Inspection on 08/11/05 for St James Park Nursing Home

This inspection was carried out on 8th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 James Park Nursing Home 13/10/08

St James Park Nursing Home 11/10/07

St James Park Nursing Home 08/01/07

St James Park Nursing Home 30/05/06

St James Park Nursing Home 06/06/05

St James Park Nursing Home 15/03/05

St James Park Nursing Home 09/09/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE St James Park Nursing Home Bradpole Bridport Dorset DT6 3EU Lead Inspector Chris Gould Unannounced Inspection 8th November 2005 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 St James Park Nursing Home DS0000020498.V264469.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 James Park Nursing Home DS0000020498.V264469.R01.S.doc Version 5.0 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 BUPA Care Homes (CFC Homes) Limited Mrs Elizabeth Jane Wilson Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46) of places St James Park Nursing Home DS0000020498.V264469.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th June 2005 Brief Description of the Service: St James Park is a large BUPA owned care home registered to provide nursing care to a maximum of 46 older people. The home is situated in the quiet country village of Bradpole, a short drive away from the town of Bridport. The accommodation is arranged over three floors and a passenger lift provides access to all floors of the home. There are 30 single and six double bedrooms; most have en-suite facilities. 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. St James Park Nursing Home DS0000020498.V264469.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection by two inspectors took place over seven and quarter hours on one day in November 2005. This inspection assessed 15 standards and the outstanding requirements from the previous inspection. A tour of the premises took place and three residents care records were inspected. Documents and records were viewed relating to the running of the home. Eight residents and the staff on duty were spoken with during the inspection. Elizabeth Wilson the registered manager was available throughout the inspection. The bed occupancy in the home was 39 residents. This report should be read in conjunction with the report of the previous inspection that took place in June 2005. What the service does well: What has improved since the last inspection? New medicine trolleys have been provided specifically designed to be used with the ‘blister pack’ method used to package the medicines and an audit system has been developed to ensure residents’ medicines are administered safely. Cleaners and a dedicated laundry person have been employed for Saturday and Sunday. The general cleanliness of the home was found to have improved in most areas. Elizabeth (Liz) Wilson has been registered by CSCI as the manager of St James Park and a head of care has been appointed to assist the manager with staff St James Park Nursing Home DS0000020498.V264469.R01.S.doc Version 5.0 Page 6 training, supervision and day to day running of the home. One resident commented that ‘if you told the manager then things happened quickly’. 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 James Park Nursing Home DS0000020498.V264469.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 James Park Nursing Home DS0000020498.V264469.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): EVIDENCE: These standards were not assessed on this occasion. This report should be read in conjunction with the report of the previous inspection that took place in June 2005. The home does not provide intermediate care therefore standard 6 is not applicable. St James Park Nursing Home DS0000020498.V264469.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 The absence of a clear and consistent care planning system to adequately provide staff with the information they need to satisfactorily meet residents’ personal, social and health care needs has the potential to place residents at risk. Residents are protected by the systems in place to ensure the safe administration of medication. Care practices carried out by some staff are not always appropriate resulting in resident’s privacy and dignity being compromised. EVIDENCE: All residents have individual plans of care and the three residents care records inspected had been reviewed at least monthly. The records varied in their content and the changes identified following evaluation were not reflected in the action plan. The detail in the action plan was insufficient to provide staff with the information required to meet residents’ needs. There was no reference to the residents’ oral hygiene and St James Park Nursing Home DS0000020498.V264469.R01.S.doc Version 5.0 Page 10 action plans state ‘body wash daily or bath once a week’ but no further information of how this was to be achieved. Action plans were not in place to demonstrate how residents are assisted to manage their continence. In discussion with residents their needs are not appropriately met by the actions of staff. Two records inspected included information relating to wounds. Wound care documentation has been implemented since the last inspection. The records inspected did not contain sufficient detail of a clear assessment, plan of care or evaluation of the wounds. The three records identified that the residents are at high risk from developing pressure ulcers. A care plan has not been developed to identify the preventative actions to be taken. A contract is in place for the safe disposal of medicines no longer required. New medicine trolleys have been provided specifically designed to be used with the ‘blister pack’ method used to package the medicines. An audit system has been developed for medicines not in the Monitored Dosage System (MDS) blister packs by dating packs when they are started. Medicine Administration Records inspected had been appropriately completed. A number of residents’ rooms still contain continence products on view to anyone visiting the room. Liz Wilson said that a storage solution has been ordered. Staff were seen knocking on doors before entering but on a number of occasions this did not happen and staff just opened the door and walked in. Residents commented that when two staff are providing care they carry out a conversation between themselves excluding the resident. A resident described how an inappropriate care practice failed to respect their dignity. St James Park Nursing Home DS0000020498.V264469.R01.S.doc Version 5.0 Page 11 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): 15 Residents are offered a menu that provides a varied and well balanced diet. EVIDENCE: Three cooked meals are provided each day with a hot drink and biscuits mid morning and a hot drink and cake, biscuits and fruit during the afternoon. Menus are changed every twenty-eight days and a choice is provided. The main course on the day of inspection was beef stroganoff and rice with alternatives of poached fish, sausages or salad. Residents spoken with all commented that the food is ‘good’. The three meals are offered between 8am and 5pm with no routine provision