Inspection on 04/03/08 for St George`s Nursing Home

This inspection was carried out on 4th March 2008.

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

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 24/02/09

St George`s Nursing Home 23/01/07

St George`s Nursing Home 04/10/05

St George`s Nursing Home 15/04/05

St George`s Nursing Home 08/09/04

St George`s Nursing Home 01/04/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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 De La Warr Road Milford-on-Sea Lymington Hampshire SO41 0NE Lead Inspector Beverley Rand Unannounced Inspection 4th March 2008 10:50 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 DS0000011444.V359457.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 DS0000011444.V359457.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St George`s Nursing Home Address De La Warr Road Milford-on-Sea Lymington Hampshire SO41 0NE 01590 648000 01590 644210 StGeorgesMilford@aol.com 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) St George`s Hospital Ltd Mrs Julia Frances Hutton Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36), Physical disability (8), Physical disability of places over 65 years of age (36), Terminally ill (8), Terminally ill over 65 years of age (36) St George`s Nursing Home DS0000011444.V359457.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: St Georges Nursing Home is located in a quiet residential area of the coastal village of Milford-on-Sea. The home is registered to provide nursing care for up to 36 older people and this can include up to 8 individuals who may be physically disabled. There are some amenities in the village, an area popular for holidays, including some shops, churches, surgery and dental practice. The home is very much part of the local community and many of the residents accommodated lived locally before moving in. The bedroom accommodation for residents is on 2 floors and a passenger lift and stairs provide access to the 1st floor. All bedrooms are single and 18 of these have en-suite WCs. The building has equipment, aids and adaptations to help promote the independence of the residents. The communal /shared areas of the home comprise a lounge on the ground floor and a lounge/dining room on the first floor and a large conservatory on the ground floor. There is also level access to well planned and extensive landscaped gardens. The current fee charged to service users is £765 a week. This fee excludes the Registered Nursing Care Contribution, which is currently £101 a week and is not paid by the service user. St George`s Nursing Home DS0000011444.V359457.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection. Prior to our visit to the home we looked at the previous inspection report and the Annual Quality Assurance Assessment, (AQAA) which was completed and sent to us on time by the manager and responsible individual. We were accompanied on the day by an, ‘expert by experience’. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The expert spoke to all of the service users who were able to talk to her, which was the majority. She spoke to them about everyday life, such as the organised activities. The inspector spoke with five staff, the manager and the responsible individual and looked at records such as staff recruitment files. What the service does well: What has improved since the last inspection? The home now ensures that Criminal Records Bureau checks and Protection of Vulnerable Adults checks are in place before new staff begin work. The home continues to undergo refurbishment as necessary. St George`s Nursing Home DS0000011444.V359457.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. St George`s Nursing Home DS0000011444.V359457.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 DS0000011444.V359457.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): 2. Standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre admission assessment process is good and ensures that service users’ needs are assessed and that the home can meet them. EVIDENCE: The AQAA stated that each potential service user has an individual preadmission assessment to ascertain whether the home can meet their needs. Service users are provided with information to explain the way the home is run. Each prospective service user is given the opportunity to visit and spend time in the home before making their decision. New service users have an eight week settling in period during which time any issues can be addressed. An individual holistic package of care is planned, implemented and evaluated from pre-admission and throughout the service user’s stay. St George`s Nursing Home DS0000011444.V359457.R01.S.doc Version 5.2 Page 9 We looked at the pre-admission assessments for three service users users and found that they contained all the necessary information. During the inspection, the local NHS assessment team were in the home, re-assessing the needs of two service users. St George`s Nursing Home DS0000011444.V359457.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): 6, 7, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that all service users have care plans in place which detail their individual personal care and healthcare needs. Procedures are in place to protect service users from the risks of medication. Staff uphold the principles of privacy and dignity. EVIDENCE: The AQAA states that each service user is supported to make their own decisions as far as possible and the home uses a person centred care plan system, which we evaluate at regular intervals. The care workers are trained in giving choice to residents and in ways to enable them to make decisions. There is a policy of knocking before entering rooms to ensure privacy, dignity and respect. The home has access to a private physiotherapist, so if the need is identified, the service can be arranged quickly. All service users have private phones in their rooms with direct dialling in and out, or if they wish, calls can pass through the switchboard if assistance with dialling or receiving calls is St George`s Nursing Home DS0000011444.V359457.R01.S.doc Version 5.2 Page 11 required. All service users have the opportunity of an annual eye test arranged on the premises, or as may be required, and dental treatment is easily arranged when needed. Service users also attend appointments for audiology tests, diabetic screening, or other specialist care requirements. We looked at care plans for three service users and found them to contain detailed daily notes, individual plans of care, risk assessments, continence assessments, pressure area assessments and so on. The plans were reviewed on a monthly basis and service users users or their families were involved in the process. We spoke with five staff about these care plans and they knew the people well, understanding their individual needs. The home has medication policies and procedures in place and we found medication to be stored appropriately. There were no gaps in the recording of medication administration. Two service users administer some of their own medication, which the manager said was stored appropriately. Controlled drugs were stored and signed for correctly. The medication administration record sheets were on top of the medication trolley in the hallway and the manager said they were usually kept there or in the office. We were concerned about the confidentiality of this arrangement and the manager agreed to keep them in the office. The manager told us that the registered nurses administer medication and that she was looking into organising supplementary training for them. The expert by experience spoke with service users about how the staff work with them. Responses included, ‘excellent’, ‘very good’, ‘lovely, I feel at peace’ and, ‘couldnt be better’. St George`s Nursing Home DS0000011444.V359457.