Inspection on 15/08/07 for St David`s

This inspection was carried out on 15th August 2007.

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.

Other inspections for this house

St David`s 14/11/06

St David`s 29/12/05

St David`s 13/07/05

St David`s 23/10/04

St David`s 29/06/04

St David`s 23/10/02

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE St David`s 65 West Hill Road St Leonards On Sea East Sussex TN38 0NF Lead Inspector Elizabeth Dudley Key Unannounced Inspection 15th August 2007 19:30 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 David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St David`s Address 65 West Hill Road St Leonards On Sea East Sussex TN38 0NF 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) 01424-439266 01424 440789 melvenia@stdavids.wanadoo.co.uk Miss Melvenia Davidson Miss Melvenia Davidson Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That a maximum of two service users with physical disabilities requiring nursing care over 65 years of age may be accommodated in single rooms 7 or 22 when vacant. That one service user admitted in October 2003 under 65 years of age may continue to reside in the home. That only service users aged 65 years or over on admission are admitted into the home 14th November 2006 2. 3. Date of last inspection Brief Description of the Service: St. Davids Care Home is a large detached property located in a residential area of St. Leonards-On-Sea. It provides nursing and personal care for up to 23 residents of an older age or who have a physical disability. The Home is set out on three floors and a passenger lift provides access to all floors. A large lounge area with a sunroom attached provides sea views and some of the upper floor rooms also have spectacular views to the sea. At the front of the building there is a small area providing off road parking facilities. The home provides care and support to residents who are both privately funded and those who are funded by Social Services. The home’s fees as of 15th August 2007 range between £487.00- £650.00 per person per week. Additional costs for extra services such as the provision of chiropody, hairdressing and newspapers are available from the manager. The homes literature states that one of its main aims is ‘the management of St David’s Nursing Home pride ourselves on offering a highly professional care service for the elderly with a personal touch’. St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on the 15th August 2007 and was facilitated by Ms M Davidson owner and manager. During the inspection a tour of the home took place and documentation, which included care plans, personnel files, training records, medication charts and health and safety records, was examined. Prior to the inspection ten questionnaires were sent to residents and visitors to the home and two to health care professionals. Two questionnaires from residents, one from a relative of a resident and one from a health care professional have been returned and the inspector thanks them for taking the time to complete these and their contribution to the inspection process. Comments received were positive although on two questionnaires it was identified that communication with staff and visitors could be improved. Six residents, six members of staff and one visitor were spoken with during the day and only positive comments received about the home. Resident’s comments included “ I am well looked after here and the staff are very good”. “ We can choose what time to get up and go to bed, whatever we want”. A visitor said “ This is a lovely home, my relative is always comfortable and well looked after and the home is like this all the time, not just at inspections. I would be happy to live here myself”. What the service does well: Documentation provided to prospective residents includes photographs and comments from residents as well as including all the information the resident may find useful regarding daily life in the home. St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 6 The service provides nursing care to older people. A thorough assessment of the individuals health, personal, psychological and social care needs was in place, and instructions for the care to be given were clear whilst treating the resident as an individual and including their preferences. There is a training programme in place for all grades of staff and care staff are encouraged to undertake training for the National Vocational Qualification level in 2 Care. Registered nurses undertake further training in line with the needs of those living in the home. The home is very clean and well maintained and provides a comfortable environment for those living there. What has improved since the last inspection? What they could do better: The scope of activities provided should be more fully developed to ensure that residents receive sufficient stimulation during the times that the activities person is not on duty. Residents need to be aware of activities on offer on a daily basis so that they can make the choice of whether they wish to participate. A questionnaire from a health care professional stated that more stimulation for those residents with mental health needs of the older person was needed, and more training for staff on dementia care would be beneficial to residents. Please contact the provider for advice of actions taken in response to this St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St David`s DS0000014039.V346910.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection St David`s DS0000014039.V346910.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6. People who use the service experience excellent quality outcomes in this area. Prospective residents benefit from the provision of comprehensive and wellpresented information, which enables them to make a decision over whether the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a Statement of Purpose and Service User Guide, which meet the standards and the regulations. The Service User Guide is in a user-friendly format, contains coloured photographs of life in the home and residents opinions of the home and provides information about the daily life of the home. A copy of this is given to each resident and taken to prospective St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 10 residents when the manager assesses them prior to their admission to the home. Pre- admission assessments take place prior to residents being admitted to confirm that the home can meet their needs. Assessments are undertaken by the manager, include physical psychological and social needs and form the basis of the care plan. The manager informs prospective residents in writing over whether the home can meet their expectations and needs and all residents are admitted for a months’ trial period. On admission residents are provided with a copy of the home’s terms and conditions, which includes the amount of fees payable by the residents. The home admits residents for respite care but not for intermediate care. St David`s DS0000014039.V346910.