Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 09/08/05 for St Clements Nursing Home

Also see our care home review for St Clements Nursing Home for more information

This inspection was carried out on 9th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

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 is a modern building and all bedrooms have en-suite facilities and there has been an ongoing programme of re-decoration. The mangers office is on the lower ground floor and is easily accessible to visitors entering the home. The standard of food in the home is good and all residents confirmed they enjoyed the meals.

What has improved since the last inspection?

There is a new manager and deputy manager in post who appear committed and keen to address the shortfalls in the home. The manager has worked a range of shifts to meet all staff and has commenced regular staff meetings. He has also meet many of the relatives and is hoping to commence regular meetings with them. Staff stated they found the new manager fair and the deputy addressed any issues raised. On discussion with residents the were content living in the home and some felt the manager was getting things done now. There appears to have been some improvement in staff morale and communication. There has been a marked improvement in the medication system, which the deputy manager has taken responsibility for. Also some aspects of privacy are being addressed by staff.There is ongoing activity in respect of the general decoration around the home. New flooring has been provided to the kitchen and laundry plus carpets to the lounges and corridors. The organisation is also in the process of replacing bedroom furniture, which will provide lockable facilities for residents valuables etc. They have also had one flat floor shower installed and considerable work has been undertaken in respect of the water system to ensure adequate hot water temperatures. There has been a new sluicing disinfector in the sluice, new handling equipment and the home is expecting a supply of new mattresses, which will improve the area of tissue viability. There was an audit in respect of infection control and improvements made in respect of hand washing facilities and staff have individual gel to use. An activities organiser has taken up post and is in the home two hours each day between Monday and Friday and this proved to be very successful.

CARE HOMES FOR OLDER PEOPLE St Clements Nursing Home 8 Stanley Road Nechells Birmingham B7 5QS Lead Inspector Ann Farrell Unannounced 9 August 2005 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 Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service St Clements Nursing Home Address 8 Stanley Road Nechells Birmingham B7 5QS 0121 327 3136 0121 328 1464 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) Noblefield Limited Care Home 37 Category(ies) of Older People, Dementia - over 65 (37) registration, with number of places St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. 27 Nursing and 10 Residential places, categories DE(E) and OP. 2. The manager achieves the Registered Managers Award or equivalent by April 2005. 3. The manager achieves a recognised training module in caring for people with dementia by April 2005. 4. Personal reading in respect of social values in caring for older people. Date of last inspection 5 April 2005 Brief Description of the Service: St Clements is a purpose built three-storey home situated in a built up residential area in Birmingham. The home provides accommodation to thirtyseven elderly residents in 27 nursing beds and 10 residential beds. There are twenty-five single bedrooms and six double rooms and all have en-suite facilities consisting of a toilet and wash hand basin. Access to the home is gained by the lower ground floor and a passenger lift gives access to the ground and first floor. There is limited parking on the lower ground floor to the front of the property, which is covered. There is a small garden with steep elevations that is accessed from the ground floor. Communal facilities consist of a large lounge on the ground and first floor. There is also a dining room on the ground floor that is adjacent to the kitchen, which provides all the meals. A laundry facility is situated on the lower ground floor, where washing of residents personal clothing is undertaken. There are bathing facilities on each floor, however, some of these are not suitable for the clent group. St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was conducted over one day commencing at 8.00 am on 9th August 2005. This was the first statutory inspection for 2005/2006. The manager was present for the inspection. During the inspection process the inspector toured the home, sampled residents files and other documentation. The manager, four members of staff and approximately seven residents were spoken to. A number of residents were unable to communicate verbally. The feedback from residents was generally good. It was stated that most of the staff are good, they respond quickly and are attentive. The organisation have employed a new manager and deputy manager and they have commenced work on improving a number of the systems in the home. A number of requirements have been carried forward as they were not assessed at the time of inspection. What the service does well: What has improved since the last inspection? There is a new manager and deputy manager in post who appear committed