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Inspection on 21/09/05 for St Catherine`s Nursing Home

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

This inspection was carried out on 21st September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

St Catherine`s continues to provide appropriate care and accommodation for residents who need a general nursing, EMI nursing or personal care placement. The home was well-managed and provided residents with a clean and comfortable environment in which to live. Residents were supported and cared for appropriately and encouraged to make personal choices and retain as much personal independence as possible. Residents praised staff and the care they are given at the home, and felt comfortable enough to raise any concerns they may have with senior staff at the home who they described as accessible and approachable.

What has improved since the last inspection?

Residents were of the view that the quality of meals had improved recently and that the range of leisure activities and social events have become more varied. Although some environmental issues are identified in this report the general environment continues to improve.

What the care home could do better:

There have been issues surrounding changes in the staffing levels within the home for a few weeks prior to this inspection. Although these issues have been addressed there remains a high level of anxiety in residents, their relatives andstaff that these issues may arise again in the near future. Clearly as senior management undertake reviews in this area residents and relatives must be communicated with clearly and their views sought as part of the review process. Ventilation and floor covering issues were identified within the EMI unit and the residential unit is in need of another WC. Management at the home have identified the need to update the nurse call bell system within the home.

CARE HOMES FOR OLDER PEOPLE St CATHERINES Queen Street Horwich Boltob BL6 5QU Lead Inspector Mike Murphy Unannounced 21 September 2005 st 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 CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service St Catherines Address Queen Street Horwich Bolton BL6 5QU 01204 668744 01204 668727 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) Tameng Care Limited Mrs Christine Mellor CRH N Care Home with Nursing 61 Category(ies) of OP Older Person - 31 registration, with number DE(E) Dementia over 65 - 29 of places DE Dementia - 1 St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Within the maximum registered number of 61, there can be: Up to 29 service users in the category of DE(E) (Dementia over 65 years of age) One named service user in the category DE (Dementia under 65 years of age) Up to 31 service users in the category OP (Old age not falling within any other category) Within these numbers Nursing care can be provided for up to 14 service users The registration to revert to the original respective categories should the named service user leave the home. The service should employ a suitably qualified and experienced Manager who is registered by the Commission for Social Care Inspection. Date of last inspection 24th November 2005 Brief Description of the Service: St. Catherines is a purpose built Home with accommodation on the ground and first floors. The home is situated within walking distance of Horwich Town Centre. Car parking is provided to the front of the home and garden space is provided to the sides and rear.The home is registered to provide accommodation to 61 residents and offers nursing and personal care services. However, because the two double rooms are now used only as single rooms, the maximum number of services users at any one time is reduced to 60. There is a dedicated dementia care unit.All rooms are for single occupancy; one room has en-suite facilities. St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the home’s first of two annual inspections for the inspection year 2005 to 2006. The inspection took place over seven hours. The inspector spoke to 16 of the 57 residents and 8 relatives, toured the premises, and inspected care and other records maintained at the home. The standards inspected included those concerned with health and personal care, the environment, meals provided by the home, how complaints are dealt with, staffing levels, and how residents safety is protected. The home continues to be well managed and is generally well maintained. However a number of issues were identified that included the environment/equipment and staffing. These are individually addressed within the body of this report. What the service does well: What has improved since the last inspection? What they could do better: There have been issues surrounding changes in the staffing levels within the home for a few weeks prior to this inspection. Although these issues have been addressed there remains a high level of anxiety in residents, their relatives and St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 6 staff that these issues may arise again in the near future. Clearly as senior management undertake reviews in this area residents and relatives must be communicated with clearly and their views sought as part of the review process. Ventilation and floor covering issues were identified within the EMI unit and the residential unit is in need of another WC. Management at the home have identified the need to update the nurse call bell system within the home. 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 CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,4,5. Standard 6 does not apply to this service. Prospective residents were being appropriately assessed prior to admission. This is essential to ensure that the home is able to meet the needs of such prospective residents and assist them in choosing if the home is suitable for them. EVIDENCE: Inspection of 8 residents care records revealed that a pre admission assessment had been conducted on all 8. These assessments included consideration of prospective residents physical, psychological and social needs. These assessments were supplemented by others conducted by various health and social care professionals such as doctors, nurses and social workers. Discussion with 4 residents revealed that they had been able to come to the home for trial visits prior to their admission – and that these are actively encouraged by the home. They felt this was most useful because it made them more in control of their own lives as well as enabling them to make an informed choice regarding their future. Further discussion with residents also St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 9 indicated that the