Inspection on 17/09/07 for St Claire`s Nursing Home

This inspection was carried out on 17th September 2007.

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 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 Claire`s Nursing Home 28/09/06

St Claire`s Nursing Home 08/12/05

St Claire`s Nursing Home 31/08/05

St Claire`s Nursing Home 10/03/05

St Claire`s Nursing Home 19/01/05

St Claire`s Nursing Home 22/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE St Claire`s Nursing Home Birchwood Avenue Doddington Park Lincoln Lincs LN6 0QR Lead Inspector Elisabeth Pinder Key Unannounced Inspection 17th September 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Claire`s Nursing Home DS0000002602.V347187.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 Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Claire`s Nursing Home Address Birchwood Avenue Doddington Park Lincoln Lincs LN6 0QR 01522 684945 01522 696540 jane.dring@virgin.net 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) Lifeline Nursing Services Limited Mrs Jane Elizabeth Dring Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (2) of places St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide personal care and nursing care for service users whose primary needs fall within the following categories:- Old age not falling within any other category (OP) (40) Physical disability (PD) (2) The 2 PD beds are to be used on a named basis only. One bed in the category PD is registered for a service user as named in the Notice of Proposal to Register dated 14 May 2005. One bed in the category PD is registered for a service user as named in the Notice of Proposal to Register dated 11 July 2005. The maximum number of service users to be accommodated in the home is 40. 28th September 2006 2. 3. Date of last inspection Brief Description of the Service: Lifeline Nursing Services Ltd owns St Claire’s Nursing Home. The home is a purpose built single story care home providing personal and nursing care for people aged 65 years and over. The home is situated on the outskirts of the City of Lincoln in a residential area. Local shops and community facilities are close by, and the City centre can be accessed by bus or by car. The home is set within its own grounds with small garden areas and car parking. These areas can be accessed by foot and wheelchair. St Claire’s is separated into four main zones and five lounge/dining areas. Eight bedrooms have en-suite facilities. The home is appropriately adapted to meet the needs of older people with disabilities, which include lifting appliances and assisted bathing. The home is staffed by registered nurses and care staff and there is a programme for staff training and supervision in place. Current fees range between £348.00 - £558.88 St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit to the home was undertaken by one inspector and formed part of a key inspection, focusing on all the key standards. Throughout this report the terms ‘we’ and ‘us’ refer to The Commission for Social Care Inspection (CSCI). The visit lasted approximately seven hours and took into account previous information held by us including the previous inspection report and improvement plan. Prior to the visit the providers had returned their Annual Quality Assurance Assessment (AQAA) and this will also be mentioned throughout this report. The main method of inspection used was ‘case tracking’ which involves selecting residents and tracking the care they received through looking at their records and observing staff that provide their care. A period of time was spent observing the care being given to residents and the interaction between staff and residents. The manager, responsible individual and two members of staff were spoken to as well as three visitors. No ‘Have your say about’ questionnaires were received. What the service does well: What has improved since the last inspection? St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 6 An activities co-ordinator has been appointed and final recruitment checks are being made. Fire safety procedures are now being carried out as per fire safety regulations and regular fire drills and alarm tests are being carried out. The manager has taken action to ensure staff receive adequate training including induction training and safeguarding adults training enabling them to meet the needs of people living in the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Claire`s Nursing Home DS0000002602.V347187.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 Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 standard 6 is not applicable Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People coming into this service have access to information to help them make a decision about moving into the home. However, information gathered prior to admission is limited so their needs may not be assessed and planned for. EVIDENCE: The Statement of Purpose and Service User Guide are currently being up dated to show the changes in the leadership of the company. These documents contain sufficient detail about the home to help people understand the services that are offered and what they can expect and give clear information about the fees payable and any additional costs. The guide is given to residents or their relatives on admission. However, neither detail how prospective residents can access copies of our reports or how the service will meet the equality and diversity needs of people and the manager agreed to address this. St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 9 The AQAA received from the provider details the procedures taken to ensure the care needs of new admissions will be met. However, the records of two new residents admitted since the previous inspection showed that information obtained before their admission was limited and did not provide staff with a clear knowledge of their needs. The company representative present during the visit said that new systems including new assessments and care planning records are currently being set up in another of their homes and these will be introduced in all Lifeline homes as soon as possible. Staff spoken with said they are not involved in the assessment process but they are always given information about the person and they know the importance of making new residents and their families feel welcomed. One resident said he had chosen this home ‘on recommendation’ and was very pleased with his choice. Terms and conditions are held on individual files and residents and/or their representative have signed in agreement. St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans have