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Inspection on 08/12/05 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 8th December 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.

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 of non-confidential information, 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. A fire safety inspection has been undertaken since the last inspection, which indicates that the home meets the standards set by the fire safety officer.

What the care home could do better:

Care plans are in place for all residents. These plans would benefit from consistent structured reviews, which reflect outcomes for residents. A supervision system is in place for the care team, which would benefit from a formal structure, which ensures records are in place to confirm that each team member receives a minimum of six supervision support sessions a year.

CARE HOMES FOR OLDER PEOPLE St Claire`s Nursing Home Birchwood Avenue Doddington Park Lincoln Lincs LN6 0QR Lead Inspector Roger Harrison Unannounced Inspection 8th December 2005 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.V268373.R01.S.doc Version 5.0 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.V268373.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Claire`s Nursing Home Address Birchwood Avenue Doddington Park Lincoln Lincs LN6 0QR 01522 684945 01522 693992 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.V268373.R01.S.doc Version 5.0 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. 31st August 2005 2. 3. Date of last inspection 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 in place. St Claire`s Nursing Home DS0000002602.V268373.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspector undertook this unannounced inspection over a four-hour period. The Inspector toured the building, talked with residents 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 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: 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 Claire`s Nursing Home DS0000002602.V268373.R01.S.doc Version 5.0 Page 6 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.V268373.R01.S.doc Version 5.0 Page 7 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 [Standard 6 N/A]. Residents personal and social care needs are met using pre-admission assessments, which ensure the needs of each individual can be anticipated and met in an appropriate way. EVIDENCE: The Manager provided information regarding assessments undertaken with new residents prior to them entering the home. These assessments were completed using visits to individuals in their own homes, or in hospital, and by creating opportunities for residents and their families to visit the home prior to admission. A residents guide and contract containing terms and conditions are shared with any new resident, and a separate information leaflet is used to highlight the different levels of care offered. Trial periods are used to fully assess presenting needs so that the care team can be sure all long term care needs can be fully met. Care plans looked at confirm that this information is made available to new residents at the time they move into the home. The home does not offer an intermediate care service. St Claire`s Nursing Home DS0000002602.V268373.R01.S.doc Version 5.0 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. The staff team have a caring approach toward residents and their dignity and privacy is respected. Care and nursing plans are completed with residents, which need to be reviewed monthly, using more detail to evidence that changing needs are being met, and to reflect outcomes for residents. Systems are in place, which ensure the 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 and privacy needs are discussed as part of the care plan process. Two residents told the Inspector that they feel they are fully supported by the care team with their personal care needs, and one resident said “ I have just move into the home and I have settled well, I get everything I need here” Care plans showed that needs are met and that each care episode is recorded. There was some evidence available that showed care plan reviews/risk assessments are undertaken, however, these had not been undertaken regularly, or formally for all the plans looked at. This was discussed with the Manager on the day of inspection, who confirmed that work is being undertaken to update all care plans further. Residents are encouraged St Claire`s Nursing Home DS0000002602.V268373.R01.S.doc Version 5.0 Page 9 wherever possible to self medicate. Where this is not possible, medication is administered by trained, senior staff. Controlled drugs were seen to be in a locked cupboard within a secure medication room. Medicine records were up to date, and the inspector observed medicines being administered safely as part of a residents care plans. St Claire`s Nursing Home DS0000002602.V268373.R01.S.doc Version 5.0 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 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 good quality, providing a varied and nutritious diet for residents. EVIDENCE: The inspector spoke to four residents about daily life at St. Claries. Each resident said that they were able to do what they wanted to do; and that they were supported to use time privately or to undertake other activities in the home. Individual cultural and religious needs are supported through the care planning process as part of a social care assessment, and residents confirmed that they are supported to take part in wider community activities as they wished. Residents were seen to have personalised their own rooms and several residents confirmed that they have visitors and that they are made to feel welcome by the staff team. All rooms 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 creative activities as they wish, 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, which is used actively by residents to sell craft items made 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. St Claire`s Nursing Home DS0000002602.V268373.R01.S.doc Version 5.0 Page 11 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 Claire`s Nursing Home DS0000002602.V268373.R01.S.doc Version 5.0 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 and 18. The manager and care team take complaints seriously and wherever possible involve residents and carers