which “had not been painted for years” (according to one staff member). The home has 5 bathrooms, one of which on the first floor was being used to store equipment. Previous requirements given at the last two inspections for allocating storage space have not been met. The bathrooms should be available for service users at all times, and not used as storage areas. Two of the bathrooms need refurbishment – the “blue bathroom” on the first floor, and the rear bathroom on the ground floor. Both of these have damaged baths which had been patched up. Both rooms have broken tiles, and one has a window sill which needs repainting. Both of these two baths can only be accessed from one side, and this can be restrictive for staff, as high dependency service users would be more secure if the baths could be accessed from both sides. There is a requirement to produce an action plan for these two rooms. The home is equipped with a passenger lift, sufficient hoisting facilities, and other equipment such as bed rails, commodes and grab rails. There are some nursing beds, and some divan beds. The Manager said that if an additional nursing bed was found to be needed at a pre-admission assessment, the Provider would purchase one. There is insufficient space for storage of equipment, and this has been the subject of a requirement in 2 previous reports. The Manager’s office is very small, and is unsuitable for the purposes of management. The home has a choice of communal areas, including a lounge, dining room and conservatory on the ground floor, and a small quiet lounge on the first floor. The hairdresser was using the conservatory for hairdressing purposes, and the wires across the floor could compromise safety, although extra care was being taken. There is a patio area outside the conservatory, where service users like to sit in good weather. Radiators throughout the premises are fitted with guards. The Inspector was unable to confirm that hot water temperatures are checked regularly and are satisfactory. Sluicing facilities were seen to be adequate. The laundry room is very small, and would be considered as inadequate except that it was extremely well organised. Dirty linen is kept in laundry bags on the floor and entered straight into the washing machine. Red alginate bags are used for managing soiled items of clothing. The laundry is fitted with a St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 19 commercial washing machine and a commercial tumble dryer. The housekeeper uses a chemical system which destroys MRSA bacteria at 40 degrees. There is very limited space for ironing, and for storing clean items. The housekeeper has devised systems to ensure that clean items are returned to linen cupboards or bedrooms as quickly as possible. Cleaning programmes have been implemented to ensure that areas behind beds, skirting boards, tops of wardrobes etc. are all cleaned weekly/2 weekly. The cleaning staff write in a folder to confirm what tasks they have done. The housekeeper requests new items of bed linen, towels, tablecloths etc. from the Provider as needed, and keeps a record of when these are purchased. St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 The quality for this outcome area is adequate. Staffing levels are satisfactorily maintained in the daytime. Staff recruitment practices, staff induction, and records for staff training and nurses PIN numbers, need to be improved. EVIDENCE: Staffing levels were set as 1 nurse and 6 care staff in the mornings; 1 nurse and 4 care staff for afternoons/evenings, and 1 nurse and 1 carer at night. This was reported as working out well in practice, as it enables care staff to spend time with service users in the mornings, and not to rush them. The Manager is usually supernumerary in the mornings, enabling her to attend pre-admission assessments and other meetings. As there are always a number of service users who require 2 for transfers, the Inspector is not convinced that 1 nurse and 1 carer is sufficient staffing at night, as it means that if the nurse is attending to nursing needs or medication, he/she has to be taken away from this to assist with moving and handling. The home had 10 out of 17 care staff trained to NVQ 2 or more, and this constitutes 58 , which is good. One other carer had commenced NVQ 2 and another was due to start. Several care staff had completed degree courses in health and social care, and one had just left to commence nurse training. Another carer said she had a place to start nurse training. St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 21 The Inspector examined 5 staff files – a nurse, 2 care staff, a domestic, and an Occupational Therapist (activities staff). The nurse’s file had a PIN number confirmation with a date which had expired. The records in the MAR charts also showed expired PIN number dates. The Manager stated that all the PIN numbers had been checked and updated, but the records do not reflect this. Staff files showed that staff had been requested to give a 10 year working history. This should have been amended, as the requirement is now for a full working history. One staff file had no details recorded for education or working life. Most staff files had 2 written references, but one had only 1 written reference, and another had a reference addressed “To whom it may concern”. This is not considered as a satisfactory reference. All staff had completed a health questionnaire, and all staff had completed CRB checks (apart from the new kitchen assistant working under supervision). No evidence was seen to show confirmation of POVA First checks, prior to commencing employment, although the Manager said these were carried out. No proofs of identity had been kept on file for the files viewed. All staff had been given terms and conditions of employment, a job description, and a contract after successful completion of their probationary period. Most staff had good training records, although a file for a domestic staff, (who had worked at the home for a few years) had no training records at all. This file should have included at least basic training in mandatory subjects – fire safety, infection control, health and safety and POVA training. The home was employing staff from at least 5 countries abroad, some of which are outside the EU. One of these files had no copies of passport, work permits, or birth certificate. The Manager told the Inspector that the home would be following the Learn to Care induction course, but the Inspector did not see any evidence of this in use. There was no staff training matrix, and the Inspector could not verify that all staff had had mandatory training. However, some staff files showed evidence of moving and handling training, fire safety, food hygiene, and first aid. Updated training for nurses