Inspection on 10/02/06 for St Benedict`s Nursing Home

This inspection was carried out on 10th February 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Benedict`s Nursing Home 06/10/09

St Benedict`s Nursing Home 15/04/09

St Benedict`s Nursing Home 19/08/08

St Benedict`s Nursing Home 05/10/07

St Benedict`s Nursing Home 10/01/07

St Benedict`s Nursing Home 10/08/06

St Benedict`s Nursing Home 27/07/05

St Benedict`s Nursing Home 11/11/04

St Benedict`s Nursing Home 21/06/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE St Benedict`s Nursing Home 22 - 23 St George`s Terrace Herne Bay Kent CT6 8RH Lead Inspector Jenny McGookin Unannounced Inspection 10th February 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 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 Vacant 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.V282274.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Of the 25 nursing beds 8 are also registered for the admission of residential clients 27th July 2005 Date of last inspection Brief Description of the Service: St Benedict’s 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. 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. There are twenty-one single bedrooms, four of which have en-suite facilities, and two shared rooms, one of which has an en-suite facility. The Home has four communal areas and there is a shaft lift to the first floor. There is a ramp from the rear lounge into a conservatory area, and at the entrance of the front door, all of which enables Service Users with limited mobility to have access to most areas of the Home. The Home has several aids and adaptations in place. There is a call-bell system in operation and TV points in every bedroom. The garden has a paved patio area with garden furniture. St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which was used to check progress with matters raised from the last inspection (July 2005,) given their timeframes had run their course; and to reach a preliminary view on other aspects of the dayto day running of the home. This report should, therefore, be read in conjunction with the July report. The inspection process took seven half hours, and involved meetings with three residents over lunch, the manager and two staff (including the cook). The inspection also involved an examination of records and policy documents and the selection of one resident’s case file, to track their care. Five bedrooms were inspected for compliance with the National Minimum Standards on this occasion, along with some communal areas, which were identified for attention at the last inspection or where refurbishment had been carried out. Interactions between staff and residents were observed throughout the day. What the service does well: What has improved since the last inspection? What they could do better: The lack of progress with most matters raised for attention at the last inspection, is judged a disappointing use of the inspection / regulatory processes and will affect the overall rating of this home. Some further matters St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 6 were raised for attention on respect of record keeping (medication administration; property maintenance). There needs to be one-to-one formal documented supervision in full compliance with National Minimum Standard 36, to ensure residents are in safe hands at all times. This is judged a major shortfall Some matters were raised in respect of policies, and it is recommended that staff be required to confirm having read and agreed to comply with policies with their signatures and date, as evidence of their ownership. Care planning needs to be more holistic and demonstrably inclusive of residents, relatives and representatives. Some communal areas have very restricted useable floor space, and consideration should be given to providing adequate storage facilities for equipment and wheelchairs when not in use – the use of bedrooms or corridors is not judged appropriate. 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.V282274.R01.S.doc Version 5.1 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.V282274.R01.S.doc Version 5.1 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, 2, 3, 4, 5, 1. The home has a Statement of Purpose and Service User Guide but they do not provide Service Users and prospective Service Users with all the information they need to make a decision about moving into the home. 2. There are contracts governing each placement between the home and the resident, or their representative, but they do not have all the elements recommended to protect residents’ interests. 