Inspection on 23/01/07 for St Catherine`s Nursing Home

This inspection was carried out on 23rd January 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Catherine`s Nursing Home 06/08/08

St Catherine`s Nursing Home 02/04/08

St Catherine`s Nursing Home 10/12/07

St Catherine`s Nursing Home 08/06/07

St Catherine`s Nursing Home 28/06/06

St Catherine`s Nursing Home 08/03/06

St Catherine`s Nursing Home 21/09/05

St Catherine`s Nursing Home 24/11/04

St Catherine`s Nursing Home 13/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St Catherine`s Nursing Home Queen Street Horwich Bolton Lancashire BL6 5QU Lead Inspector Grace Tarney Unannounced Inspection 23rd January 2007 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 Nursing Home DS0000005697.V309075.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 Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Catherine`s Nursing Home Address Queen Street Horwich Bolton Lancashire BL6 5QU 01204 668744 01204 668727 st.catherines@fshc.co.uk 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) Tameng Care Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Christine Isabel Clarke Care Home 61 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30), of places Physical disability (1) St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 61 service users to include:Up to 30 service users in the category of DE(E) (Dementia over 65 years of age) Up to 30 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 30 service users One named service user in the category PD (Physical Disability) The registration to revert to the original respective categories should the named service user leave the home. 28th June 2006 2. Date of last inspection 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 and the local shops. It is close to a main bus route and not too far from the motorway network. 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. This unit has its’ own lounges and dining room. The bedrooms on the first floor are for the nursing and residential residents and are reached either by stairs or a passenger lift. There is a lounge and dining room on the first floor and a lounge and dining room on the ground floor which is for the residential residents. Most of the toilets and bathrooms have aids to assist any resident with a disability or mobility problem. St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home was not told that this inspection was to take place although the home was aware that an inspection was due. This was because several weeks before the inspection questionnaires (comment cards) were sent out to the residents, their relatives and to the home itself. These comment cards asked what people thought of the quality of the service and the facilities provided. 10 comment cards were returned, 5 from residents and 5 from relatives. Two Inspectors visited the home and were there for 9 1/2 hours. They looked at care and medicine records to ensure that the health and care needs of the residents were being met. They also looked at how many staff were provided on each shift to make sure the residents needs were being met, and also looked at how management recruit their staff. To make sure that the home and the equipment in it was safe one of the Inspectors looked at the maintenance and service records of the equipment within the home. The Inspectors then looked around the building at the bedrooms, bathrooms toilets and sitting areas to check if they were clean and well decorated. They then visited residents in their own bedrooms and lounge areas. The Inspectors also looked at the food stocks and what the residents were having for their lunch and evening meal. In order to get further information about the home the Inspectors also spent time speaking to 3 residents, 4 relatives, the deputy manager,2 qualified nurses, 9 care assistants, the cook & kitchen assistant and the activities organiser. A copy of the last inspection report is kept in the administrators’ office and the managers’ office. The Service User Guide informs that residents/relatives can request a copy from the manager The provider informed the inspector that the fees within the home ranged from £380.01 to £339.74 per week for those residents funded by local authorities and £390.00 to £445.00 for private residents who pay for their own care This information was received on the 29th of November 2006. What the service does well: Before residents went into the home one of the senior nurses visited them in their own homes or in hospital to make sure that the care they needed could be provided by the home. People visiting the home are made welcome and can visit at any time. The staff teams work well together and good systems are in place for sharing information about residents. St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6. Quality in this outcome area is good. Residents have a detailed assessment undertaken before their admission to the home and this gives an assurance both to residents, relatives and staff, that a resident is only admitted if the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Inspection of 2 resident care files showed that assessments had been undertaken prior to admission. Before any resident was admitted to the home a senior member of the staff from the home undertook an assessment of their needs. Assessments undertaken by other professionals requesting a residents’ admission i.e. care manager/social worker were also in place. These were kept with the care plans. The pre-admission assessment document used however, did not have information about foot care and history of falls. The actual form that is used once a person has been admitted to the home does include these details. The Inspector was shown a document that has recently been introduced by the company. This is the Dependency Assessment Rating Tool. This is very St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 9 detailed and covers all the areas required by the Standard. The form states that it should be used for both the pre-admission assessment and assessments following admission. Standard 6 does not apply. The home does not provide Intermediate Care. St Catherine`s Nursing Home DS0000005697.V309075.