Inspection on 28/07/06 for St Dominic`s Nursing Home

This inspection was carried out on 28th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Dominic`s Nursing Home 15/09/09

St Dominic`s Nursing Home 18/09/07

St Dominic`s Nursing Home 02/11/05

St Dominic`s Nursing Home 28/11/04

St Dominic`s Nursing Home 18/05/04

Similar services:

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE St Dominic`s 71 Filsham Road St Leonards On Sea East Sussex TN38 0PG Lead Inspector Liz Daniels Key Unannounced Inspection 28th July 2006 12:20 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 Dominic`s DS0000014040.V298697.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 Dominic`s DS0000014040.V298697.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Dominic`s Address 71 Filsham Road St Leonards On Sea East Sussex TN38 0PG 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) 01424-436140 01424-460767 St Dominic’s Nursing Home limited Mrs Margaret Dempsey Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51), Physical disability (51) of places St Dominic`s DS0000014040.V298697.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is fiftyone (51) Service users must be aged sixty-five (65) years or over on admission Service users with a physical disability may also be accommodated Date of last inspection 2nd November 2005 Brief Description of the Service: St. Dominic’s Care Home is a large property in a residential area of St. Leonards-On-Sea. It provides personal and nursing care for up to fifty-one (51) residents of an older age including those with physical disabilities. However, in general, a maximum of forty-six (46) residents are accommodated. The home is arranged over four floors and a passenger lift enables access to all floors. There are six double bedrooms, all with en-suite facilities and thirty-six single bedrooms, thirty-two with en-suites. The home has hoists, bath hoists and an assisted shower room for those who are less mobile. There are also grab rails and disability aids in the bathrooms and toilets. A large dining room on the lower floor and separate lounges on each of the other floors provide communal space and there is also a good-sized garden area to the rear: all areas are accessible for those with limited mobility. There are spectacular views from the upper floor rooms to the sea and across land to Eastbourne. At the front of the building there are car-parking facilities for up to approximately 10 cars. The home is now under new ownership; however the Director of Nursing and Registered Manager continue, whereby the same management structure remains. Prospective residents or their representatives are welcomed to view the premises, discuss their needs with the Registered Manager and spend time with the staff and residents. Weekly fees, as at 26/7/06, range from £495 £650. The fees do not include hairdressing, chiropody, residents’ telephone line rental and calls, and any sundries such as newspapers and toiletries; these are charged as extras. Written information is available from the Manager on request; the home’s Statement of Purpose and a copy of the Commission’s last report are also available in the main entrance hallway of the home. St Dominic`s DS0000014040.V298697.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced. It included a visit to the home by an Inspector, which began at 12.20pm and lasted for eight hours and a further visit after the weekend lasting an hour and a half. The Registered Manager and the Director of Nursing both facilitated the visit and were present for discussions and feedback from the inspection. The Inspector spoke with five other staff and chatted with two in more detail; the visit also provided the opportunity to meet with several residents in the lounges and to talk in detail with four of them either in the lounge or in the privacy of their own rooms. As many of the residents at St. Dominic’s are frail, it was difficult to discuss any areas in depth and to seek their views. The Inspector was also able to tour the premises before examining records. These included resident’s files, medication records, staff files, training records, the accident log and the complaints log. Evidence contributing to the inspection has also been gathered from previous inspections and from data provided by the Registered Manager. Any other information about the service that has come to the Commission has also been considered. All of the key standards and those where concerns had been raised at the last inspection, were inspected. There were 44 residents on the day of the site visit. What the service does well: What has improved since the last inspection? Four Requirements from the last inspection have been met. As a result information about the service is now contemporaneous and, following an assessment, prospective residents and their relatives are assured that their needs can be met. The procedures for the Protection of Vulnerable Adults now reflects Social Services as the lead agency who will initiate any investigation into possible Adult Abuse and recruitment procedures now ensure that evidence of identity is held on file for all staff. In addition quality assurance processes based on seeking the views of residents are in place; the aim is that feedback will be measured against the homes aims and objectives and also inform its Annual Development Plan. St Dominic`s DS0000014040.V298697.R01.S.doc Version 5.2 Page 6 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 Dominic`s DS0000014040.V298697.