CARE HOMES FOR OLDER PEOPLE
St Helen`s Nursing Home 41 Avenue Victoria Scarborough North Yorkshire YO11 2QS Lead Inspector
Mrs Rosalind Sanderson Key Unannounced Inspection 24th August 2006 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 Helen`s Nursing Home DS0000063755.V309818.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Helen`s Nursing Home DS0000063755.V309818.R01.S.doc Version 5.2 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.V309818.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th November 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 disorder. The home is located close to the town centre of Scarborough, its amenities and facilities. 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. A local bus route serves the home. The accommodation provided is in both single and double bedrooms on three floors and there is a passenger lift giving access to the upper floors. Information about the services that the home offers is made available to service users and their relatives prior to admission in the form of an information booklet. The fees charged at 24th August 2006 range from £429 to £478 per week. Extra charges are made for the chiropodist, hairdresser and personal toiletries. St Helen`s Nursing Home DS0000063755.V309818.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. St Helens is owned by Hamilton Care Limited and was registered with the Commission for Social Care Inspection on 2nd September 2005. The key inspection has used information from different sources to provide evidence. These sources include: • • • • Reviewing information that has been received about the home since the last inspection Information provided by the registered person on a pre inspection questionnaire; Comment cards returned from relatives, GP’s and care managers A visit to the home by the inspector. Comment cards were sent out to ten relatives, three GP’s and five care managers. From these, eight were returned from relatives, one from a GP and two from care managers. Comments received included five saying how the new owners and managers have had a very positive effect on the home. The information provided by Mr Roy Tomlinson, Registered Manager was in the form of a pre inspection questionnaire that included details about current service users, staff and health and safety precautions in place at the home. A site visit was carried out by one inspector and lasted for eight hours. Two service users, four relatives and seven staff were spoken with. The nature of service user’s illnesses at this home means that they are not always able to give their written or verbal views and comments. During the visit care practices were observed, where appropriate, and time was also spent watching the general activity within the home. This enabled the inspector to gain an insight of what life is like at St Helens for the people that live there. All of the above information has been used to formulate an ‘Inspection Record’ to assist the inspector to plan the site visit and evaluate the evidence. The Registered Manager and Head of Care were available to assist throughout the day. The Responsible Individual was available for part of the day and was present at the feedback session. What the service does well:
St Helen`s Nursing Home DS0000063755.V309818.R01.S.doc Version 5.2 Page 6 People who use this service can be assured that they will have their care needs fully assessed prior to admission. This means that the staff at the home are fully aware of these needs and able to meet them in full. Once admitted the care of each person is carefully planned and all staff are aware of what each person needs. The daily routines and likes and dislikes of each service user are explored and staff endeavour to find a way to meet these. The service users are offered a good well balanced diet with a choice of food at each mealtime so that individual tastes and preferences are catered for. One service user commented, ‘I’m fussy about food but the food here must be good because I’ve eaten it all’ Staff at the home are well trained to meet the needs of this service user group. There are plenty of staff on duty during the daytime hours so that they have time to spend with service users either together or on an individual basis. The management of the home is open and inclusive. Staff are encouraged to discuss concerns and told what to do if they have concerns. This means that service users are protected from the possibility of abuse in any form. What has improved since the last inspection? What they could do better:
St Helen`s Nursing Home DS0000063755.V309818.R01.S.doc Version 5.2 Page 7 In order that the safety of service users is fully protected the registered persons must address the issues identified at the inspection. These include completing the work identified to ensure that the measures in place to address fire prevention and containment are effective. The registered person must also ensure that risk assessments are in place in respect of the hot water outlets identified and the use of bedrails in the home. A system must be put in place system that would enable them to identify any safety issues and address them promptly in the future. Staff must be recruited in accordance with the Department of Health guidelines to ensure the continued safety and protection of the service users. An official notice was left with the Manager and Responsible Individual requiring that these issues were attended to immediately where possible and within twenty-four hours otherwise. Immediate action was taken and written confirmation was received by the inspector within twenty-four hours that all of the above issues had been attended to. The night staffing levels must be reviewed as they have fallen below previously agreed levels. 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.V309818.R01.S.doc Version 5.2 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.V309818.R01.S.doc Version 5.2 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): 3, standard 6 is not applicable. Quality in this outcome area is good. Service users are assured their assessed needs will be met at St Helens. This judgement has been made using all available evidence including a visit to the service EVIDENCE: The pre admission assessments were looked at for four service users. This included two recent admissions and the assessments of two people who had lived at the home for a longer period. The records showed that the manager uses all available information including social services care plans, hospital discharge letters and information received from service users, where possible, and their relatives. This information is used to inform the homes in depth assessment. The comprehensive information that is gathered ensures that the staff are aware of service users needs and a decision can be taken whether or not they will be able to meet these needs. This means that all service users admitted to the home can be confident their needs will be met.