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 poor. The care plans reflect the support needs of the residents but some of the care practices compromise their privacy and dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Individual care plans were in place for each resident. Each care plan had a photograph of the resident attached. The care files of 5 of the residents were inspected, 3 on the dementia unit and 2 on the nursing unit. The care plans gave some information and instruction and guidance on how some of the care needs of the residents were to be met when problems had been identified but did not give enough detail about what a resident could do. The care plans were “problem orientated”. The staff looked at whether or not there was any risk in relation to the residents developing pressure sores and also if they were at risk due to problems with their diet and fluid intake. These are called risk assessments. They also assessed if it was safe to use bed rails and looked at any other general safety risks. St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 11 They also looked at and they wrote down, how the residents were to be assisted with being moved around and by how many members of staff and what equipment, if any, was to be used to assist in safe moving and handling. Staff were regularly looking at any changes in the residents’ conditions and were writing down when they had assessed it. This is called an evaluation of the care being provided. In some of the care plans there was no evidence to show that either the residents’ families or representatives were involved in the drawing up of the care plan. To ensure that an accurate and agreed care plan is in place they should be involved. The care plan of one resident on the nursing unit showed that she had been admitted to the home with pressure sores. A good plan of care was in place for the treatment of the sores and for prevention of further pressure sores, however the size and grade of the pressure sores was not always documented. Measuring and grading pressure sores makes it easier to identify if there has been an improvement or deterioration in their condition. From the care plans inspected it was seen that the residents were weighed at least on a monthly basis. Some residents were being weighed more often, on a weekly basis, but the care plans looked at did not document how often the residents were to be weighed. Staff were recording the residents’ weights into a book, however the weights from the weight book were not always being transferred into the residents care plan. 1 resident, due to his medical condition, could not be weighed. Inspection of his weight chart showed that staff had put down his approximate weight. This should not be done, as it could be misleading. When a resident was identified as losing weight the staff did put in place a care plan to try to address the problem. 1 resident had been referred to a dietician Inspection of the care files identified that the residents had access to health care professionals, such as dentists, opticians, chiropodists and district nurses. Equipment necessary for the prevention and treatment of pressure sores was readily available within the home. 1 resident had been assessed in November 2006 as needing a special type of bed but this had still not been made available. Of the 5 comment cards received from residents 3 said that they always received the medical support that they needed and 2 said that they usually did. A relative made the following comment in the survey comment cards: “I am very happy with the care my husband gets”, Visiting relatives told the Inspectors “I’m quite happy’” “Can’t fault them” “I am quite happy with the home”. The medication systems for all 3 units were inspected during this visit. Overall a safe system of medication management was in place. St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 12 The home has a designated locked medicine room that is situated on the ground floor and this room is used by all the units of the home for storage of stock medications and clinical equipment. The medicine trolleys were securely stored in the medicine room and controlled drugs were stored correctly and safely. A new drugs fridge was in place and the temperature was being recorded on at least a daily basis. Some issues were identified in relation to the following: Two lots of Temazepam had been dispensed, 1 in December 2006 (in a bottle) and 1in January 2007 (in a sheath). Staff were using the tablets dispensed in January first instead of using those dispensed in December. It was difficult to know if the tablet bottle from December had been opened and if staff were actually checking the number of tablets in it, as they should be. Staff told the Inspector that they did not have a tablet counter. To make sure that tablets are counted correctly management should consider getting one. Dementia unit. Handwritten instructions for medicines (Transcriptions) were not always signed, checked and countersigned. Signing and checking transcriptions reduces the risk of drug errors. Residential unit. The times that medications were to be given had been changed on 2 of the medication administration sheets (MAR) seen. The prescription sheets stated they were to be given in the morning but the staff were giving them at 9 p.m. There was no evidence to show why they had been changed and by whom. Staff must not change a prescription. They must refer the issue back to the prescribing GP. Handwritten instructions for medicines (Transcriptions) were not always signed, checked and countersigned. Signing and