Inspection on 28/06/06 for St Catherine`s Nursing Home

This inspection was carried out on 28th June 2006.

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 23/01/07

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 28th June 2006 10:00 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.V297966.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.V297966.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) Care Home 61 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (29), Old age, not falling within any other of places category (30), Physical disability (1) St Catherine`s Nursing Home DS0000005697.V297966.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 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 service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. The registration to revert to the original respective categories should the named service user leave the home. 8th March 2006 2. 3. 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.V297966.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 were sent out to the residents, their relatives and to the home itself. These questionnaires asked what people thought of the quality of the service and the facilities provided. Only 4 questionnaires were returned. All were from relatives The inspector visited the home over two days and spent a total of 15 hours inspecting. During this time the Inspector looked at care and medicine records to ensure that the health and care needs of the residents were being met. She 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 and train their staff. To make sure that the home and the equipment in it was safe, the Inspector looked at the maintenance and service records of the equipment within the home. She also looked at how the management handle the residents’ spending money. The Inspector then looked around the building at the bedrooms, bathrooms toilets and sitting areas to check if they were clean and well decorated. She then visited residents in their own bedrooms and lounge areas. This was to check out the care that was being provided for them. The Inspector also looked at the food stocks, the menus and what the residents had for their lunch and evening meal. In order to get further information about the home the Inspector also spent time speaking to 3 residents, 4 relatives, 3 qualified nurses, 4 care assistants, the cook, the activities organiser, the administrator and the manager. 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 £339.74 –£ 465.00 per week This information was received on the 14th July 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. The home has a commitment to ongoing staff training. St Catherine`s Nursing Home DS0000005697.V297966.R01.S.doc Version 5.2 Page 6 The nurses and senior care staff make sure that they continually look at anything that may be a risk to the residents. They then make sure that they write down in the residents care plan when they have done this, and what action they have taken to reduce the risk. A relative told the Inspector that the staff on the Nursing Unit always keep him informed of any concerns or changes in his relatives’ condition. He felt that the staff were “very good”. A resident on the Nursing Unit told the Inspector that she had no complaints and that “they were all very good”. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Catherine`s Nursing Home DS0000005697.V297966.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.V297966.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. Whilst the preadmission document could be more detailed, the system for ensuring that all prospective residents had a assessment undertaken prior to admission to the home gave an assurance both to residents, relatives and staff that a resident was only admitted if the home could meet their needs. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Dementia Unit. Inspection of 3 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. The pre-admission assessment document used however, was not in accordance with the requirements of the Standard. There was no information about the residents’ foot care, history of falls, social interests hobbies religious and cultural needs, personal safety and risk, and carer and family involvement. St Catherine`s Nursing Home DS0000005697.V297966.R01.S.doc Version 5.2 Page 9 The admission assessment however contained most of the above. The assessment documents were not looked at on the nursing and residential unit as the Inspector was informed that the document in use is standard throughout the home. Standard 6 does not apply. The home does not provide Intermediate Care. St Catherine`s Nursing Home DS0000005697.V297966.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 & 10 Quality in this outcome area is adequate. Although the care plans contained some important information they did not fully reflect the support needs of some of the residents. The system for handling medicines was not as safe as it should have been. This could put the residents at risk of not receiving their medicines safely. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The actual admission assessments were detailed and gave a clear picture of the residents’ needs. The care plans were “Core Care Plans” this means that they have basic standard information in them but then are individualised for each resident. 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 also 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. St Catherine`s Nursing Home DS0000005697.V297966.R01.S.doc Version 5.2 Page 11 They also assessed if it was safe to use bed rails and looked at any other general safety risks. 