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Inspection on 19/08/08 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 19th August 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

People living in the home said that all the staff are kind to and care for them. Residents are cared for by staff in sufficient numbers. Staff demonstrated a genuine commitment to promote residents` well-being. Care plans generally provide staff with the information needed to care for the residents and these are regularly reviewed. The Director showed a commitment to improve the environment and address all deficits identified.

What has improved since the last inspection?

The back garden provides a pleasant environment for the residents to sit out in. Care plans provide relevant and reviewed information about residents` needs. Residents who need a hoist have been provided with their own individual slings.

CARE HOMES FOR OLDER PEOPLE St Benedict`s Nursing Home 22 - 23 St George`s Terrace Herne Bay Kent CT6 8RH Lead Inspector Lisbeth Scoones Unannounced Inspection 19th August 2008 09:45 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.V369316.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.V369316.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 Ltd Mrs Gillian Dawn Wren Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (0) of places St Benedict`s Nursing Home DS0000026118.V369316.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP) The maximum number of service users to be accommodated is 25. Date of last inspection 5th October 2007 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 has since 31 July 2008 two new Directors. The Responsible Individual Mrs R Persand 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. The home offers mainly nursing care but residents requiring residential care can be accommodated. Weekly fees range from £300 - £310 for residential care and £460 - £560 for nursing care depending on the needs of the resident and the rooms available. St Benedict`s Nursing Home DS0000026118.V369316.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Key Lines of Regulatory Assessment (KLORA) have informed the judgements made based on records viewed, observations made and written and verbal responses received. KLORA are guidelines that enable The Commission for Social Care Inspection (CSCI) to make an informed decision about each outcome area. This unannounced inspection took place over two days. It was started on 19th and completed on the 26th August 2008. It comprised discussions with one of the Directors who is the Responsible Individual, the deputy manager, 5 care staff on duty, the cook and the housekeeper. The registered manager was on holiday and a return visit was arranged to complete the inspection. A number of residents were spoken with and an accompanied tour of the premises was carried out. Documentation in relation to care planning, risk assessments, medication administration, menus, staff rotas, complaints and staff files were examined. During the second visit, training records were inspected and management issues discussed. The registered manager completed an AQAA (annual quality assessment audit) in October 2007 and information therein informed the inspection process. Whilst comment cards were sent to the home for residents and staff to complete, none of these were returned. An immediate requirement notice was issued at the site visit. This related to pre-employment checks. What the service does well: People living in the home said that all the staff are kind to and care for them. Residents are cared for by staff in sufficient numbers. Staff demonstrated a genuine commitment to promote residents’ well-being. Care plans generally provide staff with the information needed to care for the residents and these are regularly reviewed. The Director showed a commitment to improve the environment and address all deficits identified. St Benedict`s Nursing Home DS0000026118.V369316.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. St Benedict`s Nursing Home DS0000026118.V369316.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.V369316.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective residents have the information needed to make an informed choice about where to live. Residents’ contracts/statements of terms and conditions are being reviewed to reflect the recent changes of ownership. Residents’ needs are assessed prior to admission to determine whether the home can meet their needs. EVIDENCE: The registered manager advised that the Service User Guide has been updated. There was however no copy on the premises for the inspector to view and it was requested that a copy be forwarded to the CSCI. There was St Benedict`s Nursing Home DS0000026118.V369316.R01.S.doc Version 5.2 Page 9 no copy of the recent CSCI inspection report on display. The Director said this would be addressed. The home has recently been issued with a current registration certificate, which was seen on display. The registered manager or her deputy undertake a pre-admission assessment for every person choosing to come and live at the home. This is to ensure that the home can meet health care, physical, social and psychological needs. Those pre-admission assessments viewed were comprehensive evidencing that the home could meet their needs. The home does not offer intermediate care as described in Standard 6 of the National Minimum Standards. St Benedict`s Nursing Home DS0000026118.V369316.