checking transcriptions reduces the risk of drug errors. The majority of the bathroom/toilet doors on the dementia unit were either without an overriding door lock or the lock was broken. The disabled toilet on the nursing unit also had a broken lock. Having toilet/bathroom doors that do not lock compromises the privacy and the dignity of the residents. On the dementia unit the Inspectors saw that at least six of the residents were not wearing any stockings. Their legs were bare. The staff spoken to on the unit agreed with the inspectors that this wasnt dignified but they said that it was a problem trying to get stockings for the residents. All the residents on the dementia unit were given plastic cups for their hot and cold drinks. Staff told the Inspectors that this was because some of the residents threw their cups about. The Inspectors saw no evidence of this during their visit. Some of the residents were sitting very quietly and managed to eat their meal without any assistance. If plastic cups must be used then this should be on an individual needs basis. St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 13 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 poor. The residents do not receive a nutritious and well-balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents’ routines of daily living and their social interests were recorded in their care plans. An activities co-ordinator is employed to provide activities for each of the units. An activity chart is displayed within the reception area. Activities such as singa-long, darts, pub lunch, parties and games are provided between the hours of 2pm and 4pm each afternoon. However the chart showed that the staff would provide a number of the activities. Staff on the dementia unit told to the inspectors that, although activities are displayed they do not always take place. The hobby therapist spends more time on the other units or undertaking other tasks within the home. Due to the staffing ratios on the dementia unit it is almost impossible for staff to carry out activities, therefore little is provided. Records are made for each individual to show what they have been actively involved in. Some of the comments were, ‘enjoyed it’ and made her/his day’ whilst other entries were ‘no interest’ and ‘not in the mood’. Whilst this may be the case perhaps they need to consider alternative options. St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 14 The home has also recently had access to the mini bus, which is owned by the organisation. This was to be used for a two-week period for day trips etc, however it was found that it did not have a valid MOT certificate therefore could not be used. Of the 5 resident comment cards returned in answer to the question: Are there activities arranged by the home that you can take part in? 3 said “sometimes” 1 said “usually” and 1 said only at party times. The positioning of the residential lounge and dining room gave the residents little freedom of choice as to where they spent the day. Their bedrooms are situated on the first floor and they are all brought down to the lounge area in the morning and taken back in the evening. Once in the lounge there was limited space for them to walk around. The lounge area was very cramped. The corridor from this lounge leads to working areas of the home such as the kitchen, laundry and staff rooms. Residents told the Inspector that they are able to have visitors at any reasonable time and they can see their visitors in private. Visiting relatives confirmed this. One relative told the inspectors “No problems visiting. I can stop as long as I want”. Staff told the inspectors that the residents are encouraged to bring personal possessions into the home. Some of their bedrooms were personalised with small pieces of their own furniture, pictures, photographs and ornaments etc. The majority of bedrooms on the dementia unit however were very sparse. The inspectors did not dine with the residents but watched breakfast and lunch being served on the dementia unit. A list was displayed on the wall. It identified residents who had a puréed diet and residents who had a soft diet. The Inspector asked the staff to remove it as it openly identified the needs of the residents. Staff were advised to keep it more discreet by perhaps putting it inside a folder. The daily menu was displayed but the four-week menu was not available to look at. The Inspector requested that the home send copies of the four-week menus to her, which they did, so that she could look at the contents. Throughout the four weeks it was seen that home-made soup was on the menu every lunchtime plus a light snack of sandwiches, or sausage rolls, cheese on toast, fish fingers or similar. The Inspector was told that those residents requiring a soft or pureed diet had home-made soup at lunchtime. There was no soft diet alternative available. The residents have a cooked breakfast every day, a lighter meal at lunchtime and the main meal in the evening. The food was brought to the unit in a heated trolley. For breakfast the residents were having cereal/porridge, scrambled or poached egg on toast, tinned tomatoes and tea or coffee. The lunchtime menu for those residents requiring a soft diet was home-made soup. Residents who did not need a soft diet were given soup and cheese or beans on toast. The residents just having soup were being offered bread. For dessert all the residents were given mandarin jelly and evaporated milk. St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 15 The menu for the evening meal was a choice of chilli or savoury mince, served with chips, mashed potato, broccoli and carrots. This food served on the day of inspection did not correspond with what was on the menu. It is written on the menu that for most of the evening meals 2 fresh vegetables are available. The inspectors were told that fresh vegetables are not bought into