CARE HOMES FOR OLDER PEOPLE
St Helen`s Nursing Home 41 Avenue Victoria Scarborough North Yorkshire YO11 2QS Lead Inspector
Mary Slattery Unannounced Inspection 16th November 2005 10:00 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 Helen`s Nursing Home DS0000063755.V260344.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 Helen`s Nursing Home DS0000063755.V260344.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St Helen`s Nursing Home Address 41 Avenue Victoria Scarborough North Yorkshire YO11 2QS 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) 01723 372763 01723 501502 Hamilton Care Limited Mr George Roy Tomlinson Care Home 26 Category(ies) of Dementia - over 65 years of age (26), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (26) St Helen`s Nursing Home DS0000063755.V260344.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection This is the first inspection following registration with the Commission for Social Care Inspection on 2nd September 2005. Brief Description of the Service: St Helens is a care home providing nursing care for up to 26 people from the age of 65 years of age who have dementia and/or mental dissorder. The home is located close to the town centre of Scarborough, its amenities and facilities. The accommodation provided is in both single and double bedrooms on three floors and there is a passenger lift giving acces to the upper floors. There is a small garden area to the front of the house and parking for visitors is limited on the road at the side of the house. St Helens is owned by Hamilton Care Limited and was registered with the Commission for Social Care Inspection on 2nd September 2005. St Helen`s Nursing Home DS0000063755.V260344.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report related to an unannounced inspection carried out on the 16th November 2005. The inspection took five and a half hours plus 2 hours preparation time. A tour of the premises was carried out, which included the service users private accommodation. A selection of the homes’ records were looked at and time was spent observing the activity in the home, talking and listening to service users, staff and visitors. The focus of the inspection was on a number of key standards, inspecting the case records of a number of service users to establish if they corresponded with their experiences of life in the home. The registered manager and two representatives of the company were available throughout the inspection and the findings were discussed and agreed at the close of the inspection. What the service does well:
St Helens provides nursing care and accommodation for service users from the age of 65 years who have dementia and mental illness. This is the first inspection following the registration of Hamilton Care Limited. A number of improvements have been made since registration and the company plans to continue to improve all aspects of the service, the premises and facilities. Nursing staff with mental health and general nursing qualification and care staff who are working towards or who have achieved NVQ levels 2 and 3 are employed. They have sufficient staff on duty at all times during the day to meet the assessed needs of the service users. The care plans that were looked at were informative and the daily records detailed the care delivered and any changes in the service users conditions. They have forged links with a wider group of external health care professionals to ensure that the holistic care needs of the service users are being met. St Helen`s Nursing Home DS0000063755.V260344.R01.S.doc Version 5.0 Page 6 The staff receive the support guidance and ongoing training they need to develop and maintain their skills and they are encouraged to express their views about all aspects of the service. Service users relatives are kept informed about any changes and are made welcome when they visit the home. The home was warm bright and free from offensive odours and the service users are benefiting from the purchase new furniture and equipment. The change in the daily routine in the home puts service users first and their needs and wishes are considered at all times. All of the service users looked well cared for and the staff were observed to be respectful towards the service users and clear about each individuals needs. Visitors were complimentary about the staff and said that they were satisfied with the care given to their relative. The atmosphere was calm and pleasant and staff spent time with the service users. What has improved since the last inspection? What they could do better:
To carryout a full review of the policies and procedures and up date them to reflect Hamilton Care Limited. Make arrangements to monitor the medication system to ensure that there are no gaps in the administration records and that service users are receiving their medication as prescribed. St Helen`s Nursing Home DS0000063755.V260344.R01.S.doc Version 5.0 Page 7 Make arrangements for the nursing staff to attend medication training and all staff to attend abuse awareness training. To make sure that all staff adhere to the fire safety policy and that there is not a communal supply of toiletries and that all such items are safely stored in service users bedrooms. 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 Helen`s Nursing Home DS0000063755.V260344.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Helen`s Nursing Home DS0000063755.V260344.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. People are provided with information about what the home provides. Information is gathered about people before they move into the home to make sure their needs can be met in a safe manner. EVIDENCE: The statement of purpose and the service users guide have been reviewed and amended to reflect the changes that have taken place following the recent purchase of St Helens by Hamilton Care Limited. Service users who are self funding are provided with a contract and terms and conditions agreement and there are contracts in place for those that are funded by the local authority. A review of the assessment tool has been carried out and a new format has been introduced that gives greater scope for gathering information about the mental health needs as well as the physical nursing needs of service users. The majority of the service users are not able to give clear information about their nursing needs therefore information is gathered from relatives, hospital staff and care managers. The registered manager does the assessments and
