Inspection on 04/11/05 for St Georges Nursing Home

This inspection was carried out on 4th November 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Georges Nursing Home 13/02/07

St Georges Nursing Home 01/06/05

St Georges Nursing Home 16/02/05

St Georges Nursing Home 27/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St Georges Nursing Home 2 - 4 Marine Drive Fairhaven Lytham St Annes Lancashire FY8 1AU Lead Inspector Mrs Lynne Lynch Announced Inspection 4th November 2005 9:30am 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 Georges Nursing Home DS0000006086.V256012.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 Georges Nursing Home DS0000006086.V256012.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Georges Nursing Home Address 2 - 4 Marine Drive Fairhaven Lytham St Annes Lancashire FY8 1AU 01253 730502 01253 730502 stgeorges@centuryhealthcare.co.uk 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) Century Healthcare Limited Mrs Marie Noblett Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (27), Physical disability (2) of places St Georges Nursing Home DS0000006086.V256012.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st June 2005 Brief Description of the Service: St.Georges Care Home with Nursing offers care and nursing to 29 service users with physical and medical needs. The home is situated within five minutes walk of the Fairhaven Lake complex and is in within reach of local shops, a postoffice, and churches. There are regular bus services and Ansdell Railway Station is 10-minute walk away. Accommodation is provided in a detached Victorian property, which has been modernised to suit the needs of the service users while still encapsulating the many original features of this period. St Georges Nursing Home DS0000006086.V256012.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and started at 9.30am, took place over seven hours and was carried out by the inspector and the Commission for Social Care pharmacy inspector. The inspector spoke to the registered manager and the personnel manager for Century Healthcare. Five residents and one member of staff were spoken to. Comment cards were issued prior to the inspection. Eight were received back from relatives and four from residents, at the time of the report. Care records and staff files were examined. A tour of the premises was undertaken and the pharmacy inspector for the Commission for Social Care carried out a thorough audit of medication procedures with the registered manager. The Commission for Social Care Inspection assess all standards over the two required inspections per year. Standards assessed on this inspection were the ones outstanding from the previous inspection. What the service does well: What has improved since the last inspection? The home is currently transferring care planning information onto a different format which they feel will be an improvement. The homes chef has attended a training course regarding preparing pureed meals. Pureed diets are now prepared in separate elements. The home is currently discussing with service users the option of having a lock on their bedroom door and a lockable facility in their room. When rooms become empty these are being added as a matter of course. St Georges Nursing Home DS0000006086.V256012.R01.S.doc Version 5.0 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. St Georges Nursing Home DS0000006086.V256012.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 Georges Nursing Home DS0000006086.V256012.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): 3 There is a good assessment procedure in place, which ensures the needs of the residents can be met. However this is a little lengthy and repetitive and staff need to become more familiar with this process. EVIDENCE: St Georges has recently commenced using a new care planning process. The records of three residents were examined. All had assessment information, including information about the specialist needs required by residents, all of which was acquired prior to admission. There was also evidence of social work assessments being carried out to supplement the homes assessment. The homes admission pack and pre admission pack is extremely thorough and contains much information, however the assessment paperwork is lengthy, being approx eighteen pages long and is repetitive in some areas of information. The homes is still in the process of transferring the information held onto the new format and therefore omissions on some of the standard forms were noted and the manager was asked to reaffirm to staff the importance of fully completing documentation. Staff at the home still appeared to be a little St Georges Nursing Home DS0000006086.V256012.R01.S.doc Version 5.0 Page 9 lacking in confidence in respect of this new format and require further support in respect of this. The manager or senior staff member will visit prospective residents to carry out an assessment of need, prospective residents or their relatives are invited to visit St Georges to meet the staff and view the facilities. A relative spoken to at the time of the inspection confirmed that he had viewed the home prior to his wife’s admission. Staff members confirmed they had access to all information and could describe in detail the care needs of residents. St Georges Nursing Home DS0000006086.V256012.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): 7,8,9 and 10 A good care planning system is in place however this should be consistently applied and reviewed to ensure changing needs are responded to. Resident’s welfare is closely monitored and health needs are met. EVIDENCE: The home is implementing a new care planning format, which is very thorough and covers all areas of care needed and includes a section on the person/relatives perception of care required. Two residents spoken to were able to confirm they had a care plan and knew who their key worker was. Information is currently being transferred on to the new format however these remain incomplete, however staff are still able to consult the old care plans, which set out in detail the action needed to be taken by care staff to ensure that all aspects of health, personal and social care needs of the service user are met. However these have not been consistently reviewed and reviews do not take place