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Inspection on 04/04/07 for St George`s Nursing Home

Also see our care home review for St George`s Nursing Home for more information

This inspection was carried out on 4th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The standard of care in this home is excellent and the care staff have a good understanding of individual care needs of the service users in their care. They also have a good insight into dementia awareness.The home is designed to allow service users space to wander in a safe and secure environment. Individual accommodation is also of a high standard. Privacy and dignity are respected and service users are helped to make choices about basic living skills for example what they wear, and how they spend their time. An activities coordinator, and two assistants manage leisure activities. These are published in a monthly newsletter. The catering arrangements are excellent and provide a wide and varied choice of food with several snacks and beverages offered throughout the day to encourage service users to eat. Staff recruitment and training is ongoing and the training coordinator organises all the training to meet all the personal development needs of the staff. The home is well managed by an experienced manager with the management and organisation skill necessary to manage a home of this size.

What has improved since the last inspection?

Since the last inspection the manager has had the time to invest in reorganising the layout of space to promote safety. Various rooms have changed use providing a more service user- friendly environment. A central treatment room has been created and the staff training room has been relocated to the end of the building. Some bedrooms have been redecorated, and more profile beds purchased. The garden group overseen by the activities staff has painted the garden furniture.

What the care home could do better:

There have been no requirements as an outcome of this inspection.