St Helen`s Nursing Home DS0000063755.V260344.R01.S.doc Version 5.0 Page 10 the findings are discussed prior to an admission being agreed to ensure that the staff can meet their needs and that any specialist equipment needed would be in place. The assessment records looked at gave clear information about the service users personal, social, physical and mental nursing care needs and any identified risks relating to tissue viability, nutrition, continence, falls and associated behaviours. The outcomes of the assessment are discussed with the service users and/or their representatives prior to admission. Prospective service users and their representatives are invited to visit the home to look at the accommodation prior to moving in on a trial basis. The home does not provide intermediate care. St Helen`s Nursing Home DS0000063755.V260344.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. There are systems in place to ensure that the service users nursing, personal physical and mental health care needs are met. EVIDENCE: The care plans have been reviewed and all new service users are admitted according to the new admission procedure. The care plans looked at gave information about all aspects of the service users needs including their wishes at the time of death. Work has been done to keep clear records of patterns of behaviour, methods of communication, risk assessments in relation to bed safety rails, falls, movement around the home, medication, tissue viability care and the management of continence. Contact has been made with the psychiatric services on behalf of service users who exhibit challenging behaviour. Behaviour patterns of a number of the service users are being recorded and reviews have been arranged to look at the most effective ways of the management of challenging behaviour and the correct use of therapeutic medication to help improve the service users health and quality of life. The care plan records looked at gave information about the type and level of care delivered any treatments and interventions in relation to medication,
St Helen`s Nursing Home DS0000063755.V260344.R01.S.doc Version 5.0 Page 12 tissue viability and mobility, visits and interventions from external health care professional including general practitioners, chiropodist and the tissue viability nurse. Plans are in place for service users to have a moving and handling assessment including those service users who need specialist seating. The nursing and care staff are fully involved in care planning; reviews and recording in the service users care plans. The medication system and facilities were inspected and it was established that medication times are in accordance with the service users needs and preferences. Gaps were found in the medication administration records and the records indicated that the nursing staff were not clear about the use of medication that had been prescribed on a PRN basis to assist with the management of challenging behaviour. Medication training for nursing staff needs to be arranged and a medication monitoring system needs to be implement to highlight and rectify any errors and to confirm that service users are receiving their medication as prescribed. The staff were observed speaking to service users in a respectful manner and attending to their personal care needs in private. St Helen`s Nursing Home DS0000063755.V260344.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): 12, 13,14 and 15. The visiting arrangements are flexible enabling service users to keep contact with family and friends. Service users are helped to exercise choice about their daily lives and the food they eat. EVIDENCE: The majority of the service users are not able to make an informed decision about daily living. The ways in which they let staff know their needs is clearly recorded and management plans are in place for staff to follow to ensure they receive the attention and care they need. Part of the initial assessment focuses on gathering information about the past interests and lifestyles of the service users and details about their family and friends. This information helps the staff to put together a care plan, which includes the arrangements to assist people getting up and going to bed and daily living activities. Visitors are welcome in the home and one visitor informed me that her husband had greatly improved since admission and that he was very well cared for by the staff. Due to the mental health conditions of some of the service users there can be a lot of noise in the home and to reduce the disturbing effect this may have on
St Helen`s Nursing Home DS0000063755.V260344.R01.S.doc Version 5.0 Page 14 others people have the opportunity to spend peaceful time in their own rooms or have one to one time with the staff. Service users have the opportunity be involved in activities and plans are being developed to implement a more structured and meaningful activities programme. The care plan records evidenced that nutritional assessments are carried out and where necessary discussion are held with doctors and dieticians to make sure their dietary needs are catered for. The menus are under review to increase the variety of food offered. Food supplements were being used correctly and attention has been given to liquidised food to make sure that it retains the protein and calorific content. There was plenty of drinks and snacks available, sufficient staff were on duty to assist the service users at mealtimes and records of fluid and food intake are kept for those service user who are frail and have some difficulties with swallowing and or poor appetites. These records assist staff in care reviews and for alerting external health care professionals for advice and guidance to ensure that the service users nutritional needs are met. Sufficient staff were available at lunchtime to assist the service users and to make sure that the mealtime is a social occasion. Some service users become restless and may move away from the dining room and staff are available to manage this situation and minimise any disturbance to other service users. St Helen`s Nursing Home DS0000063755.V260344.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 18. The home provides people with information about how to make a complaint and all staff are clear about the action to take to protect service users from abuse. EVIDENCE: Information about how to make a complaint against the service is made available to service users, visitors and other stakeholders. The service users are not always able to complain about their care or about how they are treated by the staff. The care plans focus much more now on how the service users make it known that they are not happy with the care they receive and life in general in the home. The policy of the home is that all the required checks will be carried out on staff prior to their employment. The staff have demonstrated a good understanding of the procedure for reporting allegations and/or suspicions of abuse. It is important that all staff attend abuse awareness training and have access to the reporting process within the local authorities adult protection policy and procedure. St Helen`s Nursing Home DS0000063755.V260344.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): 19,20,21,22,23,24 and 26. The standard of the environment has improved providing service users with a bright, clean homely place in which to live. EVIDENCE: The home was clean, bright and free from offensive odours and the service users bedrooms were personalised. A number of the bedrooms are shared and appropriate screening was in place to ensure privacy when personal care is being delivered. A lot of work has been carried out to improve the structure of the premises the internal decoration and provision of new equipment. Repair work to the roof was underway at the time of the inspection. All parts of the home have been thoroughly cleaned and new carpets laid in a number of the bedrooms. New beds and mattress have been purchased, the parker bath has been repaired and the bath hoists have been made secure. There are sufficient useable bathing and toilet facilities for the number of service users accommodated.