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Dominic`s DS0000014040.V298697.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Good information about the service provided at St. Dominic’s has been produced, and a thorough assessment of prospective residents takes place, ensuring a resident’s individual needs can be met. EVIDENCE: The Resident’s Guide and the Statement of Purpose for St. Dominic’s have both been updated to reflect the recent change of ownership. It is included in a ‘Welcome Folder’, which is available in the main entrance hallway of the Home. The Manager confirmed that the home could provide a copy in varying formats to suit individual need, on request. A copy of the guide is given to prospective residents and a copy has been put in each room for current residents. Also included in the folder is the analysis of the last survey conducted amongst residents and their relatives, as well as the most recent inspection report from the Commission (CSCI). A copy of the home’s complaints procedure is available in the guide with the contact details for the CSCI. St Dominic`s DS0000014040.V298697.R01.S.doc Version 5.2 Page 9 As has been found at previous inspections, it is usual practice that, following an enquiry, prospective residents or their relatives are invited to visit St. Dominic’s and spend time with the Manager and staff, view the available rooms and discuss the home’s suitability. If they then wish to pursue an admission, the Director of Nursing or Registered Manager undertakes an assessment in their own home or if they are in hospital, they visit them there. A comprehensive pro-forma is completed. The Manager confirmed that she also asks for information from the prospective resident’s Care Manager, or from nursing and medical staff if the person is in hospital. Their written assessment when available then helps underpin the home’s pre-admission assessment. If the home is suitable, a letter is now sent to the person, or their relatives, to confirm that the home can meet their assessed needs. Once funding has been agreed, if it is needed, they are then admitted for a trial period. The resident is then provided with a statement of the terms and conditions of occupancy, identifying the services provided. Four resident’s files were viewed during the inspection. All had comprehensive pre-admission assessments in place although two had not been dated and signed; the information gathered had been used to underpin a plan of care for each resident. Each of the four residents had also had nursing assessments and Risk Assessments. One resident who met with the Inspector, had been admitted four months previously. She had had an assessment the day prior to her admission but when asked was unclear how long she had been at St. Dominic’s and could not therefore recall the manager coming to see her to chat about her needs. St. Dominic’s does not provide Intermediate Care, although residents are admitted for planned respite care. Very occasionally, emergency respite care is also provided. St Dominic`s DS0000014040.V298697.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The comprehensive care plans promote individualised health and personal care for the residents and the practises in place encourage residents to be cared for with respect and dignity. EVIDENCE: The care files for four residents were reviewed. All had care plans and risk assessments to reflect the individual needs of the resident. All had been reviewed monthly and there was evidence that they had been updated, although some amendments in care had not been signed or dated. A ‘Daily Report’ is completed for each resident whereby any significant events are recorded and any changes in care are also passed on verbally in the handover between each shift. On admission the staff explain to each resident that they will have a care plan, discussing the care that is required with the resident and their relatives. However the Manager confirmed that in practice the care plans are not routinely shared with residents although any care given is explained and any new care introduced is discussed with them and/or their relative. St Dominic`s DS0000014040.V298697.R01.S.doc Version 5.2 Page 11 The condition of residents’ skin is assessed and monitored, any pressure areas are recorded and if a sore develops the treatment and outcome is documented. The Manager confirmed that occasionally advice has been sought from a nurse specialising in tissue viability but, in general, staff within the home manage any wounds. Alternatively the home refers residents back to the GP and a district nurse is asked to visit. However there is no protocol in place to meet the National Institute for Clinical Excellence (NICE) guidelines for pressure area care. These recommend that any person who develops a Grade 2 pressure sore is referred to a nurse specialist, enabling the resident to have expert