CARE HOMES FOR OLDER PEOPLE
St Bernadettes Nursing Home 25-27 Trinity Road Scarborough North Yorkshire YO11 2TD Lead Inspector
Mary Slattery Unannounced 22 June 2005 10:00 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 Bernadettes Nursing Home J53 J04 S28011 St Bernadettes Nursing Home V231736 220605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service St Bernadettes Nursing Home Address 25-27 Trinity Road Scarborough North Yorkshire YO11 2TD 01723 366522 01723 501502 N/A Complete Care Homes Limited 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) Miss Ingrid Louise Campbell Richards Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places St Bernadettes Nursing Home J53 J04 S28011 St Bernadettes Nursing Home V231736 220605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Service users from 60 years of age. Date of last inspection 29/10/04 Brief Description of the Service: St Bernadettes provides nursing care and accommodation for up to 27 service users from 60 years of age. The home is located in a residnetial area of Scarborough and the amenities and facilities of the town are approximately a mile away from the home. The accommodation provided is in single and double bedrooms over 3 floors. There is ramped and level access to the home and two passenger lifts giving access to the upper floors. There are garden to the front and side which are used by the service users and there is private parking facilities for visitors and staff. The home is owned by Complete Care Homes Limited and was registered with the Commission in 2002. St Bernadettes Nursing Home J53 J04 S28011 St Bernadettes Nursing Home V231736 220605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report related to an unannounced inspection carried out on the 22nd June 2005. The inspection took 4 hours plus 2 hours preparation time. A tour of the premises was carried out, which included the service users private accommodation. A selection of the homes’ records were looked at and time was spent observing the activity in the home, talking and listening to service users, staff and visitors. The focus of the inspection was on a number of key standards, inspecting the case records of a number of service users to establish if they corresponded with their experiences of life in the home. The registered manager was available throughout the inspection and the findings were discussed and agreed at the close of the inspection. What the service does well:
The home was bright, clean and cheerful and there was a good provision of equipment to assist service users with their mobility. Good information had been collected comprehensive care plans were in place. about the service users and The staff enable the service users to make decisions about how their care is to be delivered and family members are encouraged and supported to be involved in their relatives care. There is wide range of activities designed to suit hobbies and interests, and opportunities for service users to keep mentally alert and physically active. There was an exhibition of paintings in the dining room all of which had been created by the service users. Carries out a robust staff induction and provides training opportunities for all staff. The service users spoken to said they were more than happy with the service, the attention they got from the staff and the encouragement to remain as independent as possible. Relatives were also very positive about the quality of care provided, the flexible visiting arrangements and the quality of the food provided. All of the service users appeared well cared for and those who were in bed were comfortable and kept safe from harm. A number of the service users were taking advantage of the good weather and the staff made sure they were protected from the sun.
St Bernadettes Nursing Home J53 J04 S28011 St Bernadettes Nursing Home V231736 220605 Stage 4.doc Version 1.30 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.
St Bernadettes Nursing Home J53 J04 S28011 St Bernadettes Nursing Home V231736 220605 Stage 4.doc Version 1.30 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 Bernadettes Nursing Home J53 J04 S28011 St Bernadettes Nursing Home V231736 220605 Stage 4.doc Version 1.30 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, 2, 3 and 5. People are provided with considered information about what the home provides. Information is gathered about people moving into the home to ensure their needs are met in a safe manner. EVIDENCE: The statement of purpose and the service user guide gave information about the type of care and services that are provided. Copies of the documents are available in the home and every service user has a copy of the service user guide. The manager reviews the documents on a regular basis to ensure they accurately reflect the services offered. The information is being translated into other languages for service users who’s first language is not English. No service user is admitted to the home without an assessment of their needs being carried out.
St Bernadettes Nursing Home J53 J04 S28011 St Bernadettes Nursing Home V231736 220605 Stage 4.doc Version 1.30 Page 9 Information is gathered about the service users physical, personal and social care needs. Areas of risk are identified including those associated with pressure ulcers and falls. Service users and their representatives are invited to visit the home to discuss the services offered and to agree the findings of the assessment. The manager said that all service users are issued with a contract/terms and conditions document. Copies are not kept of the service users files in the home. St Bernadettes Nursing Home J53 J04 S28011 St Bernadettes Nursing Home V231736 220605 Stage 4.doc Version 1.30 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 and 10. There are good systems in place to ensure that the service users health and personal care needs are met. EVIDENCE: The care plans looked at gave detailed information about the service users health care needs and the arrangements that are in place to meet these and by whom. There was information about all aspects of the service users health care needs, treatments and interventions and contact with any external health care professional including their general practitioner. Risk assessments were in place with action plans to minimise risk. The daily records confirmed the type and level of care given and the outcomes of that care. The service users have a named nurse and a keyworker who are responsible for the monitoring and review of their care and for maintaining accurate records. There was information about the service users wished regarding their death and the care plans are agreed and signed by the service users and or their representatives. The service users said that they liked living in the home, that they were treated with respect and staff were attentive to their needs.