and keen to address the shortfalls in the home. The manager has worked a range of shifts to meet all staff and has commenced regular staff meetings. He has also meet many of the relatives and is hoping to commence regular meetings with them. Staff stated they found the new manager fair and the deputy addressed any issues raised. On discussion with residents the were content living in the home and some felt the manager was getting things done now. There appears to have been some improvement in staff morale and communication. There has been a marked improvement in the medication system, which the deputy manager has taken responsibility for. Also some aspects of privacy are being addressed by staff. St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 6 There is ongoing activity in respect of the general decoration around the home. New flooring has been provided to the kitchen and laundry plus carpets to the lounges and corridors. The organisation is also in the process of replacing bedroom furniture, which will provide lockable facilities for residents valuables etc. They have also had one flat floor shower installed and considerable work has been undertaken in respect of the water system to ensure adequate hot water temperatures. There has been a new sluicing disinfector in the sluice, new handling equipment and the home is expecting a supply of new mattresses, which will improve the area of tissue viability. There was an audit in respect of infection control and improvements made in respect of hand washing facilities and staff have individual gel to use. An activities organiser has taken up post and is in the home two hours each day between Monday and Friday and this proved to be very successful. What they could do better: Re-decoration of the home needs to be continued and the programme of replacing the furniture needs to be completed. The dining and bathing facilities needs to be reviewed/enhanced in order to provide appropriate facilities for residents. Also the arrangements for storage need to be reviewed. The arrangements for addressing concerns or complaints from residents needs to be clarified to all in the home and systems put in place to advise senior staff about them, so that appropriate action may be taken and records maintained. Aspects relating to respecting residents privacy and dignity needs to be further enhanced. Also action needs to be taken to address issues in relation to items of missing laundry and ironing of resident’s clothes. Suitable systems need to be put in place for regular staff supervision and consultation with residents. The process of assessment and care planning of residents needs to enhanced and records should provide more detail to ensure consistency of care. Suitable arrangements must be in place to all residents to have regular checks form health professionals and records must be retained in the home. Filing systems and storage of records etc needs to be reviewed and be put in an orderly fashion to ensure easy access to information. Staff should wear appropriate foot wear when on duty for the purpose of health and safety. St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 7 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 Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 8 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 Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 9 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) 3,4,6 Information is available for prospective residents wishing to enter the home, but it requires enhancing. The assessment process needs to be developed further to ensure all resident’s needs are identified when being admitted to the home. EVIDENCE: The home generally admits residents for long-term care, but on occasions there are admission for respite care. They have a service user guide available for prospective residents. There is also a statement of purpose, which requires developing and enhancing to provide sufficient detailed information. The staff liaise with social workers who provide a written care plan for residents who wish to enter the home. Senior staff undertake a pre-admission assessment to determine if they are able to meet residents needs. On inspection of records for a resident who had recently been admitted to the home there was evidence that an pre-admission assessment had been undertaken, but there was no evidence available to indicate that the home had confirmed in writing that they could meet the needs. St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 10 On admission to the home staff complete the admission sheet and these were in place for the sample of files inspected. On inspection it was noted that all areas had not been completed, there was no evidence of a continence assessment or mental health assessment where relevant. Also there was no evidence that the resident or relatives were involved in the assessment process. On discussion with the new manager he stated he had not admitted any residents to the home since he came into post. The home is registered to care for residents with dementia and there are currently a number of residents who suffer with confusion/dementia. At previous inspections a requirement has been made for staff to undertake training in respect of dementia and handling behaviour that challenges. On discussion with the new manager he stated he had experience in this area and would develop of training package. Decoration of the home has been undertaken