Inspection on 15/08/07 for St George`s Nursing Home

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 Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St George`s Nursing Home 21/07/06

St George`s Nursing Home 07/12/05

St George`s Nursing Home 10/06/05

St George`s Nursing Home 18/10/04

St George`s Nursing Home 03/06/04

Similar services:

Ashlong House

Spring Lane Care Home

Avenues (The) (Neave Crescent)

Barrington Lodge Nursing Home

Beacon House Nursing Home

St Mary`s Convent & Nursing Home

1-3 Frederick Gardens

The Royal Star and Garter Home

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

CARE HOMES FOR OLDER PEOPLE St George`s Nursing Home 61 St George`s Square London SW1V 3QR Lead Inspector Wynne Price-Rees Key Unannounced Inspection 15th August 2007 10:30 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 George`s Nursing Home DS0000026018.V344577.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 George`s Nursing Home DS0000026018.V344577.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St George`s Nursing Home Address 61 St George`s Square London SW1V 3QR 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) 020 7821 9001 020 7821 0707 stgeorgesnh@aol.com Mrs Elizabeth Kerins-McManus Mrs Elizabeth Kerins-McManus Care Home 44 Category(ies) of Physical disability (0), Physical disability over 65 registration, with number years of age (0) of places St George`s Nursing Home DS0000026018.V344577.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st July 2006 Brief Description of the Service: This is a care home that provides nursing care for up to thirty-nine residents and is located in the Pimlico area. There are currently thirty-six residents. The home is situated in a square and is a series of inter-connected Georgian mansion blocks that has access to all areas by lift and stairs. It is within easy access of transport links, local shops and other facilities. St Georges has been established for over forty years and many of the senior staff and management team have been in post for a number of years. The Care Manager is also the Proprietor and this is a stand-alone home rather than part of an organisation. Therefore the care provided is very friendly and personalised to the style of the Care Manager. St George`s Nursing Home DS0000026018.V344577.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over six hours on one day. Residents, relatives, staff and management were spoken with as part of the process. Records and procedures were inspected and care practices observed. Six residents’ and their records were case tracked. The home had provided required information prior to the inspection taking place. The Care Manager was not present during the inspection as they were on leave. What the service does well: What has improved since the last inspection? What they could do better: The care plans must be developed to reflect the leisure activities and interests of the residents. The medication administration sheets must be accurately St George`s Nursing Home DS0000026018.V344577.R01.S.doc Version 5.2 Page 6 filled in without gaps and if gaps are identified, at the three-monthly audit, an explanation and if the medication was administered must be recorded. The tablet count must also be accurately recorded. The home needs to liaise with the fire brigade to determine if full evacuation drills are required or if it is preferable that residents’ remain in their rooms in event of fire to await evacuation by the fire brigade. A drill must be carried out once this has been determined and then subsequent quarterly drills must take place including one at night. Staff CRBs must be renewed and up to date staff contracts put in place. 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. The summary of this inspection report can be made available in other formats on request. St George`s Nursing Home DS0000026018.V344577.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 George`s Nursing Home DS0000026018.V344577.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a written assessment policy and procedure that senior staff, who have responsibility for carrying out assessments follow. This was evidenced by the assessment information contained in the six care plans case tracked. This information is used to formulate the initial care plan. The assessments meet the requirements of the standard and the same procedure is used when providing respite care. Residents confirmed that the assessment process incorporates as many visits to the home, by prospective residents and their relations, as needed to help determine if they wish to move in. A relative of a prospective resident arrived at the home, during the inspection, for a premises tour. Although they had not made an appointment the home duly obliged. St George`s Nursing Home DS0000026018.V344577.R01.S.doc Version 5.2 Page 9 St George`s Nursing Home DS0000026018.V344577.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All six residents’ case tracked had care plans in place. There were goals in place that were identified from residents’ needs and wishes. These were underpinned by risk assessments that were located in other files such as manual handling. The health care needs of each resident were clearly identified and detailed. There were daily notes that fed monthly care plan reviews. Whilst health needs clearly identified three of the six care plans gave no information regarding residents’ interests or preferred activities. Those that did give information regarding this aspect of care were not very detailed. All residents’ files showed that they are registered with GPs of their choice and some have opted to retain the GPs they had prior to moving to the home. They also have access to community based health care services if required. The medication administration sheets were inspected for each resident and a number of gaps in the recording identified. Whilst in some instances the reason St George`s Nursing Home DS0000026018.V344577.R01.S.doc Version 5.2 Page 11 for the lack of entry was recorded, in others there was no explanation. In the ones that did record it was not stated if the medication had been given or not. There were also some gaps in the tablet count. The home has a policy and procedure regarding residents’ rights to privacy and dignity that staff are required to read as part of their induction and follow as part of their duties. Observation of care practices and residents’ spoken with confirmed that privacy and dignity are observed. St George`s Nursing Home DS0000026018.V344577.R01.S.doc Version 5.2 Page 12 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents’ spoken with said they are given the opportunity to join group activities provided by the home if they wish and decide depending on the nature of the activity and if it holds an interest for them. During the inspection a number of residents were participating in a crossword session with two carers. A resident told the Inspector there had been a classical music concert the day before that was well attended. Another resident said they were having friends over for a drinks party in the afternoon. Residents were observed coming and going as they wished. Some residents said they take advantage of the local amenities going to the theatre and out for tea and dinner. They also visit the Tate Modern. The residents’ spoken with said they felt the level and type of activities suited them and their needs. The home’s visitor policy is that visitors are welcome at any time that is convenient to a resident and does not impact adversely on others. If someone is visiting after 8.00pm, they are requested to telephone first. St George`s Nursing Home DS0000026018.V344577.R01.S.doc