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Inspection on 08/01/07 for St James Park Nursing Home

Also see our care home review for St James Park Nursing Home for more information

This inspection was carried out on 8th January 2007.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People considering moving into St James Park receive a full assessment and are provided with the opportunity to visit and spend time at the home to make sure that it is able to meet their needs. Residents are offered a menu that provides a varied and well balanced diet that is served in pleasant surroundings. On the day of inspection the home was very clean, of comfortable temperature and adequately staffed. The home is well equipped, attractively decorated and suitably furnished.The standard of care is generally good and each resident has a documented plan of care. Staff are enthusiastic, competent and receive training. Residents are satisfied with St James Park. Comments received during the inspection included "I think it`s wonderful here; everybody`s so nice and so is the food...I love everything about it".

What has improved since the last inspection?

Since the previous key inspection a number of significant improvements have been made. In accordance with requirements contained in the report of the last inspection the home has improved documentation for care planning and associated assessment processes and has improved standards of medicine handling; thereby ensuring that staff have correct guidance on the needs of residents, and that residents receive medicines as prescribed. A satellite kitchen has been installed on the first floor for the provision of beverages and `out of hours` (evening and night time) snacks; most importantly the use of this kitchen enables residents on that floor to have freshly made toast; it had previously been made in the main kitchen and inevitably cooled during transport to first floor rooms.

What the care home could do better:

As observed during the previous key and random inspections some incidents of poor practice were again noted. With particular regard to the very frail residents who are dependent on staff to promote their dignity and comfort, improvements must be made to ensure these important aspects are not neglected and residents are properly cared for at all times.