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. People who use the service experience good quality outcomes in this area. Care planning identifies the current health care and personal care needs of the resident and direct the staff to provide this care in a holistic person centred manner. The standard of medication administration safeguards the resident. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Five care plans (33 ) were examined in depth in order to gain a view of the documentation underpinning the care given to the residents. Care plan formats have recently been reviewed and the care plans showed a thorough description of the care needed and the actions required to meet these needs. All care plans have been reviewed on a monthly basis or more or more frequently if the resident’s condition warrants this. St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 12 Most care plans did not show that they were formed following formal consultation with the residents or their representatives, the manager said that this was in the process of being addressed, but there was evidence in the care planning that resident’s preferences involving the care to be given were included in the care plan. Wound care plans showed involvement of wound care specialist nurses, the care that was being given, and when this ceased to be required. There was sufficient clarity in the care plans to enable care staff to give the care that was needed, with care plans updated to reflect current needs. Discussions were held with the manager regarding identification in the care plans of the pressure mattresses used and the type of continence aids required for individuals. Risk assessments are in place to identify any risks to the individual whether from equipment or from other means. These are in a separate file to the care plans, and have been reviewed on a regular basis. A social care plan is in place and the activities co-ordinator records participation of residents in social interaction or activities. Residents can keep their own General Practitioners if in the area and have access to a full range of other health care professionals as required. Staff were treating residents with respect and courtesy, and residents confirmed that this was always the case. The home has a range of medication procedures and policies and documentation, which safeguard the residents, and documentation showed that these procedures were adhered to, with staff providing a safe system of administering the medication. Staff will assist individuals to administer their own medication if they are able to do so. Residents nursed in bed were seen to be comfortable and with records in place in their rooms relating to the care given at specific intervals. The home has not commenced specialised training for end of life care, but documentation showed that residents could spend their final days in the home. St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 13 St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.14.15. People who use the service experience good quality outcomes in this area The provision of leisure activities is not sufficiently developed to enable residents to enjoy a range of stimulating activities on a daily basis. Residents’ choices and preferences relating to the activities of daily living direct the routines of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an activities programme, this reflects the activities available and includes card and board games and some outings and an activities coordinator comes into the home once a week for three hours. It was unclear whether staff undertake activities in the home during the time the activities person is not working and residents in their rooms were unaware of what activities are available. Activities within the home need to be further developed to ensure that all residents have the opportunity for stimulating St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 15 activities which take into account both previous and present interests. Some residents may benefit from more time being spent with them on a one to one basis. There are some opportunities for residents to go out with the manager taking some out in the car at intervals and staff taking individual residents out for walks. The menu is run on a monthly rolling menu with the cook ascertaining the choices of each resident on a daily basis both at lunch and suppertime. Residents have the option of two choices both at supper and lunch and the supper menu generally has a cooked option. Residents said, “ The food is average”. “ Good home cooking and we get a choice of two meals” and “ The food, on the whole, is ok.” A recent environmental health inspection made some recommendations and these are in the process of being fulfilled. Food was well presented and staff were seen assisting residents in with courtesy and empathy. Residents were able to have meals in either their rooms or in the lounge, some residents sit at a table in the conservatory to eat their meals. Visitors are welcome in the home and said that they are kept informed of the residents’ condition and that staff were ‘open and welcoming’. Visitors said that the residents always looked ‘well fed and very well cared for’. Various ministers of religion visit the home and residents can see these in private if they wish. St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18. People who use the service experience good quality outcomes in this area Residents and visitors to the home can feel confident that any complaints they may have will be dealt with in a professional manner. Staff are aware of their responsibilities in safeguarding the residents in their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has received two complaints since the last inspection, one related to the home’s requirements for a hoist to be used when moving and handling residents, this was substantiated but dealt with in a manner which enabled the homes policies to be upheld. One related to a resident’s dissatisfaction health care outside of the home was addressed by the home on behalf of the resident. One adult safeguarding allegation was received from the hospital about the late diagnosis of an injury, records held by the home showed that this was unsubstantiated on the part of the home. The home has a complaints policy, which is made available to residents in the service user guide, and residents spoken with said that they knew to whom to St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 17 make a complaint and were sure that this would be dealt with a professional and transparent manner. All staff have received adult protection training but the manager has not yet updated her training in line with the new protocols and stated her intentions of doing this. St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. The home is comfortable and clean, providing a pleasant environment