Inspection on 04/10/05 for St George`s Nursing Home

This inspection was carried out on 4th October 2005.

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 24/02/09

St George`s Nursing Home 04/03/08

St George`s Nursing Home 23/01/07

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 Tim Inkson Unannounced Inspection 4th October 2005 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 DS0000011444.V255528.R01.S.doc Version 5.0 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.V255528.R01.S.doc Version 5.0 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 643011 01590 644210 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 Limited Mrs Julia Frances Hutton Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34), Physical disability (7), Physical disability of places over 65 years of age (34), Terminally ill (7), Terminally ill over 65 years of age (34) St George`s Nursing Home DS0000011444.V255528.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. A total of seven service users in the PD and TI categories may be accommodated at any one time. 15th April 2005 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. There are some amenities in the village which is situated in an area popular for holidays, including some shops, churchs, a surgery and dental practice. A wider and more comprehensive range of services and amenities are available in the towns of New Milton and Lymington both approximately 5/6 miles away. The home is very much part of the local community and many of the residents accommodated lived locally before moving in. Established some 60 years ago, St Georges was first used as a maternity hospital and over the years has been used for several different medical/health related purposes. It has been a nursing home for some 25 years. St Georges has well-established links with healthcare professionals and other local businesses. The home provides nursing care for up to 34 older people and this can include up to 7 individuals who may be terminally ill. The bedroom accommodation for residents is on 2 floors and access to the 1st floor is provided by a passenger lift. All bedrooms are single and 18 of these have en-suite WCs. The building has equipment, aids and adaptations that 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. There is also level access to well planned extensive landscaped gardens. St George`s Nursing Home DS0000011444.V255528.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the second of two inspections of the home that must be undertaken in the 12-month period beginning on 1st April 2005. It started at 09:15 hours and finished at 15:30 hours. The inspection procedure included looking at some of the premises including a sample of 4 bedrooms to view their furnishings and equipment. It also included an examination of some documents and records, observation of staff practices where this was possible without being intrusive and discussion with residents (3) and their visitors/representatives (5), and staff (4). A questionnaire returned by the home’s manager and comment cards from residents (13) and relatives/visitors (7) also influenced the contents of this report. At the time of the inspection the home was accommodating 34 residents and of these 6 were male and 28 were female and their ages ranged from 44 to 104 years. No resident was from a minority ethnic group. The home’s registered manager and the responsible individual representing the registered provider i.e. St George’s Hospital Ltd, were both present throughout the day to provide assistance and information when required. What the service does well: What has improved since the last inspection? There were no requirements made as a result of the last inspection of the home on 15th April 2005. The home had implemented a new system for managing the care of terminally ill residents and the staff were enthusiastic about the approach that had been St George`s Nursing Home DS0000011444.V255528.R01.S.doc Version 5.0 Page 6 adopted and in particular the clear documentation that enabled them to ensure that all aspects of a dying residents needs were addressed. Improvements to the home’s accommodation were due to be in use in the near future based on the construction of a conservatory that will provide more communal/shared space and the conversion of former offices into spacious bedrooms with en-suite facilities. 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 DS0000011444.V255528.R01.S.doc Version 5.0 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.V255528.R01.S.doc Version 5.0 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): 2 and 3 The home’s admission procedures were good and they included the provision of clear licence agreements/terms and conditions of accommodation that informed both parties of their respective rights. Assessments were also made of the needs of potential residents before they moved into the home to ensure that the home could provide the care and support that they required. EVIDENCE: Discussion with some residents and relatives/visitors indicated that residents and/or their representatives were issued with licence agreements/terms and conditions of accommodation when they moved into the home. These documents were set out in simple terms the basic rights of all parties concerned. • “We were given a contract the day that she moved in”. The records of 6 residents were examined and these included copies of detailed assessments that the home had arranged of the needs of the individuals concerned. On this occasion as at the last inspection of the home on 15th April 2005 it was apparent from discussion with residents and the documents examined that the needs of potential residents were identified before the persons moved into the home. St George`s Nursing Home DS0000011444.V255528.R01.S.doc Version 5.0 Page 9 Where individuals had been admitted to the home through community care management arrangements, copies of assessments completed by the relevant local authority social services department were also available. The pre-admission assessments were complemented by more thorough and comprehensive assessments of a resident’s needs when they moved into the home and during that person’s trial or initial 8 week period living in the home (see also page 12). There was documentary evidence that assessments of residents needs were reviewed regularly and revised as necessary when an individual’s circumstances had changed. St George`s Nursing Home DS0000011444.V255528.R01.S.doc Version 5.0 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, 9 and 11 There were good plans of care in place that ensured that residents received the help and support that they needed. Procedures and systems for the administration of medication and management of death and dying were good. EVIDENCE: On this occasion as at the last inspection of the home on 15th April 2005, a sample of the care plans of residents were examined (6). The documents were detailed and the plans were based on the assessments the home carried out in order