and each floor is a different colour, but there is a lack of signage. It is recommended that this area be reviewed and advice taken where necessary. An audit has recently been undertaken with the tissue viability nurse and a number of new mattresses have been ordered. At the time of inspection it was noted that bed safety rails are used on a number of beds and the manager will need to ensure that when pressure relieving mattresses are in use the bed safety rails are of a suitable height. The manager has received a supply of sliding sheets and has been training staff in the use of them. The manager stated he has spoken to all staff about the use of footplates on wheelchairs and this is being reinforced where necessary. He also stated staff have informed him that the deputy manager has had a big influence on the methods of handling residents. On discussion with a member of care staff she stated the deputy manager was very good and if any concerns are raised he will address them promptly. St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 11 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 There are systems in place to meet resident’s health needs, but the lack of comprehensive records and follow up cannot guarantee that all residents needs are met or that consistency of care is provided. The home demonstrated some good practice for medicine management. EVIDENCE: Nurses draw up a care plan for each resident following admission to the home outlining how the resident’s needs are to be met by staff. On inspection of a sample of records it was noted that there had been no real developments in this area e.g there were no photographs of residents, there was no handling assessment in another, the nutritional assessment in another had been undertaken, but there was no objective tool to indicate if a resident was underweight or overweight such as BMI. Some areas were lacking in detail and other care plans were not comprehensive in respect of covering all areas of need. Care plans had been reviewed intermittently, but had not been consistently updated to reflect changes and there was no evidence that the resident or their representative had been involved in the process. All care plans are still stored in the office on the lower ground floor, which are not easily accessible to staff. The manager discussed this area and stated he had plans to make care plans more accessible to staff, which he hopes to address in the near future. St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 12 In order for a consistent approach to care detailed care plans should be in place for all staff to easily access. Previously issues have been identified with the handover at the change of shift and it was stated that these issues have been resolved ensuring that all care staff receive a verbal report when they arrive on duty. The majority of residents are registered with a local G.P. who visits the home regularly each week. At the previous inspection it was stated that service users would receive regular health checks, but it could not be confirmed that this was occurring at present or if residents were having regular visits from health professionals such as the chiropodist, dentist etc. The manager stated that they have obtained some new blood sugar monitoring equipment and he was in the process of having the insulin changed to the pens to reduce risks of injury. Staff are also in the process of enhancing residents privacy with the use of net curtains to windows and curtains to toilets. During inspection it was noted that an incontinent pad was used on an armchair for one resident who was sitting in the lounge and the hairdresser was attending to a number of residents in one bedroom. This is not appropriate practice. At lunch time it was noted that the majority of residents go to the main dining room. Staff had lined the residents up in a queue waiting for the passenger lift from the first floor. Again this was not considered good practice. On discussion with residents they stated they were generally satisfied and they found most staff to be attentive and attend fairly promptly to call bells. One stated “you get better treatment here than at home”. Another stated they would like more frequent baths and at the previous inspection it was stated they would like to know staff’s names. During the course of the inspection it was noted that duvet covers were being still being used as sheets, although staff had been advised that they may pose a risk to residents. The filing system for charts and forms remains poor, but the new manager stated that they are in the process of reviewing all the systems. The pharmacist inspector undertook an inspection of the medication and found the majority of audits were correct demonstrating that most medicines had been administered as prescribed. Some medicines had been administered but not recorded and a few had been recorded as administered but had not been. Overall these were in the minority. Systems had been implemented to check the medicines into the home. St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 13 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) 12,13,15 There has been an improvement in the range of choice of activities available to residents with the employment of an activities co-ordinator, which needs continual input to further expand it. The dietary needs of residents are fairly well catered and choices are available, but action needs to be taken to enhance