home was meeting their needs appropriately. Comments were made by residents such ‘ they understand what needs to be done to help me’, ‘I know I am in the right place because I have got much better’. A number of residents were concerned that a recent drop in staffing levels had impacted on the quality of the care/service they received – however since this issue has been addressed by the home they are of the view that these issues have been resolved satisfactorily. A number of resident’s relatives also expressed the view that the home was now appropriately meeting the needs of their family member – relatives expressed concerns over the recent changes to staffing levels within the home that is referred to above, but were satisfied the issues have been addressed. St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10. The health and personal care needs of residents at the home were being assessed and addressed appropriately. The arrangements for the management of resident’s medicines were appropriate and staff interacted and assisted residents sensitively and appropriately during the inspection. Clearly these are important factors in ensuring residents receive appropriate care and treatment. EVIDENCE: The health care records of 8 residents who live at the home were inspected on this occasion ( 3 general nursing, 3 EMI and 2 residential). These were found to contain care plans that were initially based on the pre-admission assessment that is referred to earlier in this report. Care plans addressed the health, personal and social care needs of residents and were formally evaluated at least monthly. Risk assessments, that seek to protect resident’s health and safety were also recorded in respect of residents skin integrity, mobility, and nutrition (including weight monitoring) and other relevant areas and were also evaluated at least monthly. The arrangements for resident’s medicines were secure and appropriately documented. These arrangements St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 11 are operated by the nursing and – in the case of ‘residential’ residents – senior care staff at the home all of who have undergone training in the management and administration of medicines. The inspector was informed that the supplying pharmacy is appropriately licensed to remove medication that is no longer required in the home. Discussion with residents indicated that staff at the home treat them with respect and seek to maintain resident’s dignity and privacy particularly when personal care is being provided. Examples of such comments are ‘ the staff are very nice to me’, ‘nothing is too much trouble’, ‘ I can go to in my room when I want to’, ‘ and my family are free to visit me at any reasonable time’. Residents also indicated in their comments, and this was supported in discussion with staff and inspection of care records, that they are able to access health care services appropriately, this included access to opticians, dentists, and chiropodists. Clearly this assists residents in maximising their health and well being. All residents were registered with a local GP. St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,15. The home continues to provide a high standard of recreational and leisure activities for residents in a way that actively encourages the participation of relatives and others. Meals provided a balanced and varied diet. These are important area for residents as the activities and meals provided are central components of how they describe their satisfaction or otherwise with a home. EVIDENCE: Residents report that the routines of daily life are as flexible as is reasonable in a communal living setting. An activities co-ordinator is employed by the home. A programme of activities, events, and outings was prominently displayed in the home. This programme was varied and designed to meet the requirements of all groups of residents within the home. The home is able to access a minibus for outings – which occur on a regular basis. Numerous activities and outings had been planned for the Christmas and New Year period and beyond. It is noted that the families and friends of residents as well as staff employed at the home participate in and support these activities. Resident’s spoke positively in respect of the meals provided for them by the home. Staff served and assisted residents appropriately and sensitively with their lunch during this inspection. St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 13 Menus were varied, balanced and provided choice. Meal times were reasonable and as flexible as possible in a communal living setting. Medical dietary needs were catered for. Where particular problems are encountered the assistance of the community dietician is sought. Residents spoke very positively in respect of the food provided, flexibility of meal times, choice of meals and dining areas provided. Comments made included ‘ the food is excellent here’, ‘I can have something else to eat if I wish’. The kitchen was not inspected on this occasion. St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18. Appropriate steps have been taken to provide an environment where residents and their supporters feel comfortable with making a complaint if necessary, and to prevent residents becoming victims of abuse. These are important areas that are crucial to the protection of resident’s in a care home, many of whom are extremely vulnerable. EVIDENCE: Discussion with residents and their relatives indicated that there was a general awareness and information provided that enabled people to make a complaint if they desired. A detailed and accessible complaints procedure was in place and prominently displayed in the home, which included details of how complainants could contact the CSCI if desired. Resident’s spoken to felt comfortable and confident enough to raise a complaint if they felt it necessary to do so. Inspection of policies and procedures operated at the home, discussion with staff and inspection of staff training records indicated that staff were aware of the importance of protecting resident’s from potential abuse and how to communicate any concerns they may have in this area. St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,22,24,25,26. There have been significant improvements in the communal and private accommodation provided for service users throughout the home. An ongoing programme of redecoration and refurbishment was in operation. However a couple of environmental issues were identified during the inspection. EVIDENCE: An ongoing programme of refurbishment and redecoration was in operation at the time of this inspection. All areas of the home designated for resident’s use were accessible to