to identify what help individuals needed (see pages 9 and 10). The plans set out clearly the actions staff had to take and what specialist equipment was needed to provide the support and assistance each person required. Observation and discussion with residents, relatives/representatives confirmed that individuals received the help they needed and that the equipment was in place as set out in their plans of care. • “They look after me alright”. • “I am totally reliant on staff, it takes two to get me into bed and they are lovely and most kind”. • “The care is first class”. All nursing and care staff spoken to were fully aware of the contents of the care plans that were sampled and the assistance that the individuals concerned required. St George`s Nursing Home DS0000011444.V255528.R01.S.doc Version 5.0 Page 11 The care plans documents included assessments of the potential risks to a resident e.g. falls and choking. Nationally recognised methods and documents were used to assess the risk to residents of among other things, pressure sores (Waterlow) and malnutrition (Prideaux). There was evidence that care plans were evaluated and reviewed at least monthly. Notes were kept of the help and care provided to residents each day and these were cross-referenced to the goals that were set out in individuals care plans. It was noted that the goals in care plans promoted the fundamental principles/values that underpin social and health care e.g. independence and choice. Residents were “encouraged” and “supported” to achieve their agreed goals such as maintaining their personal hygiene. Their likes and dislikes were noted to ensure that their preferences were met. There was evidence that residents and/or their representatives were involved in developing plans of care and documents had been signed by them indicating their agreement to the contents. The home had written policies and procedures concerned with the management and administration of medication. A range of reference material about medication was readily available including copies of the British National Formulary (BNF) and MIMs. Medication was kept in locked and secured medicine trolleys, cupboards and where required in medical refrigerators on the ground and first floors of the home. Controlled drugs were stored securely and in appropriate metal locked cabinets. Medicines were dispensed from their original containers and the only staff responsible for the management and administration of medication were registered nurses. The home’s registered manager said that the competence of these staff had been assessed and they attended training in “medicine management and usage”. The manager also said that on 10th October 2005, the home was changing to a monitored dosage system with “blister packs” for the management and administration of medication. A new contract had been agreed with a national pharmacy chain and they had provided training in the new system. Staff spoken to were enthusiastic about the change and confirmed that they had received training both generally and also for implementing the new system. Records were kept of the ordering, receipt, administration and the disposal of medicines and these were accurate and up to date. The home had produced a new procedure (19th September 2005) that was concerned with the “disposal of unwanted drugs and medicines” that reflected recent changes in the National Health Service contract for community pharmacists and ensured compliance with legislation about the disposal of waste. The home had developed strong links with the local Primary Care Trust and also a local hospice and had written guidance and policies available concerned St George`s Nursing Home DS0000011444.V255528.R01.S.doc Version 5.0 Page 12 with managing the death of residents. New procedures had been implemented by the home in June 2005 based on best practice that was initially developed in Liverpool and known as the “Liverpool Care Pathway”. Specific, comprehensive and clear documented plans were used for terminally ill residents when a multi-professional team had agreed that an individual’s death would occur within a few days. The plans ensured that all matters that should ensure a “good death” were included in the plan for the person concerned e.g. involvement of family/friends; communication and insight/understanding; spiritual needs; pain control; personal hygiene; pressure care; psychological support of individual and family/friends; practical needs if family/friends; and procedures following death. Health care assistants and registered nurses spoken to said that they received training and support from the local hospice in palliative care matters and that the new care pathway was “brilliant” and “a good idea”. The records of two residents that had recently died were examined and it was apparent from notes that had been kept that the comfort of the individuals and the support of their relatives had been paramount. St George`s Nursing Home DS0000011444.V255528.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 The home had good procedures in place for enabling residents to exercise selfdetermination. EVIDENCE: The home had a written policy about the management of service users finances i.e. “service users rights – handling their monies and valuables”. The home encouraged residents to handle their own financial affairs or alternatively arrange for a representative to do so. The home did not act as appointee for any resident. There were pamphlets/leaflets in the entrance of the home from an independent organisation that that described itself as an advocacy service and stating it could provide advice, information and guidance that could be helpful to residents and their families. The home’s Service Users Guide contained information about local organisations that could provide independent advice to residents including solicitors and religious bodies/churches. A copy of the guide was available in every bedroom. At the time of the inspection a resident was being visited by a representative of hers that dealt with her financial affairs on her behalf. St George`s Nursing Home DS0000011444.V255528.R01.S.doc Version 5.0 Page 14 A number of residents had brought personal belongings and items of furniture into the home with them. One bedroom that was seen had been personalised with the occupant’s own furniture, ornaments and pictures. The home kept records of any furniture brought into the home by a resident. The home had the following written policies and procedures concerned with sensitive information that it kept about residents: • Confidentiality of information • Access to personal files . All sensitive information and records were kept securely locked filing cabinets and drawers. St George`s Nursing Home DS0000011444.V255528.