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Inspection on 16/08/05 for St Benedict`s Nursing & Residential Home

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

This inspection was carried out on 16th August 2005.

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.

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

On the day of inspection there were a high percentage of frail people who were nursed in bed. These people received a good standard of care from staff including regular change of position and fluids. All people who live at the home were well kempt and all who expressed an opinion stated that they appreciated the care and support afforded to them.The home offers a varied menu of home cooked and nutritional meals. Lunch, seen during the inspection,was appetising and plentiful. It is apparent that there is a good team spirit within the staff team and that staff had positive relationships with the people who live at the service.

What has improved since the last inspection?

Since the last inspection six adjustable beds and one specialist mattress used in the prevention of pressure sores have been purchased. This was a requirement made at the last inspection 20th January 2005.

What the care home could do better:

As previously stated on the day of inspection there was a high percentage of frail people living at the home. Despite the recent purchase of a number of specialist beds it is evident that additional investment in equipment is required including beds, commodes and specialist mattresses. The environment is in need of refurbishment. A number of the carpets and furniture are ageing and in need of replacement. The kitchens and bathrooms are now in need of refurbishment.

CARE HOMES FOR OLDER PEOPLE St Benedicts Nursing and Residential Home St Benedict Street Glastonbury Somerset BA6 9NB Lead Inspector Justine Button Unannounced 16 August 2005 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 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 Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service St Benedicts Nursing Home Address St Benedict Street Glastonbury Somerset BA6 9NB 01458 833275 01458 833402 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr David Edwin Wills White Mrs Pamela Margot Carey Care Home with Nursing. 39 Category(ies) of Old Age (39) registration, with number of places St Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Elderly persons of either sex, not less than 60 years, who require general nursing care. 2. Up to 9 beds for personal care. Date of last inspection 20th January 2005 Brief Description of the Service: St Benedict’s Care Home is formed from an adapted house with a purpose built extension. It is within easy walking distance from the town centre, although up a slight hill. Accommodation is on two floors, with a four person lift. There is a level patio area approached from the lounge and there is a garden laid mainly to lawn. There are 26 single rooms and 6 double rooms. 29 rooms have en-suite facilities. The home provides nursing care for up to 30 people and personal care for up to 9 older people. St Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over one day by one inspector. The inspection was unannounced and carried out as part of the annual inspection programme for the home. The Registered Manager, Mrs Carey, was available throughout the inspection and inspectors appreciated the help provided by Mrs Carey and her staff throughout the inspection. Feedback was given to Mrs Carey at the end of the inspection. 32 people were living at the home. All of the people living at the service and relatives spoken to were satisfied with the service they receive at the home. The inspectors concluded that the home is providing a mostly good service. There is however evidence of lack of investment in some key areas particularly with the provision of some equipment. People spoken to confirmed that staff are kind and respectful and inspectors observed staff interacting in a kindly manner with all service users. Lunch was observed and looked plentiful and appetising having been freshly prepared by the cook. This is the first inspection using the new CSCI reporting format, which focuses on outcome statements for National Minimum Standards. The inspector’s aim on this inspection visit was to seek views on the quality of the service from as many service users as possible and to speak to staff. A tour of the premises was made, care in the home observed and a range of records was inspected, including care records. What the service does well: On the day of inspection there were a high percentage of frail people who were nursed in bed. These people received a good standard of care from staff including regular change of position and fluids. All people who live at the home were well kempt and all who expressed an opinion stated that they appreciated the care and support afforded to them. St Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 Page 6 The home offers a varied menu of home cooked and nutritional meals. Lunch, seen during the inspection,was appetising and plentiful. It is apparent that there is a good team spirit within the staff team and that staff had positive relationships with the people who live at the service. 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. St Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection St Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 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 standard(s) 1, 3, 4 & 5. Standard 6 intermediate care is not offered at St Benedict’s. Prospective residents and families are provided with adequate information prior to moving into the home. Interested parties are able to visit the service People’s needs are assessed prior to moving to the home. EVIDENCE: The service has a statement of purpose and this document can be found in the entrance hall. This document was reviewed and contained all the necessary information. A copy of the service guide is available in all the bedrooms and again these documents contain the necessary information. People spoken to were aware of the documents. Prior to moving into the home a member of the senior staff team go to meet the prospective individual. During