CARE HOMES FOR OLDER PEOPLE
St Catherine`s Care Home West Road Newcastle Upon Tyne NE15 7PY Lead Inspector
Mary Blake Key Unannounced Inspection 22nd November 2006 09:30 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 Catherine`s Care Home DS0000041216.V302847.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 Catherine`s Care Home DS0000041216.V302847.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Catherine`s Care Home Address West Road Newcastle Upon Tyne NE15 7PY 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) 0191 2452400 june.spoors@stcuthbertscare.org.uk St Cuthberts Care Vacant Care Home 45 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (34) of places St Catherine`s Care Home DS0000041216.V302847.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17th January 2006 Brief Description of the Service: St Catherines Care Home is purpose built and provides nursing, personal and social care. It also provides 11 Dementia care beds for older people. The home is situated on the West Road in Newcastle upon Tyne and is part of St Cuthbert’s Care. The home is accessible to all local amenities and public transport. All the accommodation is at ground level and there are extensive gardens and there is ample car parking. There are 45 single en-suite bedrooms, six of which could be used as companion rooms. Several of the bedrooms have patio doors, which lead into the internal secure garden. There are several communal lounges and two dining rooms. There is a conservatory, Chapel and quiet room. There are bathrooms, a shower room and toilets close to all resident areas. All of the facilities cater for those with disabilities. The fees for the home are from £426 to £436 per week. The statement of purpose is available to residents, families and visitors. St Catherine`s Care Home DS0000041216.V302847.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over one day and involved two inspectors. All of the key standards have been assessed during this visit and from other information provided to the Commission. A tour of the premises was carried out. Residents care records, staff records and additional statutory records were examined. Case tracking was undertaken, this involved following the care of individual residents. The acting Registered Manager, deputy, three care staff and three ancillary staff were spoken to and the inspectors met sixteen residents and their families on their visit and spoke privately with eight. 18 resident and 27 relative questionnaires were received prior to the site visit. These were varied the majority being very positive and four highlighting issues around a broken hoist, lack of activities, lack of consistent staff and bland food. It was noted that these issues had already been addressed by the acting Registered Manager. What the service does well:
Staff were kind and considerate when helping residents. Residents and relatives explained the admission process; this usually includes a visit from the manager. This helps new residents identify their own needs and enables staff to meet their needs during their stay. The service gives excellent support to enable individuals to make decisions and participate in the running of the home. Residents said, and it was seen, that staff were kind, considerate and supportive. Residents and their families are fully involved with their care plans. Staff were friendly and relaxed with the inspectors and were keen to discuss their work and the residents care needs. The home and staff create a positive atmosphere, which residents commented upon and which is welcoming to families and visitors. The home has strong links with supporting health professionals, who give good health support to residents. There is a complaints procedure and in addition resident views are actively sought. Residents felt their views were listened to and acted upon.
St Catherine`s Care Home DS0000041216.V302847.R01.S.doc Version 5.2 Page 6 The home is furnished and decorated to a very high standard and provides comfortable and pleasant surroundings for residents. Individual bedrooms are very well furnished and all are ensuite. Aids and adaptations assist the residents to move freely and independently around and outside of the home. Bathrooms are of a high standard with a number of assisted facilities to enable residents to feel more comfortable and supported to enjoy this time. The communal areas are well decorated and used for a range of social events. The garden provides opportunity for residents to enjoy the outdoors and is landscaped to provide access for all residents. The Chapel enables residents to attend services or have individual time for reflection and prayer. The home is well staffed with a skilled, consistent and trained staff team giving security to residents. Staff recruitment and training records were clear and concise and contained all relevant information. The vetting process helps protect residents. The staff have a good understanding of residents individual needs. The residents were very complimentary about the staff. For example “they are all very caring and good listeners” “all of the staff were wonderful I had just come here and they could not do enough for me” Residents live in a home, which is very well run and managed. Comments from residents and relatives included “ As a family we find St Catherine’s excellent” “I have always been satisfied with the standards of care and attention given to my sister”. “I would like to bear witness to the patience and understanding of both the trained staff and carers for all in their care” “We are very pleased with the way the home is run, our mother is very happy to be there” “A good home” “A very happy place” “The home has always been first class”. What has improved since the last inspection? What they could do better:
St Catherine`s Care Home DS0000041216.V302847.R01.S.doc Version 5.2 Page 7 The care plans must be regularly reviewed and updated to ensure that residents changing care needs are identified, as this will enable staff to provide the care needed. The complaints record must include outcomes and details of complainant satisfaction as this enables the management to overview improvements and assess the effectiveness of the complaint procedure. All staff in the home must be made aware of POVA and have received appropriate training, as this may compromise resident’s safety. Staff must be supervised within the recommended timescales of six times per year as this provides the management overview of staffs ability to provide satisfactory care for residents. 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 Catherine`s Care Home DS0000041216.V302847.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 Catherine`s Care Home DS0000041216.V302847.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): 3,4 & 5 Intermediate care is not provided Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have their need fully assessed by care staff and have opportunities to visit before admission to the home. EVIDENCE: Pre-admission assessments are undertaken and reflect the needs of the residents. Care plans had good information to ensure that the home can meet the needs of the prospective resident. The Manager is involved in the decisions and in the majority of instances visits the residents herself prior to their admission. Residents and relatives spoke of visiting the home prior to admission and that this was useful to reduce anxiety and make the settling in process easier. “I came to look around first” “recommended by my doctor”
St Catherine`s Care Home DS0000041216.V302847.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are having their needs met by the staff in the home and the staff are skilled in providing the care in a sensitive and dignified manner. This is shown in the documentation and care plans in place. The residents receive their prescribed medication in line with safe working practices. These systems ensure that residents receive their medication in a safe and appropriate way. EVIDENCE: Six care plans were examined; they were of generally of a good standard, with relevant risk assessments for the prevention of falls, nutrition, moving and assisting, continence promotion. The plans had not been consistently reviewed and updated on a regular basis.