the home; all the vegetables are frozen or tinned. Dessert was cherry cake, bananas, yogurt, jelly and fruit and cream. As previously stated in this report, all the residents on the dementia unit were given plastic cups for their hot and cold drinks. Staff told the Inspectors that this was because some of the residents threw their cups about. The Inspectors saw no evidence of this during their visit. Also paper plates were used as side plates for the bread. Drinks were being served regularly, juice was available on the tables and hot drinks were also served during throughout the day. The Inspectors visited the kitchen at tea-time and observed the kitchen staff plating up the meals for the nursing unit. Each meal had the same amount of food and gravy on and it was evident that residents were not given a choice in relation to the content and amount of food being served to them. When asked why the food could not be served in a heated trolley and dished up on the unit the Inspectors were told that this is how theyve always done it. This practice was seen during the last inspection. The kitchen staff on duty gave the inspectors the following information: Fresh meat is delivered to 2/3 times per week. Fresh salad, potatoes and fruit are provided but none of the vegetables are fresh. All vegetables are frozen. There were sufficient food stocks in place. Fresh full cream milk is provided. There were items of food in the fridge that were left uncovered. Open items in the fridge need to be covered and dated. Of the 5 resident comment cards returned, in reference to the question of: Do you like the meals at the home? 2 said “usually” and 1 said “sometimes” 1 said “never”. 1 comment was “ I think he does, he is a good eater”. Another comment was “ Teeth have been lost in the home so can only eat pap”. St Catherine`s Nursing Home DS0000005697.V309075.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 & 18. Quality in this outcome area is good. The complaint system in place enables residents to feel that their views are listened to and acted upon. Staff have a good knowledge and understanding of what abuse is, thereby reducing the possible risk of harm or abuse to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints procedure was in place and was displayed in the reception area. It was easy to understand and gave an assurance that complaints would be responded to within 28 days. A discussion with residents and relatives indicated that there was a general awareness of how to make a complaint. In answer to the question on the comment card “Do you know how to make a complaint”? 4 said “usually” and 1 said “always”. In answer to the question “Do you know who to speak to if youre not happy? “2 said always and 3 said “usually”. A policy and procedure was in place in relation to the detection of abuse and neglect (including whistle-blowing) and how to respond to suspected abuse. Staff continue to receive training in abuse awareness. Training records were kept in their personnel file. St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 17 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 20 21 24 25 &26. Quality in this outcome area is poor The residents are living in an environment that is not adequately heated, is unhygienic and in parts is in need of redecoration and refurbishment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Inspectors visited each unit, walked around most of the building and looked at several bedrooms, the lounges, the dining rooms, corridors and the laundry. Dementia unit The residents have the use of any of the 2 lounges, a conservatory and the large dining room. Grab rails to aid mobility are in place along the corridor walls. New wooden /laminate flooring had been fitted to the corridors and dining room. This made the unit look much brighter and staff said that it was easier to keep clean. Staff told the inspectors that they were awaiting pictures for the corridor walls so that the unit will look more homely and personalised. St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 18 The conservatory/lounge had no blinds or curtains to the windows. These windows were dirty and marked. The conservatory leads onto a nice patio/seating area and enclosed garden. The door handle to the adjoining lounge area was marked with faeces and the closing devise was broken. The smaller lounge had an assortment of mismatched furniture, stained carpets particularly towards the outside door and no curtains to the windows. There were enough toilets and bathrooms to meet the needs of the residents. Toilets were within close proximity of communal spaces and had aids to assist access and mobility. The majority of the bathroom/toilet doors were either without an overriding door lock or the lock was broken. The locks were not working on the following: The toilet no 77,98, 88, & 76. The toilet/bathroom near room 43 was not identified as such. The decor in the bathroom near room 43 and toilet 98 was poor. The flooring in toilet 76 was very stained and the bathroom near room 43 smelt very badly of urine. The majority of the bathrooms/toilets felt very cold. The Inspectors took the room temperature of the bathroom near room 43. This read 15 degrees C. The room temperatures should be a minimum of 21degrees C to provide adequate warmth. Several of the bedrooms smelt strongly of urine and had soiled carpets and dirty mirrors and windows. Walls and doors were soiled with dirt and faeces, windows were scratched, unwashed and had cobwebs. Most were in need of decorating and old furniture without a lockable space was in use. 7 bedrooms had new furniture that housed a lockable space. The bedside lamps were not working in 5 of the bedrooms. None of the beds had valance sheets on, although staff said that they were available. The bedding provided was mismatched and of a poor quality, some items were frayed or had holes in them. Some beds