CARE HOMES FOR OLDER PEOPLE
St George`s Nursing Home Northgate Lane Moorside Oldham Lancashire OL1 4RU Lead Inspector
Tracey Rasmussen Unannounced Inspection 26th January 2006 09:00 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 DS0000031914.V279933.R01.S.doc Version 5.1 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 DS0000031914.V279933.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service St George`s Nursing Home Address Northgate Lane Moorside Oldham Lancashire OL1 4RU 0161 626 4433 0161 678 2473 admin@stgeorgesnursinghome.co.uk www.stgeorgesnursinghome.co.uk St George`s Nursing Home (Oldham) Ltd 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) Care Home 55 Category(ies) of Dementia (20), Dementia - over 65 years of age registration, with number (30), Old age, not falling within any other of places category (20), Physical disability (15), Physical disability over 65 years of age (25) St George`s Nursing Home DS0000031914.V279933.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. No Service User to be admitted into the home who is under 30 years of age. The Manager must be supernumerary at all times. A minimum of 2 Registered Mental Nurses and a minimum of 2 Registered Nurses must be on duty between the hours of 8 a.m. and 3 p.m. A minimum of 1 Registered Mental Nurses and 2 Registered Nurses must be on duty between 3 p.m. and 8 a.m. Service users to include up to 20 OP, up to 20 DE, up to 30 DE(E), up to 15 PD and up to 25 PD(E). 15th June 2005 Date of last inspection Brief Description of the Service: St Georges Nursing Home is a purpose built nursing home, which was first registered in October 2002. The home is owned by St Georges Nursing Home Limited and is registered to provide nursing care to 55 people, primarily to older people with dementia type illnesses. The home also offers general nursing care unit and an early onset dementia facility in a separate suite. St. Georges is situated in Moorside, approximately three miles away from Oldham Town Centre. Access to the Pennine Moors is literally minutes away. Local amenities and access to local bus services is readily available. Close to the home is a new housing estate and a medical practice centre has recently been built. Outside the home, some borders have been planted, patio areas developed and other areas around the building have been grassed. Car parking facilities are available. Accommodation is provided over two floors. Each floor is split into two separate suites and each suite provides a lounge, dining room and bathroom facilities. Keypad security locks are used in the home. All bedrooms are spacious single rooms providing en-suite facilities. Bathing facilities are available on each floor. Facilities are also available for service users and visitors to make a drink. The home is a no-smoking home. St George`s Nursing Home DS0000031914.V279933.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over almost seven hours on Thursday 26th January 2006 by one inspector. Not all the standards were assessed at this visit. A tour of the home took place and care records, staff employment records and staff training records were seen. Time was spent talking to the manager, residents and staff and observing routines within the home. A short verbal feedback of the findings from the inspection was given to the manager and the proprietor of the home. What the service does well: What has improved since the last inspection?
There have been significant improvements in almost all aspects of the service in the home. A new manager has been in post for six months and she has been supported by a weekly visit from a management consultant. This has enabled the manager to make great strides in improving and developing the service. This has resulted in a calm, relaxed home environment where residents appeared settled and where one resident who could comment said, “things had improved greatly”. Staff said moral was ‘much better’ Concerns and comments about the quality of the food provided in the home have been addressed. A monthly catering meeting is held where residents and relatives are also invited. New menus have been provided which offer a range of meals
St George`s Nursing Home DS0000031914.V279933.R01.S.doc Version 5.1 Page 6 The manager has reduced the number of agency care workers in the home ensuring a consistent standard of care is provided. Staff have training in mandatory aspects of health and safety and a weekly training session was being provided for Abuse. Quality assurance questionnaires have been sent out and the results correlated and displayed in the home. Meetings for residents, relatives and staff have been undertaken. Complaints have been addressed. 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 George`s Nursing Home DS0000031914.V279933.R01.S.doc Version 5.1 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 DS0000031914.V279933.R01.S.doc Version 5.1 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, 4 and 5 Resident’s needs are assessed before they move into the home. The home can confirm they can meet the needs of the resident on admission. EVIDENCE: A sample of care files were seen on each of the four units. Each file had a community care and or nursing assessment, which detailed clearly the specific care needs of the resident. This was supported by the home’s own assessment. Nursing staff spoken too stated that they or a nurse colleague did go out and assess a prospective new resident before admission to the home. The new manager of the home has ensured that staff training is a priority. New staff receive induction training, mandatory training has been provided and NVQ training is well established. A dementia care training programme was being developed. The home was in the process of up dating its service user guide and statement of purpose to ensure accurate information is provided to residents and visitors in the home. The home does not offer an intermediate care service (Standard 6)
