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Inspection on 09/01/08 for St Bernadette`s Nursing Home

Also see our care home review for St Bernadette`s Nursing Home for more information

This inspection was carried out on 9th January 2008.

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

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

All prospective residents are assessed before moving to the home to make sure that staff can support them properly. People will only be allowed to move there if the staff are able to provide the care they need. There are close and regular links with the local community and a dedicated activities organiser plans events and activities in the home according to what people would like. There is a stable staff group, who are well trained and supported who can provide the right care for the people living there. Comments from people living there include "The staff are lovely. They are very kind". There is an enthusiastic manager who knows the residents very well and who sees `getting it right` for them as her main priority. This means the home is run for the benefit of the people living there. One visitor commented. "If you ask me for a fault, I couldn`t find one".

What has improved since the last inspection?

There has been planned refurbishment and redecoration in various parts of the home. New furniture has been bought for the lounges, dining room and bedrooms, which improves the environment for the people living there. A new patio and sensory garden is almost complete. This has been financed with grant money and will improve the outside space for people living at the home. All the sluice rooms in the home now have hand washing facilities, to reduce the risk of cross infection and placing people at risk. Locks have been added to sluice doors to prevent unauthorised people accessing these rooms and potentially coming to harm.

What the care home could do better:

The care planning records describing how people are to be supported in the home could be more individual. Assessments could be carried out to identify people who are at risk of coming to harm. Advice could be sought where `risk` is identified, as a way of promoting health and preventing any further deterioration. All of these would contribute to keeping people safe and well. Staff could routinely count non-blister packed drugs as a way of checking that drugs are being given and signed for according to the person`s prescription. The manager could make sure that staff serve drinks in such a way that they do not hold the rims of the cups. This would be more hygienic and would reduce any potential risk of infection. The new hot water system could be reviewed by the plumbing contractors and water temperatures could be monitored more closely to reduce the risk of people being scalded, from water that is too hot. The manager could make sure that bedrails are fitted, checked and maintained properly in order to keep people safe and prevent them coming to harm.The manager could make sure that records that are required to be kept at the home are available for authorised people to look at. This is to comply with the law.

CARE HOMES FOR OLDER PEOPLE St Bernadette`s Nursing Home 25-27 Trinity Road Scarborough North Yorkshire YO11 2TD Lead Inspector Jean Dobbin Unannounced Inspection 8th January 2008 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 Bernadette`s Nursing Home DS0000028011.V356619.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 Bernadette`s Nursing Home DS0000028011.V356619.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Bernadette`s Nursing Home Address 25-27 Trinity Road Scarborough North Yorkshire YO11 2TD 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) 01723 366522 01723 361325 roger.somauroo@btinternet.com Complete Care Homes Ltd 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 Bernadette`s Nursing Home DS0000028011.V356619.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age Range 60 years plus Date of last inspection 22nd February 2007 Brief Description of the Service: St Bernadettes provides nursing care and accommodation for up to 27 people of either gender who are aged over 60. The home is located in a residential 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 gardens to the front and side of the house that are used by people living there and parking is available on the road. Current information about services provided at St Bernadette’s in the form of a Statement of Purpose, service user guide and the most recent inspection report published by the Commission for Social Care Inspection, which are available by contacting the home. Information provided by the manager in January 2008 indicates that the current weekly fees for the home ranges from £373 to £410 plus the Funded Nurse’s Charge. This does not include hairdressing, chiropody or newspapers. St Bernadette`s Nursing Home DS0000028011.V356619.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. This is what was used to write this report. • • • Information about the home kept by the Commission for Social Care Inspection. Information asked for, before the inspection. This is called an Annual Quality Assurance Assessment (AQAA). Information from surveys sent to people who live at St Bernadette’s, their relatives, and other professional people who visit the home. 10 were sent to people at the home but none were returned. 3 were sent to people’s relatives and 2 were returned. 2 were sent to GPs and 1 to a Care Managers and 1 was completed and returned. 