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 Dementia Unit The care plans of 3 of the residents were inspected. Each care plan had a photograph of the resident attached. One of the care plans inspected showed that the resident had a catheter in the bladder to enable the resident to pass urine. There was quite a detailed care plan for the catheter but there was not enough information about how often the urine drainage bags were to be changed and how the catheter and surrounding areas were to be cleaned and looked after. This resident was also losing weight but there was no care plan in place to address this problem. A dietician had seen this resident in October 2005 because of swallowing difficulties and treatment was prescribed. It was not until June 2006 however that a care plan was put in place to address the problem. This resident was at high risk of developing pressure sores but there was no care plan for the prevention of pressure sores in place. Another of the care plans inspected showed that the resident had previously had a pressure sore. There was a wound chart dated 23/3/06,showing the area, size and condition of the wound but nothing had been documented after this date. There was no up to date evidence about the state of the wound. This resident was also losing weight but there was no care plan in place to address this, neither was there an eating and drinking care plan. Several of the assessment documents were either not named, not signed or not dated. Staff were not always timing their entries on the daily reports. 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. 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. Nursing Unit The care plans of 2 of the residents were inspected. Each care plan had a photograph of the resident attached. The care plans gave a lot of good information and clear instruction and guidance on how some of the care needs of the residents were to be met when problems had been identified, but there was not enough information in relation to how to care for one of the residents with diabetes and what problems staff would need to watch out for. The care plan stated that the residents’ blood sugar was to remain controlled but it did not state how this was to be achieved. St Catherine`s Nursing Home DS0000005697.V297966.R01.S.doc Version 5.2 Page 12 There was not enough information about the care of the residents’ skin and the importance of the involvement of the chiropodist to keep the residents’ feet and nails healthy. There was not enough information about the care of the residents’ eyes such as regular check ups with the optician. There was a good care plan in place for the care of this residents’ urinary catheter. The care plan of another resident showed that she had pressure sores to her hips and 1 heel. 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 documented. Measuring and grading pressure sores makes it easier to identify if there has been an improvement or deterioration in their condition. A mannequin chart was in place that identified where the wounds were but this was dated 13/7/05. The care regime for a resident who was artificially fed with a PEG was very confusing. The fluid/feed chart documented 1st bolus and 2nd bolus etc and did not give a true indication of what the bolus was. The chart did not give a clear indication of the times and amount of feed to be given. Staff were advised to write out the feed regime and place it in the care plan and in the residents’ room. The daily reports were quite detailed but some staff were not always timing their entries. There was evidence that some relatives were involved in drawing up the care plan. Residential unit The care plans of 2 of the residents were inspected. Each care plan had a photograph of the resident attached. The care plans gave 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 there was not enough information in relation to how to care for one of the residents with diabetes and what problems staff would need to watch out for. This residents’ diabetes was controlled with insulin that was given by the district nurses. There was not enough information about the care of the residents’ skin and the importance of the involvement of the chiropodist to keep the residents’ feet and nails healthy. There was not enough information about the care of the residents’ eyes such as regular check ups with the optician. There were also no instructions about what to do in the event of the blood sugar levels being too low. One resident had a urinary catheter and the care plan showed that the district nurse had the responsibility for dealing with the changing of the urine bag. There was not enough information however about the actual care of the catheter and surrounding areas. Staff were regularly looking at any changes in the residents conditions and were writing down when they had assessed it but they were writing on 2 St Catherine`s Nursing Home DS0000005697.V297966.R01.S.doc Version 5.2 Page 13 different forms. They were writing on the evaluation form and on the care plan agreement form. No explanation was given for this duplication. Nursing Dementia and Residential Units From the care plans inspected it was evident the residents were weighed at least on a monthly basis. The care plans did not document how often the residents were to be weighed. Staff told the Inspector that it was accepted practice that residents were weighed monthly. Inspection of care plans showed that staff did not always take action when a weight loss had occurred. The Inspector checked out the weight recordings of 10 residents who were either on the nursing or dementia units. 