the environment and equipment to make it a more pleasurable experience. EVIDENCE: Since the previous inspection the home has employed an activities co-ordinator who works two hours each afternoon between Monday and Friday. The inspector saw her at the time of the inspection, but did not have opportunity to speak to her about the programme of activities etc. However, it is an area that has been lacking in the home for a considerable period of time and will be of benefit for the residents. The assessments undertaken with resident will need to obtain information about any past interests/hobbies and an appropriate plan drawn up to meet their needs and preferences either in groups or for individuals. Visiting is fairly flexible and residents have a choice of areas to receive visitors. However, currently there is no separate area where residents can meet visitors in private. The new manager has spoken to many of the relatives and hopes to commence regular meetings with residents and relatives to ensure there is a consultation process within the home. St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 14 The home has a well appointed kitchen, which has had new flooring fitted and been decorated since the last inspection. Separate catering staff provide cover for all the meal and t here is a four-week rotating menu, which offers a choice of meals and staff were observed to be asking residents about choices for the next day. On discussion with residents they stated the meals were of a good standard and one resident stated he received fresh fruit from the kitchen. On the day of inspection the inspector had lunch with the residents. Although the meal was of a good standard it was noted that the dining room was very cramped and one resident was asked to stand up to enable another resident to gain access to her seat. Some tables did not have condiments, some of the pureed meals were served in bowls and all the food was mixed together. Many of the residents had blue aprons put around their necks to protect their clothing, which was not always successful and lacked dignity. It was recommended that a suitable alternative be found. When staff were assisting residents they were either standing or kneeling on the floor and one resident was sat in his wheelchair by the entrance door. Plate rings were in use but there was no other evidence of any equipment to assist residents in eating independently. St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 15 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 Systems for dealing with complaints needs to be reviewed and everyone made aware of procedures so that residents can be assured of appropriate action being taken. EVIDENCE: The complaints procedure is displayed in the reception area and forms are available for comments or suggestions. On discussion with some residents they discussed some issues that they were not fully satisfied with, but it appears that they had not discussed them with the manger or anyone else. They were advised that if there were any concerns they should be discussed with the manager enabling the home the opportunity to address them. Also the manger will need to ensure that all residents are informed of the procedure for raising any concerns or complaints. In addition, staff need to be aware that if any concerns are raised they are reported to a senior member of staff so that action can be taken. On discussion with the new manager he was unable to locate a copy of complaints made to the home and is currently addressing systems within the home. The Commission has received two complaints since the beginning of the year. One complaint, which was investigated by the Commission, involved numerous aspects including staff attitude, poor standard of care, poor medication procedures, inadequate cleaning of the home, poor access to the call bell, poor communication systems and lack of confidentiality, lack of activities, inadequate procedures for wound dressing and handling of residents monies and personal items missing. All the area were fully upheld or partially upheld. Part of the investigation in respect of medication is ongoing as further information was required. The second complaint involved allegations of racism and procedures around recruitment selection, promotion and training of staff St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 16 by the manager at the time. This was investigated by the organisation which found the allegations to be unfounded, but did find that the manager had formed a very close relationship with one member of care staff whom she spent a lot of time with in the smoking area and could be perceived as favouritism by staff. Since these two complaints the manager ceased employment and a new manager has been appointed who is addressing the issues. St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 17 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) 19,20,21,23,24,25,26 The environment is generally safe although a number of outstanding requirements means that the comfort of some residents could not be ensured. Further decoration and replacement of furniture is required to enhance the homeliness of the environment. EVIDENCE: St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 18 The home is a modern three-storey building. Since the last inspection there has been an improvement in the standard of cleanliness in the home. There is limited parking to the front of the building with a small garden