CARE HOMES FOR OLDER PEOPLE
St Georges Nursing Home 5 Byfleet Road Cobham Surrey KT11 1DS Lead Inspector
Mavis Clahar Unannounced 7 July 2005 @ 9:00am
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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 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 Georges Nursing Home H58 H09 S17641 St Georges V229178 070705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service St Georges Nursing Home Address 5 Byfleet Road Cobham Surrey KT11 1DS 0113 381 6100 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes Limited Mr Emilio Fesser CRH - Care Home 44 Category(ies) of DE(E) - Dementia over 65 (44) registration, with number MD(E) - Mental Disorder over 65 (44) of places St Georges Nursing Home H58 H09 S17641 St Georges V229178 070705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1 - In this home the 44 Service Users may comprise up to 41 people within category DE(E) Dementia over 65, or up to 41 people within the category MD(E) Mental Disorder over 65. 2 - The age range of Service Users accommodated within this home is from 60 years in the categories DE(E) Dementia over 65 or MD(E) Mental Disorder over 65. 3 - Up to 5 Service Users falling within the category MD Mental Disorder may be admitted from the age of 40 years. 4 - The age range of Service Users in the catefory MD Mental Disorder is 40 to 64 years. 5 - Day Care may be provided for up to 4 Service Users from the age of 40 years of age within the categories DE(E) Dementia over 65, DE Dementia, MD Mental Disorder or MD(E) Mental Disorder over 65. Date of last inspection 14 October 2004 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.All bedrooms are furnished to a high standard with ensuite facilities, and are equipped with a television and telephone point, allowing each service user to stay in touch with life outside the home. Modern safety features fitted in each bedroom include 24- hour nurse call system, smoke detectors and thermostatically controlled radiators.Meals are prepared daily by the chef, using fresh produce and are served in the home’s dining room or in the service user’s bedroom if required. A varied menu provides a nutritious diet, with frequent snacks and light meals throughout the day.The Activity Suite is well staffed and service users are encouraged to participate in the programme of activities, which includes a varied, and entertaining social calendar. St Georges Nursing Home H58 H09 S17641 St Georges V229178 070705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection to be undertaken in the Commission for Social Care Inspection year April 2005 to March 2006. This inspection was unannounced and was carried out on the 7th July 2005. This means that no one at the home or the management knew of the intended inspection. The inspection lasted five and one half hours. The first part of the inspection was spent with the Deputy manager discussing the new inspection format, reviewing service users files, care workers files, and checking care workers CRBs and POVA records. Only one service user in this home is capable of coherent speech, therefore the information gained for this report is dependant upon the documented records found in the service users file and from information gained from speaking to care workers. On the day of the inspection there were no visitors to the home. The second part of the inspection was spent observing service users interaction with staff, speaking to the service users and tour the home. This was followed by sharing of information with the deputy manager the findings of the inspection. Care workers spoken to on the day were happy about the conduct and the management of the home. The home has made some improvement to its décor since the last inspection. Currently there is building process in progress and the home has lost two bedrooms on a temporary basis to maintain the safety of current service users whilst the new building is taking place. What the service does well:
Care workers at this home say they are knowledgeable about the needs of the service users. Information gathered from the Relatives satisfaction survey showed that relatives rated the attention service users received from care staff as high. They also documented the cleanliness and maintenance of the home as very good. The grounds and gardens were also rated highly. There was unanimous agreement that the home treated their relative as individuals. St Georges Nursing Home H58 H09 S17641 St Georges V229178 070705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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 Georges Nursing Home H58 H09 S17641 St Georges V229178 070705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection St Georges Nursing Home H58 H09 S17641 St Georges V229178 070705 Stage 4.doc Version 1.40 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 standard(s) 3 The home was found to be working well in respect of the standard inspected. EVIDENCE: Due to the severity of the disabilities of the service users in this home 20 of the care files were randomly inspected. The home has a very comprehensive assessment tool, which is fully used. All files inspected demonstrated that service users were assessed prior to entry into the home. This was followed by a full health and social needs and risk assessment from which the care plans are developed. The care plans although signed and dated by staff, they were not signed by service users or relatives. A requirement was issued on this standard. The care workers spoken to on the day of inspection were knowledgeable about the disease process of the service user in their care. St Georges Nursing Home H58 H09 S17641 St Georges V229178 070705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 8 The health and personal care needs of service users are met with evidence of good care planning and documented delivery. EVIDENCE: Review of random service users files demonstrated that a comprehensive plan of care was drawn