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Inspection on 31/08/05 for St Claire`s Nursing Home

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

This inspection was carried out on 31st August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 home provides a welcoming setting for residents, who were observed being supported to retain control and choice over their lives. All residents are fully involved in the plan of care provided and have a copy wherever appropriate in their room. The manager and staff team are committed and caring. Feedback from residents confirmed that their needs are seen as central to the service and that they are met in the way they want them to be.

What has improved since the last inspection?

The care team continue to provide a consistently positive approach to meeting the needs of residents.

What the care home could do better:

There is a need for an updated fire safety inspection. This was discussed with the deputy manager on the day of the inspection and the fire safety team were contacted to negotiate a date.

CARE HOMES FOR OLDER PEOPLE St Claires Residential/Nursing Home Birchwood Avenue Doddington Park Lincoln LN6 OQR Lead Inspector Roger Harrison Unannounced 31 August 2005 @ 09:30 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 Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service St Claires Nursing Home Address Birchwood Avenue Doddington Park Lincoln LN6 OQR 01522 684945 01522 693992 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) Lifeline Nursing Services Limited Mrs Jane Elizabeth Dring Care Home 40 Category(ies) of Old Age (OP) - 40 registration, with number Physical disability (PD) - 2 of places St Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The two PD beds are to be used by the named persons only. Date of last inspection 10 March 2005 Brief Description of the Service: Lifeline Nursing Services Ltd owns St Claires 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 Claires is seperated 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 includes 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. St Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspector undertook this unannounced inspection with assistance from Deputy Manager Dawn Witt, over a five hour period. The Inspector toured the building, talked with residents and family carers within the home and spoke with staff members using a method of inspection called “case Tracking”. This involved selecting four residents currently living at the home in order to track the care they receive through the checking of their records, discussion with them about individual experiences, talking to the care staff and observation of care practices within the home. What the service does well: What has improved since the last inspection? What they could do better: St Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 Page 6 There is a need for an updated fire safety inspection. This was discussed with the deputy manager on the day of the inspection and the fire safety team were contacted to negotiate a date. 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 Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 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 Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 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) 2 and 3 [Standard 6 N/A] Residents social and personal care needs are met, with individual need considered together with the care team and choice offered before, and on admission about when and how services are provided. EVIDENCE: Residents told the inspector that contact was made with them by the home before admission took place to introduce the service, provide information and to undertake a pre – admission assessment. Visits are encouraged to ensure that wherever possible residents and carers view the home before admission. Records looked at confirmed that there is a comprehensive resident guide and contract which is signed by the resident and includes a statement of purpose. A separate information leaflet sets out the different levels of care offered. Residents and carers are involved in the assessment of need and a trial period is used by the home to fully assess wether all needs can be met by the care team. Care plans showed that this information is provided at the start of the process. St Claires does not provide an Intermediate care service. St Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 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, 10 and 11. The staff team have a caring approach toward residents and their dignity and privacy is respected in a variety of ways at every stage of the care giving process. Detailed care and nursing plans are provided ensuring that residents social, health and personal needs are supported in the best way possible. Systems are in place which ensure he safe storage, recording and administration of medicines. EVIDENCE: All residents have a plan of care in their room. Each individual has a named key worker highlighted who is responsible for updating and reviewing the care plan. Individual choice is discussed as part of the care giving. One resident told the inspector that, ”I feel safe here. I can choose to lock my room and have visitors whenever I want”. A carer visiting the home told the inspector that, “They look after my friend really well. He has been here for a few weeks and everything he needs is here”. Care plans showed that needs are met and that each care episode was recorded. All residents are encouraged wherever possible to self medicate. Where this is not possible medicines are administered by trained senior staff. Controlled drugs were seen to be in a locked cupboard within a secure medication room. Medcine records were up to St Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 Page 10 date which included wider medical needs, for example dressings, and the inspector observed medicines being administerd safely as part of a residents care plan. Care plans are reviewed monthly or sooner if needed to include risk assessments which involve local doctors and other health professionals as required. The care team were seen to provide sensitive and caring support to residents at all times, and in particular at the time of death. Care plans looked at showed that residents needs are discussed and respected, Quiet space is provided and the care team were seen to be able to take time to listen to family carers residents which is important in helping to prepare for loss. The manager showed the inspector a card that a family carer had recently written to the manager to add their thanks and to praise the staff about the way their relatives needs had been supported at the time of death. St Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 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, 13,14, and 15. The care team regard the rights and choices of each individual resident as central to their work. Staff have a good knowledge of individual social, and cultural need which ensures that control and choice about how residents live their lives is supported. Food in the home is of high quality, providing a varied and nutritious diet for residents. EVIDENCE: The inspector was able to talk to several service users about daily life at St. Claires. Many said that they were able to do what they wanted to do; many choose to stay in their rooms and entertain themselves by watching television, listening to music or reading. Individual cultural and religious needs are supported through the care planning process as part of a social care assessment and residents were able to confirm that they are supported to take part in local community activities as they wish. Residents were seen to have personalised their own rooms and several residents confirmed that they have visitors and that they are made most welcome by the staff team. The inspector observed and talked with family and friends coming and going throughout the inspection and was told that they were always made to feel welcome. All rooms St Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 Page 12 have telephone points and residents have the option of having a phone in their room. Where this is not a preference a mobile telephone is available for residents to ensure access to private calls when needed. The care