Inspection on 17/09/08 for St Edmund`s Nursing Home

This inspection was carried out on 17th September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Edmund`s Nursing Home 12/12/06

St Edmund`s Nursing Home 10/01/06

St Edmund`s Nursing Home 06/07/05

St Edmund`s Nursing Home 30/11/04

St Edmund`s Nursing Home 11/06/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 05/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Edmund`s Nursing Home Worcester Road Off Barrowby Gate Grantham Lincs NG31 8SA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alison Jessop     Date: 1 7 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: St Edmund`s Nursing Home Worcester Road Off Barrowby Gate Grantham Lincs NG31 8SA 01476576811 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Sally Gillian Robinson Type of registration: Number of places registered: Lifeline Nursing Services Limited care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: No one falling within category OP to be admitted into St Edmunds Care Home where there are 48 persons already accommodated No one falling within category PD to be admitted into St Edmunds Care Home where there are 4 persons already accommodated The maximum number of persons to be accommodated at St Edmunds Care Home is 48 Date of last inspection Brief description of the care home St Edmunds is situated in a residential area on the outskirts of Grantham and is approximately two miles from the town centre. Grantham is a market town, and contains a wide range of amenities. The home is close to a bus route; local shops and taxis are used to access the town centre. The home is a single story facility, arranged Care Homes for Older People Page 4 of 27 0 4 Over 65 48 0 Brief description of the care home in four wings. Each wing has its own lounge and dining area, and there is a communal room at one end of the home, which is used for activities and entertainment. The home is built around a courtyard, which is fully enclosed, and laid to lawns, shrubs and patios with garden furniture. The home is registered for forty-six residents. Lifeline Nursing Services Ltd operates the home, and it is one of three homes operated by the company. There are adjoining warden - controlled bungalows operated by the same company. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection was carried out over one day by two Regulatory Inspectors. We looked closely at the care of four residents. We looked in detail at the care received by the residents, this process is called case tracking. We gained feedback from the residents and/or their relatives, we looked at their care records, medication records and generally observed what life is like for them living at the home. We looked at the environment and spoke to a team of nurses. We also gained feedback from two relatives. Throughout periods of the day we spent time with the acting manager and the company Director who are temporarily managing the home in the Care Homes for Older People Page 6 of 27 absence of the Registered Manager. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 27 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a robust admission procedure which ensures that the needs of the prospective resident can be met. This home does not provide Intermediate Care. Evidence: Needs assessments are carried out by the manager or a senior nurse. New residents are not accepted unless it is felt that residents needs can be met. The information gained during the assessment forms the individual care plan. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and personal care needs are met and staff provide care in a dignified manner. The needs of the people who lack mental capacity may not be fully considered which means that choices and rights may not always be respected. Evidence: Each resident has a care plan that includes information gained during the initial assessment process and from the resident and/or their representative. The care plans are person centered and are kept in the residents bedrooms. One resident said I look at my care plan regularly and agree changes made on a monthly basis. Care plans do not contain assessments on a persons mental capacity. The health care needs of each resident are monitored and recorded, although some of the recording was inconsistent. Some entries had not been made on pressure sore prevention charts, turning charts and oral hygiene. Residents spoken to said that the care they receive has improved recently as there are more staff. There were issues previously raised about the service that residents were not being assisted to the toilet Care Homes for Older People Page 12 of 27 Evidence: when required or that people were left for long periods of time without care and attention. No evidence could be found to substantiate this on the day of the inspection and staff also said that they now have more time to attend to residents needs. Residents have access to health care services such as Gaps, district nurses (for residential/non nursing residents), chiropodists, community nurses and other specialist health care services. One resident has access to a nurse who is a specialist for Huntingtons Disease. There were plenty of fluids available to residents and those who are unable to assist themselves were regularly offered fluids by the staff. The service has purchased new equipment such as hoists, hoist slings and slide sheets to be able to move people safely. Specialist, individual items of equipment were observed such as inflatable bed sides. Nurses administer medication to the residents. The medication trolley was left unlocked and out of sight whilst medication was administered to a resident in their bedroom. Recording of medication administration and non-administration was satisfactory. Nurses ask residents who are able to respond if they require medication for pain relief. There was not a protocol in place for people who are unable to respond and therefore pain relieving medication may be given or nor given as required. Staff were observed to treat residents in a dignified manner. Residents spoke highly of the staff saying the staff are marvelous, very kind and caring. One residents choice was not respected when she was told by staff that she must have bed rail cushions on her bedrails, even though she had been able to make an informed choice that she did not want these. The resident was not consulted with and was not offered other ways of protecting her safety whilst maintaining her choice and dignity. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at the home are provided with appropriate social stimulation and get a good choice of nutritious food. The soft furnishings and fittings in the lounges have not been established to meet residents needs or designed to promote use. Evidence: The home has employed an activity co-ordinator who provides residents with a monthly activity programme. This included bingo, quizzes, church services, entertainment and others. Most of the residents spoken to said they enjoy the activities. On the day of the inspection all of the residents apart from two were sitting in their bedrooms. Lounges appear to be utilised only for when there are activities. The lounges contained a circle of chairs with a TV in the corner. Residents said that they can accept visitors at any time they choose. One relative said the staff always make you feel welcome. One residents choice was not respected when she was told by staff that she must have bed rail cushions on her bedrails, even though she had been able to make an informed choice that she did not want these. The resident was not consulted with and was not Care Homes for Older People Page 14 of 27 Evidence: offered other ways of protecting her safety whilst maintaining her choice and dignity. The meals provide a choice of nutritious food. Comments about the food were good. One resident said I get a hot breakfast everyday, the food is good. Another said the food is very good, we get a choice and we can ask for snacks too. Residents who are unable to eat independently are provided with assistance in a sensitive manner and at an appropriate pace. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are not always dealt with in a formal manner, this means that the complainant may not be satisfied with the response. Residents are protected from harm by thorough recruitment procedures however may not be protected from financial abuse as they cannot safely store their valuables. Evidence: The service has received one complaint, this was initially received by the manager of the service and was in relation to the poor care a resident received whilst staying at the service. The complaint was passed onto the Adult Safeguarding Team for investigation and a case conference is pending. The complainant contacted CSCI as they were dissatisfied with the response from the manager. The Director of the company had telephoned the complainant and felt that at the end of the discussion the matter was resolved. The service did not formally respond to the complainant and therefore the complaint was upheld. The outcome of the complaint had not been properly logged. A copy of the complaints procedure and comment cards are left in the hallway on entrance to the home. Staff spoken to are aware of the Safeguarding Adults Procedure. A copy of the local authority procedure is available in the home. Recruitment procedures are satisfactory. There is an Adult Safeguarding Investigation being carried out by the local authority Care Homes for Older People Page 16 of 27 Evidence: following an allegation of poor care and neglect. The provider attended a meeting where the issues were disclosed and has since made improvements to the service in order to protect the safety of the service users. Residents do not have lockable facilities to store their money and other valuables. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and clean. The soft furnishings and fittings in the lounges have not been established to meet residents needs or designed to promote use. Evidence: There are several lounges for residents to sit. Most residents preferred to stay in their bedrooms. The bedrooms all looked very homely and most people had brought with them personal items of furniture from home. The lounges looked quite bare and other than a circle of chairs and a TV, there were very few other items to make the lounges look homely. The service has not provided a lockable cabinet for residents to safely store money, valuables and if appropriate medication. The home was very clean and staff observed good infection control procedures. There were no unpleasant odours at all and residents commented on how clean the home is. Care Homes for Older People Page 18 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are sufficient and they are well trained to meet the specialist needs of the residents. Recruitment procedures are robust which protects residents from harm. Evidence: The staffing levels were immediately increased following concerns raised about the care during the Safeguarding Adults strategy meeting. All residents and staff said that the increase in staffing levels has improved the quality of care provided. The service is currently recruiting a deputy manager as it was recognised by the company that a managerial post is required in order for their to be a manager on duty when the registered manager is not working in the home. Recruitment procedures were looked at and new staff are not recruited until satisfactory references and Criminal Record Disclosure are received. This ensures that residents are protected from harm. Staff said that they receive regular training. Nurses stated that they receive specialist training as required in order to meet the individual needs of the residents. Care staff also receive regular training and are supervised whilst working with the residents by the nurses. Care Homes for Older People Page 19 of 27 Care Homes for Older People Page 20 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The interim management arrangements are working well and staff feel supported to carry out their role. Financial procedures do not protect the safety of the residents personal money and valuables. Evidence: The Registered Manager is not currently working at the home. Interim managerial arrangements have been made. The company Director visits the home most days during the week and the acting manager who also manages another home is working at the home 2-3 days a week. Staff spoken to said they feel supported and there is no indication that outcomes or the people who live there are adversely affected. The acting manager stated that a new deputy manager role has been introduced and recruitment is being completed for this post. Quality Assurance questionnaires are due to be sent out to residents and relatives to find out if they are happy with the service. Residents meetings are held every 3 Care Homes for Older People Page 21 of 27 Evidence: months where residents and relatives can express their views and ideas. Residents or their representatives are expected to manage their personal finances. The service has not provided lockable facilities for residents to store their money and other valuable items safely. The home does not have a procedure for managing personal finances. Trolleys carrying cleaning fluids were left unattended in the hallway. Care Homes for Older People Page 22 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 The monitoring of health 31/10/2008 care such as fluid intake and pressure sore prevention must be consistently recorded. To ensure that health care needs are met and responded to where there is a change to the residents well being. 2 9 13 Unlocked medication trolleys 31/10/2008 must not be left unattended by staff. Residents, staff or visitors could gain access to medications stored by the service. This could create a risk to residents. 3 10 12 You must enable residents 31/10/2008 to make choices with respect to their care whilst maximising their safety. Care Homes for Older People Page 24 of 27 To ensure that human rights are respected whilst protecting resdinets from harm. 4 14 12 Residents must so far as safe and practicable be able to make choices about the care they receive. To ensure that choice and human rights are respected within a risk management framework. 5 24 16 Each resident must have access to a private lockable storage space in which they can store money, valuables or medication. In order to protect residents personal property. 6 35 13 A procedure must be put in place which protects residents from financial abuse. To protect those residents who may not be able to fully safeguard their finances and valuable possessions. 7 38 13 Hazardous substances must not be left unattended. This may cause serious harm to anyone in the home. 31/10/2008 31/10/2008 31/12/2008 31/10/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 27 1 7 Staff need to record/show evidence that the residents mental capacity has been considered when reviewing their care. It is recommended that the lounges are made more homely so to as encourage residents to utilise these areas and provide more stimulation. It is recommended that a formal response is made to complainants to tell them what action has or is being taken. 2 12 3 16 Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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