3 of these residents had lost weight and there was no care plan to address the weight loss. On the nursing unit 1 resident needed to have regular swallowing exercises undertaken by the nursing staff. These were not being undertaken as often as they had been prescribed. 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 and the Inspector was informed that the district nurses could provide more specialist equipment if needed for the residential residents. Only the medicines for the dementia and residential units were inspected during this visit. The medicines for the nursing unit will be looked at during the next inspection. 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 units have a medicine trolley that is kept on each unit in a communal area, and is secured to the wall when not in use. . The stock medications were not segregated into any form of order. This could result in inadequate stock rotation and even drug errors The drugs fridge was not working and medications that needed refrigeration were being stored in a separate part of the satellite kitchen fridge. The policies and procedures in relation to medicine management were not kept either with the medicine trolley or in the medicine room. Controlled drugs were stored correctly and safely. Dementia unit. Some issues were identified in relation to the following: Handwritten instructions for medicines (Transcriptions) were not signed, checked and countersigned. Signing and checking transcriptions reduces the risk of drug errors. The medication administration sheets (MAR sheets) were not always being filled in when the medication had been given. One resident was prescribed Paracetamol 3 times per day but a member of staff had written that this only needed to be given as and when necessary. St Catherine`s Nursing Home DS0000005697.V297966.R01.S.doc Version 5.2 Page 14 Staff must not change a prescription. They must refer the issue back to the prescribing GP. Eye drops that should not have been refrigerated were being stored in the satellite kitchen fridge. Staff must follow the storage instructions on the container. Medication (insulin) was not stored in the container that it was dispensed in. Residential unit. Some issues were identified in relation to the following: The medicine trolley on the residential unit was kept secured on the corridor close to the main kitchens but was blocking a fire exit. The carer in charge of the unit was told to remove the trolley immediately and to ensure that it is stored in the medicine room. One residents’ prescribed medication was to be given “ as directed”. This was written on both the container and the prescription sheet. The resident was being given this medication on a very irregular basis. Staff were instructed to contact the residents’ GP to clarify just when and how often this medication was to be given. When a prescription stated that one or two tablets were to be given, staff were not documenting just how many tablets had been administered. Prior to the 22nd of June 2006 a resident had been prescribed his medication as follows: take 1 at night. This had been changed by a member of staff and the hand written transcription directed that the resident was to have 2 tablets at night for 1 week. The Inspector was told that this was following a visit by the residents’ GP. There was no evidence in the residents care notes to show that there had been a specific change of medication. The Inspector told the carer in charge of the unit to contact the GP surgery so that the accurate dose of medication could be given. The surgery informed the carer that the resident was to have one tablet twice a day. The residents spoken to said that the staff treat them with kindness and respect. Relatives confirmed this. During the inspection staff members spoke with residents in a kindly and respectful way. Staff spoken to gave examples of how privacy and dignity were promoted. They told the inspector that they were told how to ensure that the privacy and dignity of residents was maintained when they started working at the home. They realised the importance of knocking on bedroom, bathroom and toilet doors and waiting for a response before entering. Both the nursing and residential unit do not have an enclosed office. This raises issues of confidentiality and privacy when dealing with issues around the residents’ care. The Inspector also saw a list displayed on the wall in front of the nurse station on the nursing unit. This list identified which continence pads the residents were to wear. The nursing staff were asked to remove this list immediately as it compromises the dignity of the residents. St Catherine`s Nursing Home DS0000005697.V297966.R01.S.doc Version 5.2 Page 15 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 the following standard(s): 12 13 14 & 15 Quality in this outcome area is adequate. Due to the layout of the home, especially the residential unit, the residents were not able to enjoy a great amount of personal freedom and choice. Although some residents did find enjoyment with the range of activities available they could be further improved. Not enough importance is attached to ensuring that there is a choice of menu and that meals are varied and nutritious. This judgment 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 by the home on a fulltime basis. A programme of activities, events, and outings was prominently displayed. The home shares a minibus with the companies’ other homes. The activities organiser told the Inspector that he does not always follow the activities programme. Quite often it will be changed to suit the needs of residents at the time. . He also told the Inspector that family and friends of the residents as well as the staff help out with the trips out and any other special events, such as a garden party. 