Inspection on 29/04/05 for St Catherines Care Home

This inspection was carried out on 29th April 2005.

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

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

Other inspections for this house

St Catherines Care Home 13/04/07

St Catherines Care Home 01/09/05

St Catherines Care Home 07/01/05

St Catherines Care Home 16/07/04

St Catherines Care Home 15/09/03

St Catherines Care Home 04/11/02

St Catherines Care Home 26/02/02

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

CARE HOMES FOR OLDER PEOPLE St Catherines Care Home Barony Road Nantwich Cheshire CW5 5QZ Lead Inspector Anthony Cliffe Unannounced 29 April 2005 09:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Catherines Care Home F51 F01 S18740 St Catherines V222171 290405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service St Catherines Care Home Address Brony Road Nantwich Cheshire CW5 5QZ 01270-610881 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Community Integrated Care Mrs C Penfold Care Home 40 Category(ies) of OP - Old Age (20) registration, with number DE(E) - Dementia (20) of places DE - Dementia (1) MD(E) - Mental Disorder (1) St Catherines Care Home F51 F01 S18740 St Catherines V222171 290405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 40 service users to include: * Up to 20 service users in the category of OP (old age not falling within any other category) * Up to 20 service users in the category of DE(E) (Dementia over the age of 65) * One service user in the category of maybe DE (Dementia) * One named agreed service user in the category of MD(E) (Mental Disorder over the age of 65) 2. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with Commission for Social Care Inspection. 3. Date of last inspection 7th January 2005 Brief Description of the Service: St. Catherine’s care home is a single storey building situated on the outskirts of Nantwich. The home provides nursing care for 20 older people diagnosed with dementia and 20 older people whose needs are due to physical frailty. The home is operated by Community Integrated Care, a not for profit organisation. Bedroom acccomodation consists of 38 single and one double bedroom. There are no en-suite facilities. There are day facilities including a lounge, dining room, and conservatory on each unit. There is a large foyer entrance with seated area and separate shared activities room situated off this area. Externally the gardens have been landscaped to provide a sensory garden with raised flowerbeds. The home is situated on a bus route and is close to the town centre and local shopping facilities. It also has its own transport. St Catherines Care Home F51 F01 S18740 St Catherines V222171 290405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place over a period of seven hours. The inspector agreed the format of the inspection with the manager. The inspection was carried out using a process of cross referencing the documentation of identified service users following discussion with them, and following the delivery of care and support to them. A tour of the building, including all communal areas, the laundry and a number of bedrooms, was completed. Six service users and three relatives contributed their experience of living in and visiting the home. Six of the staff on duty were spoken with. What the service does well: St.Catherines Care Home provides a safe and well-maintained environment for service users and the manager continues to purchase pictures and soft furnishings to complement the refurbishment. There is a good choice of lounges and external garden areas. The home is a single storey building and is well equipped to meet the needs of service users. The home is welcoming and provides a comfortable seating area at the entrance. Service users’ health needs are met to a good standard. This is supported by detailed pre admission assessments completed by the manager or deputy manager. Service users are cared for as individuals and their care plans are written taking account of the person and not their health condition. All of the people spoken with were satisfied with the care that they, or their relatives, were receiving. Service users’ relatives are kept well informed and are involved in their care. Visitors are made welcome. A good variety of food is provided, including the choice of a cooked breakfast every day. There is a stable staff group who have a positive attitude towards service users. The home has a competent and experienced manager. St Catherines Care Home F51 F01 S18740 St Catherines V222171 290405 Stage 4.doc Version 1.30 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. St Catherines Care Home F51 F01 S18740 St Catherines V222171 290405 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection St Catherines Care Home F51 F01 S18740 St Catherines V222171 290405 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 All service users are fully assessed before moving into the home to ensure the home can meet their identified needs. EVIDENCE: Care documents relating to four service users were examined. They contained pre-admission assessment documentation completed for these people by the manager or deputy. For the three recent admissions, assessments were available from the services where they had been accommodated prior to admission to the home. Two service users were self funded and one was funded by the local authority. Pre admission assessment had been completed with relatives present. They were very detailed and recorded all the relevant information. Copies of the assessments from the local NHS professionals involved in the service users’ care were obtained. The home had agreed care plans with service users or their relatives to meet there assessed needs. St Catherines Care Home F51 F01 S18740 St Catherines V222171 290405 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 and 10. Service user plans ensure that health and social care needs