up. The inspector noticed that care plans and risk assessment although very thoroughly prepared were not signed by service user or relative on behalf of the service user. A requirement was issued on this standard. From the documented evidence in service users files it was shown that care needs are fully met. St Georges Nursing Home H58 H09 S17641 St Georges V229178 070705 Stage 4.doc Version 1.40 Page 10 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 standard(s) 12 13 Links with family and friends and the community are good and support and enrich service users social and spiritual needs. EVIDENCE: The home now employs one full time and two part time Activities Coordinators, enabling the home to be covered five days per week one week and seven days the next. Service users have the choice to participate or not in the planned activities. Visiting is unrestricted but on the day of inspection the inspector did not see any visitors at the home. Service users were enjoying different activities on the day of inspection. One group was watching a pre recorded film whilst another was being made ready for the afternoon entertainment which will be provided by outside performers; and another group was relaxing in their lounge listening to the radio. The one service user capable of verbal expression said he was contented at the home and he can go out if he feels like. St Georges Nursing Home H58 H09 S17641 St Georges V229178 070705 Stage 4.doc Version 1.40 Page 11 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 standard(s) 18 Care workers files demonstrated that they are trained to recognise and report all incidents of actual or suspected abuse to service user. EVIDENCE: Carer workers spoken to confirmed they have had training in recognition and reporting of abuse to service users. All new care workers have had an introduction to recognising and reporting abuse in their introduction training. Review of the home’s policy on adult protection was up to date. A copy of the complaints procedure is kept on the hall table in the reception along complaints procedures for the use of service users, visitors, relatives and staff. One complaint was received by the home since the last inspection and this has led to the dismissal of a member of staff. St Georges Nursing Home H58 H09 S17641 St Georges V229178 070705 Stage 4.doc Version 1.40 Page 12 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 standard(s) 19 The standard of décor within this home is good with evidence of continued improvement through maintenance and future planning. The home presents as a comfortable and homely environment for service users. EVIDENCE: Service users lives in a clean well maintained home; although major building work is being carried out at the home service users safety is not being compromised. The home has temporarily closed two bedrooms and a part of the corridor near to the extension site to prevent service users wondering into the building site. The home is working on its planned programme of refurbishment to the home. St Georges Nursing Home H58 H09 S17641 St Georges V229178 070705 Stage 4.doc Version 1.40 Page 13 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 29 The assessed health and social needs of the service users are met with evidence of good documentation of actions taken by care workers. The home follows their recruitment and retention policy, which is based on their equal opportunity policy. EVIDENCE: From discussion with care staff, and the rota documentation of the number, grade and skill mix of staff over a twenty-four hour period appeared adequate to meet the assessed health and social needs of the service users. Discussions with care workers and review of a random sample of their files and the homes training record revealed that care workers are trained to do the work they are asked to perform. Regular updating of information and supervision are also provided and documented. It was noted that care worker employed prior to 2002 did not have a photograph included in their personal files. A requirement was issued on this standard. St Georges Nursing Home H58 H09 S17641 St Georges V229178 070705 Stage 4.doc Version 1.40 Page 14 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The manager is well supported by the senior staff in providing clear leadership throughout the home with all care workers spoken to on the day of inspection demonstrating and awareness of their roles and responsibilities. EVIDENCE: Policies within the home such as recruitment and retention, recognition and reporting of abuse, updating of knowledge, moving and handling, all provide evidence that service users and care workers safety and welfare are crucial to the smooth running of the home. Relatives are encouraged to be involved in the running of the home and many relatives attend the bi-monthly relatives meeting as documented in the minutes. The home’s visits on a weekly basis and more often if required. The Psychiatrist visits on a three monthly basis to aid in maintaining the health and safety of service users.
St Georges Nursing Home H58 H09 S17641 St Georges V229178 070705 Stage 4.doc Version 1.40 Page 15 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x x x x x x 3 St Georges Nursing Home H58 H09 S17641 St Georges V229178 070705 Stage 4.doc Version 1.40 Page 16 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 3 Regulation 15 Requirement Care plans should be signed by service user or relatives to demonstrate that consultation has taken place in developing the care plans. A recent photograph is to be included in the personal files of all persons working at the home. Timescale for action 7.10.05 2. 29 19 Schedule 2 (1) 7.10.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations No recommendations were made on this inspection. St Georges Nursing Home H58 H09 S17641 St Georges V229178 070705 Stage 4.doc Version 1.40 Page 17 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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