advice and an individualised plan of treatment. There are various types of pressure relieving mattresses and cushions, including air overlay mattresses, to support the management of pressure areas at St. Dominic’s. Resident’s dependency is also assessed and the risk of falling is identified. The home has electric hoists, (last serviced in May 06) and there is a wheel-in shower and hoist-assisted baths for those with reduced mobility. Grab rails are fitted in the toilets and raised seats are available; there are also adjustable beds. Each resident has a continence assessment as part of their admission and if necessary they are seen by the continence nurse specialist. Nutritional screening is also undertaken and resident’s weights are monitored. The chiropodist visits the home and arrangements are made for residents to see a dentist or optician as needed. Some of the staff prefer to always work in the same area of the home, improving continuity of care for the residents, whilst others rotate and therefore get to know all the residents. Where possible residents remain registered with their own GP or they register with a GP of their choice. No current residents wish to self-medicate. A resident’s medication is discussed at their pre-admission assessment and the Manager assesses whether it is appropriate for them to self medicate if they wish to do so, recording it as a Risk Assessment. The Manager confirmed that it is unusual for residents at St. Dominic’s to self administer their medication, either because they are not confident themselves to do so and prefer not to, or they are assessed as being unable to do so safely. The medications for the home are stored in a clinical room, with some stock in a wall cupboard, but most in a medicine trolley. The ‘Controlled Drugs’ (CDs) are stored appropriately and a correct record kept of their administration. There is a drug fridge and the temperatures are recorded daily. The MAR charts for all the residents had all been correctly completed on the day of the visit. The name of residents with their photo, accompanies their MAR chart. The trained nurses at the home administer medications and either they or the carers assist the residents with taking them, although carers are not involved in the administration of CDs. Medication ready for disposal is then recorded and signed for by two trained nurses. The Director of Nursing audits medications in the home three times a year. St Dominic`s DS0000014040.V298697.R01.S.doc Version 5.2 Page 12 Staff who met with the Inspector confirmed that they aim to support residents by providing personal and nursing care where needed, but at the same time they endeavour to maintain privacy and dignity, showing respect when residents are undergoing examinations or personal care. Resident’s telephones were seen in some of the rooms. Screens are available for those residents in double rooms and during the visit, staff were observed to be attentive and courteous. One resident who met with the inspector commented that ‘I feel looked after’ and another confirmed that ‘they look after us’. St Dominic`s DS0000014040.V298697.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The recreational pursuits that are available, must be circulated to all residents in the home, to ensure that their social, cultural, religious and recreational interests and needs are met. EVIDENCE: There are lounges on each floor at St. Dominic’s, enabling the residents to sit together and watch television, read or meet with their visitors. Videos and various games are available, as well as a selection of books. The home does not have an ‘Activity Co-ordinator’ in post. However some activities are arranged; a violinist and a pianist visit on an ‘ad-hoc’ basis and a Tai Chi session is organised each week. One nurse is trained in aromatherapy and a manicurist offers hand massage for the residents. Residents are told of any activities that have been arranged and for the main holiday celebrations such as Easter and Christmas, a small brochure is circulated outlining events that have been organised. One resident attends a social club in Silverhill, and one attends church each week for which the home arranges a taxi. A hairdresser visits the home each week and a nun visits twice weekly, meeting any residents who wish to chat St Dominic`s DS0000014040.V298697.R01.S.doc Version 5.2 Page 14 with her. However details of her visits are not publicised but passed on verbally and informally. Friends and relatives are encouraged to visit at any time that suits the resident concerned and details of external advocacy services are publicised in the main entrance. Resident’s meetings have been arranged in the past but the manager confirmed that attendance was poor. There is not currently a date fixed for the next meeting. Arrangements are made if residents wish to receive communion and the home currently celebrates the Christian festivals. There are several nurses and carers employed from overseas and the management team ensures their off duty allows them to celebrate their festivals or have a period of leave to enable them to visit their families at home. Although there have not been celebrations at St. Dominic’s for