St Catherine`s Care Home DS0000041216.V302847.R01.S.doc Version 5.2 Page 11 Residents have a care plan which includes a detailed assessment and a plan of care. Risk assessments are completed for: prevention of falls, wound care, moving and assisting, and there is good care planning around areas such as continence promotion. There is an assessment to look at residents’ food and fluid intake. Residents access NHS services and facilities as necessary. The care plans showed that specialist advisors are used for individual residents. Daily reporting of residents care was satisfactory with any changing health care of residents being reviewed but not always updated in the care plan. “The trained staff are very good and they always make a point of keeping me informed in any changes to my mothers condition” Medicines management was appropriate. The staff record the medicines correctly when they are ordered. The prescriptions are then checked when they are received in the home from the General Practitioners and are then sent to the Chemist for dispensing. The medicines received from the pharmacy are checked against the record of what was ordered and prescribed so that any errors can be picked up. Medicines no longer required are disposed of safely. No resident manages his or her own medication. Staff were treating residents with respect and dignity. Personal care was given in privacy. Staff used residents preferred name at all times. Relatives and residents were very complimentary about the staff in the home and felt that they were able to have privacy in their own rooms “Staff have been caring and thoughtful, helping out whenever needed as well as anticipating needs” “they always gave me my dignity”. “I feel that on the whole the carers and nurses are very caring, patient and respectful”. St Catherine`s Care Home DS0000041216.V302847.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are satisfied with the flexibility of their routines for daily living and activities. Arrangements for residents to maintain contact with their family and friends and the local community are suited to each individual’s needs and vary accordingly. A limited range of social activities is in place, which is thoroughly enjoyed by residents and their families. The food served is good and the residents are happy with the improvement to the quality and the quantity. EVIDENCE: Residents were generally happy and enjoyed being able to move freely around the home. Relatives and residents felt that there was insufficient social activities programme both within and outside of the home and this was currently being addressed. “I would like to take part but there are never any activities. The daily activities that had been provided were varied and thoroughly enjoyed by residents. The residents are encouraged to go to places
St Catherine`s Care Home DS0000041216.V302847.R01.S.doc Version 5.2 Page 13 in the local area and families are encouraged and supported to take residents out and about. Residents take control of their daily routines in simple but important ways including the time they get up, what and when they eat and how they spend their time. All residents said that they are able to make choices about how they spend their day. The residents’ bedrooms were personalised and residents said they were very happy with the decoration and furnishings. Residents have visitors at any time and are able to use their own rooms, the small lounges or the larger, busier lounges to receive them. The meals served were good and all of the residents enjoyed the food, which was well cooked. Staff support was on hand. The tables were nicely set and breakfast and lunch was seen as social occasions. The chef is part of the staff team and made themselves available to residents for comments and requests. Residents were extremely positive “always very good and varied, sometimes too much” “the food is very good” “the meals are very good and if you wanted anything else you got it without any problems” “my husband had not been eating and had lost weight but since coming to St Catherine’s he is eating well and gaining weight “ always a choice so always something I like” Some questionnaire had negative comments “ the food is often bland and lacks imagination” “I enjoy breakfast and lunch but tea leaves something to be desired” many residents feel that these shortfalls had now been addressed. St Catherine`s Care Home DS0000041216.V302847.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home ensures residents and relatives aware of the complaints policy by making it available in a variety of places. Complaints are managed satisfactorily and the necessary action taken but not sufficiently recorded. Staff had not completed training in the Protection of Vulnerable adults and this is necessary to ensure that residents are protected. EVIDENCE: The complaints procedure is displayed in the home and available within each resident bedroom. The records of the complaints made to the home was examined and was unsatisfactory, as it did not detail who had undertaken the investigation, outcomes and complainant satisfaction. Twelve of the residents said that they knew problems were dealt with and how this would be done “everyone is approachable” “It has never been necessary here in our experience” “Never had a problem” “I have had no need to complain but would be able to if the need arose “ very happy here” “don’t know which particular person but feel like any member of staff would help” “would approach any member of staff” St Catherine`s Care Home DS0000041216.V302847.R01.S.doc Version 5.2 Page 15 The acting Registered Manager stated that staff were aware of the whistle blowing policy and informing the Manager of any incidents or issues of which there are concern. Staff confirmed this. The acting Registered Manager had completed Protection of Vulnerable Adults training. Further staff training is planned. St Catherine`s Care Home DS0000041216.V302847.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents stay in a safe environment. There are good communal areas, bedrooms are ensuite and there are assisted baths and showers. There are a wide range and number of adaptations and aids to assist residents to move freely around the home. The entire home is decorated and furnished to a very high standard. The home is very clean, pleasant and hygienic. EVIDENCE: The location and layout is suitable for the residents who come to stay here. There are lounges and dining rooms. These are pleasantly decorated and furnished. Residents were able to use the entire home and there was a range of television and audio equipment available for their use.