CARE HOMES FOR OLDER PEOPLE St George`s Nursing Home 5 Byfleet Road Cobham Surrey KT11 1DS Lead Inspector Mary Williamson Unannounced Inspection 10:00 4th April 2007 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 DS0000017641.V333195.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 DS0000017641.V333195.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St George`s Nursing Home Address 5 Byfleet Road Cobham Surrey KT11 1DS 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) 0113 381 6100 fessere@bupa.com www.bupa.com BUPA Care Homes (BNH) Limited Mrs Carol Dione Purdy Care Home 60 Category(ies) of Dementia - over 65 years of age (60), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (60) St George`s Nursing Home DS0000017641.V333195.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. In this home the 60 Service Users may comprise up to 60 people within category DE(E) or up to 60 people within category MD(E) The age range of service users accommodated within this home is from 60 years in the categories DE(E) or MD(E) Up to 8 service users falling within the category MD - excluding DE, may be admitted from the age of 40 years to 64 years. Day Care may be provided for up to 4 service users from the age of 40 years of age within categories DE(E), DE, MD or MD(E). 6th October 2005 Date of last inspection Brief Description of the Service: St. Georges Nursing Home (one of the BUPA homes) is situated in a rural setting on the outskirts of Cobham, close to the renowned Wisley Gardens. St. Georges is a single storey, purposed built home designed specifically to provide safe and secure environment for service users requiring dementia nursing care. The carefully planned layout of the home provides a safe environment for service users to walk around freely. St Georges has a number of reception rooms, providing a central meeting place where service users can get together to chat, watch television or read. A feature of the home is the pleasant central secure courtyard garden, where service users can spend time strolling or relaxing on the patios. Modern safety features fitted in each bedroom include 24- hour nurse call system. The fees charged in this service are £185 per day. St George`s Nursing Home DS0000017641.V333195.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first site visit of a key inspection and was unannounced. The inspection took place over five and a half hours. Mary Williamson, Regulation Inspector, carried out the inspection. The Registered Manager Mrs Carol Purdy represented the establishment. A tour of the premises was undertaken and a number of records relating to the care of the service users and the management of the home were examined. It was possible to meet most of the service users and talk with a small amount of them, some in more detail than others. It was also to talk with visiting relatives all of whom had positive feedback about the home. Discussions were held with staff both in groups and individually. They all had a good understanding of the service users they care for, and were aware of the specific needs associated with dementia. The kitchen was visited and the chef spoken to. The choice and variety of food offered is very good, and appropriate to meet individual needs of service users. There were various activities in progress and some service users had enjoyed a trip out to a local beauty spot during the morning. Other activities included art and craft and watching television. There was a training session in progress for ten staff on abuse awareness. The manager and the training coordinator were able to demonstrate the training provided for staff at various levels. The recruitment procedures in the home were sampled and employment records seen. All the employment documentation seen appeared to be in order. The Commission for Social Care Inspection would like to thank the service users, manager, and the staff team for their help and hospitality during this inspection. What the service does well: The standard of care in this home is excellent and the care staff have a good understanding of individual care needs of the service users in their care. They also have a good insight into dementia awareness. St George`s Nursing Home DS0000017641.V333195.R01.S.doc Version 5.2 Page 6 The home is designed to allow service users space to wander in a safe and secure environment. Individual accommodation is also of a high standard. Privacy and dignity are respected and service users are helped to make choices about basic living skills for example what they wear, and how they spend their time. An activities coordinator, and two assistants manage leisure activities. These are published in a monthly newsletter. The catering arrangements are excellent and provide a wide and varied choice of food with several snacks and beverages offered throughout the day to encourage service users to eat. Staff recruitment and training is ongoing and the training coordinator organises all the training to meet all the personal development needs of the staff. The home is well managed by an experienced manager with the management and organisation skill necessary to manage a home of this size. What has improved since the last inspection? What they could do better: There have been no requirements as an outcome of this inspection. St George`s Nursing Home DS0000017641.V333195.R01.S.doc Version 5.2 Page 7 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 DS0000017641.V333195.R01.S.doc Version 5.2 Page 8 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 DS0000017641.V333195.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3, and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is sufficient information available to service users and their relatives to help then make a decision about living in the home. Contracts of occupancy and needs assessments are in place. The home does not provide intermediate care. EVIDENCE: The home has a statement of purpose and service user guide in place and all service users and their relatives have access to a copy of this in order to help them make a decision about living in the home. The manager stated all prospective service users have a needs assessment undertaken to determine the suitability of the placement and if needs can be St George`s Nursing Home DS0000017641.V333195.R01.S.doc Version 5.2 Page 10 met. Five of these assessments were randomly sampled which were all very informative. Contracts of occupancy were in place and outline the care to be provided, the accommodation offered, the amount of fees payable to include the method and frequency. The home does not provide intermediate care. St George`s Nursing Home DS0000017641.V333195.R01.S.doc Version 5.2 Page 11 