Inspection on 21/07/06 for St George`s Nursing Home

This inspection was carried out on 21st 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 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 15/08/07

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 Unannounced Inspection 21st July 2006 10:00 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.V292429.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.V292429.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 Mrs Elizabeth Kerins-McManus Mrs Elizabeth Kerins-McManus Care Home 39 Category(ies) of Physical disability (39) registration, with number of places St George`s Nursing Home DS0000026018.V292429.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th December 2005 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-eight residents with a new resident moving in on the inspection day. 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.V292429.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. During the inspection four residents’ files were case tracked and nine residents and one relative spoken with individually. A sample of records were checked and care delivery observed. The current fees range from £630 to £1160 per week depending on the type of accommodation provided. What the service does well: What has improved since the last inspection? What they could do better: St George`s Nursing Home DS0000026018.V292429.R01.S.doc Version 5.2 Page 6 One area identified for improvement was in the recording of medication administered, as there were a few gaps in the recording with no explanation entered on the charts. The complaints book could not be located. 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 George`s Nursing Home DS0000026018.V292429.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.V292429.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): 3 & 6. The quality outcome for this area was good. All residents including those receiving respite care are fully assessed prior to moving into the home. EVIDENCE: The four residents’ files case tracked showed that full assessments were carried out in each area required by the standards, by senior staff that are trained to do so. There is also a written policy and procedure that assessing staff follow. The same procedure is used for permanent residents’ and those receiving intermediate care and everyone has access to the same facilities. Residents receiving intermediate care are also supported to maintain and increase their independence in readiness for when they return home. 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. The new resident was flying in from Spain to move in on the inspection day. St George`s Nursing Home DS0000026018.V292429.R01.S.doc Version 5.2 Page 9 St George`s Nursing Home DS0000026018.V292429.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 & 10. The quality outcome for this area was good. The residents have individual care plans, health needs are met and medication is generally appropriately administered and recorded. They are treated with dignity and respect. EVIDENCE: The four care plans case tracked demonstrated that goals are set from needs identified that are underpinned by risk assessments. The goals and risk assessments are regularly reviewed and updated according to identified changing needs and the reviews are fed by daily record entries. The reviews take place monthly or as required depending on nature of identified needs. The residents and relatives spoken with felt they are treated with respect and their dignity and privacy observed. Privacy, dignity and respect are part of core induction training and are included in the staff handbook. All residents are registered either with the GP attached to the home or their own GP if they prefer. They have full access to community based health care services and there were very comprehensive health care records in place that are regularly updated and reviewed. These include nutrition and treatment of pressure sores. St George`s Nursing Home DS0000026018.V292429.R01.S.doc Version 5.2 Page 11 There is a written medication administration policy and procedure and records were checked for each resident. Although generally up to date and well recorded, there were four blank non- entries and one initialled error. Three of the entries had been picked up by the checking system although no explanation regarding them was recorded. The pharmacist delivers medication and disposes of any that is not required. This was fully documented. Currently there are two self-medicating residents who have been risk assessed to do so. They are monitored and reviews carried out six monthly or as required. The staff that administer medication are trained to do so. A recommendation was made at the last inspection regarding intermittent tablet counts and this has now been addressed. St George`s Nursing Home DS0000026018.V292429.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. The quality outcome for this area was good. The residents interviewed felt the lifestyle they have in the home matched their needs and wishes and they were in control of their lives and made their own decisions. Family and friends are welcome to visit at reasonable times. Everyone felt the food provided was excellent with enough variety and choice. EVIDENCE: The residents’ spoken with felt there were enough activities provided within and outside the home to meet and stimulate their interests and most preferred to follow their own pursuits independently although many also enjoyed the afternoon board game and other sessions. A concert was held the day before the inspection. Many residents make use of activities provided locally, particularly the theatre, lunch out and art gallery visits. They all confirmed that they choose what they wish to do, when they want to do it and receive visitors when they feel it is convenient. This was evidenced by observation of the support provided by staff and way it was provided. A visitor confirmed that they visit whenever they wish provided it does not inconvenience other residents’. All conversations with the residents confirmed that they felt listened to and staff and the management made time to chat with them on a one to one basis. St George`s Nursing Home DS0000026018.V292429.R01.S.doc Version 5.2 Page 13 They were confident that their opinions are listened to, acted upon and it was the small attention to detail that made the difference. All residents spoken with praised the quality and choice of food provided and this was reflected in the meals available during the inspection. Nutrition and diet are key areas of health care planning within the individual care plans and this was confirmed by the four files case tracked. St George`s Nursing Home DS0000026018.V292429.