3, 4. Prospective residents are assessed prior to admission to establish the extent to which their needs can be met by the home, and how potential risks will be managed. Service users are generally content with the way they are supported by the home. 5. Prospective residents, or their representatives, have the opportunity to visit the home before proceeding with the admission and there is a trial stay to further inform their choice. EVIDENCE: St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 9 Information There is a revised Statement of Purpose and Service User Guide (both dated October 2005), which usefully describe the facilities, services and principles of care; but the last inspection reported that a number of elements listed by this standard were not in the previous edition and some of these elements were found to be still outstanding in respect of this latest edition. These matters have been separately reported back to the Registered Provider. Both documents are written in a font size and style likely to meet most readers’ needs but would benefit by a contents page, to facilitate the reader’s access. Given the Statement of Purpose’s assertion that the home operates “a strong diversity policy”, it needs to be more specific about the ways in which that policy is implemented e.g. whether its Statement of Purpose, Service Users’ Guide or other information is available in other formats (e.g. large print, tape) or languages, and how to access them. It also needs to be in a position to describe what staffing and catering resources are available to meet diversity issues as well as demonstrate its knowledge of local religious, cultural resources, places of worship. Feedback on the day of this inspection confirmed that obtained at the last inspection; specifically that the decision to apply to this home was influenced more by its locality (i.e. close to where the resident or their friends or relatives lived) and by personal recommendation, or previous contact than by any public information produced by the home itself. Contracts There are contracts governing each placement (whether self funded or funded by a third party) but a number of matters were reported to be in need of inclusion or amendment at the last inspection, and found to be outstanding. These matters have been separately reported back to the Registered Provider. Admission Process The home carries out a preadmission assessment, and the prospective resident or representative is invited to visit the home. Records confirm there is a standard preadmission assessment form to ensure a consistent approach. One resident was able to confirm this process. Another said that she was, through hospitalisation, not aware or involved in this process. Each resident is offered a trial stay of one month. On their admission, the home carries out further assessments and their first care plan is drawn up in this time. Intermediate Care St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 10 The inspector had understood that this home did not provide intermediate care, but the latest edition of its Service User Guide states that it can provide rehabilitation and convalescence, in which case all the elements of National Minimum Standard 6 will apply, and will be subject to inspection in future. St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 7. The assessment and care planning processes cover a range of health and personal care needs, as well as some social care needs – though this requires further development 8. The home is served by a range of healthcare professionals, to promote good health and has generally adequate facilities for privacy. 9. The home has a procedure for the management of medication, but the manager needs to ensure this complies with accredited guidance on best practice. 10. Residents confirmed that staff treat them well, and that their privacy is respected. 11. There is a policy in place to ensure that residents receive proper care when dying, and that their needs are catered for. However, regulatory duties need to be included. EVIDENCE: St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 12 Care Planning The care planning process starts on admission, and records confirm care plans are underpinned by risk assessments and are reviewed monthly – in each case counter signed by the staff reviewing them. However, findings confirmed those from the last inspection, that records of reviews often showed no change overall, and there were still gaps in the records in respect of follow-up of some social care needs (interests, activities). Less clear, moreover, was the extent to which residents or their relatives were involved in formal reviews, thereon, for want of records. Only those reviews led by care managers do this. Neither resident spoken to on this occasion showed any recognition of an active care planning review process. But one did generally recall being asked questions about their care needs right at the start. This matter was recommended for attention at the last inspection and found to be still outstanding. Health care The home accesses a range of healthcare professionals, including 15 GPs from 4 GP Surgeries, so residents clearly have some choice. But residents would need to pay for chiropody, physiotherapy of any special or private treatment or medication themselves. Medication. There is a Drug Procedure but this only provides a general guide. At the last inspection, the inspector recommended the home obtain a copy of the latest Royal Pharmaceutical Society Guidance for further details and to check compliance with its provisions. This matter was found to be still outstanding. The inspector noted that a list of staff authorised to administer medication showed two staff who no longer worked at the home and three whose PIN numbers appeared to have lapsed. The inspector was assured that this was simply a question of updating records as the manager had seen the updated PINs. Records need to be updated. 