other festivals, the Manager explained that the nurses and residents chat about their different cultural backgrounds. The Manager is therefore confident that the home could meet the needs of residents with varying social and cultural needs, although they may not be able to provide some special diets that necessitate single food preparation. Social and emotional needs are identified in the care plans and the staff who spoke with the Inspector felt the residents are encouraged to maintain any hobbies they may have, if possible. One resident who spends most of her time in her room said she ‘doesn’t go downstairs much, as I can’t talk about anything deep. There’s nothing to join in with’. Another said she usually watches the television and ‘sometimes there are quizzes but there’s nothing else to do’. The garden is accessible for residents but one commented that ‘I don’t go out in the garden – I’m not offered the chance’. Of the seven service user surveys returned to the Inspector prior to the visit, two of the respondents said there are ‘always’ activities for them to take part in, two said ‘usually’, one said ‘sometimes’ and one said ‘never’. (One survey had not been completed for that section). The value of providing more structured activities and circulating the plan to those residents, who spend more time in their room, was discussed and agreed. None of the current residents manage their own financial affairs; in general relatives or solicitors act on their behalf. The home does not act as the appointee for any resident. Previous inspections have found the food provided at St. Dominic’s is varied and enjoyed by the residents. Meals can be eaten in the dining room or in one of the lounges. Alternatively some residents prefer to eat in their own rooms. The menu seen by the Inspector was nutritious and varied. Two choices of meal were available for lunch and during the summer months a light tea of soup, sandwiches and a dessert is served. The Manager explained that residents are asked their choice for lunch and that there are also standard alternatives available if residents prefer. One resident who met with the Inspector described the food as ‘OK – I like some’, and another commented that ‘the food is a bit samey on occasions and I’m bored with sandwiches’. In St Dominic`s DS0000014040.V298697.R01.S.doc Version 5.2 Page 15 the surveys returned, three responded that they ‘always’ like the food, three said ‘usually’ and one said ‘sometimes’. One commented that ‘the food is good’. The kitchen was not inspected at this visit, but previous inspections have not raised any concerns. Some residents have small fridges in their rooms to enable them to keep cold drinks or particular choices of fresh food. St Dominic`s DS0000014040.V298697.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a satisfactory complaints procedure and residents are confident that their views are listened to and acted upon. Safe measures are in place to ensure residents are protected from abuse. EVIDENCE: As stated earlier in this report, the home’s complaints procedure is displayed in the Resident’s Guide. There is a policy within the home that clearly identifies timescales for any concerns or complaints to be investigated and a response to be given. The outcome of any investigation would be fed back to the complainant. The resident who spoke with the Inspector during the site visit and the service user surveys received, expressed confidence in the Management Team overall; five of them responded that they ‘always’ know who to speak to if not happy, one said ‘usually’ and one commented ‘no’. Similarly there was the same response when asked if they knew how to make a complaint. The CSCI had not received any complaints about the service since the last inspection although one has been lodged since this site visit; the last entries in the home’s complaints log were in April and May 06. The investigation and outcome had not been fully recorded but this was discussed and the Manager explained that there were still some areas outstanding that were being followed up. Questionnaires asking for feedback and envelopes are in the main hallway for any relative or visitor to complete; these provide the opportunity for them to be anonymous if they prefer. St Dominic`s DS0000014040.V298697.R01.S.doc Version 5.2 Page 17 Adult Protection policies and procedures continue to be in place and Criminal Record Bureau (CRB) Disclosures are applied for as part of the recruitment process. Eleven of the fifteen nurses have been trained in ‘Adult Abuse’ within the last twelve months; similarly eight of the nineteen carers have had training. A copy of the East Sussex multi agency guidelines is available in the home and the home has its own flowchart identifying Social Services as the lead agency in any investigation. Staff who spoke with the Inspector demonstrated that they knew the appropriate action to be taken to protect any individual, if suspicious of abuse. St Dominic`s DS0000014040.V298697.