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home’s care planning system provides staff with suitable information to deliver care safely. Residents’ health care needs are generally well met and the home works well with other health care professionals. Residents are protected by the home’s medication procedures. Residents feel that they are treated with privacy and dignity. Residents’ wishes and preferences in respect of death and dying should be recorded. St Benedict`s Nursing Home DS0000026118.V369316.R01.S.doc Version 5.2 Page 11 EVIDENCE: A sample of care plans seen demonstrated that these are well written, supported by risk assessments and regularly reviewed. Care plans could be further enhanced. See also standard 10 in respect of death and dying and standard 11 in respect of preferred activities. In addition to the daily notes written by nurses, key workers complete a daily record and ‘tick chart’. It was recommended that these be audited to ensure that all planned care is timely provided. Residents spoken with said that their health and personal care needs were being met. Care plans showed that when necessary the home called in heath care specialists such as dieticians, chiropodist, psychiatric nurse and district nurse. The home had pressure relieving equipment and other aids. Since the previous inspection an additional hoist has been made available and residents now have their own individual slings. The clinical room was visited which provides a tidy, temperature-controlled environment. A controlled drug audit was carried out and proved satisfactory. Medication charts were examined and were in general well maintained. Two recommendations were made in respect of the immediate action to be taken when a ‘gap’ in administration is noted and the need for double signatures for any handwritten entries to the medication charts. All residents spoken with said that they liked the staff and that they were treated with respect for their privacy and dignity. Good interaction was observed between people living in the home and the staff. The home currently does not record residents’ wishes in respect of death and dying. It was recommended that this be recorded. St Benedict`s Nursing Home DS0000026118.V369316.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The activities of daily living are flexible to accommodate residents’ wishes and preferences. Residents are provided with a range of varied, wholesome meals. EVIDENCE: In conversation with the residents and staff it is evident that routines of daily living are flexible. People can go to bed and get up when they want. They can have meals in their rooms or in the dining area. Visitors are welcome at any time. They can visit their relatives and friends in the privacy of their room or in any of the communal areas. The home has a part time activities lady who chats with people and does puzzles with them. The home however could not evidence the activities on offer and no activities programme is on display. The previous inspection report recorded that particularly for people with a cognitive impairment or who spend St Benedict`s Nursing Home DS0000026118.V369316.R01.S.doc Version 5.2 Page 13 long periods in bed this would be important. This issue was discussed with the Director who said this would be addressed. Residents are encouraged to go to the dining room for lunch. Residents spoken with said that the food was nice and that they are given a choice. A resident had a print out of her weekly choices. The cook has been at the home for 17 years and knows the residents very well. She said it was important to her to speak to the residents to find out if they had enjoyed their meal The kitchen was tidy and appears to be well managed. The Director agreed that it is in need of upgrading and that space is limited. St Benedict`s Nursing Home DS0000026118.V369316.R01.S.doc Version 5.2 Page 14 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 adequate This judgement has been made using available evidence including a visit to this service. People living at the home know that they are able to complain and believe that their complaints would be taken seriously. Some staff have had training regarding the safeguarding of vulnerable adults but for some staff this is overdue. EVIDENCE: People living at the home said that if they had any concerns they would feel happy to approach the manager or one of the trained staff. A formal complaints procedure is on display on the notice board. The home has a complaints book, which contained no entries. In the AQAA the registered manager reported that through staff supervision, staff would be reminded to pass on any complaints residents might have made. See also standard 36 in respect of supervision. As evidenced on the training matrix, staff are provided with POVA training. This was however overdue for some staff and the policy and procedure need updating. As recently appointed staff have not yet started their formal induction programme, they have not been instructed at the home. See also standard 30. St Benedict`s Nursing Home DS0000026118.V369316.R01.S.doc Version 5.2 Page 15 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, 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents live in an environment that has improved but needs further upgrading n respect of decoration, furniture and bathing facilities. Residents’ safety cannot be guaranteed in the absence of records of hot water temperatures. The home is generally clean and free from odour but an infection control issue needs to be addressed. EVIDENCE: The home has recently changed Directors who are currently coming to grips with everything that needs to be done to maintain and upgrade the home. A maintenance person is employed for 12 hours a week. St Benedict`s Nursing Home DS0000026118.V369316.R01.S.doc Version 5.2 Page 16 In discussion with the Director it was evident that she knows the home’s strengths and weaknesses and where improvements need to be made such as in bathrooms. It was recommended that a development and improvement plan be devised. See also standard 33 in respect of quality assurance. Currently no records are kept of regular temperature checks of all hot water outlets. Without a formal system residents’ safety cannot be guaranteed. A thermometer check of a hot water outlet in one of the baths revealed a temperature of 48 Degrees Celsius. Other checks revealed correct temperatures of 43 degrees. See also standard 38. The carrying out of such checks is a requirement of this report. The Director said that she has recently introduced cleaning schedules to ensure that the home is cleaned effectively. Whilst the home was in general clean, it was noted that the sluice rooms contained many miscellaneous items, which could prevent