them. Adequate and suitable WC and bathing provision was accessible to service users on the general nursing and EMI units. However on the ground floor residential unit the changing needs of residents on this unit has identified the need to provide another toilet. The inspector was informed this issue is being addressed. A total of 15 resident’s bedrooms were inspected, on the general nursing, EMI and residential unit, on this occasion – these were clean, St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 16 appropriately/adequately furnished and very personalised. Communal lounges and dining areas were clean, warm and appropriately furnished. However the floor covering in the EMI conservatory lounge area is badly marked and has sustained numerous cigarette burns. Appropriate aids and adaptations were in place throughout the home that assists residents to maintain their safety and meet their physical needs. A nurse call system is in place for residents/staff to summon assistance. The inspector was informed that there are plans to update the existing system. Individual aids and adaptations are provided following referral to the appropriate health care professional. The home was clean and free of odour at the time of this unannounced inspection and the home was generally well ventilated – apart from the office on the EMI unit where the mechanical ventilation fan was not working. Resident’s who were able to express a view spoke positively in respect of the home’s environment stating that it was kept generally very clean, was warm, and comfortable to live in. They felt comfortable about personalising their bedrooms and indeed said staff encouraged and helped them to do so. Clearly this enables residents to live in as homely environment as possible. St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 Staffing provision at the home has been an important issue in recent weeks prior to this inspection. Whilst those concerns have been addressed residents, their relatives and staff continue to express their concerns that the staffing provision may again change. EVIDENCE: The general nursing/residential units staffing arrangements were meeting the assessed needs of residents with staffing levels having been returned to the levels in operation prior to the senior management review of staffing at the home. The staffing arrangements on the EMI unit appear to be meeting the assessed needs of residents, although lengthy discussions with staff indicate that there are tensions between staff groups on this unit which are in need of addressing. This unit would benefit from the appointment of a unit manager with a psychiatric nursing qualification who can provide full time leadership and support. The inspector was informed that attempts have been made to recruit such a unit manager. It is noted that there was no RMN employed on the EMI unit at the time of this inspection. However it is acknowledged that the general nursing staff employed on the EMI unit were enabling service users to access the support and advice of community mental health services. The inspector was informed by a senior manager of the company who operate the home that a detailed review of residents dependency levels and staffing provision within the home was being undertaken and that this review would include seeking the views of all interested parties – particularly residents and their supporters. St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 18 Inspection of 2 recently employed staff personnel files revealed that these contained an application form (including health declaration), 2 written references, a Criminal Records Bureau check (including a ‘POVA first’ check), proof of identity and evidence of induction training. Inspection of training records demonstrated that staff at the home were provided with appropriate training in care and related issues – including NVQ training. St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) 31,33,35,37,38. The home continues to be appropriately managed. This is important as residents need to have confidence in and access to competent managers. EVIDENCE: The current registered manager is a very experienced registered nurse manager and has completed an NVQ4 in management. Discussions with residents within the home, their relatives, and staff employed at the home indicated that the registered manager has developed a management style that is open, supportive, positive and inclusive. The arrangements for the management of resident’s personal allowances – where these are managed by the home – were secure and appropriately documented and audited. St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 20 The following certificates of inspection/service records were found to be satisfactory on this occasion; electrical systems/equipment, fire fighting equipment – including the fire alarm system and fire safety log, lifting equipment, gas safety, accident records/monitoring, monitoring of hot water temperatures, general and specific health and safety risk assessments, and control of clinical waste disposal. Records in the home were stored appropriately and staff are trained in the importance of confidentiality. St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 2 2 3 x 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x 3 x 3 3 St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 22 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 22 Regulation 13 Requirement That an action plan is submitted to the CSCI that details the proposals for updating the existing nurse call system within the home. That the CSCI is informed of the proposed date to install another WC in the residential unit on the ground floor of the home That the mechanical ventilation in the EMI unit office is repaired. That the floor covering in the EMI conservatory lounge area is replaced That an action plan detailing how it is proposed to recruit a suitable unit manager fro the EMI unit is submitted to the CSCI That the CSCI is informed in writing of the outcome of the forthcoming resident dependency level/staffing review particularly those outcomes that relate to any proposed changes in staffing levels within the home Timescale for action 31st of October 2005. 31st of October 2005 31st of October 2005 31st of December 2005 31st of October 2005 when review has been completed 2. 21 23 3. 4. 5. 25 20 27 23 16 18 6. 27 18 St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Turton Suite, Paragon Business Park Chorley New Road Horwich Bolton, BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St CATHERINES F56 F06 S5697 St Catherines V230634 210905 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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