St George`s Nursing Home DS0000031914.V279933.R01.S.doc Version 5.1 Page 9 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 and 10 Residents were treated with respect and dignity. The care planning documentation was not consistently sufficient to meet personal and health care needs of residents. EVIDENCE: Residents observed in all parts of the home were neatly presented and attention had been paid to personal grooming. Staff interacted with residents in a relaxed and pleasant manner. One resident spoken to on the general nursing unit said that, “Everyone was much happier” with the new manager. The resident also said, ‘Moral was good and the care was good’. Care planning documentation was seen on all four units in the home. Three out of four files did have detailed care plans. Discussion with nursing and care staff on the under 65 dementia care unit did identify that staff were providing individualised care to the residents but the level of support provided was not reflected in the care plan seen. This care plan contained generic interventions and did not reflect the specialist nature of the service provided to the resident.
St George`s Nursing Home DS0000031914.V279933.R01.S.doc Version 5.1 Page 10 Evaluations of the effectiveness of care plans were recorded differently on each unit and the quality of information was also varied. All the care files seen did have the appropriate assessments such as Waterlow skin assessments, moving and handling assessments and nutritional assessments. However, these were not always recorded accurately. Records were available of the community health and medical services used by the home for each resident. Medication practices were not assessed at this inspection. The registered person and manager did state that the home was in the process of rolling out a programme of providing height adjustable beds to all units in the home so ensuring physical care needs of residents could be met safely. St George`s Nursing Home DS0000031914.V279933.R01.S.doc Version 5.1 Page 11 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 and 15 Life style choices are available but records of resident’s social needs need developing. The choice and quality of food provided has improved. EVIDENCE: The home employs an activity coordinator who works on each of the units throughout the week. The activity coordinator does keep a record of each resident’s participation and interaction in specific activities. These are kept separate from the resident’s care records. Care files seen contained little reference to the social aspects of the service. Discussion with the manager did identify that she was aware of this area development and she stated that she had recently sent out requests to next of kin for social history information to develop person centred social care plans. Staff were polite and supportive to residents and residents responded positively to staff. Routines in the home enabled residents to make some choices such as rest and retirement times. The meal service delivery had improved significantly since the last inspection visit. The new manager had listened to residents and families and new menus had been developed. Menus were displayed on each unit and residents were asked their preferences each day.
St George`s Nursing Home DS0000031914.V279933.R01.S.doc Version 5.1 Page 12 A monthly catering meeting had been set up where residents and relatives were encouraged to attend. One resident said she did attend and that the food was ‘much better’. Menus seen offered a variety of meals, which included a full cooked breakfast daily, traditional hearty meals, lighter meals such as prawn cocktail, homemade soups and a variety of desserts and puddings. The lunch of braised steak and onions with fresh mash potatoes, carrots and green beans was sampled. This was tasty and nutritious. Both the manager and a resident said that there were still ‘niggles’ that needed to be addressed with the menus but this would be undertaken at the next catering meeting. St George`s Nursing Home DS0000031914.V279933.R01.S.doc Version 5.1 Page 13 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 Residents can be confident that complaints are responded to appropriately. Residents are protected from abuse. EVIDENCE: Since the last inspection the proprietor and manager have updated the home’s complaints procedure. One formal complaint has been received since the last inspection. This had been addressed in accordance with the home’s policy and procedure. Staff spoken to on the units did say that they dealt with any issues identified by relatives or residents immediately. The home had also updated its policies and procedures for the protection of vulnerable adults in line with ‘No Secrets’ and Oldham Social Services policy and procedure. Staff training in abuse had commenced in the home. One nurse undertook a weekly training session to raise awareness of abuse. Records of staff attendance were available. St George`s Nursing Home DS0000031914.V279933.R01.S.doc Version 5.1 Page 14 