this visit an assessment of needs is conducted. This assessment ensures that the home can meet the needs of the person. The assessment is documented and forms the basis of the initial care plan. A number of the initial assessments were viewed. Relatives spoken to St Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 Page 9 confirmed that they were able to visit the home when looking to chose a service. St Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10. . All people who live at the service have a care plan which sets out their health and personal needs. The health needs of the people who live at the service are met in part. Medication is safely handled. EVIDENCE: All people who live at the service have a care plan which details their health and personal needs. Five of the plans were viewed in detail. These demonstrated that assessments had been completed and reviewed on a regular basis. The assessments are then used in the development of the care plans. The plans were written in clear English and gave clear instructions and guidance to the care staff. None of the plans for any of the service users showed evidence that the individual had been involved in the development or review of their plans. This is good practise. The service user plans showed that individuals who live at the service have regular access to health care professionals including GP, dentist etc. St Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 Page 11 For the frail people who live at the service care was reviewed through out the day. This demonstrated that appropriate care was given including regular changing of position, fluids and oral hygiene. As stated there are currently a high percentage of frail people living at the service. There are a number of specialist beds and mattresses available. These are used in the prevention of pressure sores and help staff when supporting people who are nursed in bed. When the waterlow scales (a tool used to assess the risk of developing pressure sores) were reviewed these showed that twenty-four people had a score of 15 or above i.e. at high risk. Fourteen of these were a score of above 20 i.e. at very high risk. Given these assessed needs the amount of pressure relieving equipment needs to be reviewed. On the day of inspection eight people were in need of adjustable beds as they were nursed in bed for significant periods during the day. Although it is appreciated that six such beds have been purchased since the last inspection, now giving a total of eight, this level of investment needs to continue. The service currently has two hoists used in moving and handling. Given the amount of people who are frail and in need of such support this number needs to be reviewed. The provision for medication was not viewed on this occasion, however the management conduct a regular internal audit. These audits were viewed and showed that drugs were stored and handled in a safe manner. People and relatives who were spoken to during the inspection all stated that the staff treated them with dignity and respect. Staff were observed knocking on bedroom doors prior to entering. Staff were also observed treating and talking to people in a kindly manner. St Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15. Some social activities are on offer but these could be developed further. People who live at the service are able to maintain contact with family and friends. The meals provided are of a satisfactory standard. Choice could be developed. EVIDENCE: The activities plan was on display in one of the corridors. This was not specific for the week of the inspection. Activities therefore tend to be repetitive on a weekly basis. There is no dedicated activities organizer so the activities on offer are dependant on the time available to the care staff. Some of the people who lived at the service, who were able to give an opinion, stated that there was not a lot going on. A number stated that they would like to see this area developed. Activities currently on offer include quizzes, bingo and reminiscence. Communion is also available from clergy from local churches. A number of people were seen to visit the service on the day of inspection. All people who live at the service stated that visitors and friends were made welcome at any time. This is supported by information in the service user guide. St Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 Page 13 Lunch was viewed on the day of inspection. Lunch consisted of cottage pie served with cabbage and swede. A choice is offered. On the previous day staff ask people what choice they would like.. One person at the service is a vegetarian and so was served a separate meal. Soft or liquid diets were also available. People spoken to stated that they would be able to ask for an alternative if they did not like what was on offer. Fruit sponge and custard was then served. The kitchen was seen on the day of inspection. Although clean and tidy on the day of inspection the kitchen fittings are old and in need of replacement. The ambient temperature within the kitchen was very warm especially when the oven and gas rings are in use. When the kitchen is refurbished this area will need to be addressed. Fridge and freezer temperatures were viewed and these were with safe limits. It is recommended that foods be dated when opened. St Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16. The complaints procedure needs to be reviewed to ensure that people are aware how and who to make a complaint to. EVIDENCE: The complaints procedure is on display in the main entrance of the home. This procedure needs to be reviewed to ensure that it is up to date. The current procedure does not state the details of the CSCI. People may wish to use the CSCI as an avenue to complain. The complaints procedure should also be in the Service User Guide. People who were spoken to stated that they would feel able to raise any concerns with the manager. There has been one complaint since the last inspection. This has been dealt with via the manager and care manager in an appropriate manner. St Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 & 26. The home is clean and tidy. Parts of the service are in need of refurbishment and redecoration. Good practise guidelines with regard to one aspect of infection control are not being adhered to. EVIDENCE: A tour of the building was conducted on the day of inspection. Although clean and tidy some of the fixtures and fittings are old and now in need of replacement. These include some of the bedroom furniture and carpets. People are able to personalise their rooms with their own possessions. There are 4 communal bathrooms with assisted baths and 6 en-suite bathrooms, which also have adapted baths. There is one shower room. There are toilets sufficient in number. 