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 (excellent). This judgement has been made using available evidence including a visit to this service. Health, personal, emotional, and social care needs of service users are outlined in detailed care plans. The medication practices in the home safeguard the service users, who are treated with dignity and respect. EVIDENCE: Care plans are based on QUEST, which is a BUPA system of care planning. Five care plans were randomly sampled which were well maintained, informative and used as a working document. Care plans are written with information obtained from the needs assessment and input from relatives and other health care professionals. They are reviewed regularly and updated daily. Care plans also include risk analysis of tissue viability assessments, nutritional assessments, manual handling assessments, and the use of bed rails. Health care arrangements in place are good. All the service users are registered with a local GP practice that visits the home on Wednesday mornings or more frequently when required. St George`s Nursing Home DS0000017641.V333195.R01.S.doc Version 5.2 Page 12 Service users also have access to dental care, chiropody, and an optician service on a regular basis. The Psychiatrist and CPN (Community Psychiatric Nurse) also visit the home. Several service users were being nursed in bed and appeared comfortable and well cared for. Currently there are no service users in the home with a pressure sore. The home has a medication policy in place. All medication administered to service users is administered by Registered Nurses in accordance with the home’s policy and the Nursing and Midwifery Council guidelines on administration of medication. Medication recording charts are well maintained and there are clear audit trails of medication entering and leaving the home. There are currently no service users in the home capable of self administration of medication. Service users are treated with dignity and respect and staff were observed to knock on service users bedroom doors prior to entering. Staff addresses service users by their preferred name and were constantly explaining tasks and procedures to service users before undertaking them. St George`s Nursing Home DS0000017641.V333195.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15.Quality in this outcome area is (excellent). This judgement has been made using available evidence including a visit to this service. The social and recreational arrangements in place meet the assessed needs of the service users. Family links are maintained and the nutritional needs of service users are met. EVIDENCE: The home employs an activities coordinator and two activities assistance who arrange activities over seven days. A monthly activities programme is published and includes details of seasonal events planned. These include poetry reading in honour of William Wordsworth, a Grand National sweepstake afternoon, and Queen Elizabeth themed activity in honour of her birthday. On the day of the inspection some service users had gone on an outing to Painshill Park during the morning with staff, and an Easter theme art and craft afternoon also took place. There is an activities room located centrally, which allows the service users to wander in and out as they please. Community links are maintained and include outings to local attractions. St George`s Nursing Home DS0000017641.V333195.R01.S.doc Version 5.2 Page 14 Spiritual needs of the service users are recognised. The local vicar of St. Mary’s in Byfleet visits the home to undertake a Holy Communion Service. Visits can also be arranged for members of other clergy to visit the home on request. Service users are supported to maintain contact with their family and friends. Visitors are welcome in the home at any reasonable time. There was opportunity to talk with a few relatives during the day who all stated that they are made to feel most welcome and are always kept informed of ongoing events and changing needs of service users. The manager stated that she organises relative meetings every three months. Service users are helped to exercise choice and control over their lives. Staff encourage service users choose the cloths they wish to wear, help them choose from the menu, and what activities they wish to participate in. It was good to note from talking with staff that they have a good understanding of individual needs and interests. The kitchen was visited and the chef spoken to. The menus were seen and provide a wide range of choice and variety of food. Individual needs are catered for, and the chef explained that he also provides a “grazing” died offering some service users meals every two hours to encourage them to eat. Currently there are twenty- six service users that require a soft diet and feeding with several more requiring prompting to eat. Staff were observed providing sensitive support to these service users. Service users who were able to make comment about the food stated that the food was very good. The manager stated that arrangements could be made for relatives to dine with service users on request. Lunch clubs are also arranged through the leisure services team. St George`s Nursing Home DS0000017641.V333195.R01.S.doc Version 5.2 Page 15 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, and 18. Quality in this outcome area is (excellent). This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure and abuse awareness procedure which protect the service users. EVIDENCE: The home has a complaints procedure in place and a copy of this is available at the reception area. Most of the service user would have to rely on relatives, friends or advocated to implement this procedure on their behalf. The manager stated that that the last complaint was received in October 2006. Relatives spoken to felt that if they had to make a complaint that they were confident that this would be acted upon professionally. The home has an abuse awareness procedure in place. During the inspection ten staff were attending a training day in the home on abuse awareness. The training coordinator and the manager were facilitating this course and the manager is an abuse awareness trainer. The course content was seen and is detailed and person centred focused. It outlines procedures to be followed and includes rights, dignity, individuality and personal choice. The staff spoken to stated that they enjoyed the training and all passed the exam on completion. St George`s Nursing Home DS0000017641.V333195.R01.S.doc Version 5.2 Page 16 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, 20, 22, 24, and 26. Quality in this outcome area is (excellent). This judgement has been made using