in resolving issues as soon as they are evident. The Care team know how to act in order to protect residents from abuse. EVIDENCE: It is company policy that all concerns, including verbal complaints are recorded. The complaints procedure and subsequent complaints were looked at and discussed in detail with the manager. There had been two internal complaints made since the last inspection, which appear to have been appropriately dealt with. Where complaints require further investigation and response by the home, the manager has keeps 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 supports training for all staff about the need to protect residents from all types of abuse, Evidence of this training was available on staff files, and the Manager confirmed that she has not needed to invoke the adult protection procedure over the last twelve months. During the inspection a discussion with two members of staff helped to confirm that the team are aware of necessary protocols to invoke the procedure. St Claire`s Nursing Home DS0000002602.V268373.R01.S.doc Version 5.0 Page 13 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): 19,22 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 well maintained. The area outside the home is also well maintained with open and enclosed safe garden areas. 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, using care plans actively to detail residents changing needs and to address any risks associated with the right to make choices. St Claire`s Nursing Home DS0000002602.V268373.R01.S.doc Version 5.0 Page 14 The building has appropriate fire safety equipment and the care team were aware of procedures to follow when needed. The Manager confirmed that since the last inspection a scheduled fire safety inspection had been undertaken in October 2005 by the fire local fire department to review arrangements and check facilities. The subsequent report provided confirms that the home is currently meeting fire safety standards in an appropriate way. St Claire`s Nursing Home DS0000002602.V268373.R01.S.doc Version 5.0 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 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 and 30. The Manager has a recruitment procedure and training plan in place, which helps promote safe practice and protects residents. There is an appropriate mix of skilled trained staff in adequate numbers to meet the needs of residents. EVIDENCE: During the inspection the inspector observed the sensitive practice of appropriate numbers of staff with the right sort of skills to meet residents wide ranging needs. The recruitment policy and terms and conditions of employment in place are used by the Manager to ensure that a full range of checks are made before starting any new staff member and staff files looked at confirmed that recruitment procedures are followed properly. There is an induction programme in place for all new staff members, which includes safe moving and handling training along with other key competencies that support staff development. The Manager informed the inspector that the home has developed a training and education plan for the full year. When looked at as part of the inspection this plan showed that training is offered to all staff members and that essential training is provided, as needed, for example Fire safety, health and safety and adult protection. This programme includes a plan, which aims to increase numbers of staff holding NVQ qualifications. During the Inspection staff told the Inspector that they felt supported by the Manager to do their jobs and were able to describe the action they would take in order to protect the health and safety of residents living at the home. Since the last Inspection the Manager has instigated a Fire Safety Officer assessment. The outcome was shared with the Inspector, which confirmed that current arrangements are in place to safeguard residents appropriately. St Claire`s Nursing Home DS0000002602.V268373.R01.S.doc Version 5.0 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 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): 33, 36 and 38. The home is well managed and run in the best interests of residents living in the home. The staff team receive supervision, which would benefit from a formal structure to enable each team member to be fully supported through a minimum of six recorded sessions a year. EVIDENCE: The home has a well-established registered manager who continues to use training and development to update skills and knowledge in relation to the care needs of residents. The home has a range of policies and procedures; these are kept in the manager’s office and are used as part of the supervision process to maintain staff and residents safety, which aims to ensure that all resident’s needs are met in a consistent way. There was evidence available to confirm that supervision is provided for the staff team, however this is not undertaken using a structure which fully ensures each staff member receives supervision regularly, with records maintained. This was discussed with the Manager on the day of inspection, who confirmed that she is reviewing existing processes in order to implement an improved system of supervision. St Claire`s Nursing Home DS0000002602.V268373.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 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 X X 3 X X 2 X 3 St Claire`s Nursing Home DS0000002602.V268373.R01.S.doc Version 5.0 Page 18 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 OP7 Regulation 14(2) and 15(2) Requirement A comprehensive care plan must be completed The plan for every service user must be reviewed each month and updated on a regular basis. Service users and their representatives (where appropriate) must be involved in the devising of care plans where possible. The registered person must implement a formal supervision structure to enable supervision to be carried out at least six times a year. Timescale for action 08/03/05 2. OP36 18(2) 08/03/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Claire`s Nursing Home DS0000002602.V268373.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Lincoln Area Office 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 Claire`s Nursing Home DS0000002602.V268373.R01.S.doc Version 5.0 Page 20 - 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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