improved but still do not contain sufficient information to ensure all the needs of people and how they are to be met are identified. This has the potential that residents’ needs may not be fully met. Residents are not fully protected by the current procedures in place for recording medication administered. Residents, wishes, preferences, privacy and dignity are well respected EVIDENCE: Information provided in the AQAA reads that ‘full assessments are carried out according to activities of living’. Care plans examined during the visit mainly focused on the physical health care needs of residents and how these were to be met. The social needs of people were not always identified and this was discussed with the manager who agreed to address this. St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 11 Whilst it is acknowledged that some care plans are kept in residents’ rooms and regular reviews are held, some read ‘no change’ and do not show residents and/or their representatives involvement or agreement. One resident said she did not always get the care needed and felt staff did not always take notice of her when she told them she was in pain. However, another resident said he was very satisfied with the care and felt his needs were being met. Risk assessments have been written where risks have been identified and the management of the risk had been balanced against the choices and wishes of the individual person. Records showed that residents regularly see their GP and, where necessary, consultant, opticians and dentists. Photographs of residents are kept with their MAR sheets (medication administration record) and medication being given to residents during the lunch-time period was observed. Medication is given to residents by trained staff, however, the member of staff giving medication signed the MAR sheet before giving medication to the resident and a discussion was held with her about this to avoid records being altered should medication be refused. The staff team were observed to generally carry out their duties with kindness and sensitivity towards the residents, especially when attending to their personal needs. A resident and her relative were spoken with and both said that they were satisfied with the care and said they had just been asked to sign the plan of care. St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples’ interests are generally accommodated and they are able to enjoy a lifestyle which is flexible and varied. Meals provided are well balanced and nutritional. EVIDENCE: Since the previous inspection an activities co-ordinator has been appointed and is due to commence shortly. The role is initially for sixteen hours each week and will include developing a plan of activities with residents and also looking at how the needs of those who are unable to join in organised activities can be met and will include equality and diversity needs. The manager said that the home has recently received a grant and plans are in place for a sensory garden to be built which will include wind chimes and plants with different smells and touch, and a mobile projector will be purchased which can move to rooms where residents are cared for in bed. St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 13 Musical entertainers visit approximately every eight weeks and a reminiscence afternoon is booked for 18th September. One resident spoken with said that she did not wish to join in with activities although no one comes in to see her apart from her husband. Another resident said ‘I sit in my chair all day, I get very bored and staff do not often have time to chat’. However, another person said he ‘couldn’t find a better place’, he enjoys going out every day for a walk and often plays cards with a neighbour in the evenings. A variety of space is offered for visitors to meet their relatives in and a visitor spoken with said that they were always made to feel welcome. The mid-day meal was observed being served, it was well presented and nutritionally balanced. Several people had pureed food and were assisted with eating, however, one member of staff was seen standing over a resident whilst assisting him which may be intimidating. Varied comments were received from residents, these included ‘the food is adequate’, the food’s not too bad’, and ‘the same sort of thing each tea-time’. Menus showed that a choice of main meal is offered and a selection of choices are available each tea time. The Environmental Health Officers had visited the home and recorded that the systems used were over and above what was necessary to achieve standard. All kitchen staff had the basic food hygiene award. St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures are in place to protect residents as far as possible from harm, however, not all residents are fully aware of the complaints procedure which may lead to their views not being heard. EVIDENCE: Complaints records were seen and all had been investigated using the home’s complaints policy. Records are kept of the outcome of complaints and these were well documented. Most people spoken with did not know the procedures to take should they wish to make a complaint, although all said they did not have any concerns at the moment. Specific comments were: ‘although we were not given any information about making a complaint we would talk to the nursing staff’, ‘I have no idea how to complain, but would talk to staff’ and ‘no information was given but it is so open here’. A relative raised a concern with us in October 2006 and agreed to discuss it with the care manager. However, this had not been raised with the manager and a discussion was held about sending questionnaires to all relatives to help the company review the quality of the service they are providing. St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 15 Since the previous inspection some staff have completed safeguarding adults training and staff spoken with had a good knowledge of abuse and the procedures to take should an allegation be made. St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home live in a clean, pleasant and hygienic environment and they are able to personalise their rooms. EVIDENCE: Information provided in the AQAA shows that systems are in place for the maintenance and renewing of furnishing and equipment when needed. Risk assessments are carried out on the premises to ensure that residents are safe from any potential hazards. Bedrooms of residents ‘case tracked’ were viewed and all were clean and tidy and well personalised and specialist equipment was provided where needed. Staff were seen wearing protective clothing and people spoken with