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Inspection on 10/01/07 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 January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

What has improved since the last inspection?

What the care home could do better:

The Inspector noticed at this visit that the service users` contracts could be worded more clearly, and produced in a larger print for easier reading. There is a recommendation for this. The Provider acknowledged that the manager needs more office space dedicated for her use. As there is an unused bathroom, it would be an improvement to use this space more effectively. The inspector also pointed out that the clinical room is very small, so some reorganisation of these areas of the home could be beneficial.Some documentation was out of date, and needs to be followed through. This particularly related to fire extinguisher servicing records, and Pat testing for electrical items.

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 Key Unannounced Inspection 10th January 2007 09:40 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.V318684.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.V318684.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 Mrs Gillian Dawn 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.V318684.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. Date of last inspection 10th August 2006 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.V318684.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a second key inspection carried out during this inspection year, to assess the progress which had been made in the home since the last key inspection in August 2006. The service was given a low rating on that occasion, mainly due to the Inspector’s concerns about administrative matters, whereby she was unable to evidence good practice in a number of areas. A meeting was held with the Provider in September 2006 to talk through these concerns, and he gave a positive response, and a commitment to address these issues. This inspection included receipt of pre-inspection documentation, feedback from relatives, and a six hour visit to the home. The manager was present throughout the visit, and was able to clarify details of care and administrative procedures. The provider was also present for some of the time. The Inspector was pleased to note that the Provider and manager had acted promptly to deal with all the issues raised, and had either already met the standards concerned, or were in the process of meeting them. The home’s rating has been raised as a result of the work they have put in. What the service does well: What has improved since the last inspection? St Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 Page 6 The last inspection report included 14 requirements for standards which were below the level to meet the National Minimum Standards. These have all been addressed to some extent. A summary is as follows: Records of “PIN” numbers for nurses administering medication have been updated. Infection control measures for the kitchen have been reviewed and are more rigidly enforced. The complaints procedure on display has been updated; and a complaints log has been implemented. The Provider has employed a part-time maintenance person to oversee the ongoing routine maintenance and general décor of the home. One of 2 bathrooms identified has been fitted with a new bath; the other (which is not needed) is out of use while the Provider and manager discuss the best possible use for this space. The home was uncluttered in regards to equipment, and the requirement to produce more storage space was no longer applicable. The Inspector has agreed with a clause in the service users’ contracts in regards to locks on bedroom doors. These will be fitted if requested. The manager has commenced work on updating all existing staff files, and has updated and tightened recruitment procedures where needed. An induction programme which is compliant with “Skills for Care” is now available for use. A staff training matrix is being implemented. A quality assurance process has been commenced. The Provider is carrying out monthly monitoring visits in the home. Formal one to one staff supervision has been commenced. Documentary evidence for health and safety standards was more easily available. Opportunity for increased activities for service users is being kept under review, with more made available according to service users’ wishes. Staff training in adult protection could be verified. What they could do better: The Inspector noticed at this visit that the service users’ contracts could be worded more clearly, and produced in a larger print for easier reading. There is a recommendation for this. The Provider acknowledged that the manager needs more office space dedicated for her use. As there is an unused bathroom, it would be an improvement to use this space more effectively. The inspector also pointed out that the clinical room is very small, so some reorganisation of these areas of the home could be beneficial. St Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 Page 7 Some documentation was out of date, and needs to be followed through. This particularly related to fire extinguisher servicing records, and Pat testing for electrical items. 