within the grounds. There is a large lounge on the ground and first floor, where the majority of residents reside. A dining room is situated on the ground floor, but this is not adequate in size to accommodate the number of residents using it and the manager has been asked to review the arrangements for meal times. These areas have been redecorated and new carpets have been fitted to lounges and corridors. They are adequately furnished, but some of the seating in the lounges may not be appropriate for some of the residents and an audit is to be undertaken with the tissue viability nurse. All bedrooms have an en-suite facility that includes toilet, wash hand basin. Since the last inspection soap dispensers have been fitted in all areas to enable staff to wash their hands and they have been provided with individual hand gel dispensers for good infection control. There are communal bathrooms on each floor where residents rooms are situated, but there are only two in the home that are suitable as assisted bathing facilities, which is not sufficient for the number of residents. In addition, some tiles are missing from the wall in one bathroom and they would benefit from decoration to enhance the facilities. Toilets are strategically placed through the home. All bedrooms are provided with basic furnishings and the organisation are in the process of replacing some of the furniture which is not suitable. The new furniture includes lockable facilities for residents who wish to store valuables of medication, but there are not suitable locks and keys to doors for residents who wish to lock their door Rooms are individually and naturally ventilated and windows are provided with restrainers for safety and security reasons. Lighting appeared adequate, but some residents did not have any bedside lights. Radiators are of the low surface temperature type and there has been considerable work on the hot water system to ensure adequate and safe temperatures. During the inspection it was noted that some of the doors were propped open, some did not have closures in place and some of the extractor fans were not working. Laundry facilities are situated on the lower ground floor, but are rather cramped. A lock has been fitted to the door for security, the damaged flooring has been replaced and a separate wash hand basin has been fitted. However, the cupboards need replacing and generally there is a lack of storage space throughout the home. On discussion with some residents they stated that items of clothing go missing and there are times when the standard of ironing needs improving. St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 19 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 Adequate staffing levels are maintained for the current number and dependency of residents and there has been an improvement in the recruitment procedures. EVIDENCE: At the time of inspection there were 33 residents in the home. Staffing rotas indicated that there were two nurse and six carers on duty during the morning, one nurse and five carers on duty during the evening, one nurse and three carers overnight. Currently the home are using agency staff to cover some of the shifts, but it was stated that they tend to use the same staff to ensure some consistency. In addition, there are catering, domestic, laundry, administration staff and handy man who support the care staff. A small number of staff files for newly appointed staff were examined and were found to be satisfactory. The manager stated that he was reviewing the staff training and records will be inspected at the time of the next inspection. St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 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 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) 31,32,36,38 There is a new manager and deputy manager in post who appear committed to addressing the outstanding issues and there appears to have been some improvement in staff morale. Staff meetings have commenced, but formal supervision and meetings with residents and their relatives is to be developed. EVIDENCE: The organisation have employed a new manager and deputy manager since the time of the last announced inspection. They both have a number of years experience in the nursing profession. The manager stated he hopes to commence the Registered Care Managers Award in the near future and is to apply to the Commission for registration. He is responsible for one establishment and there are lines of accountability in the home and externally. On discussion with a number of staff they stated they found the new manager to be good, fair and stated he was taking an interest in all areas of the home. There has been one staff meeting since up tool up post in July and another one is planned to take place within the next ten days. Formal supervision has not commenced yet, but he discussed the possibility of starting with group St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 21 supervision for small numbers of staff. He also stated that he is hoping to commence meetings with residents and their families. Feedback from residents was positive about the new manager and it was stated “ he is nice and he is starting to get things done”. During the inspection it was noted that some staff were wearing “flip-flop” type shoes, which are not suitable in respect of health and safety. St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 x 15 2 COMPLAINTS AND PROTECTION 2 2 