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. St. Dominic’s provides a comfortable well-maintained home for residents to live that is clean, pleasant and hygienic. However the poor adherence to fire regulations compromises the residents’ safety and welfare. EVIDENCE: St. Dominic’s is a detached property situated in a residential part of St. Leonard’s and within easy access of local shops. Accommodation is arranged over four floors and each floor can be accessed by a shaft lift. There are lounges on each floor where pastimes are available or residents can meet together, as well as a good size dining room on the lower floor where some of the organised events are held. Resident’s bedrooms that were seen contained personal possessions and staff were seen to be respecting residents’ privacy by knocking before entering. St Dominic`s DS0000014040.V298697.R01.S.doc Version 5.2 Page 19 All radiators are guarded and emergency lighting is provided throughout the home. Thermostatic controls are fitted to the water outlets in bathrooms and en-suite facilities: the outlets are checked each month and the water temperature recorded. Magnetic door guards have been fitted to the corridor fire doors throughout the building that need to be held open and to some of the bedroom doors, enabling those residents to choose to have their door open. However some bedroom doors were wedged open on the day of the visit; this practice must cease. The Manager confirmed that some residents do not wish to have their door closed whilst in their bedrooms during the day; alternative arrangements must therefore be put in place that do not compromise fire safety for the residents. The fire alarm is activated weekly to ensure the fire doors close appropriately; different alarm points are used each time. There are also incidental fire drills. Twenty-eight of the thirty-four nurses and care staff have had training in fire prevention and protection this year; the remaining staff will attend the next session organised in September. As with past inspections the home was found to be comfortably furnished, clean and free from any odours. Six of the respondents in the service user survey answered that the home is ‘always’ fresh and clean and one said ‘usually’. Policies are in place for managing infected linen and it is washed separately to other laundry. There is also a sluice room on each floor, containing a disinfector. The laundry room is situated in a separate building to the main part of the home and infected or soiled linen is not carried through areas where food is prepared or stored. The room has an impermeable floor and the walls are painted; the paint is now chipped and is not easily washable. However there are plans for some new building works at the home and it is anticipated new laundry facilities will be a part of that. There are two industrial size washing machines with a 95°C wash and a sluice facility; a smaller washer is used for all the kitchen linen. St Dominic`s DS0000014040.V298697.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using evidence including a visit to the service. Residents are protected by the recruitment procedures in place, although there are insufficient staff that have been assessed as appropriately qualified, or have received the required training, to ensure that residents are in safe hands at all times. EVIDENCE: St. Dominic’s has registered nurses on duty for the full 24-hour period. A nurse is responsible for leading the shift on each floor, supported by care staff. The aim is that there is a total of nine staff each morning, six in the evening and four staff at night. These numbers appear adequate for the number of residents that the home is registered for. Agency staff are not used as the home has its own ‘bank’ of staff to provide temporary cover. Two cooks, kitchen and cleaning staff, maintenance and gardening staff are also employed. Of the twenty-two care staff, five have obtained the National Vocational Qualification (NVQ) Level 2. The Director of Nursing is currently exploring the openings for four staff to undertake their NVQ Level 3. Some of the care staff in post are trained nurses from overseas who have not undertaken the adaptation course to be registered as a trained nurse with the Nursing and Midwifery Council (NMC). The home has assessed them as competent in some aspects of care and has developed its own monitoring tool to record this. However their competency has not been paralleled with the NVQ. St Dominic`s DS0000014040.V298697.R01.S.doc Version 5.2 Page 21 Four staff files were inspected during the site visit. All had CRB disclosures, and a completed application form containing all the appropriate information. One person had been in post for several years and there were not two references ‘on file’. The Director of Nursing agreed that a statement of the individual’s performance and competence whilst at St. Dominic’s would be compiled and held on file. Copies of birth certificates and passports were available and each had a copy of the contract with terms and conditions of employment. An annual training programme is in place for both the trained nurses and the care staff. The mandatory training including fire training, ‘Moving and Handling’ and ‘First Aid’ are scheduled, but there is also specialist training specific for the needs of the residents currently at St. Dominic’s. All training is held in work time whereby staff have a minimum of three paid training days per year. One member of staff who met with the Inspector explained that she ‘found the training opportunities good’ and that she ‘feels valued’. Another stated that the Director of Nursing ‘constantly encourages everyone to attend training and to keep up to date’. St Dominic`s DS0000014040.V298697.