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 Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,4. (standard 6 is not applicable for this service) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has good procedures in place to ensure that the staff and premises can meet the individual requirements of service users. The contract could be written more clearly. EVIDENCE: No changes had been made to the statement of purpose or service users’ guide. These are well produced and include all relevant information. The Inspector discussed the format of the contract with the manager. All service users are provided with a contract, but the Inspector noted at this visit that the content could be defined more clearly. Also, the document is in small print, which could be difficult for some service users’ relatives to read. A recommendation was given to update this. St Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 Page 10 All service users are assessed prior to admission by the manager or deputy manager, in their home or in hospital. The Inspector viewed 2 pre-admission assessments at this visit, including one for a recent admission. These showed that the manager assesses every aspect of care regarding physical and mental health, social needs, family involvement and personal risks. She ensures that the home will be able to meet the needs of individual service users, and that the home has any equipment required prior to admission. The manager also obtains a copy of joint hospital/social service assessments to provide additional information. St Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 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. 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. Care staff are well trained, and deliver a high standard of personal care. Service users/next of kin are involved with care planning where possible. Health needs are well met in this home. EVIDENCE: The Inspector assessed care plans at the last inspection, and found them to be well put together and maintained. Two care plans were examined at this inspection to check that there is ongoing good management of these. One of these was for a newly admitted service user, and the other was for a service user who requires wound care. The care plans showed that detailed information was obtained on admission, and was clearly documented. Details included points such as when the service St Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 Page 12 user likes to get up or go to bed; past medical history and current diagnosis; a medication list; dietary needs; any wounds or pressure sores; communication needs; and any equipment needed. The care plan is then set out with assessments for: dependency (personal hygiene, mobility, nutrition etc.); continence and bowel care; pain assessment (“as necessary” medication for pain relief is entered each time it is given with the reason why); cognitive assessment; night assessment; and risk assessments. This is followed by a section for care plans – set out according to each individual’s needs, as assessed by the activities of daily living. Risk assessments included: manual handling (including equipment used); waterlow scores; wound dressing records; nutrition assessment and weight chart. Consent forms are included and signed if indicated (e.g. for use of bedrails). Wound dressings were clearly documented for each dressing change, noting the state of the wound and the treatment given. Each wound has separate documentation. Care plans are reviewed and updated each month, and the nurses carry out this review with the service user. One of the care plans showed clear progress for the service user with their mobility, since being admitted to the home. Both care plans viewed were well set out, easy to follow, and very detailed. Care plans are working tools, which the care staff understand and follow. The majority of care staff have completed NVQ 2 or equivalent, and have a good awareness of how to deliver care sensitively. Risk assessments are well thought through. Care plans are individually written, showing person centred care. Care staff are given responsibility for a number of service users each morning, and write the daily reports for these. The nurse on duty includes additional information. Turn charts and fluid charts are used as indicated. Records regarding professional health visits are kept with these, and show suitable involvement from GPs, dietician, dentist etc. A carer escorts service users when they attend hospital appointments. Care plan folders included preadmission assessments and transfer information. Most aspects of medication were satisfactory at the last visit, so the Inspector concentrated on the areas of requirement and recommendation. A requirement to update the list for trained nurses administering medication had been carried out, and a clear record was seen at the front of the Medication Administration Records (MAR charts). Clear records are maintained for all medication brought into the home, and all medication for disposal. These provide a sufficient audit trail. A disposal bin is kept in the clinical room, which is locked when a nurse is not present. The medication trolley was well organised. The clinical room temperature was satisfactory. The clinical room is very small, and the manager St Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 Page 13 and Inspector discussed the possibility of using a larger room for this in due course. (There is a spare unused bathroom). Service users were seen to be well groomed, and with attention to detail – clean teeth/dentures, shaved, hair done etc., and were observed as being cared for with privacy and dignity, and a sense of genuine concern. Standard 11 was assessed at the last inspection, and was being met. St Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is aware of the importance of offering a variety of activities, and is working to increase these. Nutritional needs are well met, and infection control standards for the kitchen have been improved. EVIDENCE: The manager stated that the home is offering an increased variety of activities