4/21 medication administration records inspected had “Authorisation of Homely remedies” documents which usefully listed a range of indications, maximum daily doses and contra-indicators etc – in each case the document was properly signed and dated by resident and GP. This was judged sound practice, but the inspector was advised that some GPs won’t provide them though all had been asked to. The inspector looked at 21 medication administration records. 4 had unexplained gaps, and there were some inconsistencies in the codes being used by staff to record irregularities. Practice needs to be consistent. Privacy and Dignity St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 13 The daily routines are as flexible as healthcare needs will allow. Residents confirmed that they can choose when to get up and go to bed. Feedback from the residents confirmed that their privacy was respected and that staff generally treated them well. With two exceptions, all the bedrooms in this home are single occupancy, which means personal care and treatments can be given in privacy. Shared rooms have screening to afford occupants some privacy. However, at the last inspection it was noted that by drawing curtains around the bed closest to the window, this effectively deprived the other of all, or almost all, natural sunlight. This is still said to be the case and is not an ideal arrangement. Death and Dying The home has a policy for the care of residents who are dying. It needs to include the need to notify the CSCI of all deaths (Regulation 37); the retention of records for three years from the date of the last entry, and medication for seven days after death in case of a Coroner’s Enquiry. St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 12. Accepting that coming into residential care can often be a disappointing change of circumstances, both residents had adjusted to their lifestyle in this home. This home offers a very limited range of activities inside and outside the home, and both residents would like the home to organise more. 13. There are open visiting arrangements, and the home is well placed for access to local shopping outlets and the sea front activities. 14. There is choice and control over most aspects of daily routines. Personal care is offered in a way, which generally protects residents’ privacy and dignity. 15. The meals in this home are generally very satisfactory, offering both choice and variety and catering for personal preferences. Residents can also opt to eat where they eat and at different times. EVIDENCE: As was found at the last inspection, residents were not able to give many examples of any particular interests and hobbies being actively promoted by the home. However, feedback from the manager sand residents confirmed there were occasional painting or craft sessions (though this currently was only of interest St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 15 to 1-3 residents), games such as dominoes, and support with activities such as knitting. The home has its own library room, supplemented by the local Mobile Library. Both residents indicated that they were resigned to their lifestyles in this home, though both wished the home would organise more activities or outings. At the time of this inspection visit there were no outings planned. As reported at the last inspection, the re-introduction of an Activities Co-ordinator would be of benefit. The Statement of Purpose states that the home can arrange for visits by clergy or for staff to accompany residents to church if friends or relatives cannot, but there was still no information for prospective residents on local religious resources or services to the home (matter raised at the last inspection). Only one resident was reported to attend church services off site. Contact with friends and relatives The home has open visiting arrangements, and feedback from residents confirmed that their visitors were always made welcome whenever they visited. A couple of the residents have had phones installed in their bedrooms (which would be at their own expense) and some other bedrooms were already connected (calls and set up costs would be borne by residents). The home has a pay-phone which can be taken into every room – and there are plug outlets throughout the home to facilitate this. The daily routines are as flexible as healthcare needs will allow. Both residents confirmed that they can choose when to get up and go to bed, and come and go as they chose. They can choose where to take their meals (though there is a dedicated communal dining room, albeit cramped), and also have some choice over meal times. Catering There is a 6-week menu cycle, based on the residents’ expressed preferences. The meals in this home tend to be traditional English, though the cook is able to catering for some special needs such as one diabetic resident. There is a choice of two options at lunchtime and more at suppertime. The cook orders provisions on line for both homes in the group, and is keeping records of the meal options actually consumed by individuals, as required. Meals sampled on both days of this inspection were well prepared and presented, and residents were observed being assisted by staff in a respectful and unhurried way, although there was a signal lack of conversation on this occasion. St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 16. There is a complaints procedure readily available, though this will require amendment to fully comply with this standard, and residents feel that any complaints they had would be listened to and acted on. The home relies on staff, or the residents’ families and friends to raise issues and represent the interests of the less able residents. There are no independent advocacy services. 