were very St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 17 satisfied with the cleanliness of the home, with specific comments ‘the cleaners are very good’. The previous visit reported that cleaning materials were safely stored and the staff spoken with were satisfied with the awareness training and equipment provided to enable them to undertake their roles. Areas of the home seen were clean, pleasant and homely with no unpleasant odours. St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing numbers are adequate to meet the needs of people currently living in this home and they are supported by staff who are appropriately trained. EVIDENCE: Since the previous inspection the manager is taking action to ensure staff receive adequate training including induction training to enable them to meet the needs of people living in this home. However, the induction programme is being reviewed as the manager feels the current training is complicated and timescales are not always met. Plans are also in place to ensure more staff undertake the National Vocational Qualification (NVQ), which is a recognised training award in care. The home has recently received inclusion in ‘Gold Standards Framework’ chosen due to the commitment of staff providing a high standard of care to residents nearing the end of life. Information provided in the AQAA shows that there are a mixed gender and mixed ethnicity of staff working in this home. Staff spoken with confirmed that they receive regular training opportunities and training offered is appropriate St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 19 for the needs of residents. However, they had not had specific training in equality and diversity and not all staff had a clear understanding of this. Records showed that there are normally six staff on duty each morning, four in the afternoons and three throughout the night. The manager’s hours are in addition to these although she does cover the occasional shift if a member of staff calls in sick at short notice. Residents and relatives spoken with said that at times they felt there was not enough staff on duty, mainly at the weekends when some residents have had to wait for their call bells to be answered. This was discussed with staff who said they always go to the resident and establish if it is an emergency and then prioritise according to need. Records examined of newly recruited staff showed that they had been recruited using safe robust procedures. The manager said all care staff are given copies of The General Social Care Council Codes of Practice, setting out their responsibilities as care workers looking after vulnerable adults. St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This service is being well managed with procedures in place to ensure the health and safety needs of residents are met. EVIDENCE: The manager has the necessary experience and qualifications to run this home and has been in post for a number of years. She has commenced the Registered Managers Award and undertakes regular training. Recent training has included health & safety, a mentorship course and training regarding the Mental Capacity Act. St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 21 She has regular meetings with staff and her door is always open for staff to speak with her about care practice issues or raise any concerns, however, these are not always recorded as formal supervision and it was agreed to address this. Staff and residents comments were very positive about the manager, all said she was approachable and available when needed. The manager said that resident and relative meetings are poorly attended, the last being held in May and only one resident and one relative attended. Therefore she aims to send out quarterly news-letters which will be written by the activities co-ordinator and residents. Since the last inspection a quality audit report has been sent to us identifying any necessary action being taken to improve the quality of care provided. Regular questionnaires are sent to relatives and a discussion was held regarding widening this to include general practitioners (GP’s), district nurses and social workers to encourage them to give their views on improving the home. None of the residents ‘case tracked’ had any money or valuables in safekeeping and the manager said that wherever possible finances are managed by residents, their relatives and/or their representatives, however, secure facilities are available if necessary. Since the last inspection fire safety procedures have been reviewed and are now being undertaken as per fire safety regulations. The last fire alarm test was carried out on 16/09/07 and the fire risk assessment was reviewed in March 2007. Records seen also showed residents’ and staff health and safety is being promoted. St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 22 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 2 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 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 X 3 X 3 X X 3 St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 23 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 OP3 Regulation 14[1]c Requirement Pre-admission assessments must be in enough detail to ensure people coming into the home will have their needs met. Information must be gathered from all people involved in caring for the person. Reviews of care plans must be improved to include details of any changes required to the current care given and these must show that residents and/or their representatives have the opportunity to be involved. Care plans must identify the social needs of residents and show what action is needed to meet these needs. The home must provide people with information regarding how to complain to ensure all concerns or complaints can be made. Timescale for action 31/10/07 2. OP7 15 [2] b, c&d 31/10/07 3. OP12 15 and 16 [2] n 31/10/07 4. OP16 22 31/10/07 St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 24 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 OP1 OP30 Good Practice Recommendations The Statement of Purpose and Service User Guide should reflect how the service promotes equality and diversity and should detail how people can access CSCI reports. All staff should receive equality and diversity training. St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Lincolnshire Area Office Unity House, The Point Weaver Road Lincoln LN6 3QN National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Claire`s Nursing Home DS0000002602.V347187.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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