as much as possible. However, many service users in the home had high nursing needs, and often preferred to stay quietly in their rooms, or only to join in with activities occasionally. Board games, dominoes, singing afternoons etc are organised, and some service users now join in with painting/drawing sessions. The manager arranged for the home to have an extra carer on duty for over a week in the afternoons prior to Christmas, so that service users could be taken out on an individual basis to do Christmas shopping. Many like to be taken out St Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 Page 15 for walks along the seafront in good weather, or to go and listen at the nearby bandstand. The home has a quiet lounge on the first floor which overlooks the bay. This is a pleasant area to sit and read, and there is a good selection of large print books, which is changed by the local library every 3 months. Audio talking books, and CDs are also included in this arrangement. Service users are encouraged to retain as much independence as possible, and make their own decisions about where they wish to go or sit. Visitors are made welcome at any time, and are able to take service users out, if they can manage their care needs. The Inspector had expressed concern at the last inspection about the numbers of staff going in and out of the kitchen. The manager stated that infection control measures had been reviewed and made clear to staff. Staff drinks for their break are made by one staff member going into the kitchen in the morning, and wearing of disposable aprons and hand washing is strictly enforced. The cook does not allow staff to enter the kitchen when she is cooking unless absolutely necessary. Care staff do not handle the preparation of food, as there are kitchen staff employed morning and afternoon. Care staff and kitchen staff have completed basic food hygiene training. Cleaning procedures for the kitchen, ordering food, and menu planning was assessed at the last inspection and was entirely satisfactory. There is always a choice of menu, and fresh fruit and vegetables are kept available. St Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure in place, and staff are proactive in dealing with any concerns that arise. EVIDENCE: The complaints procedure on display in the entrance hall had been updated, and included the new details for the CSCI Maidstone office. The Inspector suggested that it may be helpful for visitors/service users to include the details for the local Social Services Adult department. The procedure states that a response to complaints will be given within 7 days. The manager has now implemented a complaints log. There had been no complaints made since the last inspection. The manager has an open door policy, and encourages service users and relatives to inform her or the deputy immediately if there is a problem. This enables any concerns to be dealt with promptly. They are noted in the service user’s individual daily records, and in the daily diary, to ensure they are followed through appropriately. The complaints procedure is included in the service users’ guide. The manager has started to implement a staff training matrix, and each staff member has a separate record of the training they have attended. The records St Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 Page 17 showed evidence of adult protection training, and that this was being kept up to date for all staff. Staff have an understanding of what constitutes abuse, and how to handle situations that may arise. St Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The provider has taken steps to improve the general appearance and décor of the building, and a programme of ongoing improvements has been implemented. EVIDENCE: The home’s general appearance showed a clear improvement. Décor was generally satisfactory, and the home was clean throughout. Some carpets had been replaced, and another one was on order for another bedroom. The provider employs a maintenance man to work between this home and another care home which he owns. The maintenance man was retiling the side of a bath on the day of the inspection visit. St Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 Page 19 Each room is fitted with a call bell, and these are checked professionally at regular intervals, along with the emergency lighting system. One of the baths identified at the last inspection as being of poor quality had been replaced with a new bath, and this bathroom was generally in good condition. The other identified bathroom was not in use, and the Provider and manager were in the process of discussing how best to use this area in the future, as this could be used as further office space, or even a larger clinical room. The Inspector suggested they look at the different possibilities for the best use of this area. The home did not generally appear cluttered on this occasion – except in the office at the rear of the premises. Wheelchairs are kept in each service user’s room when not in use. The hoists are constantly in use, and are therefore in the corridors or service users’ rooms. Staff are aware of the importance of not blocking fire exits. The Inspector could not see any reason to repeat an ongoing requirement for more storage space, as this no longer appeared to be needed. However, the manager has been expected to share a small office with the Provider until now, and this does not provide effective space for the manager to carry out her duties in an organised manner. The Provider stated that he would make this office available to the manager in future, and the Inspector recommended that this is carried out, or other suitable alternatives for office space agreed between