with the involvement of the service users or their relatives. The inspector advised that service users and their relatives should be encouraged to take an active part in the care planning process. The new care planning process has several sections where reviews can be recorded but it seemed unclear to staff which sections required completing. One section entitled St Georges Nursing Home DS0000006086.V256012.R01.S.doc Version 5.0 Page 11 Record of reviews and signatures was unclear as to what areas had been reviewed. Relevant risk assessments form part of these care plans. Rota’s viewed showed appropriate levels of qualified nursing staff and residents spoken to confirmed that they had regular visits from Doctors. The care plans the inspector used in the tracking process gave evidence relating to the assessment and identification of those service users that were at risk of falling. The home has participated in a falls workshop with Health Service personnel to collate statistics re falls in order to put preventative measures in place. They have also been involved in completing questionnaires for the Osteoporosis Service providing health information. Nutritional assessments and relevant interventions were documented. Aids and equipment in respect of continence, pressure relief and moving and handling were sufficient and observed in use. The manager was asked to remind all staff that footrests should be used on wheelchairs when transporting residents unless requested otherwise by the resident and this must be recorded. Records showed that good communication is maintained with medical professionals. One lady who has a terminal illness confirmed that the home liaises well with her specialist nurse and staff at the home show a good understanding of her condition. Residents were treated with respect and dignity and comment cards received from residents and relatives confirmed that privacy is respected. One relatives comment card states “The staff at St Georges are very dedicated and caring. They work hard to give the best service possible at all times and my parents are very happy and secure here in their care, which gives the family peace of mind Thank you to all concerned”. The Commissions pharmacy inspector carried out a full medication-handling audit and following this made several requirements and recommendations. The specific findings of the pharmacist inspection are available in a separate report. St Georges Nursing Home DS0000006086.V256012.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 14 Contact between residents and their family is encouraged to help them maintain relationships. Residents are able to make choices regarding their lives and supported to maintain their independence. EVIDENCE: Visitors are welcome at anytime and residents are encouraged to retain relationships with family and friends. Relatives can visit at any time for as long as they want and are always welcome at special events with some attending the recent Halloween party. All eight relatives comment cards confirmed they are able to visit their relative in private and that they are kept informed of important matters and consulted about their care. Daily dairy notes provided evidence that residents can exercise choice over how they live their lives, entries confirmed that residents could get up and go to bed when they please and have their meals were they wish. Residents spoken to confirmed this. One lady said she liked to spend time in her room and this was respected. One resident had celebrated their birthday the day before and staff had supported them to enjoy this. Another resident said” staff work really hard to make this a good home and as comfortable as possible for us”. The chef at the home has recently attended a training course in respect of preparing soft and liquidized diets and the presentation of these. These diets St Georges Nursing Home DS0000006086.V256012.R01.S.doc Version 5.0 Page 13 are now presented in a more appetising form at mealtimes with all the elements being liquidized separately and presented so. St Georges Nursing Home DS0000006086.V256012.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the above standards were inspected at this visit. EVIDENCE: St Georges Nursing Home DS0000006086.V256012.R01.S.doc Version 5.0 Page 15 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): 19 and 26 The home is generally maintained to a good standard and provides a comfortable environment for residents. There is a refurbishment and renewal programme in place. EVIDENCE: A tour of the home was conducted. The home is well maintained, comfortable and suitable for its stated purpose, however some of the areas are looking a little tired and in need of refurbishment. A new estates manager has recently been recruited and his role is to delegate work to his team of maintenance staff to ensure the home is well maintained and that work is prioritised. There is a programme of maintenance and a member of maintenance staff is at the home two days a week. One resident said, “ the workmen came when I asked to sort my lights out, I can’t sleep without a light on”. The grounds of the home provide a safe and secluded environment for the benefit of the service users. There is a ramp located to the front and rear of the home. A passenger lift ensures easy access to all areas for those who require this facility and is serviced on a regular basis. The home was seen to be maintained in a clean condition and free from offensive odours. A cleaning St Georges Nursing Home DS0000006086.V256012.R01.S.doc Version 5.0 Page 16 schedule was viewed in the home. A policy and procedure on infection control was evidenced. Appropriate measures are taken for the removal of clinical waste. The laundry facilities are sited to the rear of the home, away from any food storage and preparation areas, however the floor covering does require attention. Cleaning materials were found in the sluice room and the manager was reminded that these materials should be kept locked away at all times. St Georges Nursing Home DS0000006086.V256012.