was evidenced with a session on “best practice in medication management” in 2005, and flu vaccination training was being made available. The Manager said that most of the nurses also worked in hospitals, and were able to update their training there. However, there should be a list of skills and competencies to back this up. St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38. The quality for this outcome area is poor. Lack of clear management is affecting the quality of the home. EVIDENCE: The Manager previously resigned as Registered Manager for this home, and was reappointed as Manager after the newly appointed Manager moved elsewhere. It is evident that she provides a good lead to nursing and care staff, which reflects her love of nursing, and her preference for hands-on nursing. It is to her credit that service users feel they receive good nursing care, and are well looked after. However, a lack of management is generally evident in the home, in the documentation and general running. (e.g. staffing recruitment files are unsatisfactory; there is insufficient evidence for staff training; staff supervision has not been commenced; and there is a great deal of general maintenance to be overseen). St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 23 The Inspector was told that there are “occasional” staff meetings. There were no records of residents/relatives meetings; or quality assurance processes. Regulation 26 visits were not evidenced. However, the Manager has an open door policy, and it was clear that service users and relatives knew her well, and that staff find her very approachable. Service users’ pocket monies are stored individually in a locked place. Receipts are retained of each transaction. Formal staff supervision had not been commenced, in spite of a previous requirement. Informal supervision was evidenced in good relationships between staff, and the awareness of their different roles. The housekeeper carries out informal supervision for domestic staff. Policies and procedures had been reviewed in January 2006. Some other documentation in the home has not been satisfactorily maintained, and these are referred to in different parts of the report. Accident records were well maintained. The Manager stated that all fire tests were properly carried out, but the Inspector noted that 3 fire extinguishers were labelled for servicing with expired dates – (2 for June 2005, and 1 for 2003). Health and safety checks had been thoroughly carried out in 2004, and for another time which appeared to be since then, but this work was undated. PAT testing for electrical equipment was due in July 2006, so had just expired. Fire alarm tests, and emergency lighting were in date, and all hoists had been serviced in July 2006. St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 24 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 2 1 1 3 3 2 3 STAFFING Standard No Score 27 2 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 1 X 3 1 2 2 St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement Records of staff authorised to administer medication require updating (i.e. PIN numbers). Original timescale for 28/02/06. New timescale given. To review the infection control measures for the kitchen, ensuring that infection control measures are not compromised by allowing too many staff to have access to the kitchen. The complaints procedure on display must be amended to include timescales for reply; and a summary of complaints (a complaints log) must be available to be viewed by CSCI. To review the management of ongoing maintenance in the home; and to provide the Inspector with a planned programme of routine maintenance and decoration of the premises. Timescale for action 15/09/06 2. OP15 16 (2) (j) 01/10/06 3. OP16 22 01/10/06 4. OP19 23 (2) (b) 01/11/06 St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 26 5. OP21 23 (2) (c,d,j) To provide the Inspector with an action plan for refurbishment of the 2 bathrooms identified in the report. 01/11/06 6. OP22 23(2)(a,l, m,n) There needs to be adequate and 01/10/06 appropriate storage facilities for equipment within the home to be readily accessible to staff. Action Plan to be submitted. Original timescale – 30/09/05, and amended timescale of 30/04/06. New timescale for this requirement for 01/10/06. All bedroom doors must be fitted with locks suited to the residents’ capabilities (and accessible to staff in emergencies). Action plan to be submitted. Original timescale – 31/12/05 and amended timescale of 30/04/06. New timescale for this requirement for 01/10/06. Ensure that all staff recruitment files show a full work history; 2 satisfactory written references; proof of identity; work permits (where applicable); and confirmation of POVA first checks. To provide evidence that a satisfactory induction programme is being used for all new staff. To implement a staff training matrix, so that all types of staff training can be verified, with their dates. 01/10/06 7. OP24 12(4)(a) 8. OP29 19 and schedule 2. 31/12/06 9. OP30 18 (1) 01/11/06 10. OP30 18 (1) 01/12/06 St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 27 11. OP33 24 12. OP33 26 13. 14. OP36 OP38 18 13 (4) Quality assurance processes for consultation with service users and their representatives must be implemented. The Provider must make provision to ensure that Regulation 26 visits are carried out, and that written reports are available to the Commission on request. (Previous requirement dated 28/02/06). New timescale given. To commence formal staff supervision for all levels of staff. The Provider needs to ensure that health and safety standards are maintained, and that documentary evidence supports this. 01/12/06 01/11/06 01/11/06 01/12/06 St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 28 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 OP9 OP9 OP12 OP15 OP18 Good Practice Recommendations Ensure that homely remedies do not go out of date. To carry out regular audits for medication (e.g. monthly) for controlled drugs and for PRN analgesia. To increase further opportunities for service users to take part in varied activities and outings. To enable service users to have more choice at breakfast times. To ensure that all staff keep up to date with training in adult protection; and keep a list so that this can be verified. To review the room used as a manager’s office, which is unsuitable for it’s stated purpose. To review the levels of care staff on duty at night times. To compile an ongoing list to show the levels of nurses’ skills and competencies. 6. 7. 8. OP19 OP27 OP30 St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Benedict`s Nursing Home DS0000026118.V299709.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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