are identified and met. The procedures for managing medication had deteriorated and service users’ health is at risk from them not receiving prescribed medication. Other than meal times there were no set routines within the home and service choose there daily routine. EVIDENCE: A number of care plans were examined. All plans had a comprehensive range of assessment documents completed in full with a care plan to address the identified needs of the service users. Relatives visiting the home said that they had been involved in the care planning process. Evidence from care plans, and from conversations with service users and their relatives, indicated that the health needs of service users were met. People spoken with expressed their satisfaction with the care being provided at the home. St Catherines Care Home F51 F01 S18740 St Catherines V222171 290405 Stage 4.doc Version 1.30 Page 10 At the time of the inspection, all bedrooms were singly occupied. Personal care is carried out in the privacy of the bedroom. During the inspection, it was observed that service users with challenging behaviour were treated with patience, dignity and respect by the staff. In the dementia care unit the environment was calm, and service users who liked to walk around the unit did so unhindered, with staff keeping a discreet eye on them. Incidents were observed when service users invaded the body space of others and staff quickly diffused the situation by distracting the individuals concerned. The calm environment was enhanced by soft music being played. One service user’s health needs had deteriorated and staff had responded promptly in liaising with their general practitioner to examine the individual and decide if hospital admission was necessary. A service user spoken with at a previous inspection said ‘ I’m comfortable here and not as worried about being in a home’. The home uses a person centred approach to caring for people. It was evident in care plans that people’s routines and wishes were recorded. For example it was recorded that one service user enjoyed a drink in bed before getting up and another did not sleep without a milky drink. Food preferences were also recorded. Car plans detailed how improvements in promoting independence could influence an improvement in another area of an individuals care. An example was that staff were promoting a service user to use her walking aid and improve her mobility with the desired outcome of her remaining continent. Another example was that a pre admission assessment detailed the promotion of skills in numeracy and reading and writing for a service user diagnosed with dementia as these skills had been important throughout the service users life, career and social interests. Another service user’s records demonstrated how the home had encouraged a relative to remain actively involved in his wife’s care and had written a care plan to include him in her care and improve her independence by inviting him for lunch every day. The relative said that he used to assist his wife to eat, but since he sat with her for lunch in the dining room she had started to eat her meals independently again. Care records detailed consultation with the tissue viability nurse and improvements in pressure ulcers. Pressure relieving equipment was provided for service users identified at being at risk from developing pressure ulcers. Nutrition was assessed and monitored and weight gains noted from two of the service users’ records examined. The home gave relatives the ‘wishes in the event of death’ form for completion if their relative was unable to complete this. Signatures had not been recorded for the administration of medicines for several service users. The medicines for three service users were present within the monitored dosage system when their administration had been signed for. The courses of antibiotics prescribed for two service users had not been administered in full. See requirement 1. St Catherines Care Home F51 F01 S18740 St Catherines V222171 290405 Stage 4.doc Version 1.30 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 standard(s) 12,13 and 15 Service users are supported to exercise choice in their lifestyle and to meet their social needs. Families and friends are welcomed into the home at any reasonable time. Service users have a good choice of meals in pleasing surroundings. EVIDENCE: Service users were seen to be free to move around within the home. A variety of sitting areas were available. Staff were observed spending social time with service users. There were a number of visitors to the home throughout the day. They were made welcome and were clearly comfortable in approaching the home manager and discussing any issues with her. A visitor said she visited every other day and her friend received many visitors at any time they wished. The home provides three full meals a day. The manager said that service users could choose to have a cooked breakfast and this was observed to be served to several service users with one confirming she chooses a cooked breakfast ‘from time to time’. The main meal is at lunchtime and a choice of two main dishes is available. A visitor who stayed for lunch on the day of the inspection said it was a choice of fish in batter or fish in sauce and ‘ meals are always plentiful’. Individual choices are also accommodated. Service users are weighed on a regular basis and nutritional supplements are provided for any service users who need them. Service users spoken with said that they were satisfied with the meals provided and confirmed that choices were available. St Catherines Care Home F51 F01 S18740 St Catherines V222171 290405 Stage 4.doc Version 1.30 Page 12 On the day of the inspection the activities organiser had arranged a day out to a working farm for a number of residents, their families and carers. An activities programme was displayed. A visitor said he joined in the activities with his wife and they had been involved in