9 were sent to staff who work at the home and 5 were returned. A visit to the home by one inspector, which lasted about 7.5 hours. This visit included talking to people who live there and their visitors, and to staff and the manager about their work and training they had completed. It also included checking some of the records, policies and procedures that the home has to keep. • Information about what was found during the inspection was given to the registered manager, her line manager and one of the owners at the end of the visit. What the service does well: All prospective residents are assessed before moving to the home to make sure that staff can support them properly. People will only be allowed to move there if the staff are able to provide the care they need. There are close and regular links with the local community and a dedicated activities organiser plans events and activities in the home according to what people would like. St Bernadette`s Nursing Home DS0000028011.V356619.R01.S.doc Version 5.2 Page 6 There is a stable staff group, who are well trained and supported who can provide the right care for the people living there. Comments from people living there include “The staff are lovely. They are very kind”. There is an enthusiastic manager who knows the residents very well and who sees ‘getting it right’ for them as her main priority. This means the home is run for the benefit of the people living there. One visitor commented. “If you ask me for a fault, I couldn’t find one”. What has improved since the last inspection? What they could do better: The care planning records describing how people are to be supported in the home could be more individual. Assessments could be carried out to identify people who are at risk of coming to harm. Advice could be sought where ‘risk’ is identified, as a way of promoting health and preventing any further deterioration. All of these would contribute to keeping people safe and well. Staff could routinely count non-blister packed drugs as a way of checking that drugs are being given and signed for according to the person’s prescription. The manager could make sure that staff serve drinks in such a way that they do not hold the rims of the cups. This would be more hygienic and would reduce any potential risk of infection. The new hot water system could be reviewed by the plumbing contractors and water temperatures could be monitored more closely to reduce the risk of people being scalded, from water that is too hot. The manager could make sure that bedrails are fitted, checked and maintained properly in order to keep people safe and prevent them coming to harm. St Bernadette`s Nursing Home DS0000028011.V356619.R01.S.doc Version 5.2 Page 7 The manager could make sure that records that are required to be kept at the home are available for authorised people to look at. This is to comply with the law. 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 Bernadette`s Nursing Home DS0000028011.V356619.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 Bernadette`s Nursing Home DS0000028011.V356619.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): 3 and 6 People who use this service experience good quality outcomes in this area. The pre-admission assessment ensures that individual care needs can be met at the home and the prospective resident receives information and help to enable them to choose whether St Bernadette’s is the right place for them. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: All the care records looked at contained an assessment completed by a senior manager at the home. This is to check that staff at the home have the skills and knowledge to care for the person as well as helping the individual to decide whether they want to move there. This assessment can be completed at the person’s home or in hospital and one person spoken with confirmed that someone from the home had visited them in hospital and asked them lots of questions. The care records also contained St Bernadette`s Nursing Home DS0000028011.V356619.R01.S.doc Version 5.2 Page 10 an assessment completed by a social service care manager as well as written information provided by hospital staff on discharge. A brochure is sent out to all prospective admissions and people are encouraged to visit the home as a way of helping them to decide whether to move there. A review meeting is held three months following admission so that all parties can discuss whether the placement has been successful. Each person is provided with a service user guide, which gives information about the services available at the home. The Statement of Purpose and most recent inspection report are also available for people to read. Intermediate care is not provided at the home. St Bernadette`s Nursing Home DS0000028011.V356619.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 and 10 People who use this service experience adequate quality outcomes in this area. The personal, social and healthcare needs of people living at the home are well addressed, but they are not underpinned with sufficiently detailed plans of care. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Four care records were looked at. These describe the care and support that a person needs in order to still be in charge of their life and be as independent as possible. Whilst carers were treating people individually the care plans did not evidence that this was happening. The four people, whose records were looked at, had very different needs but their plans of care were very similar. The care plans describing ‘washing and dressing’ were identical. This did not reflect the people’s individuality. None of the care plans were written in a way that recognised people’s ability to contribute to their care and maintain some control in their lives. There were no care plans to reflect communication problems, like speech difficulties or poor vision. St Bernadette`s Nursing Home DS0000028011.V356619.R01.S.doc Version 5.2 Page 12 The records need to be in much more detail so that unfamiliar staff would be able to identify what kind of help was required. The care plans are however being reviewed monthly to make sure they are still appropriate. Some risk assessments were in place, though not all had been completed. All have a nutritional assessment for whether a person is at risk of not maintaining a stable weight because of poor appetite or a health problem. One person had a falls risk assessment, however they had fallen a few days earlier and this had not been recorded on the assessment, nor had the assessment been reviewed to check whether the staff could do more to minimise another fall. A moving and handling risk assessment had been completed, however there was reference in their care records to one walking aid, the person had a different aid in their room and the assessment said that they walked around without any aids. These inconsistencies need to be addressed so that all staff are clear about what help an individual requires. Although a number of people have bedrails none of the care plans looked at contained a risk assessment saying why they were needed. Similarly there was no consent for the use of this equipment, which should only be used when it has been risk assessed and identified as the best way of keeping people safe. (See Standards 31-38) One person had moved to the home quite recently. Although a pre admission assessment had been completed, a plan of care had still to be written. A moving and handling risk assessment had not been completed so different staff were likely to be helping the person in an inconsistent and potentially unsafe way. The individual had moved to the home with a skin problem, however there was no evidence of advice being sought from either the local doctor or specialist nurse. A specific care plan for managing this problem and preventing it getting worse had not been written. These concerns were discussed with the manager who immediately addressed them. Although records at the home need improving people living there looked well cared for. People’s clothes were clean and ironed. Some ladies wore jewellery and make-up. The carers were observed speaking kindly and gently to the people who live there and also had a little time to sit and talk with people. Observing these interactions confirmed that people are treated with respect and their dignity is promoted. A survey from a local doctor spoke positively about the standard of care at the home. They said, “The nursing care is excellent. Nurses always know what they are talking about and know the patients.” A person living there said that they always saw the doctor in private and they could ask to see the doctor and it would be arranged. Staff at the home record visits from the doctor, though there is no record of contacts with other healthcare professionals. These are recorded in the daily records, which means as the days pass it can soon St Bernadette`s Nursing Home DS0000028011.V356619.R01.S.doc Version 5.2 Page 13 become difficult to check when contact was made. It would be good practice to record all contact, including telephone calls, with these professionals, to show that staff are meeting people’s healthcare needs. This was discussed with the manager, who agreed to implement a new recording system. The medication processes were looked at. Nobody looks after their own medicines in the home, although each person has a lockable drawer in their bedroom. The home uses a blister-packed system and the record sheets were generally completed appropriately with no omissions. One person’s prescription was for ‘one or two tablets’ however staff were not always recording the number of tablets the person was receiving. This too was discussed with the manager. The manager has introduced a system where all non-blister packed drugs are counted each week to check that the actual number of tablets tallies with the projected number. This weekly check though is not being routinely done although this good practice would help to confirm that drugs are being given and signed for according to the prescription. St Bernadette`s Nursing Home DS0000028011.V356619.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, 13, 14 and 15 People who use this service experience good quality outcomes in this area. People are supported in living the life they choose and they receive a varied and wholesome diet. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People spoken with said they were very happy living at St Bernadette’s. One person said they that although they usually went to bed early they were quite confident that staff would support them if they chose to stay up later. Visitors are welcomed any time and the visitor’s book confirmed this. One relative was able to stay on a ‘put-u-up’ with their partner over the Christmas period. This recognises people as individuals and the importance of being able to maintain links with family and friends. There is a full time activity organiser, however she was not a work on the day of the site visit. She keeps good records of events at the home and there were photographs displayed of past events. There are regular visits from entertainers and local community groups and visitors spoken with confirmed St Bernadette`s Nursing Home DS0000028011.V356619.R01.S.doc Version 5.2 Page 15 that there were often things happening at the home. One person said they liked to sit outside at all times of the year and staff supported them even when it was cold. The hairdresser was visiting the following day and several people said they were looking forward to that. One lady was wearing nail varnish, which she said had been applied by a care worker. There are regular visits from different religious denominations. One person said a priestess visited weekly to provide Holy Communion. Another said that they had enjoyed attending a carol service at a nearby church. The dining room is well laid out and attractively presented. It is in a large, bright extension. There were enough staff to assist at lunchtime and individuals needing extra help were assisted in a discreet manner. The meal of braised beef, swede, broccoli and potato, followed by bakewell tart and custard, looked very appetising. There was no alternative menu, though the chef, when spoken with was able to suggest various alternatives that could be cooked at short notice. Since the last inspection, a year ago the manager and senior staff have changed the routines over mealtimes so that they are more relaxing and social events. People spoken with said that generally the meals are an enjoyable part of living there. Fresh fruit and alcoholic drinks are available. The home provides different kinds of cups and glasses for people, however one person said that they didn’t like using a plastic cup and would prefer a china one. This was discussed with the manager, who was happy to organise this. St Bernadette`s Nursing Home DS0000028011.V356619.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 and 18 People who use this service experience good quality outcomes in this area. People can be confident that complaints will be taken seriously and staff are alert to signs of possible abuse. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People living at the home and visitors spoken with, all said that they would report anything that caused them concern. People knew who was in charge and were confident that complaints would be addressed properly. The home has received and addressed two complaints appropriately since the last inspection. The Commission has received no complaints in the last year. The home’s complaints policy is displayed in the entrance hall and there are also comment cards so that people can provide positive or negative views. People spoken with said they felt very safe living at St Bernadette’s. Staff receive training in ‘abuse awareness’ and are alert to any signs that a person may be being harmed. Advocacy leaflets about local services are displayed in the entrance hall. One person descried how they had a regular visitor from Age Concern and sometimes went out in the car with them. Recruitment files looked at contained police checks to show that prospective employees were not barred from working in a care service because of a St Bernadette`s Nursing Home DS0000028011.V356619.R01.S.doc Version 5.2 Page 17 previous offence. These systems are in place to protect people from harm. (See Standards 27 – 30). St Bernadette`s Nursing Home DS0000028011.V356619.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 and 26 People who use this service experience good quality outcomes in this area. People live in a well maintained home, which is clean, warm and comfortable. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: St Bernadette’s is adapted from two semi-detached houses and is within reasonable walking distance of the town centre and the sea. Parking is available on the road. The conversion provides a homely environment, which was noted to be warm, clean and comfortable. A large extension accommodates the dining area. There are two lounges although these are only just large enough for the people living there. Visitors spoken with said they usually saw their relative in their bedroom or dining room as there was more room there, and staff were observed helping someone to their room when their visitor arrived. Because people often have St Bernadette`s Nursing Home DS0000028011.V356619.R01.S.doc Version 5.2 Page 19 a shared bedroom this can mean that there is limited space for people to talk in private. Both the communal rooms and bedrooms are decorated in a homely way. One bedroom seen contained the person’s own furniture. Shared bedrooms looked at each had a curtain screen to provide some privacy. Call bells are available in the bedrooms and when one was activated it was answered within a minute. There has been redecoration and refurbishment over the past year. Some new carpets, lounge chairs and bedroom furniture have been bought and new equipment and decoration in the bathrooms and bedrooms. On the day of the visit new curtains were being fitted in the lounge and a new floor covering fitted in the lift area. A patio area and sensory garden is almost completed at the rear of the house, which will provide an attractive sitting area in the warmer weather. Following the last inspection staff have made changes, to make the lounge next to the dining room a more pleasant area to sit. In the dining area seating arrangements have been looked at and new dining chairs bought to enable more