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Inspection on 08/03/06 for St Catherine`s Nursing Home

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

This inspection was carried out on 8th March 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The main view from residents and their relatives who were spoken to by the inspector was that the home was providing them with a good level of support and care. Comments made to the inspector included, `I am being very well looked after and all the staff have been very good to me`, `my health is much better since I have come here, it is much better than trying to manage at home`, `I am always treated politely`, `There is plenty of activities and events n if you want to join in.

What has improved since the last inspection?

The registered manager has left and a new manager has been appointed since the last inspection. Despite such a major change the home was found to be very stable. The new manager is seeking to consult with residents, their relatives and staff to take things forward at the home. Certainly the concerns expressed at the last inspection regarding staffing levels and stability of staff groups within the home have been successfully resolved.

What the care home could do better:

The home was very clean, free of malodour and generally well maintained and provides an appropriate environment for residents to be cared for. However a number of environmental issues that require to be addressed were identified and are detailed in the inspection report.

CARE HOMES FOR OLDER PEOPLE St Catherine`s Nursing Home Queen Street Horwich Bolton Lancashire BL6 5QU Lead Inspector Mike Murphy Unannounced Inspection 8th March 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Catherine`s Nursing Home DS0000005697.V285529.R01.S.doc Version 5.1 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.V285529.R01.S.doc Version 5.1 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 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.V285529.R01.S.doc Version 5.1 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. 21st September 2005 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. Car parking is provided to the front of the home and garden space is provided to the sides and rear. The home is registered to provide accommodation to 61 residents and offers nursing and personal care services. However, because the two double rooms are now used only as single rooms, the maximum number of services users at any one time is reduced to 60. There is a dedicated dementia care unit. All rooms are for single occupancy; one room has en-suite facilities. St Catherine`s Nursing Home DS0000005697.V285529.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the home’s second of two annual inspections for the inspection year 2005 to 2006. The inspection took place over six hours. The inspector spoke to 19 of the 58 residents and 4 of their relatives, toured the premises, and inspected care and other records maintained at the home. The standards inspected included those concerned with health and personal care, the environment, meals provided by the home, how complaints are dealt with, staffing levels, and how resident’s safety is protected. The home was being efficiently and effectively managed and is generally well maintained. However a number of issues were identified in respect of the environment. What the service does well: What has improved since the last inspection? What they could do better: The home was very clean, free of malodour and generally well maintained and provides an appropriate environment for residents to be cared for. However a number of environmental issues that require to be addressed were identified and are detailed in the inspection report. St Catherine`s Nursing Home DS0000005697.V285529.R01.S.doc Version 5.1 Page 6 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.V285529.R01.S.doc Version 5.1 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.V285529.R01.S.doc Version 5.1 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): 3,4,5. Standard 6 does not apply to this home. The home ensures that all prospective residents are appropriately assessed prior to admission to the home. This is essential to ensure that the home is able to meet the health and social care needs of prospective residents. EVIDENCE: Inspection of 3 newly admitted residents care records revealed that a pre admission assessment had been conducted on all 3. These assessments included consideration of prospective residents physical, psychological and social needs in relation to all the activities of daily living. The pre-admission assessments had been undertaken by the home manager. These assessments were supplemented by others conducted by various health and social care professionals such as doctors, nurses and social workers. Discussion with residents revealed indicated that they had been able to come to the home for trial visits to the home prior to their admission. They felt this was a good thing because it made them more in control of their own lives as well as enabling them to make an informed choice regarding their future. Further discussion with residents also indicated that the home was meeting their needs appropriately. St Catherine`s Nursing Home DS0000005697.V285529.R01.S.doc Version 5.1 Page 9 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): 7,8,10,11. The health and social care needs of residents were being formally addressed in individual resident’s care records. EVIDENCE: The health care records of ten residents who live at the home were inspected on this occasion out of a total of 58 who were resident at the time of inspection. These contained care plans that were initially based on the preadmission assessment referred to earlier in this report. Care plans had been developed that