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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): 7,8,9,10 Quality in this outcome area is good. Service users holistic needs are fully met. This judgement has been made using all available evidence including a visit to the service EVIDENCE: Service users look well cared for and appeared calm and content on the day of the site visit. Staff were observed speaking with service users respectfully and spending one to one time with them. All service users now have individual toiletries. The care plans that are in place show that all care and social needs have been addressed and planned for. Staff said they are aware of individual service users preferences in relation to bedtime, activities and food preferences and said that these were met. The plans also show that advice has been sought from other healthcare professionals when needed including a dietician. A relative said, ‘The manager and staff do everything they can to look after….. They do a marvellous job’
St Helen`s Nursing Home DS0000063755.V309818.R01.S.doc Version 5.2 Page 11 A care manager commented, ‘The staff at the home are very professional and caring. They have the best interests of ….as central.’ Systems are in place to ensure that medications are stored, handled and administered correctly and so this means that service users receive these safely. St Helen`s Nursing Home DS0000063755.V309818.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. Service users are able to take part in well-organised activities that provide stimulation and interest for them. Meals provided are nutritious and meet service user’s individual and collective needs. This judgement has been made using all available evidence including a visit to the service EVIDENCE: Discussions with staff showed that activities take account of the interests of the service users where possible. Individual staff are encouraged to implement activities that they may specifically have an interest in and would meet the wishes of the service users. Throughout the day service users were observed conversing with staff and moving freely around the house. A visitor to the home confirmed that they are made to feel welcome when they visit and are able to come at any time. Roman Catholic clergy visit the home on a regular basis and give communion when requested. A Church of England clergy is available to visit service users if needed. Menus are varied and nutritionally balanced. There is a choice of food at each mealtime and special diets are catered for. Discussions with catering staff showed that they knew the food preferences of individual service users.
St Helen`s Nursing Home DS0000063755.V309818.R01.S.doc Version 5.2 Page 13 Service users eat in the dining room but some have their meal in the lounge if they prefer more privacy, this was observed at the site visit. Staff were available at mealtimes to give discreet support on an individual basis when required. One service user said, ‘I’m fussy about food but the food here must be good because I’ve eaten it all’ St Helen`s Nursing Home DS0000063755.V309818.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. Service users are listened to and generally protected by the homes policies and procedures and by well-trained staff. However decisions taken for recent staff recruitments may place service users at risk This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home has a clear complaints procedure that is displayed at the home and contained in the home’s information pack. Relatives indicated on comment cards returned that they were aware of the procedure. Those spoken with on the day of the site visit were able to confirm that they knew what to do if they were unhappy about anything. They confirmed that they would be able to speak with the directors or the manager and felt happy to do so. They also indicated that they were aware they could speak to an inspector if they were unhappy about any aspect of their relatives care. No complaints have been received since the last inspection. The adult protection policy is made available to all staff. Staff have all received training in this area and those spoken with were very clear about reporting any suspicion or allegation of abuse. Staff felt very strongly about reporting anyone that acted in an abusive manner towards service users. However staff have recently been recruited to the home without the necessary pre employment checks in place. This could potentially place service users at risk of harm.
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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): 19,22,25,26 Quality in this outcome area is poor. Some elements within the environment and some poor practices may place service users at risk. This judgement has been made using all available evidence including a visit to the service EVIDENCE: The décor and atmosphere within the home is warm and welcoming. Investment has taken place to ensure that some elements that posed a risk to health and safety have been addressed. These include the wiring within the home and attention to the hot water system. However the following was noted: • Fire doors were held open by chairs, footstools or other unauthorised means. • Door closers fitted to fire doors were not in working order. • Intumescent strips fitted to fire doors to prevent spread of any fire were loose and hanging off on one fire door. • The water temperature in 2 service users bedrooms exceeded 52°c
St Helen`s Nursing Home DS0000063755.V309818.R01.S.doc Version 5.2 Page 16 • Equipment in the form of bed rails were loose fitting and in one case not fitted to the bed correctly. These issues were brought to the attention of the responsible individual and registered manager and immediate arrangements were made to rectify this within twenty-four hours of the site visit. The registered manager has since confirmed that the work has been completed and all issues addressed. Systems have been put in place to ensure these issues do not occur again. New laundry equipment has been provided that means that all laundry can be washed at correct temperatures. This will contribute to infection control within the home. All staff are aware of their responsibilities for the control of infection and to assist them the providers have issued all staff with individual alcohol hand rub and appropriate protection in the form of gloves and aprons. St Helen`s Nursing Home DS0000063755.V309818.R01.S.doc Version 5.2 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): 27,28,29,30 Quality in this outcome area is adequate. Service users are cared for by sufficient numbers of staff that are well trained. Recruitment practices may place service users at risk. This judgement has been made using all available evidence including a visit to the service. EVIDENCE: The rotas show that there are sufficient staff on during the daytime hours with the manager striving to provide six members of staff at all times. On occasions agency staff have been utilised to achieve this. The providers had given written information to the Commission for Social Care Inspection on 7/2/06 that night staff levels were now at three waking staff as had been agreed verbally following the last inspection. However with the exception of one night this was not the case. The care needs of the current service user group indicate that three night staff are needed to ensure the continued safety of service users. Some recent staff recruitments to the home had started before the necessary checks had been completed. The Responsible Individual was aware that this should not have been done but had taken the decision as staffing levels were low. She was aware that this was against the Department of Health guidance that is in place to protect service users.