2 2 3 2 3 2 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x 2 x x x x 1 x 2 St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 23 yes 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 1 Regulation 5 Requirement The registered provider must ensure the service users guide includes the most recent report, contract and details regarding fees as required in the amended regulation 5. This area was not assessed and has been carried forward from 30/12/03. The registered provider must; Enhance the statement of purpose and provide more detailed information. When completed a copy should be sent to the Commission. Ensure the statement of purpose includes details of arrangements for emergency admissions and service users admitted for respite care. This area was not assessed and has been carried forward from 30/12/03. The registered person must; Ensure residents assessments are fully completed outlining all areas of need with risk assessments. The assessments must include continence and mental health assessments where appropriate. The assessments must involve residents or their Timescale for action 30/1/06 2. 1 4 30/1/06 3. 4 18(1) 15/10/05 St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 24 4. 4 18(1) 5. 7 15 12(1) representatives. Ensure systems are in place to write to prospective residents confirming that the home is able to meet their needs in respect of health and welfare. There are systems in place for regular auditing of these documents. Ensure training is provided to staff where necessary to ensure continuity. Timescale of 30/9/03 not met. The registered person must 30/12/05 ensure; All staff undertake training in respect of caring for people with dementia commensurate with their position. Timescale of 30/10/03 not met. All staff undertake training in respect of managing challenging behaviour. The registered person must 15/10/05 ensure; Care plans are fully completed and set out in detail the action to be taken by staff to meet all residents needs. Care plans are reviewed at least once a month and updated where there are any changes in residents conditions. Residents or their representatives are involved in the process and this is demonstrated in the records e.g. signed by them. Systems are in place to ensure that all staff are aware of care plans and they are easily accessible. The manager has systems in place to ensure care plans are audited on a regular basis. Training is provided in care planning where required to ensure consistency. Timescale Version 1.40 Page 25 St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc of 30/11/03 not met. 6. 4,8 12(1) The registered person must ensure that when pressure relieving mattresses are in use with bed safety rails the rails are of sufficient height. The registered person must ensure: Regular monitoring of residents psychological health. Systems are in place for regular monitoring of chronic diseases such as diabetes. Sytems are in place to monitor wounds/presssure sores. All residents have the opportunity for regular checks with health professionals such as dentist, chiropodist, and optician and records are clearly maintained. The home should have an objective tool to determine reisdnets nutritional stated such as BMI. Duvet covers are not used as sheets. There is a supply of neurological charts in the home. Consult residents about their bathing preferences. Timescale of 27/8/03 not met. The registered person must undertake regular staff drug audits to ensure all the medicines are administered as prescribed and recorded correctly by all nursing staff. The registered person must ensure residents privacy and dignity is respected at all times to include; The appropriate use of incontinent sheets, hairdressing arrangements and arrangements for transpoting residents to the dining rooms for meals. 30/9/05 7. 8 12(1) 13(1) 30/10/05 8. 9 13(2) 30/8/05 9. 10 12(4)(a) 15/9/05 St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 26 10. 11 12(1) 11. 12 16(2)(m) (n) 12. 15 12(1) 12(4)(a) 23(2)(i) 13. 13 14. 16 22 15. 18 13(6) The registered person must review current procedures in respect of caring for residents whose condition is deteriorating to provide a co-ordinated approach and ensure policies and procedures are updated to reflect practice. This area was not assessed and has been carried forward from 30/11/04. The registered person must ensure all residents are consulted about past interests/hobbies and draw up a up a plan of activities for them (group or individual) ensure the plan is implemented and records are kept in the home. Timescale of 30/11/03 not met. The registered person should undertake a review of meal times addressing all the issues outlined in the report. The registered provider must provide accommodation for service users to meet visitors in private which is separate from their own private rooms. Timescale of 30/3/04 not met. The registered person must ensure: All residents or their representatives are informed of the procedure for making a complaint. Timescale of 30/8/03 not met. All systems are in place for all staff to inform a senior member of staff about any concerns. A record of all complaitns is retained in the home and is available for inspection. The registered person must provide training to all staff in respect of the Local Multi Disciplinary guidance in respect of vulnerable adult procedures and they are followed. This area 30/11/05 30/11/05 30/9/05 30/3/06 30/9/05 30/12/05 St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 27 16. 