people to sit at the table for their meals. Reducing the background noise now means that meals are more of a social occasion. All sluice rooms now have hand washing facilities, and locks to prevent unauthorised people gaining access. The home uses sound-activated devices, approved by the fire service, to keep some fire doors open. Hazardous chemicals, used for cleaning are stored securely and the laundry area is well maintained. One area of the home had an odour of urine, but the manager and the cleaning staff were aware of this and the area was cleaned very regularly. (The odour had gone later in the day.) Staff were observed wearing aprons and gloves, which helps to reduce the risk of infection in order to keep people safe. However one member of staff was observed giving hot drinks to people, by holding the cup around the rim, from where the person would then drink. This poor practice was discussed with the manager, who said she would discuss this with her staff. St Bernadette`s Nursing Home DS0000028011.V356619.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, 28, 29 and 30 People who use this service experience good quality outcomes in this area. There are sufficient numbers of staff with the skills and knowledge to respond to the needs of the people living there. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The staffing levels at the home are satisfactory. There is at least one trained nurse at the home at all times and there are up to seven staff on the morning shift, four on the evening and two at night. These numbers include the manager, who likes to have some supernumerary time each week. The staffing levels do fall slightly at the weekend. The rota confirmed these numbers. There is at least one domestic at work each day, a housekeeper, laundry person and chef and kitchen assistant. A maintenance person is also employed and a gardener is used on an ‘as and when’ basis’. People and visitors spoken with felt that there were enough staff to help them as needed. Comments include “ the staff are very kind” and “oh they’re lovely”. One person said they were very competent and knew what they were doing. Staff receive mandatory training and updates each year, as well as extra sessions, for example in ‘speech and swallowing’. One carer said in their St Bernadette`s Nursing Home DS0000028011.V356619.R01.S.doc Version 5.2 Page 21 survey “there are always lectures to attend at the home and the lectures are relevant to the needs of the service users.” Staff like working at St Bernadette’s so the staff group is well established and fairly stable. More than 50 of the carers have a National Vocational Qualification Level 2 in Care. People are more likely to receive safe consistent care from staff, who have a good understanding of their role. There are a number of staff working at the home whose first language is not English. One person said that whilst these staff seemed to understand them, they sometimes found it difficult to understand the accents. This was discussed with the manager who agreed to talk about this at the ‘post- inspection meeting’. The recruitment files looked at showed that processes in the home are generally robust. One staff member confirmed that they did not start work until their police check had been returned. Another care worker was working ‘under supervision’ until their Criminal Records Bureau check was available. A PoVAfirst check had been completed to show that they were not barred from working in the care sector because of a previous offence. One person’s file though, had no evidence in it (such as a passport or birth certificate) to confirm that they were who they said they were. Another file did contain copies of these documents. The way the files are put together could be improved, so that authorised people can easily check that people have not started work before they have been properly vetted. It would also assist the manager to make sure that all recruitment checks have been done. Care staff starting work following an induction process, which was confirmed by a member of staff. The manager takes an active role in checking that this learning has been followed and understood. A good induction process means that staff receive consistent introductory training in how the home runs and the policies and procedures that underpin this, so that people living there receive consistent support. St Bernadette`s Nursing Home DS0000028011.V356619.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, 33, 35 and 38 People who use this service experience adequate quality outcomes in this area. Whilst the home is well run and for the benefit of the people living there, people could be at risk of harm however, because some systems are not robust. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The manager is an experienced nurse, who has completed the Registered Manager’s award. People spoken with know who she is and say they see her regularly around the home. Staff said she is very approachable and would be happy to speak with her if they have any concerns. It was evident on walking St Bernadette`s Nursing Home DS0000028011.V356619.R01.S.doc Version 5.2 Page 23 around the home with her that she knew individuals well and knew what was important to them. The home is run in a way that encourages all interested parties to contribute. Staff commented in their surveys that “the home is a lovely place to work” and “my manager does give me support and makes sure that staff work harmoniously with each other. She gives me praise where it is needed, advice and correction as well”. “Everyone can have a say and suggestions are welcome”. There are systems in the home to show that they are monitoring how they operate so that interested parties can say what areas need changing. Questionnaires have been sent out to relatives and people living there. It would be good practice for information from these to be sorted and displayed, with a plan to say what action will be taken as a result. Resident’s meetings have been poorly attended so the manager needs to determine other ways that people living at the home can be consulted, so they can influence how the home runs. One visitor said they thought that St Bernadette’s was one of the best homes in Scarborough. “If you asked me for a fault I couldn’t find one”. People’s monies are not handled by the home, with people’s families being invoiced if necessary. There are some computerised financial records, however they were not available to look at, as the person responsible for their maintenance was not on duty and the manager did not think she could access the files. The home uses an external company to monitor health and safety in the home. Staff attend annual training in order to contribute to keeping people safe. Fire safety records were satisfactory and a fire practice took place on the day of the site visit. A fire risk assessment has been completed. Kitchen records were looked at, which showed that the chef does not check the temperature of hot food before serving to make sure a high temperature has been maintained in order to protect the health of the people living there. A discussion was held with the Environmental Health Officer by the owner of the home, who suggested random checks should be completed. This was immediately instigated. Other catering systems were satisfactory. The management of bedrails needs to be made more robust. A number of bedrails in the home were incorrectly positioned on the bed; meaning people could be at risk of serious harm. This was discussed with the manager who immediately had all the beds checked to make sure all were fitted properly. The manager needs to make sure that all bedrails are fitted correctly and regularly checked to make sure they remain in the right position, in order to protect people from harm. St Bernadette`s Nursing Home DS0000028011.V356619.R01.S.doc Version 5.2 Page 24 A new water heating system has been installed this year. Records of hot water monitoring were not available to look at. Random temperature checks showed that the hot water temperature was too low. The manager explained though that the system was not controlled properly yet and the cold-water tap had to be used to regulate the hot water temperature. This is not acceptable as the regulator valves are not doing the job that they are designed for. People could be a risk of scalding themselves. The manager requested that the plumbers returned to review the system and the maintenance person adjusted all the valves so that the maximum water temperature (with or without the cold water being turned on) was at a safe temperature. St Bernadette`s Nursing Home DS0000028011.V356619.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 X 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 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 1 St Bernadette`s Nursing Home DS0000028011.V356619.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 OP8 Regulation 12 Requirement Advice and guidance must be sought from healthcare professionals when a healthcare problem is identified so that people’s health can be maintained The hot water temperatures of all taps to which people living at the home have access, should be maintained at about 43°C and monitoring should be carried out to ensure the risk of people getting scalded is minimised. People requiring bedrails must have a clear assessment identifying need and consent. They should be fitted to the bed, checked and maintained according to MRHA (Medicines and Healthcare products Regulatory Agency) guidelines, in order to keep people safe. Timescale for action 09/01/08 2. OP38 13(4) 10/01/08 3. OP38 13(4) 31/01/08 St Bernadette`s Nursing Home DS0000028011.V356619.R01.S.doc Version 5.2 Page 27 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 OP7 OP9 Good Practice Recommendations The plans of care should be written to reflect a person’s individuality and how their independence and maintaining some control of their life can be promoted. It would be good practice to count the non-blister packed tablets weekly to check that the actual number is the same as the projected number. This would help to confirm that drugs are being given and signed for according to the person’s prescription. Drinks should be served in such a manner that staff are not handling the area of the cup, that the person then has to drink from. The way the recruitment files are put together could be improved so that the manager can more easily check that the required documents and checks have been done before someone starts working there. Good recruitment processes contribute towards keeping people safe. It would be good practice for the manager to make sure records about the home required by regulation, such as the financial records and hot water monitoring records, are available at the home, for authorised people to inspect. 3 4 OP26 OP29 5 OP37 St Bernadette`s Nursing Home DS0000028011.V356619.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. 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