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): Not assessed at this inspection. EVIDENCE: St George`s Nursing Home DS0000031914.V279933.R01.S.doc Version 5.1 Page 15 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 Staff are correctly vetted, employed in sufficient numbers and are trained to meet resident’s needs. EVIDENCE: Staffing levels in the home had improved significantly since the last inspection. The manager said she had recruited a number of care staff and this process was on-going. Agency staff were still used on occasion. The manager had begun the process of looking at ways of reducing the long shifts (14 hours plus) that some staff preferred to work. This must continue so any potential risks to residents by staff who are tired are reduced. The home had a relaxed peaceful atmosphere. Staff did not rush and interactions with residents were pleasant. Staff spoken with were complimentary about working in the home and said they felt the manager of the home had raised staff moral. The manager had commenced implementing systems to computerise staff training records. Training records were seen for a selection of newer staff and these had records of induction, statutory health and safety training and records of staff training in abuse. The manager stated that facilitator training in moving and handling had been arranged and a dementia care training package was in the process of being developed. Staff spoken too did say they felt that supernumerary induction training time was not long enough. The manager
St George`s Nursing Home DS0000031914.V279933.R01.S.doc Version 5.1 Page 16 stated that the amount of supernumerary time provided was dependent on the individual worker. NVQ training was established in the home, 60 of staff had obtained a minimum NVQ level 2 qualification. Employment records were maintained appropriately, documentation such as application form, references, health check, disclosures and Pova Firsts were all obtained before the commencement of employment St George`s Nursing Home DS0000031914.V279933.R01.S.doc Version 5.1 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): 31,32, 33, 35, 36 and 38 The management of the home promotes the health, safety and wellbeing of the residents. Residents do have a say in how the home is run. Resident’s personal money is safe. EVIDENCE: The manager of the home has been in post approximately six months and during this time she has made significant improvements in almost all aspects of the service. The proprietor of the home has used the services of a management consultant to support the manager in addressing the numerous concerns identified at the last inspection. Almost all areas of concern identified at the previous inspection have been addressed and plans to develop and improve the service further were underway. St George`s Nursing Home DS0000031914.V279933.R01.S.doc Version 5.1 Page 18 Both residents and staff spoken too were complimentary about the home and the atmosphere was calm and relaxed. One staff member said, “it was much better with this manager”. The manager had undertaken quality assurance questionnaires and the results of which were displayed in graph format on the notice board at the entrance into the home. Resident and relative meetings had been held and records of these were available. Residents and relatives have been encouraged to join the catering meeting to contribute and share ideas, opinions and concerns. Staff had attended staff meetings and staff formal appraisals had commenced Formal one-to-one supervision had not yet commenced. Resident’s personal monies were held securely and records were available which detailed all transactions. Receipts were held for all expenditure undertaken for each resident. Health and safety records were available and these were comprehensive. Fire records were maintained appropriately. St George`s Nursing Home DS0000031914.V279933.R01.S.doc Version 5.1 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 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 x x x x x x x x 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 3 3 x 3 2 x 3 St George`s Nursing Home DS0000031914.V279933.R01.S.doc Version 5.1 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 Standard OP8 Regulation 12,14,15 Requirement Timescale for action 31/03/06 2 OP8 12,14,15 The registered person must ensure service user assessments such as the nutritional assessment are undertaken using accurate information. The registered person must 31/03/06 ensure that care plans reflect the person centred care and interventions provided in the home. 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 2 3 4 Refer to Standard OP8 OP8 OP12 OP27 Good Practice Recommendations The registered person should ensure that systems to audit the quality of care plan information is undertaken The registered person should ensure that care plan evaluations are recorded in detail. The registered person should ensure that the process of recording residents social care needs continues as part of the care planning process. The registered person should ensure that the homes
DS0000031914.V279933.R01.S.doc Version 5.1 Page 21 St George`s Nursing Home 5 OP36 practice of allowing staff to work shifts of 14 plus hours is reduced. The registered person should ensure that staff one to one supervision is undertaken following the home’s appraisal. St George`s Nursing Home DS0000031914.V279933.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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