1 relative questionnaire that was returned stated that transport seems to be a problem with only 1 outing in 7 months. St Catherine`s Nursing Home DS0000005697.V297966.R01.S.doc Version 5.2 Page 16 Of the 3 resident questionnaires returned in answer to the question: Are there activities arranged by the home that you can take part in? 2 said “sometimes” and 1 said “usually”. The staff on the dementia unit felt that there was not enough stimulation for the residents. The Inspector noted that 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. There was one resident of an Eastern European background in the home but staff told the Inspector that her English was extremely good. Nevertheless the Polish staff within the home were able to communicate with her. The majority of residents had a Church of England or Roman Catholic religious faith and clergy visited the home on a regular basis. 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 Residents are encouraged to bring personal possessions into the home. Many of their bedrooms were highly personalised with small pieces of their own furniture, pictures, photographs and ornaments etc. The inspector did not dine with the residents but observed lunch being served on the dementia unit and the nursing unit. The dining tables were very sparse; there were neither tablecloths nor place mats in place. It had a very institutionalised look. This was in stark contrast to the way the tables were set on the nursing unit. The tables on the nursing unit had tablecloths, place mats, napkins and condiments. The residents have a cooked breakfast every day, a lighter meal at lunchtime and the main meal in the evening. A menu board was displayed on the wall. It identified residents who had a puréed diet and residents who had a soft diet. The food was brought to the unit in a heated trolley. The trolley contained a tureen of homemade soup and a tray of cheese on toast. The residents who needed a puréed and soft diet were given the homemade soup and the residents on normal diets were given 1 slice of cheese on toast. The Inspector asked why the residents werent being given any bread with the soup and why the residents who were having cheese on toast were not having any soup. She was told that they could have it if they asked. It was the inspectors understanding that none of the residents would be able to ask. For dessert the residents on a normal diet were given apple crumble and custard. This was homemade and looked very appetising. When asked what the residents on a puréed and soft diet were given the Inspector was told that the care is staff scrape underneath the crumble and give them the soft stewed St Catherine`s Nursing Home DS0000005697.V297966.R01.S.doc Version 5.2 Page 17 apple underneath. One of the residents had diabetes. She was given cheese on toast for a main course and pineapples in fruit juice for her dessert. Care and kitchen staff seemed uncertain about what constituted a healthy diet for a resident with diabetes. The home has a four-week rotating menu. The kitchen staff however, do not stick to the menus and do not record what has been given as an alternative. There was no active choice of menu for the lunchtime and evening meals. The Inspector 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 Inspector was told that this is how theyve always done it. Staff told the Inspector that if residents wanted any more food then they would go down to the kitchen and get it. Of the 3 resident questionnaires returned, in reference to the question of: Do you like the meals at the home? 1 said “always”,1 said “usually” and 1 said “sometimes”. . St Catherine`s Nursing Home DS0000005697.V297966.R01.S.doc Version 5.2 Page 18 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 the following standard(s): 16 & 18 Quality in this outcome area is good. The complaint system in place enabled residents to feel that their views were listened to and acted upon. Staff had a good knowledge and understanding of what abuse was, thereby reducing the possible risk of harm or abuse to residents. This judgment 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. It did not however, give the contact details for the Commission for Social Care Inspection. There was also a complaints procedure on the nursing unit that made reference to the previous registration authorities of the health authority and social services departments. This old complaints procedure needs to be removed. A discussion with residents and relatives indicated that there was a general awareness of how to make a complaint 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. A discussion with the manager and several care staff showed that they were very aware of the different forms of abuse and the procedure to follow in the event of any allegation of abuse. Staff continue to receive training in abuse awareness. Training records were kept in their personnel file. St Catherine`s Nursing Home DS0000005697.V297966.R01.S.doc Version 5.2 Page 19 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 the following standard(s): 19 20 21 24 25 & 26 Quality in this outcome area is adequate. The residents live in a clean environment that is slowly being improved. The improvements need to continue, to enable all