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30 Staffing levels are satisfactory to meet the needs of the residents. Recruitment policies have been consistently followed. Staff training in the home needs to be prioritised and recorded clearly. EVIDENCE: Staffing levels were sufficient for the number of residents living at the home. There are 28 staff in total comprising of eight qualified staff, 14 care staff and six ancillary staff. Residents said they were happy with the care they receive from the home and were well treated by the staff. Staff spoken to said they were clear about their role and work well as a team to ensure the individual and collective needs of residents are met. Six out of the eight comment cards received from relatives indicated that they were happy with the staffing of the home. The use of agency staff in the home has been reduced; there were no agency staff on duty at the time of the inspection. A training matrix is maintained which provides evidence of courses attended and when refresher courses are due. This indicated that not all staff have attended courses in mandatory areas. Only six staff were recorded as completing their moving and handling training and no staff were recorded as having completed infection control training. The manager advised that the matrix may require updating. The manager spoke to the inspector about addressing these areas via training manuals and advised that she must be satisfied that this training is adequate and meets the expectations of all governing agencies. Memos were seen advising of training available, however it seemed that on occasions there was too short notice to be able to provide staff cover in order for people to attend. St Georges Nursing Home DS0000006086.V256012.R01.S.doc Version 5.0 Page 18 Induction training is provided and staff are provided with a mentor until the registered manager is satisfied that the new staff member is competent to carry out their duties unsupervised. NVQ (National Training Qualification) training is available however progress in this area has been slow with only four care staff currently qualified to this level. The home has robust recruitment and selection processes in place and staff files show that information required by regulation is maintained including references and employment checks. The Criminal Records Bureau disclosures for all staff currently employed at the home were viewed and seen to be satisfactory. New staff do not commence duty without the required checks taking place. There is now planned supervision for staff with records to be maintained in respect of this. St Georges Nursing Home DS0000006086.V256012.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): 33,35,36 and 38 The manager is qualified, experienced and supported by the senior staff in providing clear leadership throughout the home. Resident’s financial interests are safeguarded. EVIDENCE: The registered manager at St Georges is competent and experienced she has a nursing qualification and also an appropriate management qualification. There are clear lines of accountability within the home and the wider organisation. There was also evidence of formal one to one staff supervision having taken place. However from observation of the supervision records, it was evident that staff do not routinely receive formal supervision on a regular basis. Residents meetings are currently not being held. Welcome and Discharge questionnaires are issued and completed ones were viewed. A new service user satisfaction survey is due to be implemented. The home was awarded five stars following its RDB inspection. St Georges Nursing Home DS0000006086.V256012.R01.S.doc Version 5.0 Page 20 The registered person maintains written records of charges and payments made by and on behalf of service users. The company deal with pensions/benefits for four people and residue money is forwarded to the person at the home. Records in respect of these transactions were maintained. Service users are supported and encouraged to manage their own money for as long as they are able and wish to. Should a service user be unable to manage their own affairs relatives or a solicitor will be asked to act in the best interest of the individual service user. All records of transactions with solicitors or relatives are recorded. The home has a training matrix, which shows some staff have attended courses on moving and handling, fire safety, first aid and food hygiene, however staff need to attend further training to ensure that their knowledge and skills are up to date. The home has information on the safe storage of hazardous substances, however cleaning substances were not stored in a locked facility in the sluice room. Information provided in the questionnaire completed by the manager stated that all safety equipment is regularly serviced. Fire records are maintained of a weekly alarm test and monthly drill. Accident forms were viewed and these were accurately completed. The inspector suggested a risk assessment was carried out in respect of the use of cot sides for one lady to ascertain whether these could potentially cause a risk and for the manager to consider an alternative to their use if this were the case. Water temperatures are monitored throughout the home and were maintained at a safe temperature. St Georges Nursing Home DS0000006086.V256012.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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 3 St Georges Nursing Home DS0000006086.V256012.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? yes 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. 2. Standard OP7 OP7 Regulation 15 15 Requirement Service user plans must be signed (previous timescale 31/08/05 not met) Service user plans must be completed fully and reviewed on a regular basis. Timescale for action 31/01/06 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP30 OP36 Good Practice Recommendations Staff training should be coordinated and structured with all staff receiving mandatory training. Clear records should be maintained. A programme of formal supervision of care staff should commence on a six times a year basis. St Georges Nursing Home DS0000006086.V256012.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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. Extracts may not be used or reproduced without the express permission of CSCI St Georges Nursing Home DS0000006086.V256012.R01.S.doc Version 5.0 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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