19 23(4) 17. 20 23(2)(e) 18. 21 23(2)(d) (n) 19. 22 23(2)(l) 20. 24 16(2) 23(2)(n) was not assessed and has been carried forward from30/11/04. The registered person must undertake an audit of all bedroom doors and seek advice from the fire officer as to whether closure mechanisms be availble on all bedroom doors. The registered person must ensure all fire doors are kept closed when not in use. If there is a need to keep them open they must be linked into the fire alarm system. Timescale of 30/10/04 not met. The registered person must undertake a review the current arrangements for the dining room as currently it is rather cramped. Timescale of 30/3/05 not met. The registered provider must ensure; Call bells are accessible to all toilet and bathing facilities. Provide suitable locks on all bathrooms doors that indicate when engaged. Appropriate bathing facilities are provided in sufficient numbers to meet all sresidents needs. Bathrooms are re-decorated. Damaged or missing tiles are replaced in bathrooms. Timescale of 30/3/04 not met. The registered person must review and enhance where necessary the storage facilities in the home. The registered provider must: Provide suitable locks to all residents beroom doors. Consult residents as to their wishes in respect of furnishings in line with the minimum standard, provide where appropriate and record in their care plan. 30/9/05 30/9/05 30/12/05 30/1/06 30/3/06 St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 28 21. 22. 24 26 23(2)(p) 13(4) 23(2) 23. 26 16(2)(f) 24. 30 18(1) 25. 31 8 26. 33 24 27. 35 20 17(2) Sch 4 Provide adjustable beds where necessary to meet residetns needs needs following assessment. Timescale of 30/4/04 not met. Continue with the programme of furniture replacement and provision of loackable facilities. The registered person must ensure all residents can access a light from their bed. The registered person must; Replace the cupboards laundry. Ensure the sluices are locked when not in use. Ensure all extractor fans are in working order. The registered person must ensure all residents laundry is returned to them and it is ironed properly. The registered person must ensure all newly appointed staff undertake induction training within 6 weeks and foundation training within 6 months to NTO specifications. Not assessed and carried forward from 30/9/03. The responsible person must ensure an application is forwarded to the Commission for registration of the manager. The registered person must implement a quality assurance system ensuring that stakeholders views are obtained and an annual development plan is drawn upThe registered person must ensure all policies and procedures are up to date and all staff are aware of them. This area was not assessed and carried forward from30/10/04. Any monies belonging residents must be deposited in an account in the name of the resident. The home must maintain records of all monies and valuables held 30/10/05 30/10/05 15/9/05 30/11/05 30/9/05 30/1/06 30/10/05 St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 29 28. 36 29. 38 30. 38 31. 38 32. 38 on behalf of service users and they must be up to date. There must be two signatures for all transactions, one of them being the resident where possible. Individual receipts must be obtained from the relevant company and kept for all transactions where monies are spent on behalf of residents. This area was not assessed and has been carried forward from 30/9/03. 18(2) The manager must unsure all staff receive formal supervision at least six times per year and records kept in the home. Timescale of 30/11/03 not met. 13(4) The registered person must ensure all staff undertake basic training in respect of first aid and records are kept in the home. This area was not assessed and has been carried forward from . 16(2)(j) The registered person must ensure all staff undertake training in respect of basic food hygiene and records are kept in the home. This area was not assessed and has been carried forward from 30/12/03. 23(4) The registered person must ensure there are systems in place for regular fire training and all staff are fully conversant with the fire procedure. This area was not assessed and has been carried forward from 27/8/03. Health The registered person must and safety ensure all staff wear suitable Act shoes when in the work place. 30/10/05 30/12/05 30/11/05 30/11/05 15/9/05 St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 30 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 7 8 14 Good Practice Recommendations It is recommended that a system is adopted enabling residents to be aware of members of staffs name. It is recommended that the G.P. be consulted where aromatherapy is used for residents. ( Carried forward) It is recommended that all service users be informed in writing of their right to access records and provide information regarding advocacy schemes. (Carried forward) It is recommended that the manager commence a system for auditing accidents and infections in the home. (Carried forward) 4. 38 St Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 31 Commission for Social Care Inspection Birmingham & Solihull Local Office 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham, B2 4UZ 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 Clements Nursing Home E54 S24892 St Clements V244296 090805 Stage 4 draftQR.doc Version 1.40 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!