them. The home provides suitable nursing equipment, including airflow mattresses, raised toilet seats, grab rails, commodes, and bed rails. Two new commodes had been purchased since the last inspection. The manager and housekeeper inform the Provider when furniture needs to be replaced or repaired, and the manager said that he always authorises any new items needed. Refurbishment is carried out on an ongoing basis. A bed table was seen to be of poor quality (the service user commented that “it looked like a mouse had been at it”!), and the manager said that she would arrange for a new one. Bedrooms are personalised according to choice. A few were viewed on this occasion. The manager stated that bath temperatures are checked prior to use, but there were no records to confirm this, and the manager stated she would implement a daily record in each bathroom. The Inspector also reminded her of the importance of checking hot water temperatures for any bathroom or bedroom areas where service users are able to access the hot water unsupervised. The laundry area was inspected at the last visit. The laundry room was seen to be clean and well organised, and a designated staff member was dealing with the laundry. St Benedict`s Nursing Home DS0000026118.V318684.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides sufficient numbers of staff to meet the service users’ needs, and training is well promoted in the home. There are notable improvements with recruitment procedures. EVIDENCE: The Inspector discussed the staffing numbers with the manager. The home continues to have 6 carers and 1 nurse in the mornings; 4 carers and I nurse in the afternoons, and 1 nurse and 1 carer at night. These are supported by suitable numbers of ancillary staff. The Inspector noted that the home provides an excellent ratio of care staff during the day times – especially in the mornings. This enables care staff to give a proper complement of time for service users to have individualised personal care. There are sufficient numbers of staff in the afternoons to enable them to take part in activities with service users if required, and to help assist service users at meal times. The home has a policy of not taking service users to the toilet during meal times, as this would infringe infection control. This is explained to service users prior to admission. However, service users are offered the toilet before and after meals. St Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 Page 21 The inspector discussed the night staffing arrangements with the manager in detail. The manager said that the service users being admitted to the home have increasingly high dependency needs, and it would be unusual for many service users to wish to stay up after 8 pm. There are occasionally just one or two. So most service users are assisted to bed prior to 8 pm, and do not get out of bed unaided after that time. This means that the night staff only have one or two service users to assist to bed, and all others have been attended to prior to this time. So having 2 staff on duty at night is sufficient. However, if the night staff were struggling to manage for any reason, they would inform the manager who would arrange extra staffing with the Provider. The manager covers a night shift regularly herself, so that she can personally assess the night situation, and know if more staff are needed. Care staff may be asked to come on duty earlier in the morning if a service user has an early hospital appointment, and needs to get up earlier than they might usually do. The Inspector assessed the staffing levels as being well managed. Care staff are positively encouraged to pursue training, and 3 were currently studying for a Health and Social Care degree. One of the care staff said that this includes practical training and insight, as well as academic, and working at the home is important to put into practice what is learned in the classroom. Another carer has recently started as a student nurse, and another has a placement to commence this in September 2007. Numbers of care staff with NVQ 2 or equivalent are 13 out of 16 – and the other 3 are commencing training too. This is a current percentage of 81 , which is excellent. The Inspector had raised concerns about staff files and recruitment procedures at the last inspection, and the Provider responded by stating that the home would bring all files up to date by 31st January 2007. The manager had already been through each existing staff file, and catalogued any documents which were missing. The Inspector viewed 3 which had been reviewed, and these were in good order, and had all the required documentation. Recruitment procedures have been amended to ensure that each new applicant has a CRB check carried out from this home, and to include a full employment history on the application form. The home has accessed the “Learn to Care” induction course. There have been no new staff employed since the last inspection, and so the Inspector was unable to see one of these in the completed format. The manager had sorted out the staff training file, and was implementing a staff training matrix. This enabled the Inspector to see that all staff are receiving mandatory training. Many of the nurses work in other places, including hospitals, and carry out training there. The manager has asked them to supply a copy of new training certificates to be kept on file, so that any new competencies or updates can be verified. The manager agreed that it is important for nurses to attend fire training within the home, as this is relevant to the specific building. St Benedict`s Nursing Home DS0000026118.V318684.