for those who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All parts of the home are well maintained with the home employing a maintenance person. Communal space consists of a lounge and conservatory, the latter having a dining table and giving access to a small patio garden. Residents individual accommodation consists of six double rooms, two of which have ensuite facilities consisting of a WC and washbasin, and twelve single St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 19 rooms, of which four have ensuite facilities. Those rooms without ensuite all contain hand washbasins. All rooms have a lockable drawer for resident’s personal effects and most rooms are equipped with variable height beds. Rooms are pleasantly decorated and personalised with residents’ own belongings. All rooms were clean and pleasantly decorated with carpets, curtains and bed linen being fit for purpose No rooms have a lockable door, but this can be put in place should a resident so wish. Water temperatures to resident outlets are monitored on a regular basis and records showed that these were within recommended parameters. Window restrictors were in place in all rooms above ground level and discussions were held with the manager relating to the provision of window restrictors in corridors and in the staff room, which is accessible to residents. The home has assisted bathing and showering facilities and grab rails, hoists and other aids to enable residents to maintain an independent life style. All floors are served by a shaft lift. Cleanliness in all areas of the home is of a good standard, and the laundry is well equipped and separately staffed. Staff have received training on infection control. St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People who use the service experience good quality outcomes in this area. Staff are employed in sufficient numbers and receive suitable training to meet the needs of the residents living at the home. There is a robust recruitment system, which safeguards the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rota, comments from residents and staff and observation during the inspection showed that there were sufficient staff on duty to meet the residents needs. Staff stated that there were sufficient staff on duty over the twenty-four hours to enable them to care for residents in an unhurried manner. Residents said that their call bells were answered promptly and that on occasions staff had time to come in and talk to them. St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 21 Some of the care assistants are registered nurses in their own country undertaking adaptation training various universities to register with the Nursing and Midwifery council in the UK. Twelve members (70 ) of the care staff have completed the National Vocational Qualification level 2 or 3 in care or the equivalent, and staff said that they were encouraged to undertake this and other training relevant to the care of the residents in the home. All care staff undertake a recognised induction course on commencing work at the home, with registered nurses said that they had a localised induction on commencing work and then attended ongoing courses relevant to the care of the residents in the home. Discussions were held with the manager regarding staff undertaking some training in the mental health needs of the older person which would enable the needs of those residents in the home with mental health issues relating to the older person, to be more fully met. This has also been the focus of a comment received from a health care professional. Four staff personnel files were examined. One file only included one written reference, but the home’s records showed that two had been received. All files contained all other information as required by the regulations including photographs. St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38. People who use the service experience good quality outcomes in this area. Management systems within the home protect the residents, staff and visitors. Residents are able to make their views about the home known to the management, and services offered by the home are reviewed to ensure it meets resident’s expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager and owner is a registered nurse (level 1), has undertaken the Registered Managers Award and is registered with the CSCI. St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 23 A relief manager has recently been in post for six months due to the registered manager taking time away from the home, and the registered manager/ owner is still making the decision over whether to continue managing the home on a daily basis or whether she will be employing a manager to do this. The atmosphere in the home is relaxed and calm, with staff seen to have good interaction with the residents and there is a very low staff turnover. Visitors to the home spoke positively about the atmosphere in the home. Residents and their representatives receive questionnaires on a three monthly basis regarding their views on the services offered by the home; responses from these are collated and acted upon. Staff meetings are held at regular intervals. The Annual Quality Assurance Assessment was received by the CSCI prior to its due date and provided accurate and sufficient information about the home. Policies and procedures in the home have undergone recent review. The home does not act as appointee for any of the residents, but does keep monies for safekeeping with appropriate records in place. Staff receive regular formal supervision, which includes practical skills supervision, full records are kept of this. Records showed that most staff have received recent mandatory training with relevant sessions being rescheduled to ensure participation of all staff. The Annual Quality Assurance Assessment stated that all utilities and equipment had been regularly serviced and certificates of this were seen at the inspection, and risk assessments throughout the home were in place. St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 24 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 4 3 4 4 3 x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 4 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 3 3 St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 25 N0 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 OP12 Regulation Reg 16(m)(n) Requirement Timescale for action 30/09/07 2 OP30 That a programme of activities is arranged to ensure an appropriate provision to meet individual needs. Reg 18(c ) That staff received the training to meet the specialised needs of some service users as identified in the main body of the report. 11/11/07 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 David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St David`s DS0000014039.V346910.R01.S.doc Version 5.2 Page 27 - 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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