sought to meet the health, personal and social care needs of residents and were evaluated on at least monthly basis. Risk assessments, that designed to maintain resident’s health and safety were also recorded in respect of residents skin integrity, moving and handling needs, and nutrition (including weight monitoring) and other relevant areas and were evaluated at least once a month. Where risk assessments reveal that a resident is at risk the risk assessment is supported by a care plan that seeks to minimise the risk identified. Discussion with residents indicated that staff at the home treat them with respect and seek to maintain resident’s dignity and privacy particularly when personal care is being provided. Examples of such comments are ‘ the staff are very good’, ‘the staff make sure I am well looked after here’, ‘ I can go to bed and get up whenever suites me’. Residents confirmed and this was St Catherine`s Nursing Home DS0000005697.V285529.R01.S.doc Version 5.1 Page 10 also evident in discussion with staff and inspection of care files, that they are able to receive health care services appropriately, this included access to specialist medical services, opticians, dentists, and chiropodists. This is important for resident’s to maintain as good health as possible. All residents were registered with a local GP. Care planning was based on the care and support individual resident’s required. Appropriate measures were in place to ensure that resident’s who are coming to the end of their lives are treated with dignity and compassion. St Catherine`s Nursing Home DS0000005697.V285529.R01.S.doc Version 5.1 Page 11 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): 13,14,15. It was evident that staff sought to ensure that residents were able to retain as much independence and that they are encouraged to make as may personal choices as possible in a communal living setting. EVIDENCE: Residents and their relatives stated that there were no unreasonable restrictions to visiting at the home. Relatives said they were made to feel welcome at the home when they visited and that they were kept informed of any changes or developments in the condition of their relative. Residents spoke very positively in respect of the food provided for them by the home. Menus provided a balanced and varied diet and provide reasonable choice. This is an important area for residents as the meals provided are a central component of how they describe their satisfaction or otherwise with a home. Resident’s meals are prepared on site. Lunch was observed on the day of inspection. This meal was hot and substantial. Staff served and assisted residents appropriately and sensitively. The kitchen had been subject to an inspection by an environmental health officer in October 2005. The inspector was informed that issues raised had been addressed. St Catherine`s Nursing Home DS0000005697.V285529.R01.S.doc Version 5.1 Page 12 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. Management at the home has sought to provide an atmosphere where residents and others feel comfortable with making a complaint if necessary, and to prevent residents becoming victims of abuse. These are important areas that are crucial to the protection of resident’s in a care home, many of whom are extremely vulnerable. EVIDENCE: Discussion with residents and their relatives indicated that they were aware of how to make a complaint if they felt it necessary to. A detailed and accessible complaints procedure was in place and prominently displayed in the home, which included details of how complainants could contact the CSCI if desired. Resident’s spoken to felt comfortable and confident enough to raise a complaint if they felt it necessary to do so. The home maintains a record of any complaint received, how the complaint was investigated, the outcome of the complaint, and details the final response given to the complainant. Inspection of policies and procedures operated at the home, discussion with staff and inspection of staff training records indicated that staff were aware of the importance of protecting resident’s from potential abuse and how to communicate any concerns they may have in this area. The home incorporates the local interagency protection of vulnerable adults policy into its own procedures. St Catherine`s Nursing Home DS0000005697.V285529.R01.S.doc Version 5.1 Page 13 St Catherine`s Nursing Home DS0000005697.V285529.R01.S.doc Version 5.1 Page 14 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): 19,20,21,22,24,25,26. Generally the home is well maintained and provides an appropriate environment for residents to be cared for. However a number of environmental issues that require to be addressed were identified and are detailed below. EVIDENCE: An ongoing programme of refurbishment and redecoration was in operation at the time of this inspection. All areas of the home designated for resident’s use were accessible to them. Adequate and suitable WC and bathing provision was accessible to service users on the general nursing and EMI units. Whilst a new toilet has been provided for resident’s on the ‘residential’ unit this is not yet accessible to residents as there are still construction issues. The inspector was informed that these were due to be resolved imminently. A total of 12 resident’s bedrooms were inspected, on the general nursing, EMI and residential unit, on this occasion – these were clean, appropriately/adequately furnished and very St Catherine`s Nursing Home DS0000005697.V285529.R01.S.doc Version 5.1 Page 15 personalised. Communal lounges and dining areas were clean, warm and appropriately furnished. The floor covering in the EMI conservatory lounge area has been replaced since the last inspection. It is noted that whilst the home was very clean the decoration in a number of