team encourages residents to take part in activities and employs an activities co ordinator for two days per week to plan and make choices with those residents who wish to be involved. There is a shop on site a whereby service users make things to sell to raise monies for the homes amenities fund. The inspector was able to observe residents enjoying lunch in a variety of settings around the home. Residents told the inspector they were very happy with the food provided. Menus offer a range of alternatives for all meals including a vegetarian option, and friends and relatives can choose to take meals with residents if they wish to. There is an additional charge for this facility. St Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 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 The manager and care team take complaints seriously and wherever possible involve residents and carers in resolving issues as soon as they are evident. EVIDENCE: The complaints log covered all concerns raised. It is company policy that all concerns including verbal complaints are recorded. A breakdown of the complaints log has been further developed since the last inspection which gives a better reflection of the numbers of actual complaints made about the home and the service it provides. The complaints procedure and subsequent complaints were looked at and discussed in detail with the deputy manager and appear to have been appropriately dealt with by the care home manager. The complaints log covered all concerns raised, including those from staff. On viewing of the complaints log, many were minor day-to-day concerns that were addressed immediately. Where complaints require further investigation and response by the home the manager has kept written details of correspondence and how each matter has been resolved. The home has a copy of the Lincolnshire Adult Protection Committee Procedures. The organisation has not needed to invoke the adult protection procedure over the last twelve months. The manager is aware of necessary protocols to invoke the procedure. St Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 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 Residents live in a safe clean and comfortable environment and are supported using a range of equipment to ensure that individual physical needs can be met in the right way. EVIDENCE: The home is very clean, decorated to a high standard and is very well maintained. The area outside the home is also well maintained with open and enclosed safe garden areas. The staff were seen to be following the homes health and safety policy to ensure any risk of cross contamination was minimised through the use of aprons and gloves when care giving and following correct procedures when providing both personal and domestic support. Residents told the inspector that there are sufficient bathrooms and toilets to meet their needs and the inspector observed that the care team uses five different types of hoist and a variety of equipment to ensure safety and support when mobilising for residents. The staff were seen to encourage residents to be independent and on the day of inspection the inspector observed safe practice from the care team, one resident said “Carers have St Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 Page 15 talked to me about using a walking frame but I feel safe using the support of the care team here to help me move around, I don’t want to use a frame and they respect my wishes”. Care plans are used to detail residents needs and to address any risks associated with the right to make choices. St Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 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 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, 29 and 30 The home has a robust recruitment policy which helps to support staff in their practice whilst safely meeting residents needs. There is an appropriate mix of skilled trained staff in adequate numbers to meet the needs of residents. The manager ensures that staff are recruited safely and that all checks are made to ensure the safety and protection of residents. EVIDENCE: Residents told the inspector that “staff really look after you here” and “They are so busy but they always find time to talk to me”. The inspector observed appropriate numbers of staff with the right sort of skills to meet residents wide ranging needs. In addition to the existing team the home is seeking to increase staff numbers and the inspector observed two individuals visiting the home to request application forms in order to apply for carer posts. The recruitment policy and terms and conditions of employment in place ensures that all appropriate checks are made before starting any new staff member and staff files looked at confirmed that procedures are followed. There is an induction programme and a pack is given to all new staff members which includes safe moving and handling training along with other key competencies that support staff development. The deputy manager informed the inspector that the home has developed a training and education plan for the full year. When looked at St Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 Page 17 as part of the inspection this plan showed that training and supervision is offered to all staff members and that essential training is made a requirement when needed, for example Fire safety, health and safety and adult protection. This programme includes a plan which aims to increase numbers of staff who hold NVQ qualifications. Staff told the inspector that they were supported to take up training which helped in the way care is provided overall to meet the needs of residents. St Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 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 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) 31,33, 35 and 38 The home is well managed and run in the best interests of residents living in the home, however, there is a potential risk to residents and staff if fire systems are not checked by the fire authority. EVIDENCE: The home has a well established registered manager and deputy manager who continue to use training and development to update skills and knowledge in relation to the care of residents. The home has a full range of policies and procedures which are kept in the managers office and are used as part of the supervision process to maintain staff safety and to ensure that residents needs are met in a consistent way, and remain at the heart of the process of care giving. The building has appropriate fire safety equipment and the care team were aware of procedures to follow when needed, however on checking records together with the deputy manager a scheduled fire safety inspection had not been undertaken by the fire local fire department to review arrangements and St Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 Page 19 check facilities. A call was made by Dawn Witt to the fire service during the inspection to arrange an inspection visit. Residents are encouraged to manage their own finances wherever possible and the home uses appropriate advocacy services to support residents to maintain financial independence. When this is not possible there are arrangements for the safe keeping of residents monies and records/receipts are kept by the home administrator of any activity undertaken. St Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x 3 x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 4 x x 3 x 3 x 3 x x 3 St Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 Page 21 none 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 OP19.5 Regulation 23(4)(a) Requirement The home must arrange a fire safety inspection to ensure that the building continues to comply with the requirements of the local fire department. Timescale for action 30/10/05. 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. Refer to Standard Good Practice Recommendations St Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Unity House, The Point Weaver Road, off Whisby Road Lincoln LN6 3QN 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 Claires Residential/Nursing Home C53 CO4 S2602 St Claires V246548 310805 Stage 4.doc Version 1.40 Page 23 - 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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