were provided with little covering i.e: thin blankets or duvets and had been poorly made. Several of the bedrooms were very cold and the room temperatures tested, ranged from 15 degrees C to 18 degrees C. The residents’ moving and handling support needs were displayed within the rooms and 2 rooms had broken drawers. Labels had also been placed on the out side of drawers stating where items were kept. This gave the rooms an institutionalised look. The windows had been fitted with restrainers and the doors had over-ride safety locks. Some of the rooms had been personalised however others were very sparse. Responses from the comment cards were: “ The EMI unit always smells unpleasant although it didnt when I went to view it originally” St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 19 “I would like to comment about the strong odour in the EMI unit and sometimes in the foyer” Nursing Unit The nursing unit is on the first floor, as are the residential bedrooms. The residents have the use of a lounge and dining room on this floor. The lounge was clean and warm with an assortment of comfortable chairs and footstools. Residential and Nursing Unit The 1st floor unit has 2 bathrooms and 1 shower room. One of the baths is not used. These facilities are available for both the nursing and residential residents. They had aids to assist access and mobility. The lock was not working on the disabled toilet door, the toilet seat in the toilet opposite room 31 was loose and the bath panel in bathroom 90 was chipped and splintered. The flooring in the shower room was badly marked. Hand-washing facilities and clinical waste bins were available in each of the toilet/bathing areas. Not all bedrooms were looked at on the nursing and residential unit. A random number were looked at, and the following was found: Room 6 had been completely refurbished with new carpet, décor and furniture. The room was clean and very pleasant. The Deputy Manager told the Inspectors that this was the standard that they were planning for each of the rooms throughout the home. Of those looked at several had soiled carpets, were in need of redecoration, old furniture without a lockable space and the beds were without a valance sheet. New furniture was seen in 3 of the bedrooms inspected. The bedside lamps were not working in 2 of the bedrooms. Residential Unit The residential beds are situated on the first floor but their lounge and dining room are on the ground floor. The lounge area is a conservatory and leading off this is the dining room. The conservatory was very cramped. There was very little space between the chairs for moving around. Some of the residents had high care needs, one requiring the use of the hoist. The curtains were coming off the rails in parts. The TV and the stereo were on at the same time in the same room. Residents are brought down each morning, returning after their evening meal. This provides no opportunity for the residents to do what they may choose. The staff member spoken with said that if a resident wanted to stay in their room, then they would do ½ hourly checks and some support would be offered by the nursing staff available on the 1st floor. Two assisted toilets were available close to the dining room and conservatory, one was identified as a toilet but the other was not. The heating on the dementia unit was not adequate. The unit is heated by over-head panels. They did not provide sufficient heating to keep the rooms at St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 20 an acceptable temperature. Whilst some panels were switched on others were not. Several of the bedrooms and bathrooms/toilets were very cold and the room temperatures tested, ranged from 15 degrees C to 18 degrees C. Staff commented that some areas of the building were usually warm, whilst other were colder. The laundry was clean and looked organised. Adequate equipment was in place and protective clothing was available. Staff hand washing facilities were in place in the residents’ bedrooms, bathrooms and toilets on the nursing and residential unit but the majority of the soap dispensers in place on the dementia unit had no soap in them. Also several of the toilets and bathrooms did not have a clinical waste bin. St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is adequate The residents are being cared for by experienced and caring staff however their needs are not always being met because the staffing levels provided are the absolute minimum. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing was looked at on each of the units. The following was noted: Dementia Unit Examination of the duty rotas and a discussion with staff showed that the unit was working on absolute minimum staffing levels. The unit now operates with only 1 qualified nurse between the hours of 8 a.m. to 8 p.m. During the last inspection the unit was operating on 2 qualified nurses between the hours of 8 a.m. to 2 p.m. and 1 qualified nurse between the hours of 2 p.m. to 8 p.m. Staff told the Inspector that they had been told that it had been a senior management decision to cut the number of qualified nurse hours. Between the hours of 8am to 8pm the Inspectors were told that the nurse on the unit was supposed to be supported by 6 care assistants. An inspection of the duty rotas showed however that this varied greatly and at times the unit was working on 3,4 or 5 carers only. There had also been quite a lot of the shifts covered by agency carers. During the night time hours of 8p.m. to 8am the unit operates on 1 qualified nurse and 2 care assistants. St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 22 The home has recently recruited a designated unit manager who is a Registered Mental Nurse. Feedback from staff on the unit was that times it was difficult to meet the needs of residents due to the staffing levels. Comments such as “We have been told not to use agency”, “It’s been