movement to music the previous day. St Catherines Care Home F51 F01 S18740 St Catherines V222171 290405 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 17 Complaints are taken seriously and acted upon. Service users’ legal rights are promoted. EVIDENCE: Two verbal complaints had been recorded by the manager regarding a decision to limit access through the front door after 6pm after a review of security. The manager had written to the complainants explaining the reason for the decision and that visitors after 6pm had to ring a bell to gain access. On 28th April the activities organiser held a session on voting including the various political parties ideas. There was evidence of a postal voting form in the bedroom of one service user. The manager said another service user had expressed a wish to vote but arrangements were to be confirmed dependent upon the health of the service user. St Catherines Care Home F51 F01 S18740 St Catherines V222171 290405 Stage 4.doc Version 1.30 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 standard(s) 19, 22 and 26. Service users live in a safe and well-maintained home, which is clean and hygienic. There is a commitment to improving the standard of accommodation for the benefit of service users. EVIDENCE: St.Catherines is a single storey building and all rooms and areas, including the gardens, are spacious and are accessible to wheelchair users. All communal areas and some of the bedrooms were seen during this inspection. The home has five portable hoists, which were stored within the communal bathrooms. No additional storage space had been provided as recommended at previous inspections. The manager said the laundry is due to have the equipment replaced. The home was free from odours and visitors said the home was always clean. A new fire alarm system had been installed in all areas and completed and commissioned on the day of the inspection. See recommendation 1. St Catherines Care Home F51 F01 S18740 St Catherines V222171 290405 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 28 The numbers and skill mix of staff are adequate to meet service users’ needs. EVIDENCE: On the day of the inspection there were registered nurses and care assistants on duty in sufficient numbers to meet the needs of service users. Inspection of staff rotas provided evidenced that these levels were maintained at all times. Any shortfalls are covered by staff employed at the home whenever possible. On the day of the inspection two qualified staff were working as care assistants to cover staff holidays and provide continuity of care. The manager gave information on the current numbers of care staff employed in the home with an NVQ level 2 or 3 qualification. There were twenty three care assistants employed. Nine had an NVQ level 2 and six others were working toward an NVQ level 2 or 3 qualification. When completed, the home will meet the standard. St Catherines Care Home F51 F01 S18740 St Catherines V222171 290405 Stage 4.doc Version 1.30 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 Service users benefit from a well run home that is managed on a day to day basis by a person who is fit to be in charge. EVIDENCE: St Catherines Care Home F51 F01 S18740 St Catherines V222171 290405 Stage 4.doc Version 1.30 Page 17 The home has a very experienced and competent manager who is a registered nurse and is also registered with the Commission for Social Care Inspection. She has held this post for several years, during which time significant improvements to all aspects of the home have been observed. There was evidence of positive management of the home. A visitor said ‘I can visit my wife any time and bring the dog’. ‘I can only say good things about this place. The reason we chose this place was that when I visited with my daughter she said there was not a glum face in the place it was very nice’. Another visitor said she chose the home after looking at other homes in the area and deciding to move her relative from another area. The visitor said her relative’s mental health needs were now being appropriately managed. She said ‘she is no longer isolated in her bedroom and joins in activities, even though she cannot take part she is included and likes a sing song’. ‘She pays her own fees and gets real value for money, this was a good choice the best one we made’. ‘Staff keep me informed of her health and welfare, she was recently poorly and they said ring or visit at any time’. ‘I no longer worry about her care’, I cannot praise Carolyn and the staff enough’, and ‘they are always welcoming’. An environmental health report of 3rd February recorded ‘ excellent standards well done’ during an inspection of food safety. St Catherines Care Home F51 F01 S18740 St Catherines V222171 290405 Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x 3 x x x 3 STAFFING Standard No Score 27 3 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x 3 x x x x x x x St Catherines Care Home F51 F01 S18740 St Catherines V222171 290405 Stage 4.doc Version 1.30 Page 19 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The registered person must ensure that staff administer medicnes as prescribed and record on medication administration record sheets all administrations of medicines, and any reason for nonadministration of medication. Timescale for action 1.7.05 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. 3. Refer to Standard OP22 Good Practice Recommendations The registered person should provide additional storage facilities for portable hoists. St Catherines Care Home F51 F01 S18740 St Catherines V222171 290405 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Unit D, off Rudheath Way Gadbrook Park Northwich Cheshire, CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Catherines Care Home F51 F01 S18740 St Catherines V222171 290405 Stage 4.doc Version 1.30 Page 21 - 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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