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 The home had satisfactory systems for managing residents concerns and ensuring that residents could exercise their legal rights. EVIDENCE: The home’s complaints procedure was readily accessible in the home’s Service Users Guide, a copy of which was in very bedroom. The responses in the comment cards returned by service users and relatives/visitors indicated that 85 were aware of the complaints procedure. One respondent stated, “the complaint I made was dealt with quickly”. Residents and visitors spoken to were confident about their ability to raise any complaints or concerns they might have with the home’s manager or the responsible individual representing the registered provider. The home kept a record of complaints and none had been made to either the home of the Commission for Social Care Inspection (CSCI) since the last inspection of the home on 15th April 2005. The home’s manager said that all residents who were accommodated on a permanent basis in the home were registered on the electoral roll and that most residents used a postal vote to exercise their civil right to participate in the electoral process. St George`s Nursing Home DS0000011444.V255528.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 25 and 25 The home’s bedroom accommodation was furnished and equipped satisfactorily for service users needs. There were good systems and procedures in place to ensure the bedroom accommodation was both safe and comfortable. EVIDENCE: Although on this occasion the general environment was not evaluated the following planned improvements to the accommodation were observed to be in the process of construction or conversion. • A new conservatory providing additional communal/shared space • Former office accommodation was being altered to provide a spacious bedroom with an en-suite level access shower. Residents spoken to and relatives said that they were content with the standard of their bedroom accommodation and the furnishings and any equipment in the rooms. Some indicated that they particularly appreciated the privacy afforded to them by the fact they were single rooms. All the rooms viewed were furnished and equipped as expected by Standard 24 of the national Minimum Standards for care Homes for Older People. St George`s Nursing Home DS0000011444.V255528.R01.S.doc Version 5.0 Page 17 The nurse call system was tested in one room. It was working and staff responded very quickly when it was activated. All bedrooms viewed were naturally ventilated and heated by night storage heaters that were all covered with guards to prevent residents from the risk of burns. The home’s manager and the responsible individual said that the home’s hot water system was managed to ensure that the water delivered at outlets to which residents had access was delivered at a temperature of around 43°C in order to prevent the danger of scalding. St George`s Nursing Home DS0000011444.V255528.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 Recruitment procedures for new staff were satisfactory, ensuring the protection of residents. EVIDENCE: The records of 2 staff who had started work in the home since the last inspection of the home on 15th April 2005 were examined. There was evidence that all the checks and information required before any person who would have regular contact with residents could start work in the home had been done or obtained. St George`s Nursing Home DS0000011444.V255528.R01.S.doc Version 5.0 Page 19 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): 33, 35 and 37 The home had good systems and procedures in place for; monitoring and maintaining the quality of the service it provided; safeguarding residents financial interests: and keeping statutorily required records properly. EVIDENCE: The home had written policies and procedures about “quality improvement” of the service it provided. The way this was done included: 1. Audits of some aspects of the service, such as care plans and response times to the nurse call system. 2. Using questionnaires annually to obtain the views of residents and their relatives and visitors. 3. Arranging regular staff meetings and enabling ideas and concerns to be discussed. The responsible individual representing the registered provider said, “we encourage visitors to pop in and comment or moan – whatever they want”. St George`s Nursing Home DS0000011444.V255528.R01.S.doc Version 5.0 Page 20 It was suggested that as there were a lot of people who used the home for short stays that a simple questionnaire could be used to obtain their views when they left the home. Staff spoken to said that regular staff meetings took place and all said that “things were thrashed out” and all could contribute and make suggestions and that good ideas were often implemented. The comment cards returned by both residents and visitors included many positive statements about the quality of the service provided and residents and visitors spoken to during the inspection were complimentary about the home. • “The home is excellent. It is the best we could find”. • “I can only describe the whole organisation as excellent”. • “As at this moment I am very satisfied with the manager/matron and female sisters, nurses and carers”. • “ The home is excellent, well run and with very good nursing, kitchen and cleaning staff. I appreciate occasionally being asked for ideas about activities and food”. • “This is my third stay here and I cannot praise it highly enough. It has a wonderful family atmosphere and the staff are cheerful and extremely helpful. The matron is wonderful”. The home had a range of written policies and procedures and all staff spoken to said that they were readily available, helpful and influenced the care practices in the home. • “We have to look at new one and sign to say we have read them. I use them for my own reference and it is important that things are done properly. They are up to date”. • “If there is anything new we go and read them”. • “They are very informative”. • “If I am unsure of anything I will go and look it up”. There was evidence that the home developed new policies and procedures or amended and up dated existing ones as required (see page 12). The home looked after some money and valuables on behalf of some residents. The relevant records were examined and they were accurate and up to date. The following statutorily required records were among many documents examined during the inspection and they were all accurate and up to date: • • • • • • Assessments, care plans and related records. Complaints Persons employed in the home Monies and valuables held by the home for residents Accidents Visitors St George`s Nursing Home DS0000011444.V255528.R01.S.doc Version 5.0 Page 21 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 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 X X X X X X 3 3 X STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X 3 X St George`s Nursing Home DS0000011444.V255528.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? N/A 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 DS0000011444.V255528.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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. 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