the residents in the home to live in a pleasant, comfortable and homely environment. This judgment has been made using available evidence including a visit to the service EVIDENCE: There is level access to the front of the home to allow access for wheelchair users and people who have problems climbing steps. There is plenty of parking to the front of the home. The Inspector 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 corridor walls were very bare and there was a strong smell of urine. Grab rails to aid mobility were in place along the corridor walls. The residents have the use of any of the 2 lounges, a conservatory and the large dining room. These rooms were pleasant and well decorated. New furniture and carpets had been provided. St Catherine`s Nursing Home DS0000005697.V297966.R01.S.doc Version 5.2 Page 20 There were enough toilets and bathrooms to meet the needs of the residents. Toilets were within close proximity of communal spaces. Each toilet and bathroom had a lock on the door to ensure privacy and the facilities were all clearly marked. Most bathrooms and toilets were suitably adapted for disabled use. The bedrooms were clean but several smelt of urine. Several of the bedrooms had mismatched furniture and were without a lockable space. Many of the bedrooms were personalised with the residents’ photographs and small ornaments but some were very sparse. The bedroom doors were fitted with over riding, safety door locks. The rooms were individually and naturally ventilated with under floor heating. Nursing and Residential Units The nursing unit is on the first floor as are the residential bedrooms. Grab rails to aid mobility were in place along the corridor walls. The corridors were very marked in place and there was no natural ventilation. The staff and residents were feeling very hot despite portable fans being in use. The residents have the use of a lounge and dining room on this floor. These rooms were quite pleasant, however the lounge was in need of redecoration. There was a call bell sited in the lounge/dining rooms but no call bell leads. Toilets were within close proximity of communal spaces. Each toilet and bathroom had a lock on the door to ensure privacy and the facilities were all clearly marked. Most bathrooms and toilets were suitably adapted for disabled use. One of the bathrooms had a badly marked bath. The bedrooms were clean but several of the bedrooms had mismatched furniture and were without a lockable space. Many of the bedrooms were personalised with the residents’ photographs and small ornaments. The bedroom doors were fitted with over riding, safety door locks. The rooms were individually and naturally ventilated with under floor heating. 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. These rooms were clean, well furnished and looked comfortable. 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 residents’ bedrooms, bathrooms and toilets. Staff wore vinyl gloves when delivering personal care but it was identified that they were wearing them prior to any intervention and walking around the units with them on. This contaminates the gloves and causes cross infection/contamination. Staff must receive the correct training in relation to hand hygiene and the use of protective clothing. St Catherine`s Nursing Home DS0000005697.V297966.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 & 30 Quality in this outcome area is adequate. . The dementia unit would benefit from being managed by a trained mental health nurse who had the knowledge and skills to meet the residents’ needs. The residents on the nursing unit were being cared for by suitably trained and qualified nurses and care staff but the staffing levels were at minimum levels and needs were not always being met. The residents were cared for by staff that were safely recruited. This judgment has been made using available evidence including a visit to the service EVIDENCE: Dementia Unit Examination of the duty rotas and a discussion with staff showed that there was sufficient nursing and care staff on duty to meet the needs of the 28 residents. The unit operates with 2 qualified nurses between the hours of 8 a.m. to 2 p.m. and then 1 qualified nurse between the hours of 2 p.m. to 8 p.m. In addition between the hours of 8 a.m. to 8 p.m. the unit operates with 5 care assistants. During the night-time hours of 8 p.m. to 8am the unit operates on 1 qualified nurse and 2 care assistants. There is no full-time registered mental nurse (RMN) working on the unit and no designated unit manager. The Inspector was informed that the home is in the process of recruiting an RMN for the unit. Nursing unit Examination of the duty rota, visual observation and a discussion with staff showed that the unit was operating with the absolute minimum staffing levels. St Catherine`s Nursing Home DS0000005697.V297966.R01.S.doc Version 5.2 Page 22 For the 15 residents on the unit there was 1 qualified nurse and 2 care assistants. There were 2 residents who were artificially fed by PEG (1 who needed swallowing tests at least 10 times a day) 4 residents cared for in bed, 1 with palliative care needs, 5 residents who needed to staff to move them with the hoist, 1 resident with a dressing and 1 resident with a urinary catheter. During the night-time hours of 8 p.m. 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 there was sufficient care staff on duty to meet the needs of the residents. The unit operates on 3 care staff between the hours of 8am- 8pm and 2 care staff between 8pm and 8am. The duty rosters did not document the full name of the staff members. To ensure that an accurate duty roster is in place these details must be added. Of the 29 care staff employed 11 have obtained their NVQ level 2 or above in care. This is a percentage of 38 . 