18. Residents generally feel well cared for and safe. EVIDENCE: The home’s complaints procedure is detailed in the Statement of Purpose and Service User Guide, and describes the process and timeframes involved, in general compliance with the provisions of Regulation 22. However, it still gives the CSCI as an option only if the complainant feels the complaint has not been dealt with properly or wishes to take the matter further. This is not a correct interpretation of the National Minimum Standard or Regulation 22 and the registered person will need to correct all copies. This matter was raised at the last inspection and found to be still outstanding. The home has policies on abuse and whistle-blowing and these include the need to notify the Commission of events (Regulation 37) as they occur, though this has been an area which required a better level of compliance in the recent past; and residents generally confirmed that they would know who to talk to if they had a complaint and felt safe. The home does not use any independent advocacy services but relies on staff, or the residents’ families and friends to raise issues and represent the interests of the less able residents. St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 17 St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 18 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, 20, 21, 22, 23, 24, 25, 26 19, 25. The location of this home is generally suitable for its stated purpose, and residents confirm this is a homely place to live. 20. Residents have a choice of communal areas, and furnishings tend to be domestic in character. There are homely touches throughout. The useable floor space is very limited in some areas, however, which could compromise safety. 21. There are sufficient lavatories and washing facilities and they are generally accessible to bedrooms and communal areas. 22. There is a range of equipment and adaptations to support residents and staff in safety in their daily routines and to maximise residents’ independence, though storage continues to be a problem. 23, 24. Most residents have access to the privacy of their own bedrooms and five rooms have en-suite facilities. Residents can personalise their rooms with their own possessions and items of furniture St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 19 26. The home is generally adequately maintained and all areas inspected were free of any unpleasant odours. EVIDENCE: The site of this home is judged generally suitable for access to the sea front and local community and it is generally adequately maintained. Some matters were, however, raised for attention at the last inspection, and found to be still outstanding on this occasion. There are 22 single bedrooms, all of which are at least 10 square metres. In fact, only three are between 10-11 sq metres, the others are larger. Five of these single rooms have en-suite facilities. There are also two shared rooms, one of which is 16 square metres and the other, although below the National Minimum Standard at 14 square metres has its own en-suite facilities. Five bedrooms were assessed against the National Minimum Standards on this occasion and had almost all the furniture and fitments required. All were generally well maintained and most were in satisfactory decorative order. Each room had been personalised with the residents’ possessions and, in some cases, pieces of their own furniture and there were homely touches throughout. Although several residents have said they did not want locks on their doors or any lockable facilities these should be installed as standard. The use of portable cash tins is not judged a secure enough arrangement. Of concern was the discovery that two bedrooms were being used to store wheelchairs not belonging to the occupants. This was not judged appropriate, and the manager arranged for their immediate removal. Lack of available storage facilities has been identified as a problem in this home, and the conversion of bedroom space into storage space is not being considered a viable option. The home provides a choice of communal space for each resident. There is a main lounge area, a conservatory plus a dining room on the ground floor and a second lounge on the first floor (which is known as the “Quiet Room” and has a library which is kept replenished by Canterbury library). All furnishings within the communal areas are domestic in character and of reasonable quality, suitable for the service users needs. All areas seen were adequately maintained, and hallways have been undergoing redecoration since the last inspection with more planned e.g. lounge areas. However, some corridors were found to be being used to store wheelchairs. This was not judged appropriate as they not only obstructed the safe passage of residents but also obstructed their use of handrails. The Home has a shaft lift to access all floors and all areas are linked with a call bell system. Specialist equipment includes special mattresses, raised toilet St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 20 seats, grab rails and corridor