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. The quality outcome for this area was good. Residents and relatives are confident that complaints are listened to and acted upon. They are protected from abuse. EVIDENCE: The residents’ spoken with said they were aware of the written complaints procedure although all said if they had a complaint they would speak directly with the Care Manager as they were confident that they are listened to and their views would be acted upon. No one spoken with had any complaints. On the contrary everyone was extremely happy with the service provided. The complaints book could not be located during the inspection. There is a written policy and procedure regarding abuse identification and what to do if encountered. This is also part of core induction training. Adult protection and aggressive behaviour are also included as part of the NVQ training. Staff spoken with were fully aware of what constitutes abuse and how to respond to it. The residents spoken to felt very safe in the environment in which they live. There is a comprehensive adult protection policy and procedure in place that has been made available to staff. St George`s Nursing Home DS0000026018.V292429.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. The quality outcome for this area was good. The home is well maintained and the residents felt safe living there and that it is a friendly and comfortable place to live. It was clean, pleasant and hygienic. EVIDENCE: A premises tour showed the home is suitable for its stated purpose, well decorated, furnished and maintained. There is a full maintenance programme in place and residents spoken with enjoyed their private accommodation and felt it met their needs. The home is currently applying to increase its registration to provide more suites of rooms. The home was found to be clean, hygienic and odour free. St George`s Nursing Home DS0000026018.V292429.R01.S.doc Version 5.2 Page 16 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 & 30. The quality outcome for this area was good. There were suitable numbers of qualified, well-trained staff on duty, who had met the recruitment criteria and were capable of safely meeting residents’ needs. EVIDENCE: There is currently one vacancy for a cleaner and the staff rota showed there are adequate numbers of well-trained staff on duty, at all times, to meet residents’ needs. This was demonstrated by the care practices observed, views of the residents whom found staff excellent and fact that the home was functioning to its usual high standard despite the Care Manager being on holiday. Staff records demonstrated that staff qualified to NVQ level 2 and above far exceeded the required 50 . The home also provides eight- week work experience slots for trainee nurses from Thames Valley and South Bank that are supernumerary to the staff team. A thorough written recruitment procedure is in place that adheres to current equal opportunities legislation and encompasses all the steps outlined in the standards. All staff have contracts, job descriptions and have been CRB checked. St George`s Nursing Home DS0000026018.V292429.R01.S.doc Version 5.2 Page 17 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 & 38. The quality outcome for this area is good. The home is well managed and residents feel it is run with their best interests foremost. Financial interests are safeguarded and there are full health and safety risk assessments and checks carried out. 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.V292429.R01.S.doc Version 5.2 Page 18 There is an annual business plan that contains measurable objectives with performance indicators that are regularly reviewed. There are also regular questionnaires sent to residents, relatives and staff that are used to identify areas in which performance and service and support can be improved. Notifications are forwarded to the CSCI under the required criteria. Staff receive annual appraisals as well as structured supervision sessions. The residents have their rights protected by their contracts, legal representatives and placing officers. The Care Manager is currently appointee for one resident. Any money or valuables deposited with the home, for safe keeping are kept in a safe and a record and inventory is kept. Transactions are also recorded with receipts. The Maintenance Officer carries out regular health and safety checks that are recorded and include weekly fire alarm system checks and this is also checked monthly by the company with the service contract. The fire fighting equipment was tested in November 2005. General, individual and health and safety risk assessments, including the premises, are carried out by staff, OTs and students as appropriate to respective areas of responsibility. The students’ carry out assessments as part of their training and staff oversee them. Quarterly equipment assessments and others relating to maintenance including COSHH were recorded. The equipment provided met the residents’ needs. St George`s Nursing Home DS0000026018.V292429.R01.S.doc Version 5.2 Page 19 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 3 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 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 St George`s Nursing Home DS0000026018.V292429.R01.S.doc Version 5.2 Page 20 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 2 Standard OP16 OP9 Regulation 22 13 (2) Requirement The complaints book must be made available. Medication administration records must be fully completed. Timescale for action 21/07/06 21/07/06 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 OP9 Good Practice Recommendations The tablet counts must be continuous. St George`s Nursing Home DS0000026018.V292429.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Hammersmith Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 George`s Nursing Home DS0000026018.V292429.R01.S.doc Version 5.2 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!