corridors in the home and in parts of the communal lounges/dining areas is damaged and/or heavily marked in a significant number of places and some lounge chairs were in need of replacement – the inspector was informed that an order had been made to replace some furniture within the home. These issues need to be addressed in the home’s projected programme of redecoration/refurbishment. Appropriate aids and adaptations were in place throughout the home that assists residents to maintain their safety and meet their mobility and other physical needs. A nurse call system is in place for residents/staff to summon assistance. However the home has identified the need to extend this system in the ‘residential’ lounge area of the home. Individual aids and adaptations are provided following referral to the appropriate health care professional. The home was appropriately heated, clean and free of odour and well ventilated. Residents spoke positively in respect of the home’s environment stating that it was kept clean, warm, and was comfortable to live in. They were able to personalise their own bedrooms with their own belongings. Clearly this enables residents to live in as homely environment as possible. St Catherine`s Nursing Home DS0000005697.V285529.R01.S.doc Version 5.1 Page 16 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. Staffing arrangements at the home appeared to be appropriately managed and suitable to meet the assessed needs of residents at the home. EVIDENCE: Inspection of staffing rotas provided by the home indicated that staffing provision at the home complied with the current minimum requirements that apply to care homes for older people. Discussion with the manager and senior staff indicated that they were of the view that staffing levels were appropriate to meet the current dependency levels of resident’s at the time of inspection. However discussion with senior management at the home revealed that attempts are still being made to recruit a senior nurse/unit manager for the EMI unit. Inspection of training records revealed that staff are provided with well organised and appropriate induction training at the commencement of employment, regular training in moving and handling, fire safety, basic food hygiene, protection of vulnerable adults and other appropriate care topics. Care staff have either obtained an NVQ 2 qualification (or above) in care or a currently studying to obtain such a qualification. Qualified nursing staff are provided with opportunities to update their skills and knowledge through accessing a variety of training courses. Training records were being maintained. St Catherine`s Nursing Home DS0000005697.V285529.R01.S.doc Version 5.1 Page 17 Inspection of 3 recently employed staff personnel files revealed that these contained an application form (including health declaration), 2 written references, a Criminal Records Bureau check (including a ‘POVA first’ check), proof of identity and evidence of induction training. St Catherine`s Nursing Home DS0000005697.V285529.R01.S.doc Version 5.1 Page 18 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): 31,32,33,38. The home was being efficiently and effectively managed. Residents, their relatives and staff who were spoken to described the management team as accessible and willing to listen and respond to concerns raised. EVIDENCE: A new home manager was appointed since the last inspection. This person is a registered nurse with a wide range of experience in nursing and management in care homes. The manager will need to go through a process of registration with the CSCI. Discussions with residents within the home, their relatives, and staff employed at the home indicated that the manager is supportive, positive and inclusive in her style of management. St Catherine`s Nursing Home DS0000005697.V285529.R01.S.doc Version 5.1 Page 19 The following certificates of inspection/service records were found to be satisfactory on this occasion; electrical systems/equipment, fire fighting equipment – including the fire alarm system and fire safety log, lifting equipment (including the passenger lift), gas safety, accident records/monitoring, monitoring of hot water temperatures, general and specific health and safety risk assessments, and control of clinical waste disposal. The home has confirmed in writing to the CSCI that the requirements made in a recent fire safety inspection of the home have been complied with. Records in the home were stored appropriately. St Catherine`s Nursing Home DS0000005697.V285529.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 2 2 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x X X X 3 St Catherine`s Nursing Home DS0000005697.V285529.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP19 Regulation 16, 23. Requirement 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 and when the replacement furniture referred to in the report is to be provided. That the CSCI is informed in writing when it is proposed that the new WC on the ‘residential’ unit will be accessible to residents and when the ‘nurse call bell extension is to be provided in the ‘residential’ lounge area. That the CSCI is informed in writing what progress has been made in recruiting a senior nurse/unit manager for the EMI unit. That the CSCI is informed in writing of what action is being taken to ensure the home manager is registered with the CSCI Timescale for action 30/04/06 2. OP21OP22 13, 23. 30/04/06 3. OP27 18. 30/04/06 4. OP31 8, 9 30/04/06 St Catherine`s Nursing Home DS0000005697.V285529.R01.S.doc Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Catherine`s Nursing Home DS0000005697.V285529.R01.S.doc Version 5.1 Page 23 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.V285529.R01.S.doc Version 5.1 Page 24 - 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!