hard work”, “We’ve been working below number and morale has been low” were made to the Inspectors. The Inspectors saw that the staff were doing their best to meet the residents’ needs. They were busy throughout the day. What was noted on the Dementia unit was the atmosphere during meal times. Once everyone was seated and had been served, staff sat with residents so that support and encouragement could be offered. Residents appeared very calm and settled and obviously enjoyed the interaction. Once the meal time had finished and staff were supporting individual needs or doing other tasks on the unit, the behaviour of the residents changed. They became a lot noisier and were wandering around the unit. Domestic hours provided on the Dementia unit were 8am till 3pm over 7 days. To ensure that the unit is kept clean at all times more domestic hours should be provided. Staff also said that more domestic support would help during late afternoons and early evenings after the meals have been served. This would help to keep the communal areas tidy and the bathrooms and toilets clean. Nursing Unit Examination of the duty rota & visual observation showed that the unit was operating with minimum staffing levels. For the 16 residents on the unit there was 1 qualified nurse and 2 care assistants. There were 2 residents who were artificially fed, 2 residents with pressure sores that needed regular dressings and from observation 4 residents cared for in bed. The Inspector did not look at the documented needs of the residents who were sat in the lounge but it was clear that they were highly dependent. During the night-time hours of 8pm to 8am the unit operates on 1 qualified nurse and 2 care assistants. Residential unit Examination of the duty rotas and a discussion with staff showed that the unit operates on 3 care staff between the hours of 8am- 8pm and 2 care staff between 8pm and 8am for the 14 residents. The Inspector did not look at the documented needs of the residents who were sat in the conservatory but it was clear that they were highly dependent and several needed assistance with moving and handling and with eating their meals. Of the 5 resident comment cards returned in answer to the question: “Are the staff available when you need them?” 3 said usually and 2 said always. Of the 5 relative comment cards received comments such as “The staff are excellent but there is not enough of them”. “The staff are very caring and welcoming but they are often understaffed and unable to give the amount of time and supervision to the residents”. “Recently the staffing levels have been low”. St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 23 Information from the pre-inspection questionnaire showed that of the 30 care staff employed, 10 have obtained their NVQ level 2 or above in care. This is a percentage of 33 . 3 of the staff are presently undertaking NVQ level 3. The personnel files of 3 staff members were inspected. 2 of the staff had been properly and safely employed. They had a completed application form, 2 professional references, an enhanced criminal records disclosure (CRB) check and a health status declaration 1 staff member however had no application form and no written references in her file. Inspection of the same 3 personnel files showed that the staff received induction training within six weeks of appointment to their post and further training within the first six months of appointment. The induction and foundation training was in accordance with the National Training Organisation (NTO) specifications. St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 24 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 & 38. Quality in this outcome area is adequate. Equipment and services within the home are kept safe, however some current practices do not promote and safeguard the health, safety and welfare of the people using the service This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has extensive experience within the National Health Service and has worked within the private sector since 1998. She is a Registered General Nurse (RGN) and Registered Midwife (RM.). During the last inspection of June 2006 the Inspector was told that the manager had not yet enrolled for the Registered Managers Award. The preinspection questionnaire showed that the manager was now undertaking this training. The inspectors were not able to find out any more information due to the managers present absence from the home. St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 25 The inspectors were not able to check out Standard 33 in relation to quality assurance or Standard 35 in relation to residents’ finances. This was because management were not available and therefore the documents could not be accessed. These were however, met on the last inspection in June 2006. The home had a detailed Health & Safety Policy. Regular weekly checking and testing of fire detection system, fire exits and emergency lights was undertaken and documented. The Inspector was informed that the company provide centralised fire training Information received from the pre-inspection questionnaire showed that the equipment and services within the home were serviced on a regular basis in accordance with the individual requirements. One of the Inspectors randomly checked several certificates and found that those services and equipment selected had been serviced on a regular basis. As previously stated in this report several shortfalls in relation to health and safety matters were identified. These were: Staff and resident hand washing facilities were not available in all parts of the dementia unit. The majority of the soap dispensers in place had no soap in them. To prevent the spread of infection hand washing facilities such as liquid soap and paper towels must be in place. Also several of the toilets and bathrooms did not have a clinical waste