St Helen`s Nursing Home DS0000063755.V260344.R01.S.doc Version 5.0 Page 17 Laundry equipment has been purchased and the ground floor toilet was being decorated. An assessment of the home has been carried out by an occupational therapist and the report is expected soon. The recommendations made in the report will be considered and acted upon as appropriate. Plans are in place for a working office for the staff, which will ensure privacy during handovers and provide a more secure place for storing records. A treatment room is to be made available and the dining room and sitting rooms are to be decorated and new furniture purchased. A written plan for the long-term improvements to the home will be submitted to the Commission for Social Care Inspection. The required tests had been carried out on the equipment but the fixed wiring certificate was not available for inspection. Action had been taken to address this as a matter of priority. Cigarette stubs were found outside the laundry door this is a fire hazard and needs to addressed. St Helen`s Nursing Home DS0000063755.V260344.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): 27,28,29 and 30. The increase in the staffing levels has improved the lives of the service users and the staff moral. EVIDENCE: The home employs qualified nursing staff, care staff, domestic and catering staff and a handyman. The qualified nursing staff have the relevant nursing qualifications and arrangements are in place for them and attend regular training courses to up date their practice. All staff have a training portfolio and a number of care staff have achieved or are working towards NVQ Level 2 and 3. Staff are supervised on a regular basis and will be appraised on an annual basis. The home has above the required numbers of staff on duty during the day and will be increasing the numbers of staff on duty from two to three overnight. All staff are subject to TOPPS induction and statutory training, which includes, moving and handling, fire safety, infection control, food handling. Other training completed includes tissue viability, nutrition and confusion in old age. A number of the staff records were inspected and the required records were in place, which included a current CRB and POVA check. St Helen`s Nursing Home DS0000063755.V260344.R01.S.doc Version 5.0 Page 19 The staff spoken with throughout the inspection said that changes had been made to the daily routine, the environment, the increase in the provision of equipment; staff meetings, supervision and training have enabled them to improve the quality of life for the service users. St Helen`s Nursing Home DS0000063755.V260344.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34,35,36,37 and 38. The service users will benefit from the management changes that have taken place and these changes will ensure that their needs and wishes will be put first. EVIDENCE: The registered manager is a qualified nurse and is currently making arrangements to undertake the Registered Managers Award. He works in a supernummary capacity, which allows time for the implementation of new policies and practices, monitoring the standard of care to the service users and providing support and supervision to the staff. The changes made to the daily routine in the home and the improvements made to the assessments and care plans show that the service users needs and wishes are considered at all times. St Helen`s Nursing Home DS0000063755.V260344.R01.S.doc Version 5.0 Page 21 Robust financial plans have been put in place and there are adequate funds available for the day-to-day running of the service and for the future development. The service users financial records were in good order and action has been taken to make sure that they are in receipt of the personal allowances. Protection. There is a staff supervision policy in place and staff confirmed that they have regular supervision and that they can approach the manager and the proprietors at any time. A representative of the proprietor visits the home on a regular basis to monitor the conduct of the home. A report on the conduct of the home is completed and available for inspection. The manager has regular supervision and support from the proprietors. The home has the required policies and procedures in place but they need to be updated to reflect the change of ownership. The home has a health and safety policy and procedure and all staff attend health and safety training. At present all toiletries are shared and not stored in a safe place in the service users bedrooms. This is not safe practice and needs to be addressed. St Helen`s Nursing Home DS0000063755.V260344.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 X 3 3 3 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 3 3 3 2 1 St Helen`s Nursing Home DS0000063755.V260344.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement The registered person is required to make arrangements to keep accurate medication records. To implement a medication monitoring system to ensure service users receive their prescribed medication. The registered person is required to make arrangements for all staff to attend abuse awareness training. The registered person is required to take adequate precautions against the risk of fire. A fixed wiring certificate to be in place and all cigarette stubs to be disposed of correctly. The registered person is required to make suitable arrangements for the storage of toiletries and to provide service users with individual supplies. Timescale for action 30/11/05 2 OP18 13(6) 15/12/05 3 OP19 23(4) 15/12/05 4 OP38 13(4)(b) 15/12/05 St Helen`s Nursing Home DS0000063755.V260344.R01.S.doc Version 5.0 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. 1 2 Refer to Standard OP31 OP37 Good Practice Recommendations It is recommended that the registered managers undertakes and completes the Registered Managers Award. It is recommended that he policies and procedures be reviewed to reflect the change of ownership. St Helen`s Nursing Home DS0000063755.V260344.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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