effective cleaning. In respect of the use of gloves, it was recommended that a policy be devised and staff be made aware. It was also recommended that vents in toilets be checked to ensure that these are activated and that a vent in the clinical room be cleaned. St Benedict`s Nursing Home DS0000026118.V369316.R01.S.doc Version 5.2 Page 17 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, 28, 29, 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The home has suitable numbers of staff to meet the needs of the current residents. Residents are not supported by the home’s recruitment policy and practices and this may put people at risk. Staff training has been limited and recently appointed staff have not had formal induction training. EVIDENCE: Residents spoken with said that they are satisfied with the care they receive. Whilst sufficient numbers of trained and care staff were on duty at the time of the inspection, the home could not demonstrate that all staff are competent to do their job. See standard 30 in respect of training. The home does not follow the required recruitment procedure and as a result may put residents’ protection at risk. A sample of staff files demonstrated serious deficits in respect of CRB and POVA checks, two written references, contract of employment, letter of appointment, proof of identity and photograph. Deficits were recorded at the previous inspection and the St Benedict`s Nursing Home DS0000026118.V369316.R01.S.doc Version 5.2 Page 18 registered manager reported in the AQAA that more work should be done on employment matters (staff files). The Director showed that 6 CRB application forms had been completed but had not been sent off for processing. For one member of staff a form had not been completed. An Immediate Requirement to address this issue was made. It was agreed that the staff files are in need of an urgent review and a checklist compiled of all required information as per Regulation 19, Schedule 2. All care staff on duty were spoken with. Two staff have a NVQ qualification and a third was studying for NVQ 2. One carer had been employed for six months, another for 3 months. Staff reported that they recently had First Aid, Food Hygiene and Infection Control training. This was confirmed on the training matrix. However, the matrix did not indicate that staff had recent fire safety training. See also standard 18 in respect of safeguarding vulnerable adults. It was recommended that specialist training be included such as Dementia care, wound care, continence management and Diabetes. Two recently appointed care workers said that they shadowed an experienced care worker for some weeks but that they had not received any formal induction training. A requirement to address this issue was made. See also standard 36 in respect of staff supervision. St Benedict`s Nursing Home DS0000026118.V369316.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Whilst residents feel valued, the home is currently not well managed and employment and training matters must be addressed. Staff are not formally supervised. Some areas of health and safety need addressing to ensure that people are kept safe. St Benedict`s Nursing Home DS0000026118.V369316.R01.S.doc Version 5.2 Page 20 EVIDENCE: The Director, registered manager, deputy manager and care staff on duty demonstrated that they have a good understanding of the needs of the residents. However, the home is currently not well managed, as many managerial tasks have not been carried out. See standard 29, 30 and 36 in respect of recruitment requirements, staff training and supervision. The registered manager must be provided with adequate time to fulfil her managerial roles and a job description devised that clearly states those duties she is responsible for. The Director is keen to ensure that residents’ and relatives’ views are sought and is planning to have residents’ meetings and send out questionnaires. Staff meetings are held regularly. The Director was reminded that monthly visits in accordance with Regulation 26 must be made and records kept in the home. Some residents have their personal allowances provided by relatives. Such monies are available for use as wished and are kept in a secure place. Good systems for safekeeping, recording and audit are in place. Residents have been provided with a lockable facility to safely keep items of value to them. Whilst staff said they are supported by the trained staff, formal supervision sessions have not been carried out recently. The registered manager said that this is being reintroduced and would be shared between her and the deputy manager. There are some risk assessments in place within the home. However, the health and safety of people at the home is not always well protected. Some doors were wedged open and hot water temperatures are not checked on a regular basis. St Benedict`s Nursing Home DS0000026118.V369316.R01.S.doc Version 5.2 Page 21 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 17 X 18 2 2 X 2 X X X 2 2 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 St Benedict`s Nursing Home DS0000026118.V369316.R01.S.doc Version 5.2 Page 22 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 OP29 Regulation 19 Schedule 2 Requirement The registered person shall not employ a person to work at the care home unless the Regulation and Schedule 2 are complied with This in relation to all preemployment checks The registered person shall ensure that that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform This in relation to a programme of statutory and induction training The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and as far as possible eliminated. This in relation to records of hot water temperature checks Timescale for action 16/09/08 2 OP30 18 (1) (c) 16/09/08 3 OP38 13 (4) (c) 16/09/08 St Benedict`s Nursing Home DS0000026118.V369316.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Benedict`s Nursing Home DS0000026118.V369316.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone 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.V369316.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!