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using evidence including a visit to the service. St. Dominic’s is well managed and there are quality assurance processes in place to ensure that the home is run in the best interests of residents, ensuring the residents are kept safe. EVIDENCE: The Manager at St. Dominic’s is a registered nurse with considerable experience in caring for the elderly and she has attained her Registered Manager’s Award (RMA). The Nursing Director supports her in leading a team of carers and ancillary staff. She too has attained the RMA. One member of staff commented that ‘the Management Team are very supportive’ and another that ‘the residents are well cared for’. St Dominic`s DS0000014040.V298697.R01.S.doc Version 5.2 Page 23 The home undertakes service user surveys as part of its quality assurance. These are analysed and the results publicised within the home. A copy of the analysis of the results is included with the Statement of Purpose and the CSCI report in a folder in the main hallway. The analysis is also fed-back to staff and any areas for improvement are discussed. There is an Annual Development Plan for the home and it has been found at past inspections that this is moulded and changed, dependant on current issues and the needs of the residents. The Director of Nursing confirmed that this ethos continues. As stated earlier in the report, none of the current residents manage their own financial affairs but in general relatives or solicitors act on their behalf. Some residents choose to keep money in their room in a lockable cupboard or drawer, whilst others prefer that their money be held in the home’s safe. It is kept in separate envelopes and any transactions written in a book. The residents do not have their own individual book and it is therefore difficult to track expenditure for each person. If staff are asked to shop for a resident, receipts are kept for any items purchased. The record of resident’s personal money and expenditure was discussed and the Director of Nursing agreed that it would be reviewed and separate record books will be introduced. Prior to the site visit the Manager returned data to be considered as part of the inspection. The training matrix shows that some staff had not had their mandatory annual training in ‘Moving and Handling’. However there are training sessions for these scheduled within the next few months and the Director of Nursing is confident that all staff will therefore have their mandatory updates this year. All of the trained nurses, except two, have been trained in First Aid and most staff have had fire training this year; another session is booked for September when it is anticipated the remaining staff will be updated. Many of the staff have not been trained in ‘Food Hygiene’; these sessions are not currently scheduled in the home’s training plan for the year. Maintenance records were not explored in full at this inspection as the data previously provided by the Manager suggests that all checks are maintained. The Accident Log for the home was viewed: slips, trips and falls have been recorded and appropriate action taken. The Manager explained that these are reviewed each month, any trends are identified and the action needed to reduce that trend. St Dominic`s DS0000014040.V298697.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 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 St Dominic`s DS0000014040.V298697.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13 (1) Schedule 3 (3)(n) 2. OP19 23 (4) Requirement A protocol, that meets the NICE guidelines by ensuring residents are referred to a tissue viability nurse specialist if they develop a Stage 2 pressure sore, must be in place. A door guard that will release if the fire alarm is activated must be used to protect bedroom doors that need to stay open. This is an outstanding Requirement for the last inspection. Individual records of expenditure for resident’s personal monies must be held. Timescale for action 30/09/06 28/07/06 3. OP35 17 (2)(3) Schedule 4 (9) 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations All entries in care plans should be signed and the date of entry recorded. DS0000014040.V298697.R01.S.doc Version 5.2 Page 26 St Dominic`s 2. 3. OP12 OP28 Residents should be made aware in advance, of the facilities and activities available to them, enabling them time to make a choice about their involvement. Trained nurses from overseas that are employed, as carers should be assessed as competent at NVQ level 2 standard. This was a recommendation of the last inspection St Dominic`s DS0000014040.V298697.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Dominic`s DS0000014040.V298697.R01.S.doc Version 5.2 Page 28 - 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. 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