4 of the staff are presently undertaking NVQ level 2 and 1 undertaking NVQ level 3. The personnel files of three staff members were inspected. All were in order and these 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. All members of 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. Training records were in place in the staff files inspected. training had been undertaken in the following areas: Moving and Handling. Fire Safety. First Aid. Food Hygiene. Infection Control. Health & Safety Abuse awareness. Training is an ongoing process. These showed St Catherine`s Nursing Home DS0000005697.V297966.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 & 38 Quality in this outcome area is good A satisfactory accounting system was in place that ensured the residents’ financial interests were protected. The home was safe and well maintained, however some current practices did not promote and safeguard the health, safety and welfare of the people using the 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.). She has been the acting manager at St Catherines for 4 months. Prior to this she was the qualified nurse working on the nursing unit at night. Staff spoke positively about the managers attitude and knowledge. They said that she was very approachable and listens to any concerns that they have. The acting manager has not yet enrolled for the Registered Managers Award. St Catherine`s Nursing Home DS0000005697.V297966.R01.S.doc Version 5.2 Page 24 The company has developed a quality assurance system. Questionnaires have been developed and given out to residents and relatives. Management need to ensure that the results of the responses are collated and published in the Service User Guide. Audits are undertaken of care plans, the kitchen, accidents, incidents and medications. The systems in place for the management of residents’ money were good. The home had a satisfactory accounting system in place. The administrator could determine exactly how much money the home was holding for each person and how the money was being spent. Receipts were retained for all financial transactions. 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 Most of the equipment and services within the home were serviced on a regular basis in accordance with the individual requirements. Several shortfalls in relation to health and safety matters were identified. These were: The fire exit on the residential unit was blocked with the medicine trolley. The following certificates of servicing/maintenance were not available: Checking of water temperatures. Any evidence of thermostatic control valves being in place/serviced Fixed and portable hoists. Staff wore vinyl gloves when delivering personal care but it was identified that they were wearing them prior to any intervention and walking around the units. This contaminates the gloves and causes cross infection/contamination. Staff must receive training in relation to hand hygiene and the correct use of protective clothing. St Catherine`s Nursing Home DS0000005697.V297966.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 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 2 17 x 18 3 2 2 2 x x 2 2 2 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 3 x 3 x x 2 St Catherine`s Nursing Home DS0000005697.V297966.R01.S.doc Version 5.2 Page 26 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 12 & 15 Requirement Dementia Unit. When it is identified that a resident is losing weight a plan of care to address the problem, must be implemented The resident must also have an eating and drinking care plan. Dementia Unit. When it has been identified that a resident is at risk of developing pressure sores, then a care plan for prevention of pressure sores must be put in place. Dementia Unit. Nursing documents must be named, signed, timed and dated. Dementia Unit. Care plans must the current, comprehensive and up-to-date. There must always be up-to-date evidence about the condition of any wound. Dementia Unit. There must be evidence of relative/representative involvement in the drawing up of the care plan. Dementia and Residential units. DS0000005697.V297966.R01.S.doc Timescale for action 31/07/06 2 OP7 13 & 15 29/06/06 3 4 OP7 OP7 15 15 31/07/06 29/06/06 5 OP7 15 31/08/06 6 OP7 15 31/07/06 St Catherine`s Nursing Home Version 5.2 Page 27 A more detailed care plan must be in place for the residents with a urinary catheter 7 OP7 15 Nursing and Residential units. A care plan must be in place that details how the resident with diabetes is to be cared for. This must include the care of the skin and eyes, and what to do in the event of an emergency situation, such as hypoglycaemia. 