St Bernadettes Nursing Home J53 J04 S28011 St Bernadettes Nursing Home V231736 220605 Stage 4.doc Version 1.30 Page 11 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) 14 and 15. Service users are enabled to make decisions about their lives and they have good food in pleasant surroundings. EVIDENCE: There was information in the service users care plans about how they wish to live life in the home, what they are able to do independently and what they need assistance with. Part of the care plans focus on their social history and their interest and hobbies. The activities organiser has developed a good scope of interesting things for people to do. There was an exhibition of Chinese paintings, all done by the service users. The activities are designed to enable people to keep their minds stimulated and their bodies active and for enjoyment. There is a monthly review with each service users to establish if they are finding pleasure in the activities and if they need more one to one time with the staff. All of the service users spoken with said that they food was excellent and they had plenty of choice. The menu has just been changed for the summer season and it showed choice and a well balanced diet to suit all needs and taste. Time was spent with the service users at lunch time and staff were observed assisting where needed in a sensitive manner.
St Bernadettes Nursing Home J53 J04 S28011 St Bernadettes Nursing Home V231736 220605 Stage 4.doc Version 1.30 Page 12 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 and18. There are relevant complaints and adult protection policies and procedures in place but the homes’ recruitment practices does not safeguard service users. EVIDENCE: The complaints policy and procedure is made available to service users, relatives and staff. The details of how to make a complaint are in the service users guide and displayed in the home. There is a staff training programme in place which includes abuse awareness, the reporting procedure and POVA and there is a further training session planned for later in the year. All staff sign to confirm they have read the adult protection policy and procedure. New staff have been employed prior to the required CRB check being carried out. To ensure the greater protection of the service users staff must not be employed before the required CRB is carried out. St Bernadettes Nursing Home J53 J04 S28011 St Bernadettes Nursing Home V231736 220605 Stage 4.doc Version 1.30 Page 13 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, 22 and 26. The standard of the environment is good providing people with a bright, clean and homely place to live. EVIDENCE: There are good systems in place to make sure the premises are well maintained and safe for service users and the staff. All of the required safety certificates were in place including a current insurance certificate. The decoration, fixture and fittings are of a high standard and there is a wide range of equipment available to assist service users with their mobility, including hoists, assisted baths and toilets and wheelchairs. There is ramped and level access from the home to the garden area, which is regularly used by service users in the better weather. The home was clean and fresh and there were no offensive odours and there are systems in place for the control of infection.
St Bernadettes Nursing Home J53 J04 S28011 St Bernadettes Nursing Home V231736 220605 Stage 4.doc Version 1.30 Page 14 A number of new carpets have been laid and arrangements are in place for eight more to be replaced over an eight month period. New chairs have been ordered for the lounge and a number of bedroom chairs are to be replaced. St Bernadettes Nursing Home J53 J04 S28011 St Bernadettes Nursing Home V231736 220605 Stage 4.doc Version 1.30 Page 15 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, 29 and 30. The service users receive a good standard of care from the staff. Failure to carryout the required checks on staff places service users at risk. EVIDENCE: The qualified nursing staff employed have the relevant general nursing qualification and attend training courses to up date their practice. All staff have a training portfolio and a number of care staff are working toward NVQ Level 2 and 3. Staff are supervised on a regular basis and have an annual appraisal the outcomes of which are recorded. The home has the required numbers of staff on duty during the day and overnight but does not have the required numbers of qualified nursing staff on duty at all times. All staff are subject to TOPPS induction and statutory training, which includes, moving and handling, fire safety, infection control, food handling and some are currently undertaking a Cancer Care training course. Training planned to take place includes abuse awareness and equality and diversity. All staff employed must be checked with the Criminal Records Bureau prior to taking up their post. St Bernadettes Nursing Home J53 J04 S28011 St Bernadettes Nursing Home V231736 220605 Stage 4.doc Version 1.30 Page 16 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, 35 and 38. The service users benefit from a well managed home in which their needs and wishes are put first. EVIDENCE: The registered manager is a qualified first level nurse and has a number of years experience in managing a nursing home. She is proactive in improving the service, training and supervising staff and ensuring that service users come first and their views are listened to. The registered manager must complete NVQ Level 4 or equivalent within the required timescale. The staff are not involved in the management of the service users finances they are supported by either their families or their representatives. There is a health and safety policy and procedure in place and all staff undertake health and safety training. Service users are supported to minimise risk to enable them to participate in life in the home and in the community.
St Bernadettes Nursing Home J53 J04 S28011 St Bernadettes Nursing Home V231736 220605 Stage 4.doc Version 1.30 Page 17 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 2 x x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x 3 x x x 3 STAFFING Standard No Score 27 1 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 2 x x x 3 x x 3 St Bernadettes Nursing Home J53 J04 S28011 St Bernadettes Nursing Home V231736 220605 Stage 4.doc Version 1.30 Page 18 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 18 Regulation 13(6) Requirement The registered person is required to make arrangements to protect service users being placed at risk from abuse. The registered person is required to have the required levels of qualified nursing staff working in the home. The registered person is required to carryout the required CRB checks on all staff prior to them taking up their post. Timescale for action 30th July 2005. 30th August 2005. 30th July 2005. 2. 27 18 (1) 3. 29 17 Schedule 4 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 2 31 Good Practice Recommendations It is recommended that all service users have a copy of their contract/terms and conditions in their file. It is recommended that the registered manager completes NVQ Level 4 or equivilent within the timescale. St Bernadettes Nursing Home J53 J04 S28011 St Bernadettes Nursing Home V231736 220605 Stage 4.doc Version 1.30 Page 19 Commission for Social Care Inspection York Area Office Unit 4, Triune Court Monks Cross York, YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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