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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers suitable activities and service users enjoy their meals. Visitors are welcomed. EVIDENCE: The activities programme was found to exceed the standard at the last inspection. During this visit the expert by experience spoke to service users about activities within the home. Comments included, that they ‘went out for drives’, ‘love bingo and always played when it was on’ and that they could ‘join in all events, it’s up to us’. The expert also looked at records which were kept about activities and who joined in. The home has its own mini-bus which can accommodate wheelchairs and uses this to go into the community. The AQAA states that the home has an open visiting policy, and rooms can be made available for private visiting. St George`s Nursing Home DS0000011444.V359457.R01.S.doc Version 5.2 Page 13 The home ensures that service users can personalise their rooms how they wish. The home can also access advocacy services if necessary. The home employs an award winning chef who cooks the majority of meals. The menus are planned on a fortnightly basis and includes a cooked lunchtime meal as well as a cooked tea. We saw plenty of fresh fruit and vegetables and special diets are catered for. The expert by experience spoke to service users who had mixed views about the food, but on the whole the view was good. The expert felt that the presentation could have been better. She also noted that the food was served to two service users who were sitting at a dining table, with relevant place settings but their food was served on trays rather than being transferred to the place mats. The manager did not know why this was done and agreed to look into it. Comments on the food ranged from ‘excellent’, to, ‘could be better’, ‘o.k.’ and ‘not bad’. St George`s Nursing Home DS0000011444.V359457.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 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home ensures that service users have access to the complaints procedure. Procedures are in place regarding safeguarding adults but these have not been followed, potentially putting service users at risk. EVIDENCE: The home has a complaints procedure in place and keeps a complaints log book. We looked at the log book and found it contained one complaint. The issue had been thoroughly investigated and the manager had involved a medical professional as well as discussing with staff. However, it was noted that the complaint was an adult protection allegation and it had not been reported to the local authority under their multi-agency procedure or to the Commission. The manager had detailed the investigation and the records showed she had considered contacting these agencies, but had been asked not to ‘make a fuss’ by the service user and their family. This was discussed with the manager as a wider issue regarding the home’s duty of care, individual capacity and so on. The issue was resolved following the manager’s investigation and the service user then withdrew their complaint. The expert by experience spoke to service users to see if they felt confident to use the complaints procedure. Comments made included, ‘I would tell Matron St George`s Nursing Home DS0000011444.V359457.R01.S.doc Version 5.2 Page 15 or a member of staff or a relative’, and others had, ‘nothing to complain about’. The manager and staff confirmed that training regarding safeguarding adults was provided on induction and that there were regular in-house sessions. The home has a safeguarding procedure, but this does state the need to involve the local authority. This should be reviewed and revised to refer to the local authority multi-agency procedures, to ensure that staff take appropriate action is abuse is ever suspected or alleged. St George`s Nursing Home DS0000011444.V359457.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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides the service users with a homely and clean accommodation that meets their needs. The infection control procedures at the home are good and ensure that the service users are protected. EVIDENCE: The expert by experience noted that the home appeared clean and welcoming with fresh plants on the window ledges throughout the home. Reception rooms were clean, bright and welcoming with lots of fresh flowers and plants. We looked around the premises and looked at bedrooms, communal areas, bathrooms, the laundry and the kitchen. The manager reported that the home has an ongoing programme of refurbishment. The expert went into twenty of the residents rooms and found all to be odour free and clean. It was observed that one room had two packets of incontinent pads on the floor as well as St George`s Nursing Home DS0000011444.V359457.R01.S.doc Version 5.2 Page 17 pillows on chairs and this was raised with the manager who agreed to look into it. The home was clean and homely. Furnishings were of a good standard and appropriate to the needs of the service users. The service users are provided with ample communal areas where a variety of activities are undertaken. The service users’ bedrooms seen were highly personalised and call bells were available in all bedrooms and accessible to the service users. Since the last inspection the home has refurbished five bedrooms. The refurbishment of the upstairs bathroom has nearly been completed, with a specialist bath in place. The manager said she had consulted with the service users regarding the showering/bathing facilities they would like. Many external doors and windows have been replaced. Specialist equipment has been provided to meet individual needs, such as electric beds, hoists and stand aids. The home does, however, have a problem with the storage of portable items. Equipment is stored in bathrooms and hallways. This was discussed with the manager who assured us that the equipment is always removed if the bathroom is in use. All rooms have a television and telephone. The doors are wide to accommodate wheelchairs and each has a name plaque of the service user who lives in the room. Information about infection control was available at the home and staff confirmed there was always enough protective clothing such as gloves and aprons. The laundry has a small, domestic washing machine for washing delicate items such as jumpers, as well as industrial machines with sluice programmes for household items. St George`s Nursing Home DS0000011444.V359457.