CARE HOMES FOR OLDER PEOPLE St James Park Nursing Home Bradpole Bridport Dorset DT6 3EU Lead Inspector Gloria Ashwell Key Announced Inspection 8th January 2007 10:15 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 DS0000020498.V326080.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. DS0000020498.V326080.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St James Park Nursing Home Address Bradpole Bridport Dorset DT6 3EU 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) 01308 421174 01308 427564 holdehe@bupa.com www.bupa.co.uk BUPA Care Homes (CFCHomes) Limited Vacant Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46) of places DS0000020498.V326080.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th May 2006 Brief Description of the Service: St James Park is a large care home registered to provide nursing care to a maximum of 46 older people, owned by BUPA Care Homes (CFC Homes) Limited. The nominated Responsible Individual; is Mrs Greenwood. The home is situated in the quiet country village of Bradpole, a short drive away from the town of Bridport. The home is close to a bus route, with a bus stop within walking distance for buses to and from Bridport. The accommodation is arranged over three floors and a passenger lift provides access to all floors of the home. Currently available for use are 30 single and six double bedrooms; most have en-suite facilities. (Some rooms registered for use as bedrooms are not routinely used for this purpose.) Communal rooms include a lounge, library, conservatory style dining room, three communal lounges (including one with a large dining area), five assisted bathrooms and one assisted shower. Laundering of clothing and household linen is carried out at the home and arrangements can be made for chiropodists, opticians and other health and social care professionals to visit individual residents. Fees are charged weekly; at present fees range between £500 and £722 per person. Information regarding the subjects Value for Money and Fair Terms in Contracts can be obtained from the web link: www.oft.gov.uk A report entitled Care Homes in the UK - A Market Study is available on web link http:/www.oft.gov.uk/NR/rdonlyres/5362CA9D-764D-4636-A4B1-A65A7AFD347B/0/oft780.pdf DS0000020498.V326080.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was a statutory inspection required in accordance with the Care Standards Act 2000. The inspection was announced; the inspector was in communication with the home during the evening of Friday 5 January 2006 regarding an Adult Protection allegation and consequently advised the Responsible Individual that it was her intention to conduct the inspection on 8 January 2007. She accordingly arrived at 10.15 on that date, spoke to the Responsible Individual, toured the premises and spoke to residents and staff. The inspector later arranged with the registered manager to conclude the inspection at 10.00 on 15 January 2007; on that date documentation relating to care provision and the premises was discussed and examined. The duration of the inspection (both days combined) was 7 hours. During the inspection, particular residents were ‘case tracked’; for example, for evidence regarding Standards 3, 7 and 8, records relating to the same resident were examined, and the resident spoken with. Additional information used to inform the inspection process included the monthly reports regularly sent to the Commission by the provider organisation. During this inspection compliance with all key standards of the National Minimum Standards was assessed. Since the previous key inspection a random inspection took place on 30 August 2006 to monitor progress on requirements of the previous inspection and to investigate concerns arising from a recent Adult Protection enquiry regarding the care of a particular resident. What the service does well: People considering moving into St James Park receive a full assessment and are provided with the opportunity to visit and spend time at the home to make sure that it is able to meet their needs. Residents are offered a menu that provides a varied and well balanced diet that is served in pleasant surroundings. On the day of inspection the home was very clean, of comfortable temperature and adequately staffed. The home is well equipped, attractively decorated and suitably furnished. DS0000020498.V326080.R01.S.doc Version 5.2 Page 6 The standard of care is generally good and each resident has a documented plan of care. Staff are enthusiastic, competent and receive training. Residents are satisfied with St James Park. Comments received during the inspection included “I think it’s wonderful here; everybody’s so nice and so is the food…I love everything about it”. 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. The summary of this inspection report can be made available in other formats on request. DS0000020498.V326080.R01.S.doc Version 5.2 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 DS0000020498.V326080.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (The home does not provide intermediate care so Standard 6 does not apply) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents (or their representatives) are provided with information about St James Park and are encouraged to visit in advance of admission to establish their impressions of life at the home and the standard of available accommodation. Prior to admission, the needs of each proposed resident are assessed and the home then writes to prospective residents confirming the ability to properly care for them. EVIDENCE: The records of a recently admitted resident included details of pre-admission assessment which had been carried out by the registered manager when she visited the prospective resident at a previous address. DS0000020498.V326080.R01.S.doc Version 5.2 Page 9 In advance of making the decision to enter the home the closest relatives of the prospective resident visited St James Park to view the premises on her behalf because she was too frail to do this herself. DS0000020498.V326080.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of care is generally* good and in accordance with a written plan of care for each resident ensuring that staff have sufficient information upon which to base their care practice. Residents health needs are met, all accidents are investigated and periodically audited to minimise risks of recurrence. Medicines prescribed by doctors are safely stored and carefully administered to residents by trained nurses, thereby protecting residents from medicine errors. Residents receive prescribed medicines at the correct times and in correct amounts. Residents wishing to do so can manage their own medicines. *There is room for improvement with regard to the promotion of dignity and comfort with particular regard to the very frail residents who are dependent on staff for these aspects. DS0000020498.V326080.R01.S.doc Version 5.2 Page 11 EVIDENCE: During the first day of inspection a resident had been taken to a lounge a short time before by the care worker who had assisted her to wash and dress. This resident had been left in a dishevelled state, with underwear prominently on show, stockings fallen to her ankles and the dressing from a leg wound hanging loose, exposing the wound. The inspector drew this to the attention of the Responsible Individual who took immediate action to rectify the circumstance. In the same lounge staff had seated elderly residents close to a radio loudly playing popular music; the Responsible Individual asked the residents if they wanted the radio on and when they indicated they did not she turned it off. It is again required that all care staff be reminded of their duties with regard to promoting the dignity of residents. Residents believe they are properly cared for; comments received from residents during the inspection included “I don’t think they could do any better”, and “If it goes on like this we’ll be happy”. Care records of 4 residents were examined and contained risk assessments forming the basis for care plans and daily records describing the care of each resident. To ensure correct identification of residents records contain a recent photograph of each resident. Records are kept of all accidents and in accordance with a recommendation made at the last inspection now include clear and comprehensive details of investigation and consequent actions to minimise risks of recurrence. Medication administration records were properly kept indicating that residents receive prescribed medicines at the correct times and in correct amounts those wishing to do so can manage their own medicines in accord with a risk assessment process; none of the currently accommodated residents manage their own medicines. The handling of medicines is carried out by trained nurses. In the presence of staff residents appeared relaxed, confident and at ease; staff interactions with residents were of a friendly and considerate manner. DS0000020498.V326080.