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31-38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager provides a good lead to nursing and care staff, which reflects her love of nursing. There has been a good overall improvement with management of administrative tasks. EVIDENCE: The manager is committed to providing good nursing care, and ensures that staff work with her to maintain high standards. She has built up a very good team of staff, many of whom have worked at the home for several years. The Inspector observed that they worked well together, and were always polite and respectful to service users. The manager currently has 12 hours per week just St Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 Page 23 for administration, and at all other times covers nursing duties. She has worked hard to improve many areas of administration, but is aware that she may need more hours than this to carry out all the necessary duties. It would also be of benefit for her to have a bigger office area in which to work, as discussed with the Provider (see standard 19). The manager meets with all staff at handovers, and gains feedback from them about any concerns expressed by service users, or any ideas for change in the home. She has commenced a quality assurance programme, providing questionnaires for relatives and visitors to complete on behalf of service users. It is anticipated that these will be used 2-3 times per year, with different questions. The Provider was asked at a recent meeting with the CSCI Inspector and Manager about the viability of the business, and confirmed that it is financially viable. The Inspector was pleased to find out that the manager has commenced formal supervision for all staff, and viewed the records for 3 of these. This has been delegated out, so that the housekeeper will provide supervision for domestic staff, the cook for kitchen staff, nurses for senior carers, and senior carers for other care staff. Night sisters will provide supervision for night carers. The manager does not act as appointee for anyone. Some service users have pocket money provided by relatives, which is available for use as wished, and is kept in a secure place. The manager keeps detailed records of all income and debits, and checks the accounts regularly. She also ensures that her deputy checks the accounts from time to time, as verification that the records are accurate. All receipts are retained. Some service users do not wish to have their own money, and the manager then pays for any items they want from petty cash – including hairdressing, newspapers etc. and invoices the amount to the person responsible for payment. Service users have a lockable facility in their own rooms for any money/valuables they wish to keep with them. Policies and procedures were not viewed at this inspection, and were last reviewed in January 2006. Other records were generally well maintained, except there were gaps in some servicing records. Fire training is booked regularly, and a session had been held in November 2006 when 11 staff had attended. It was noted that fire extinguishers had not been dated as having been checked by a servicing company since 2003, although the manager was sure that these had been done each year. She said that she would follow this up with the company concerned, and make sure that certification is provided, and new labels with the correct dates for the extinguishers. A requirement has been given in regards to this. St Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 Page 24 Other servicing records were viewed including the clinical waste contract; fire alarm and emergency lights testing; lift servicing; all hoists (mobile and bath hoists); and the NICEIC electrical certificate. PAT testing for electrical items was evidenced for 2004, and the manager was sure that this had been done yearly since. Again, she realised the need to chase up the company for documentation to confirm this (a plug on a laundry appliance was dated July 2005). The Provider stated that he had had a fire risk assessment carried out in October 2006, in compliance with the new Regulatory Fire Order. There is a recommendation to ensure that servicing records are all maintained up to date, so that confirmation of servicing is available. St Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 X 3 2 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 2 2 2 St Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP38 Regulation 23 (4) and Schedule 4.14. Requirement To ensure that all fire equipment is satisfactorily maintained, including fire extinguishers. Timescale for action 10/02/07 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 OP2 Good Practice Recommendations To review and update service users’ contracts, ensuring that they are clearly worded; and producing these in a larger format for easy reading. To review the size of the clinical room, with a view to moving this to a larger area. To include additional details on the complaints procedure for anyone who may wish to access these: i.e. for the local adult social services department; and the ombudsman. To decide how best to provide suitable office space for the manager, and implement this. 2 3 OP9 OP16 4 OP19 St Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 Page 27 5 6 7 OP25 OP29 OP37 To record hot water temperatures, ensuring that the thermostats keep the hot water within the required levels. To complete the updating of existing staff files. To ensure that all documentation in the home is kept up to date, including all servicing records. St Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Benedict`s Nursing Home DS0000026118.V318684.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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