rails, hoists. Access to the front door and patio is good. There is one communal WC and two communal bathroom / WCs on the ground floor, and three communal bathrooms / WCs on the first floor i.e. within reasonable access to bedrooms and communal areas. There were adaptations in each case. The home has one domestic washing machine a second washing machine with a sluice cycle, plus one dryer. The inspector was advised that sluice facilities were undergoing refurbishment, but this work was not complete and was not, therefore inspected on this occasion. St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 21 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): These standards were not inspected on this occasion. EVIDENCE: Since the last inspection, there have been no concerns raised with the Commission about the home’s capacity to maintain these staffing levels but this has been an issue in the past and will be subject to closer scrutiny at the next announced inspection. See, however, section on Management and Administration for findings in respect of the proprietor’s regulatory duty to carry out formal documented inspection visits at least once a month, and staff supervision – where major shortfalls were found. At the last inspection, the inspector found that the home needed to make more progress with NVQ training for staff. On this occasion, the inspector was advised that some training in NVQ3 was now underway, and that NVQ training was also planned for June 2006 subject to funding. This will be subject to closer scrutiny at the next inspection. St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 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, 35, 36 31. Mrs Wren has been the registered manager since December 2002 and the Commission’s registration process established that she has a range of relevant qualifications and experience. However, shortfalls in line management accountability (most notably in respect Regulation 26 visits, staff supervision) and in progress with matters raised for attention at the last inspection, combine to obtain a poor score for this standard. 35. There appear to be suitable accounting procedures in place to safeguard the residents’ financial interests. 36. Staff have ready access to line management and policies on a day-today basis, though some policies will require attention. But there needs to be one-to-one formal documented supervision in full compliance with National Minimum Standard 36, to ensure residents are in safe hands at all times. St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 23 EVIDENCE: Management Arrangements and Lines of Accountability At the last inspection the home had an acting manager who, having successfully applied for registration by the Commission, has since transferred to another home in the group. The registered manager has resumed her position, after a period of standing down, until such time as a replacement can be arranged. This arrangement is time limited. There are clear lines of accountability within the home and staff continue to report that in-house line management is generally accessible. There was no evidence, however, of the proprietor’s compliance with his duty to carry out formal documented inspection visits of his own at least once a month (Regulation 26). Notwithstanding the registered manager’s interventions, the home’s lack of progress with most matters raised for attention at the last inspection is of concern, and combines with other shortfalls to obtain a low score for National Minimum Standard 31 Policies and Procedures Staff have access to a range of policies and procedures, and fifteen were selected for closer scrutiny on this occasion. Many did not show their original issue date, but records indicate that they were subject to periodic review – although the inspector noted, with little or no change made in each case. Some elements of the policies did not, however, reflect practice (in-house or regulatory). The home does not, for example, have a key worker system, though its policy on admissions and care planning would indicate it does. Its Drug Procedure is only a general guide, which will need checking against the Royal Pharmaceutical Society model for its comprehensiveness and compliance with best practice standards (matter raised at the last inspection and found to be still outstanding). Its Complaints policy still requires amendment to obtain full compliance with all the elements of the National Minimum Standard (matter raised at the last inspection and found to be still outstanding. Other examples are detailed throughout this report. Staff Supervision Of notable concern, on this occasion, was the home’s lack of compliance with its own policy and regulatory duty to carry out formal documented staff supervision sessions. There were no supervision records in any of the seven RGN qualified staff files or in either of the two EN qualified staff files. 