31/07/06 8 OP7 15 9 OP8 12 Nursing Unit. 31/07/06 The charts used for PEG feeds must give a clear indication of what the feed regime is. The regime must also be placed in the residents’ care plan. Nursing Unit. 29/06/06 Nursing staff must follow the instructions of visiting professionals, in this instance the instructions of the visiting dietician/ speech therapist. Dementia Unit. When treatment has been prescribed by a visiting professional, in this instance a dietician, then their instructions must be followed and a care plan put in place. Nursing Dementia and Residential units. Residents must be weighed in accordance with their nutritional risk assessment, but at least on a monthly basis. How often a resident is to be weighed must be recorded in their care plan Nursing Dementia and Residential units. Stock medications must be segregated into a form of order. Nursing Dementia and Residential units. DS0000005697.V297966.R01.S.doc 10 OP8 12 29/06/06 11 OP8 12 & 15 31/07/06 12 OP9 13 31/07/06 13 OP9 13 31/08/06 Page 28 St Catherine`s Nursing Home Version 5.2 14 15. OP9 OP9 13 13 16 17 OP9 OP9 13 13 18 OP9 13 19 OP9 13 20 OP15 16 21 OP16 22 The drugs fridge must be repaired or replaced because medications must be stored at the correct temperature. Dementia Unit. Medications must be signed for once they have been given. Dementia Unit. Staff must not change a prescription. They must refer the issue back to the prescribing GP. Dementia Unit. Medications must be stored in accordance with the directions Dementia Unit. Medications must be kept in the container they were dispensed in. Residential Unit. Staff must clarify with the residents’ GP how often a medication is to be given. It is not acceptable to state as directed and then the medication to be given on an irregular basis. Residential Unit. Staff must document the actual amount/number of tablets being given. Nursing Dementia and Residential units. Adequate food must be provided for all residents. An active choice of main meal must be provided 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 contact details of the CSCI must be in place on the complaints procedure. The “old “ complaints procedure displayed on the nursing unit needs to be removed. DS0000005697.V297966.R01.S.doc 28/06/06 28/06/06 28/06/06 28/06/06 28/06/06 28/06/06 31/07/06 31/08/06 St Catherine`s Nursing Home Version 5.2 Page 29 22 OP19 16 & 23 23 OP21 23 24 OP24 23 25 OP24 16 & 23 26 OP24 23 27 OP25 23 28 OP27 18. 29 OP27 18 Nursing, Dementia & Residential Units. That the CSCI is provided with a written action plan that identifies when the corridors and communal areas in the home are to be redecorated/refurbished. (Previous requirement of 30/04/06 not complied with) Nursing and Residential units The badly marked bath must be refurbished or replaced. An action plan must be forwarded to the CSCI Nursing, Dementia & Residential Units A lockable space must be provided in all bedrooms. An action plan must be forwarded to the CSCI Nursing, Dementia & Residential Units An action plan must be forwarded to the CSCI informing when the mismatched furniture in the bedrooms is to be replaced. Dementia Unit. The smell of urine on the corridors and in the bedrooms must be eradicated. An action plan must be forwarded to the CSCI Nursing & Dementia Units. Adequate ventilation must be provided on the upstairs corridor. An action plan must be forwarded to the CSCI That the CSCI is informed in writing what progress has been made in recruiting a senior nurse/unit manager for the dementia unit. (Previous requirement of 30/04/06 not complied with) Nursing Unit. The staffing levels must be kept DS0000005697.V297966.R01.S.doc 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 29/06/06 Page 30 St Catherine`s Nursing Home Version 5.2 30 31 OP27 OP30 17 13 under constant review. Staffing must be provided according to the needs and dependency of the residents, not in accordance with the numbers. The duty rotas must contain the 31/08/06 full name and designation of the staff members. Staff must receive training in 31/10/06 relation to hand hygiene and the correct use of protective clothing. Care and kitchen staff must receive training in relation to the dietary needs of a resident with diabetes. Fire exits must not be blocked. The following certificates of servicing/maintenance must be forwarded to the CSCI. Checking of water temperatures. Any evidence of thermostatic control valves being in place/serviced Fixed and portable hoists. 31/10/06 32 OP30 18 33 34 OP38 OP38 23 13 29/06/06 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP3 OP7 Good Practice Recommendations All Units. The Pre-admission assessment document should be in accordance with the requirements of Standard 3.3. 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 & Dementia Units. It is good practice to measure and grade pressure sores. This makes it easier to identify if there has been an DS0000005697.V297966.R01.S.doc Version 5.2 Page 31 3 OP7 St Catherine`s Nursing Home 4 OP9 5 6 OP9 OP9 7 OP10 8 OP15 9 OP12 improvement or deterioration in their condition. All Units. It is strongly recommended, for security reasons, that the medicine trolleys are stored in the medicine room when not in use. All Units. The medication policies and procedures should be kept where the medicines are stored and administered. Dementia & Residential Units. To ensure the accuracy of a transcription, handwritten transcriptions should be checked with another member of staff, signed and countersigned Nursing and residential units. Management need to address the issue of the lack of privacy and the possible breach of confidentiality due to the lack of an enclosed office on these units. Dementia Unit. Serious consideration needs to be given to improving the setting of the dining tables to detract from the institutionalised look. Tablecloths/placemats and condiments should be in use. Dementia Unit. Consideration needs to be given to providing more stimulation through suitable activities. St Catherine`s Nursing Home DS0000005697.V297966.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: 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 Catherine`s Nursing Home DS0000005697.V297966.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. 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