Version 5.2 Page 13 The home provides a menu that demonstrated choice and that a balanced diet is provided. Lunch during the inspection was well presented, hot and nutritious. All residents’ asked said they thoroughly enjoyed the meals provided. St George`s Nursing Home DS0000026018.V344577.R01.S.doc Version 5.2 Page 14 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 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s written complaints procedure was located in the entrance hall. A record of complaints is kept that demonstrated they are taken seriously and responded to. There is also a separate incident book. Residents asked said they would initially discuss any problems or complaints with staff or the Care Manager who would rectify them. They said they were aware of the complaints procedure but had not had to make recourse to it. The home has a policy and procedure regarding abuse, its identification and action to take if encountered. Staff confirmed they are required to read this and follow it as part of their induction and duties. Staff are CRB checked prior to commencing employment. There are currently no POVA issues. The Care Manager is appointee for one resident who is funded by Westminster City Council. The resident is provided with an invoice that breaks down expenditure. This is also audited annually by the Department of Works and Pensions. Only one other resident has any money kept on their behalf and the home keeps a record of deposit, withdrawal and balance with receipts. The other residents’ finances are controlled by themselves, family or legal representatives. St George`s Nursing Home DS0000026018.V344577.R01.S.doc Version 5.2 Page 15 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): 19 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A premises tour demonstrated that the home is suited for its stated purpose. As this is an old building and not purpose built the layout is not ideal although residents’ spoken with said they like and it meets their needs. The provides either single room accommodation or suites of rooms depending on resident preference and availability. The home was found to be clean, tidy, odour free and reasonably maintained. During the inspection a company contracted with was checking the fire and call bell alarm systems and communal fire doors. They had also tendered for fitting of electromagnetic door closures to all bedrooms that the home intends to purchase. Elsewhere the handymen were fitting new two way locks to communal bathrooms and toilets. St George`s Nursing Home DS0000026018.V344577.R01.S.doc Version 5.2 Page 16 St George`s Nursing Home DS0000026018.V344577.R01.S.doc Version 5.2 Page 17 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff rota demonstrated that there were adequate numbers of staff on duty at all times to meet the residents’ needs. This was confirmed by residents spoken with and number of staff on duty during the inspection. There are currently two vacancies for a registered nurse and carer. The vacancies have been advertised, are at the interview stage and being covered in-house by staff, doing extra shifts, until appointments are made. There is a thorough recruitment policy and procedure that staff records demonstrated is followed. A sample of staff records also showed they are suitably qualified. The procedure meets the requirements of the standard. The staff records inspected showed the home needs to update staff contracts, make sure all are in place and CRBs that are over three years old renewed. The home meets the required 50 of care staff with NVQ level 2 or above. Mandatory induction is provided that includes training in manual handling, first aid, health and safety and basic food hygiene. There is a shadowing system in place for new staff to help understand their roles and duties. Training needs are identified during two monthly supervision sessions. St George`s Nursing Home DS0000026018.V344577.R01.S.doc Version 5.2 Page 18 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, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Care Manager is a qualified SRN, RGN, has a Diploma in Gerontology and forty years care management experience. They have also obtained an NVQ level 4-verifier certificate. There is a highly experienced and competent management team in place. The calibre of the home’s management is reflected in the high level of support and caring, professional manner in which staff observed went about their duties during the inspection despite the Care Manager being on holiday. The residents felt the home’s management and staffing was excellent. St George`s Nursing Home DS0000026018.V344577.R01.S.doc Version 5.2 Page 19 The annual business plan contained measurable objectives with regularly reviewed performance indicators. Regular questionnaires were sent to residents, relatives and staff are part of the quality assurance system and used to identify areas in which performance, service and support can be improved. Notifications are forwarded to the CSCI under as required. Annual staff appraisals and two monthly supervision sessions take place. The residents have their rights protected by their contracts, legal representatives and placing officers. The Care Manager is currently appointee for one resident. The handymen carry out regular health and safety checks that are recorded and include weekly fire alarm system and emergency lighting checks that are also checked by the company with the service contract. This was taking place during the inspection. The fire fighting equipment was tested in October 2006. General, individual and health and safety risk assessments, including the premises, are carried out by members of staff as appropriate to designation and areas of responsibility. Quarterly equipment assessments and others relating to maintenance including COSHH were recorded. The catering staff check and record fridge, freezer and cooking temperatures. It was unclear what the procedure was in the event of fire regarding resident evacuation and the home has agreed to contact the fire brigade to establish if residents who are not very mobile should stay in their bedrooms until the fire brigade arrives or be evacuated. The home also needs to carry out a fire drill once this has been established. St George`s Nursing Home DS0000026018.V344577.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 St George`s Nursing Home DS0000026018.V344577.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) Requirement All care plans must include appropriate information regarding residents’ leisure interests and preferred activities. Medication administration sheets must be correctly filled in without gaps. If gaps are found an explanation and if medication was administered must be recorded. The three monthly medication record audit must become monthly The home must contact the fire brigade to ascertain if it is preferable for less mobile residents’ to remain in their bedrooms in the event of a fire until the fire brigade arrives or should evacuation be attempted. Once a course of action has been agreed a fire drill should take place and then at three monthly intervals. All CRB checks over three years old must be renewed. All staff must have up to date contracts. Timescale for action 15/10/07 2. OP9 13 (2) 15/08/07 3. OP38 23 (4) 15/10/07 4. 5. OP29 OP29 19 (1) 18 & 19 15/10/07 15/10/07 St George`s Nursing Home DS0000026018.V344577.R01.S.doc Version 5.2 Page 22 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 George`s Nursing Home DS0000026018.V344577.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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. 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