St Helen`s Nursing Home DS0000063755.V309818.R01.S.doc Version 5.2 Page 18 All staff receive an induction to the home and currently 25 of care staff hold an NVQ qualification at level 2 or above. A further 25 are starting training within a month. Staff said they receive sufficient training to enable them to carry out their roles efficiently. They said they are able to discuss training needs and request any training they think will help them care for the service users. Trained nurses have the necessary qualifications and there is a good mix of general trained and those trained especially for this service user group. This ensures that the service users have access to well trained staff. St Helen`s Nursing Home DS0000063755.V309818.R01.S.doc Version 5.2 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): 31,33,35,36,38 Quality in this outcome area is adequate. The home is managed well and in the best interests of the service users. To ensure this continues the registered person needs to be more proactive in recognising shortfalls in order that they can be addressed promptly. This judgement has been made using all available evidence including a visit to the service. EVIDENCE: The manager is currently undertaking his Registered Managers Award. He has many years experience as a general nurse and one that specializes in caring for this service user group. He has been registered as the manager for eighteen months. He is assisted in his role by a very supportive management team. St Helen`s Nursing Home DS0000063755.V309818.R01.S.doc Version 5.2 Page 20 The providers and the manager always respond promptly to any requirements made and have done so following this inspection. The manager deals with some personal allowances for service users. Accurate records are kept of all transactions made. Staff and relatives spoken with feel the manager has an open, inclusive approach and operates an open door policy. Relatives, staff and a service user were observed freely approaching him during the day. The home has a happy atmosphere. Staff spoken to confirmed that they feel well supported by the manager to help them achieve good outcomes for service users. They have regular supervision when training needs and progress are discussed. Quality assurance within the service is carried out. The intention is that this is further developed to ensure that the views of all who have an interest can be taken into account when developing the service. Comments received from relatives and care managers indicate the amount of improvement that this service has made since the new ownership. These include, ‘The change of ownership has greatly improved regarding appearance of residents and the home generally’ ‘Money has been put into the building and improvements made’ ‘Staff are motivated by the leader’ ‘The improvements are ongoing and good luck to them all’ To ensure the continued safety and good care of service users the issues identified around health and safety, staff recruitment and night staffing levels need to be addressed. St Helen`s Nursing Home DS0000063755.V309818.R01.S.doc Version 5.2 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 3 8 3 9 3 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 3 1 X X 1 X X 1 3 STAFFING Standard No Score 27 1 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 St Helen`s Nursing Home DS0000063755.V309818.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP19 OP38 OP19 OP38 Regulation 23(4(c)) 23(4(c)) Requirement Fire doors must not be held open by unauthorised means The registered provider must make arrangements to: • Repair the door closers that are fitted to identified fire doors that are not working effectively. • Replace the intumescent strip to the door in bedroom 11 that is not fitted correctly Bed rails that were found to be loose and ill fitting should be checked immediately for safe and secure fitting. This should be done before service users next use them. A safe system must be put in place to make sure that regular checks are carried out to ensure bedrails are fitted and used correctly in the future. Risk assessments must be carried out for the hot water outlets in bedrooms 9 & 14 where the hot water temperature at the point of delivery exceeded 52°. Control measures must be
DS0000063755.V309818.R01.S.doc Timescale for action 24/08/06 25/08/06 3. OP22 OP38 13(4(c)) 24/08/06 4. OP22 OP38 13(4(c)) 31/08/06 5. OP25 OP38 13(4(c)) 24/08/06 St Helen`s Nursing Home Version 5.2 Page 23 6. OP27 18(1(a)) put in place to reduce any identified risks to service users. The night staffing levels must be restored to previously agreed levels to ensure the continued safety of service users. 22/09/06 7. OP29 OP38 19 24/08/06 The registered person must ensure that in all cases of staff recruitment a satisfactory CRB check is in place before staff are employed at the home. When a POVA 1st check is obtained the staff members must work under supervision pending receipt of the full CRB. 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. 3. Refer to Standard OP28 OP31 OP33 Good Practice Recommendations It is recommended that the management continue to encourage staff to achieve a qualification in care at NVQ level 2 or above. It is recommended that the manager complete the Registered Managers award. It is recommended that the quality assurance system that is in place is developed further to ensure all stakeholders’ views are taken into account and acted upon. St Helen`s Nursing Home DS0000063755.V309818.R01.S.doc Version 5.2 Page 24 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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