bin. St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 26 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 3 8 2 9 2 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 1 2 1 x x 2 1 1 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x x x x x x 2 St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Timescale for action Unless it is impracticable to carry 30/04/07 out such consultation, the registered person shall after consultation with the service user or a representative of his prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. Dementia Unit. There must be evidence of relative/representative involvement in the drawing up of the care plan. The registered person shall 28/02/07 having regard to the number and needs of the service users ensure that suitable adaptations are made and such support equipment and facilities as may be required are provided. Dementia Unit. The profiling bed must be provided for the resident who was assessed as being in need of one. The registered person shall make 23/01/07 arrangements for the recording, handling, safekeeping, safe DS0000005697.V309075.R01.S.doc Version 5.2 Page 28 Requirement 2 OP8 23(2)(n) 3 OP9 13(2) St Catherine`s Nursing Home administration and disposal of medicines received into the care home. Dementia Unit. Staff must not change a prescription. They must refer the issue back to the prescribing GP. 4 OP10 12(4)(a) The registered person shall make 31/03/07 suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. Nursing and Dementia units. Overriding safety locks must be fitted to all bathroom and toilet doors. The registered person shall 28/02/07 having regard to the size of the care home and the number and needs of service users provide in adequate quantities suitable wholesome and nutritious food which is varied. Nursing Dementia and Residential units. Adequate food must be provided for all residents and residents must be given a choice in relation to the content and amount of food provided. Special dietary needs must be catered for. The registered person shall 28/02/07 having regard to the number and needs of the service users ensure that all parts of the care home are kept clean and reasonably decorated. The registered person shall 31/03/07 having regard to the number and needs of the service users ensure that there are provided at appropriate places in the premises sufficient numbers of DS0000005697.V309075.R01.S.doc Version 5.2 Page 29 5 OP15 16(i) 6 OP19 23(2)(d) 7 OP21 23(2)(j) St Catherine`s Nursing Home lavatories and of wash basins, baths and showers fitted with a hot and cold water supply. Nursing and Residential units The badly marked bath must be refurbished or replaced. An action plan must be forwarded to the CSCI 8 OP24 23(2)(m) The registered person shall 31/03/07 having regard to the number and needs of the service users ensure that suitable storage facilities are provided for the use of service users. Nursing, Dementia & Residential Units A lockable space must be provided in all bedrooms. An action plan must be forwarded to the CSCI The registered person shall having regard to the size of the care home and the number and needs of service users provide in rooms occupied by service users adequate furniture and bedding. Nursing, Dementia & Residential Units Adequate bed linen must be provided. An action plan must be forwarded to the CSCI informing when the mismatched furniture in the bedrooms is to be replaced. 31/03/07 9 OP24 16(2)(c) 10 OP25 23(2)(p) The registered person shall 31/03/07 having regard to the number and needs of the service users ensure that ventilation, heating and lighting suitable for service users is provided in all parts of the care home which are used by service users. Dementia Unit. Adequate heating must be DS0000005697.V309075.R01.S.doc Version 5.2 Page 30 St Catherine`s Nursing Home 11 OP26 13(3) provided. An action plan must be forwarded to the CSCI. The registered person shall make 28/02/07 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. Staff and resident hand washing facilities must be made available in all service user areas throughout the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations All Units. The care plans should be expanded to include all the activities of daily living and focus on the positive aspects of a residents’ life and capabilities Nursing Unit. It is good practice to measure and grade pressure sores. This makes it easier to identify if there has been an improvement or deterioration in their condition. Dementia Unit How often a resident is to be weighed should be recorded in their care plan. Staff must ensure that information about a residents weight is documented in their individual care file. Nursing Dementia and Residential units. Stock medications should be segregated into a form of order Dementia & Residential Units. To ensure the accuracy of a transcription, handwritten transcriptions should be checked with another member of staff, signed and countersigned 2. OP7 3 OP8 4 5 OP9 OP9 6 OP9 DS0000005697.V309075.R01.S.doc Version 5.2 Page 31 St Catherine`s Nursing Home All Units. Consideration should be given to providing a tablet counter. 7 8 9. OP9 OP10 OP12 All units. Medicine stocks should be accurately rotated Dementia Unit. The residents should be dressed appropriately with suitable stockings/tights. Dementia Unit. Consideration needs to be given to providing more stimulation through suitable activities. Dementia Unit. If plastic cups must be used for resident drinks then this should be on an individual needs basis. All Units. The menus need to correspond with the meals that are being provided. 10 OP15 11 OP15 St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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. Extracts may not be used or reproduced without the express permission of CSCI St Catherine`s Nursing Home DS0000005697.V309075.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!