available evidence including a visit to this service. Service users live in a safe, well maintained, and clean environment, which meets their individual and collective needs. EVIDENCE: The layout and design of the home is suitable for the service users living there. The communal accommodation has been arranged to allow service the opportunity to wander about safely. There are various lounge areas, dining areas and the central activities area providing service users space without causing them to be restricted and confused. There is also access to a safe central court- yard and well a maintained garden, which is suitably furnished with garden furniture, which has been recently painted by the gardeninggroup. St George`s Nursing Home DS0000017641.V333195.R01.S.doc Version 5.2 Page 17 Individual accommodation is offered in single en-suite bedrooms, which are arranged over four units. These have been individualised to reflect individual personalities. Bedrooms have memory boxes outside their rooms containing photographs, and personal items to help with room recognition. The home has been adapted to meet the mobility needs of service users. All the rooms have been equipped with profile nursing beds, toilets have been provided with raised toilet seats and grab rails where appropriate. Hoists are available for moving and handling, call bells are in place in all rooms and there is ramp access to the gardens. The standard of cleanliness and hygiene is well maintained by the housekeeping team. The laundry is well equipped and the staff are familiar with the home’s infection control policy. St George`s Nursing Home DS0000017641.V333195.R01.S.doc Version 5.2 Page 18 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, and 30 Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. A skilled and competent team of staff in sufficient numbers to meet their needs meets Service users needs. EVIDENCE: The number and skill mix of staff on duty was sufficient to meet individual needs. Staff are allocated to individual units according to need and dependency. This is maintained over twenty-four hours. The home does not employ agency staff. There is a training coordinator in post who is responsible for maintaining training records and facilitating training courses. She explained the programme in place. All staff undertake induction training using a handbook, which they work through. All mandatory training is updated and the training coordinator maintains individual staff training profiles and provided the inspector with a copy of this training. NVQ training is ongoing and 55 of the staff hold an NVQ award. BUPA also provide training for the qualified nurses to help them with their personal development (PREP) and career progression. The manager stated that BUPA operates”Personal Best Training” scheme and that forty- one staff received awards in this during the year. St George`s Nursing Home DS0000017641.V333195.R01.S.doc Version 5.2 Page 19 The recruitment practice within the home protects the service users living there. The recruitment files sampled appeared to be in order with the required documentation in place. St George`s Nursing Home DS0000017641.V333195.R01.S.doc Version 5.2 Page 20 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, and 38. Quality in this outcome area is (excellent). This judgement has been made using available evidence including a visit to this service. Service users live in a well managed home, which is run in the best interests of the service users and promotes their health, welfare, and safety. EVIDENCE: The home is well manager by an experienced manager who has an excellent understanding of the service users needs. She is a qualified nurse and has obtained several awards and trophies from BUPA over the years for her good practice and innovative ideas. For example she introduced a customer led “pop in scheme” to accommodate four service users for respite care from one hour to twenty four hours providing respite for their relatives. She also lectures to outside organisations in dementia awareness. St George`s Nursing Home DS0000017641.V333195.R01.S.doc Version 5.2 Page 21 The manager is well supported by a large team of qualified nurses and there was opportunity to meet with some of them during the inspection. Relatives spoken to expressed their satisfaction regarding the management structure within the home and felt they are well supported and informed. The manager stated that she operated an open door policy where staff, service users and their relatives can go at any time with problems or concerns. Quality assurance is monitored by Regulation 26 visits which are retained in the home. BUPA send quality assurance audit questionnaires to relatives annually. Catering questionnaires are also distributed frequently. Relative meetings are arranged three monthly, and service users committee meetings are also held on a regular basis. The home manages the pocket money of some service users who request this. The home does not act as appointee for any service user. The health, safety and welfare of service users are promoted and there is a wide range of health and safety policies and procedures in place. The training coordinator arranges for staff to be made aware of these policies at various stages of their development. The maintenance department oversees the fire safety arrangements. The last fire drill took place two week previous, and fire alarms are tested weekly. There is a contract in place for the maintenance of fire fighting equipment and emergency lighting. The procedure for recording accidents was discussed with the manager. Each month the manager undertakes an accident analysis and discusses the frequency of falls with her senior team. This is recorded onto a graph and appropriate action taken, for example more supervision of individual service users, review of needs, or review of medication or an increase of staff numbers. Risk assessments are in place for all identified risks and safe working practice. St George`s Nursing Home DS0000017641.V333195.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 4 4 4 X 3 4 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 4 St George`s Nursing Home DS0000017641.V333195.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action 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 DS0000017641.V333195.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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. Extracts may not be used or reproduced without the express permission of CSCI St George`s Nursing Home DS0000017641.V333195.R01.S.doc Version 5.2 Page 25 - 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. 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