22 of the single rooms have en-suite facilities but not all are large enough to accommodate wheelchair users who might also need to be hoisted. A number of the communal bathrooms have stained flooring and fittings. These are in need of replacement. St Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 Page 16 There is a garden, laid mainly to lawn and this is accessible for wheelchair users. There are a number of communal sitting and dining areas. The décor in these areas is old fashioned but the areas were clean and tidy on the day of inspection. A number of bedrooms do not have en-suite facilities. For these people and those who cannot access the toilets at night commodes are used. Sharing of commodes is not seen as good practise. The manager stated that a number of additional commodes have been ordered. The management needs to ensure that there are adequate numbers for all the people who require them. The service provides specialist equipment for the needs of the service users including aids, grab rails (with the exception of adjustable beds and pressure relieving equipment). There is a through-floor lift for 4 people and a ramp links two areas on the first floor. The heating and lighting were appropriate on the day of inspection. Radiators have been covered in bedrooms and bathrooms but not in corridors or lounges. The management should consider this safety precaution. The water temperature is thermostatically controlled to the baths but not the sinks. It was reported on previous inspections that the temperature of water when stored has been tested and that systems to control Legionella have been implemented. Suitable hand washing measures are in place. St Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30. There are adequate numbers of staff to meet the needs of the service user group. Staff are trained and competent to do their job. EVIDENCE: The staffing rota’s were viewed on the day of inspection. These showed that on average eight staff were on duty in the morning and five in the afternoon and evening. The occupancy on the day of inspection was 32. These staffing levels are in line with the previous staffing notice. Agency staff are being used currently to cover sickness and annual leave. The manager stated that she tries to ensure that the same agency staff are used in order to offer continuity and consistency. The staff training records were not formally viewed on this occasion however staff spoken to stated that they had received all mandatory training. The manager stated that two staff have completed NVQ 2 and another two had commenced this award. The manager and the deputy are undertaking their assessors award. St Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 38 The service is well run and managed. This benefits all parties. The aspects of the health and safety that were inspected were well managed. EVIDENCE: The present Home Manager has been in post since 1987 and is a Registered Nurse. She plans to take an NVQ in Management. She has attended relevant training updates over the past year. Feedback from the staff and service users was that she is an effective manager, approachable and professional. There is a Deputy Manager who has a strong working relationship with the Manager. The Registered Provider has day-to-day contact with the home. There is also an administrator. St Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 Page 19 Feedback from the staff was that they worked well as a team, with several of them being employed in the home for up to 16 years. Feedback from the people living at the home was very positive with all expressing how well they were looked after and supported. The health and safety records viewed demonstrated that equipment was serviced and maintained. The records viewed included lift servicing, fire alarm servicing and water temperatures. St Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 2 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x 3 3 x x x x x 3 St Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 Page 21 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 OP8 Regulation 12 (1) (a) Requirement That the number and type of pressure relieving mattresses is reviewed. That equipment is provided in line with the assessed needs of the service user. That the number of adjustable beds and commodes are reviewed and equipment is provided in line with the assessed needs of the service user group. The Registered person should review the provision of social and recreational activities, to ensure there is adequate stimulation and opportunities for outings. THIS WAS A RECOMMENDATION AT THE LAST INSPECTION ON 20/01/05. It is required that the management conduct a review of the enviroment and develop an action plan with timescales detailing a refurbishment plan. Timescale for action 20/10/05 2. OP12 16 (2) (m) (n) 30/10/05 3. OP20 23 (2) (b) Action plan to be forwarded to CSCI by 30/11/05 St Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 Page 22 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 OP7 Good Practice Recommendations It is recommended that service users or their representatives are involved in the development and review of their plan of care. THIS RECOMMENDATION IS OUTSTANDING FROM THE INSPECTION 20/01/05. It is recommended that the CSCI details are included in the complaints procedure. 2. OP16 St Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL 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 Benedicts Nursing and Residential Home D53 - D02 S3287 St Benedicts V244942 160805 Stage 4.doc Version 1.40 Page 24 - 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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