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The quality of daily life in the home is good with residents assisted to maintain as much independence as possible. Social and leisure activities are suited to the preference and ability of each resident. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. Meals are appetising and of good quantity and quality. Most residents take meals in the large dining room on the ground floor; others receive them in their bedrooms. EVIDENCE: Many currently accommodated residents are too frail to engage in lengthy conversation; the inspector spoke to 9 of the more able resident who all indicated satisfaction with the home, including the range of activities, meal provision, staff and premises. DS0000020498.V326080.R01.S.doc Version 5.2 Page 13 The home employs an Activities Organiser for 30 hours each week to arrange visiting entertainers, one-to-one and small group social and recreational activities. Visitors are welcome at any time and a visitor spoken with during the inspection confirmed always being informed of any change in the particular residents condition. The inspector noted the serving of lunch in the dining room and that residents were evidently enjoying their meal. Residents said they were very satisfied with the quality, choice and quantity of food provided; one resident stated “the meals are very good”. DS0000020498.V326080.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home adheres to a policy/procedure for the prevention of abuse and all staff have received training in the understanding and prevention of abuse to ensure that they remain vigilant to protect vulnerable residents from such risks. The complaints procedure provides information on the procedure to follow to persons wishing to make complaint and service users know how to complain. EVIDENCE: Residents feel confident that if they had concerns or complaints they will be listened to and taken seriously. To ensure residents and their representatives have access to the complaints procedure it is included in the service user guide to the home and a copy is provided to each residents’ relative/representative. Residents know how to complain and feel confident that if they had concerns or complaints they will be listened to and taken seriously. The home keeps records of all complaints received and investigated. Since the last inspection three complaints against the home have been received and DS0000020498.V326080.R01.S.doc Version 5.2 Page 15 investigated; two related to individual food preferences, the third related to staff allocation - all have been successfully resolved. The home has developed and implemented written policies and procedures for the protection of residents from abuse or neglect and provides all staff with training in the understanding of abuse and their role in protecting residents from abuse in its many forms, including neglect. An allegation involving aspects of ‘Adult Protection’ is at present being investigated; in accordance with established protocol Dorset County Council is the lead agency for this investigation. DS0000020498.V326080.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. St James Park is a well-appointed and comfortable home. On the day of inspection the home was clean, pleasant and hygienic and there was evidence indicating that this is the usual standard of provision. EVIDENCE: St James Park is a partly traditionally built house, significantly enlarged by a purpose built extension. It offers good sized bedrooms, bathrooms equipped for the use of persons requiring assistance and comfortable communal rooms. On the day of inspection the home was clean, tidy and comfortable throughout; there were no unpleasant odours. DS0000020498.V326080.R01.S.doc Version 5.2 Page 17 From discussion with service users there was evidence that this is the usual high standard; a visiting relative stated “If the carpet gets stained it gets cleaned immediately”. There is an ongoing programme of redecoration and updating, to ensure the premises remains in good condition and continues to provide residents with comfortable and safe accommodation. DS0000020498.V326080.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home employs enough staff to meet the needs of residents and to ensure their safety and comfort and the good condition of the premises. Recruitment practices ensure the protection of residents from potentially unsuitable staff. Staff receive appropriate training and are competent to carry out their jobs. EVIDENCE: Trained nurses lead the care teams and at all times the home is in the overall charge of an experienced nurse. Staffing levels are provided in accordance with the assessed needs of residents to ensure that at all times sufficient staff are available to properly meet their needs. Comments received during the inspection included “Everybody’s so nice” and “They are very helpful and friendly”. DS0000020498.V326080.R01.S.doc Version 5.2 Page 19 Staff are enthusiastic about their work and feel they provide a good standard of care to residents and are properly supported by the management and training provision. The records of 2 recently employed staff members were examined and found to contain all essential information including two written references, an interview assessment, health details, evidence of identity and of induction training (using the Skills for Care process). At present only 7 of the 20 care staff (who are not trained nurses) currently employed by the home hold a National Vocational Qualification in care and none are training for this award so the home does not meet the standard for at least 50 of the care staff to hold an NVQ in care; the manager intends to enter more staff to train for this award. It is recommended that at the earliest opportunity arrangements be made to provide at least 50 of the care staff with an NVQ in care. The provider organisation has an enthusiastic approach to staff training; recent topics have included Health & Safety, moving and handling, infection control and fire safety training. To further assist the training of care staff there is available a range of opportunities including www.picbdp.co.uk (the Partners in Care web site), www.skillsforcare.org.uk (the Skills for Care web site), www.traintogain.gov.uk (a programme and funding stream supported by the Learning and Skills Council and Business Link) and www.lsc.gov.uk/bdp/employer/eggt_intro.htm (the Employer Guide to Training website, which is aimed at assisting employers to choose the most suitable training provider to meet their workforce needs by the use of a search facility). DS0000020498.V326080.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and staff understand their work and receive training appropriate to their needs. Residents and their representatives are satisfied with the home and feel staff care for them well and put them at their ease. The home has implemented a quality assurance system to ensure that residents remain satisfied with all aspects of the home. The home does not manage the finances of residents. The premises and equipment are properly maintained in good condition. DS0000020498.V326080.R01.S.doc Version 5.2 Page 21 EVIDENCE: Since the previous inspection a new manager has commenced work in the home and intends to apply to the Commission to become the Registered Manager. This person has already demonstrated high standards of managerial and nursing expertise and significant improvements have been made to the general running of the home and the standard of care provided to residents. The home has ongoing systems for quality assurance; satisfaction surveys are periodically issued and occasional meetings for residents and their relatives takes place. To ensure continuity of approach the home operates in accord with an extensive selection of clear and appropriate policy and procedure documents, including those for care provision, management and the premises. The home does not manage the finances of residents; residents who are unable to undertake this responsibility personally have nominated relatives, friends or other representatives to do this on their behalf. Staff trained in First Aid and health care are on duty in the home at all times. The premises are well maintained and there are regular checks/tests of all equipment. DS0000020498.V326080.R01.S.doc Version 5.2 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000020498.V326080.R01.S.doc Version 5.2 Page 23 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 Standard OP10 Regulation 12 Requirement Staff must at all times maintain residents’ dignity and comfort. Timescales of 01/07/06 and 30.8.06 not met. Timescale for action 15/01/07 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 OP30 Good Practice Recommendations It is recommended that at the earliest opportunity arrangements be made to provide at least 50 of the care staff with an NVQ in care. DS0000020498.V326080.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000020498.V326080.R01.S.doc Version 5.2 Page 25 - 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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