5/15 Healthcare assistants’ files had no supervision records and the rest only had one or two. None of the catering or domestic staff had any supervision records on file. This is judged a major shortfall and must be addressed as a priority. Residents’ Day to Day finances St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 24 The inspector was shown the accounting systems being maintained for the residents pocket money and judged them sufficiently diligent. Each resident has a secured cash tin in their bedroom, (though two were not available for checking on this occasion) which they have ready access to. The home’s arrangements for auditing its accounts were not inspected on this occasion. This inspection did not on this occasion include any business planning or service development planning arrangements. St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 25 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 2 2 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 2 3 2 3 3 2 3 STAFFING Standard No Score 27 X 28 X 29 X 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X 3 1 X X St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 4& Schedule 1 Requirement The Statement of Purpose must be amended to comply with all the elements of National Minimum Standard 1, Regulation 4 and Schedule 1. Original timeframe – 31 12 05 The Service User Guide must be amended to comply with all the elements of National Mimimum Standard 1, Regulations 5, 6. Original timeframe – 31 12 05 Medication Arrangements. The following matters are raised for attention: - The home needs to check its own policy against the Royal Pharmaceutical Society model to ensure its comprehensiveness and compliance with best practice - Records of staff authorised to administer medication require updating - Record keeping on MAR charts needs to be consistent across the staff team (i.e. use of codes. Attention to gaps) Policy on Death and Dying. This needs to include the need to DS0000026118.V282274.R01.S.doc Timescale for action 31/05/06 2 OP1 5, 6 31/05/06 3 OP9 13(2) 28/02/06 4 OP11 37, 17 30/04/06 St Benedict`s Nursing Home Version 5.1 Page 27 5 OP16 22 & Schedule 4 notify the CSCI of all deaths (Regulation 37); the retention of records for three years from the date of the last entry, and medication for seven days after death in case of a Coroner’s Enquiry. The Service User Guide has contradicting statements on the complaints procedure and needs to be amended to give the CSCI as a clear option at any stage, if that is the complainants preference. Original timeframe – 31 12 05 Each version of the homes complaints procedure needs to be amended to give the CSCI as an option at any stage, if that is the complainants preference. One version still refers to the Commission by its old title, which is liable to confuse the reader. Original timeframe – 31 12 05 30/04/06 6 OP16 22 & Schedule 4 30/04/06 7 OP22 23(2)(l)( m)(n) There needs to be adequate and 30/04/06 appropriate storage facilities for equipment within the home to be readily accessible to staff. Action Plan to be submitted Original timeframe – 30 09 05 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 timeframe – 31 12 05 Kitchen. One ceiling light requires a 2nd fluorescent strip and diffuser. Original timeframe – 30 09 05 The registered person must submit an action plan to show how he intends to meet the standard for induction of new DS0000026118.V282274.R01.S.doc 8 OP24 12(4)(a) 30/04/06 9 OP26 12(1)(a) 30/04/06 10 OP28 18(1) 30/04/06 St Benedict`s Nursing Home Version 5.1 Page 28 11 OP31 26 12 OP36 18 staff Original timeframe – 30 10 05 The registered proprietor must comply with his duty to carry out formal documented unannounced inspection visits of his own at least once a month (Regulation 26). There needs to be full compliance with the home’s own policy and its regulatory duty to carry out formal documented staff supervision sessions at least six times a year, culminating in annual appraisals, to ensure residents are in safe hands at all times. 28/02/06 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP2 OP7 Good Practice Recommendations Contract. A number of matters are raised to improve the contract Care Planning reviews should routinely record who participates in each case; include the recorded views of resident and/or their representative, and any unmet needs, so that anyone authorised to inspect them can evaluate their ownership. More attention could be given to exploring each resident’s interests, aspirations and social needs in a practical way. One or two residents wished the home would organise more activities or outings. The re-introduction of an Activities Co-ordinator would be of benefit. Some communal areas were very cluttered with equipment and furniture, and had limited useable floor space. alternative configuration or provision should be considered. 3 OP12 4 OP19 St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 29 5 OP22 There should be handrails down both sides of 1st floor corridor, to cater for all residents, and these areas need to be kept clear of obstacles at all times. The registered person should consider whether the installation of Loop systems would benefit residents with hearing aids. Electrical sockets in bedrooms need to be accessible. Double rooms should have at least three double electrical sockets Policies need to checked for compliance with best practice models and regulatory requirements, and there should be systems in place to ensure staff practice is compliant 6 OP22 7 OP24 8 OP36 St Benedict`s Nursing Home DS0000026118.V282274.R01.S.doc Version 5.1 Page 30 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.V282274.R01.S.doc Version 5.1 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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