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 adequate. This judgement has been made using available evidence including a visit to this service. The home ensures that staff are well trained and qualified. The home does not have a robust recruitment procedure to ensure service users are protected. EVIDENCE: We spoke to the manager about the staffing levels and she told us that the care staffing pattern is the following: upstairs there are two registered nurses and a minimum of five care assistants; downstairs there is one registered nurse and four care assistants. The manager and deputy manager, who are both registered nurses, work each weekday. During the night, there is one registered nurse and three or four care assistants. We looked at the rota which confirmed this. We looked at four recruitment files for new care assistants. Three of them contained the relevant paperwork, including references, Criminal Records Bureau and Protection of Vulnerable Adults check, which were all obtained before the person started work at the home. However, one file had two references, but one was not from the last employer, who was a similar care provider. Additionally, there was not written confirmation from the employer as to why the person no longer worked there. One reference was from a previous care employer and the other one was a personal one. We spoke to the St George`s Nursing Home DS0000011444.V359457.R01.S.doc Version 5.2 Page 19 manager about why a reference was not received from the last employer. She was unsure, but thought that the named referee had left the company. She did not know why she had not sought a reference from someone else, such as the manager. At the last inspection, we found other recruitment checks, (Protection of Vulnerable Adults and Criminal Records Bureau) were not in place before three new staff began work. During this inspection, we found the home now ensures these checks are in place but we found the issue regarding the reference above. We are concerned that this shows a lack of understanding about what checks must be in place to ensure staff are safe to work with vulnerable people. Staff said there was a lot of training, ‘something nearly every week’. The manager confirmed that the training programme included moving and handling, infection control, safeguarding adults and health and safety. The home has in-house trainers for moving and handling and they also have undertaken the, ‘train the trainer’ course. Fourteen of the twenty seven permanent care staff have achieved a National Vocational Qualification, (NVQ) in care at level 2 or above. Staff told us that there was always opportunity to undertake other courses, such as NVQ3. St George`s Nursing Home DS0000011444.V359457.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 adequate. This judgement has been made using available evidence including a visit to this service. The home is generally well run but improvements need to be made to ensure the protection of service users. EVIDENCE: The manager is a registered nurse and has achieved the Registered Manager’s Award. Since the last inspection the manager has continued her professional development by attending conferences and a wound care study day. She has also undertaken fire safety, food hygiene, first aid and moving and handling updates. Staff said the home was a, ‘lovely place to work’, ‘we get support which is so important’, ‘the manager will come in, problems are dealt with there and then’ and ‘she is incredibly approachable and always available’. St George`s Nursing Home DS0000011444.V359457.R01.S.doc Version 5.2 Page 21 Although there are some good outcomes for people using the service, as assessed at this inspection, weaknesses have also been highlighted, which may have an impact on the health, safety and welfare of service users. These include the management of a safeguarding issue and the standard of recruitment practices. The registered individual told us that the home does not manage money on behalf of service users but that if they needed some money, it would be provided from petty cash and then added to their account. The manager completed the Annual Quality Assurance Assessment together with the registered individual. It was detailed and identified areas they wish to improve in the next year. The data section was generally completed accurately, but the manager said she had made an assumption regarding the sexual orientation of service users. We discussed the issues regarding this area of diversity with the manager and the possible impact of assumptions. The home has sent out a questionnaire to all service users and received twenty completed ones. We saw that these responses were generally positive. The manager said she analyses the results and takes actions about any points that are raised. The home is planning to send a survey to relatives. We looked at certificates which showed equipment such as the hoists were serviced regularly. The building’s electrical wiring was tested in December. Food was stored appropriately. St George`s Nursing Home DS0000011444.V359457.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X N/A X X 3 St George`s Nursing Home DS0000011444.V359457.R01.S.doc Version 5.2 Page 23 No 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. 1 Standard OP18 Regulation 13 (6) Requirement Arrangements must be made by training staff or other measures, to prevent service users being harmed or suffering abuse, or being placed at risk of harm or abuse. Adult protection procedures must be followed to ensure allegations of abuse are investigated correctly, thereby protecting service users. Persons must not be employed to work at the care home unless they are fit to do so. The information and documents specified in Schedule 2 must be obtained before a person is allowed to work in the care home. Specifically, where a prospective employee has previously worked with vulnerable people, a written reference and the reason for ceasing to work in that position must be obtained, so that service users can be protected. Timescale for action 15/04/08 2 OP29 19(1)(b) Schedule 2 (3 and 4) 15/04/08 St George`s Nursing Home DS0000011444.V359457.R01.S.doc Version 5.2 Page 24 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 DS0000011444.V359457.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South East Office The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 DS0000011444.V359457.R01.S.doc Version 5.2 Page 26 - 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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