St Catherine`s Care Home DS0000041216.V302847.R01.S.doc Version 5.2 Page 17 There are assisted bathrooms and toilets near to all communal areas as well as ensuite facilities in each bedroom. Residents were very positive about the home “very clean and tidy” The home was extremely clean and has good hygiene practices. The grounds and garden are well maintained and are enjoyed by the residents, especially in the warmer months. The building was very well maintained, system testing had been undertaken and maintenance certificates were available. St Catherine`s Care Home DS0000041216.V302847.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager ensures there are adequate numbers of staff on duty that have appropriate skills and experience to care for the residents. The recruitment processes in place protect residents. External and internal training takes place and more that fifty percent of staff has completed National Vocational Qualifications in Care Level 2 or above exceeding the standard and providing residents with a skilled, consistent staff team. EVIDENCE: Staffing rotas showed that there are enough staff are on duty to meet the necessary staffing levels. When sickness and staff holidays occur home staff provide cover and agency staff are no longer used. There has been some staff turnover and new recruitment, which should improve the consistency in the care for residents. A relative commented, “When they (new staff) start and are managed well it should solve the problems”. Other comments included “staff are always busy and will come back later “there are not enough staff”. The acting Registered Manager had been addressing these issues with recruitment and redeployment of the staff team. Residents and relatives
St Catherine`s Care Home DS0000041216.V302847.R01.S.doc Version 5.2 Page 19 made the following comments “The staff cannot do enough to help us” “staff are easily contactable day or night” “they are wonderful people” “The staff are wonderful they could not do enough for me or anyone else” “nothing was too much for the staff” “the staff are the tip top people” Staff undertake mandatory training, National Vocational Qualifications in Care and other training. This was clarified from the sample of records inspected and discussions with staff. The training programme and records are currently under review as part of the workforce development plan. Staff said that they are undertaking or had completed National Vocational Qualification in Care level 2 or over and the home has an induction and training programme for all staff working in the home. Staff spoke knowledgably about the individual needs of residents. Staff recruitment files were examined and were satisfactory. St Catherine`s Care Home DS0000041216.V302847.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home, which is well run and temporarily managed by an experienced person. The acting Manager has good systems in place to organise the home taking into account the needs and wishes of the residents. Good quality systems have been established and are being developed. Resident’s financial interests are safeguarded. Progress is being made in staff supervisions. The health, safety and welfare of residents and staff are promoted and protected. St Catherine`s Care Home DS0000041216.V302847.R01.S.doc Version 5.2 Page 21 EVIDENCE: The residents and staff made positive comment about the acting Registered Manager and staff team; they gave examples of improved practices “better social activities” “staff are more readily available” “menus and food had improved”. And of the staff team taking time to listen and respond to any concerns they may have. Regular meetings had been held for residents, relatives and staff to discuss the proposal and changes to staff deployment and practices. Quality assurance systems are currently under review. Monthly proprietor visits are undertaken with good written reports and any issues addressed. Accidents are recorded effectively with accident analyses being completed and risk preventions being undertaken to safeguard residents. The system for checking resident’s monies was satisfactory. Staff supervision records showed a comprehensive process but that the timescales of six per year would not be met. The acting Registered Manager is currently addressing this System testing had been undertaken and maintenance certificates were available. St Catherine`s Care Home DS0000041216.V302847.R01.S.doc Version 5.2 Page 22 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 4 3 X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 3 3 St Catherine`s Care Home DS0000041216.V302847.R01.S.doc Version 5.2 Page 23 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 2 Standard OP7 OP16 Regulation 15 2 (b) 22 Requirement The Registered Person to review all care plans and that they are regularly reviewed and updated The Registered Person to review the records of complaints and this must include, the person investigating, the outcome and the complainants satisfaction The Registered Person must have all staff undertake training in the Protection of Vulnerable Adults The Registered Person must ensure that all staff is supervised at the given timescales of six per year. Timescale for action 01/02/07 01/02/07 3 OP18 13(6) 01/04/07 4 OP36 18 (2) 01/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Catherine`s Care Home DS0000041216.V302847.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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
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