for the fifteen hours from 5pm until 8am. Breakfast is provided at 8am, lunch at 12.30 and supper at 5pm. On the day of inspection lunch was served at 1.15pm. A hot drink is provided in the evening but no further food although the cook said that biscuits or sandwiches are available. St James Park Nursing Home DS0000020498.V264469.R01.S.doc Version 5.0 Page 12 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): 18 Arrangements for protecting residents from abuse are not satisfactory placing them at possible risk of harm. EVIDENCE: A national agreement between BUPA and CSCI is being sought regarding BUPA’s abuse policy and its contents. A number of staff have received training on the prevention of abuse and it is planned for the remaining staff to receive training in the near future. St James Park Nursing Home DS0000020498.V264469.R01.S.doc Version 5.0 Page 13 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, 24 and 26 Actions need to be taken to ensure that the environment the residents live in is well maintained, comfortable, clean and safe. EVIDENCE: A maintenance person is employed full time to ensure that the programme of routine maintenance and checks are undertaken. A number of bedroom doors were found not to be closing to latch. An immediate requirement that all fire doors must close to latch was issued. Since the last inspection the damp wall underneath the bay window in the lounge has been treated. The guttering around the home overflows as they have become full of leaves and may be contributing to the damp areas within he home. The activities room is no longer available to residents as it smells of damp, feels cold and the wallpaper is coming off the walls. Individual areas of damp are being treated as they occur but the cause of the problem has not been addressed. St James Park Nursing Home DS0000020498.V264469.R01.S.doc Version 5.0 Page 14 The residents’ bedrooms contained the furniture required to meet their needs. Residents commented that they were ‘quite comfortable’ in their room. Adjustable beds are not available for all residents receiving nursing care. Locks are fitted to residents’ bedroom doors and lockable storage space is provided in all rooms. Risk assessments included in care records demonstrated that a key is provided if the resident wishes and it is appropriate. Screens are provided in shared rooms. A number of pillows seen on residents’ beds were in a very poor condition and require replacement. Since the last inspection cleaners and a dedicated laundry person has been employed for Saturday and Sunday. The general cleanliness of the home was found to have improved in most areas. A bathroom floor required cleaning, the curtain at the window needed washing, there was grit in the bath and the plug raiser had become loose. A second bathroom also required cleaning. St James Park Nursing Home DS0000020498.V264469.R01.S.doc Version 5.0 Page 15 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 The numbers and skill mix of staff do not meet the needs of the residents with the potential of placing residents at risk. EVIDENCE: Residents and staff spoken with expressed concern about the staffing levels at the home. Residents commented ‘too many people for staff’, ‘weekends very short staffed’, ‘don’t respond to bells very quickly’ and time to answer bell not good’. Residents also said that even if the bell is answered fairly quickly if two carers are required the carer leaves to find a colleague and it is quite a while before they return. Similar comments were also received from residents during the last inspection and included in the report in June 2005. The staffing levels issued by the previous regulator, the Dorset Health Authority state that for thirty nine residents from 20.00 until 08.00 the staffing levels should be one registered nurse and four care assistants with a total staff of five. The home has four staff on duty during the night time period. These are minimum staffing levels and other factors must also be considered when assessing the number of staff required throughout the twenty-four hour period including the dependency levels of the residents and the environment provided within the home. St James Park Nursing Home DS0000020498.V264469.R01.S.doc Version 5.0 Page 16 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 and 38 The home is run by a person who is of good character and able to discharge her responsibilities fully ensuring residents live in a home that is well managed. Systems are in place to ensure that the home is run in the best interests of the residents. Residents’ personal monies are kept secure and with appropriate records to ensure financial interests are safeguarded. The health and safety of residents are protected by the policies, procedures, staff training and routine checks and servicing of equipment in place at the home. St James Park Nursing Home DS0000020498.V264469.R01.S.doc Version 5.0 Page 17 EVIDENCE: Elizabeth (Liz) Wilson, a first level registered nurse, was registered by CSCI as the manager of St James Park in October 2005. The registered manager has commenced the Registered Managers Award. A Head of Care has been appointed to assist the manager with staff training, supervision and day-to-day running of the home. One resident commented that ‘if you told the manager then things happened quickly’. There was evidence that regular meetings were arranged for all staff according to the departments in which they worked in the home and this was confirmed in discussion with staff. Surveys of staff, residents and relatives are undertaken annually the last in March 2005. Internal audits of each department are completed. The Responsible Individual for the home visits at least once a month and provides a written report on the conduct of the home. A copy of the report is supplied to the CSCI. Residents either manage their own finances or were assisted by family, friends or professional advisors. A number of residents have arranged for the home to hold some monies on their behalf and these are held in individual bank accounts. A programme for formal structured appraisal and staff supervision is in place but the registered manager said that it is not being implemented at the present time. The programme will recommence now that a Head of Care has been appointed. Records viewed evidenced that all gas installations, central heating, electrical wiring and appliances and equipment used to meet service user needs has been serviced and checked as appropriate. Policies and procedures are available relating to health and safety, Control of Substances Hazardous to Health (COSHH), infection control, manual handling and first aid. Records were available to demonstrate that checks on fire warning systems and equipment had taken place. Training has been provided for all staff and fire drills have taken place. A number of the records of recent accidents were incomplete including the date of the accident and details of the accident. St James Park Nursing Home DS0000020498.V264469.R01.S.doc Version 5.0 Page 18 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 X X X X 2 X 2 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 St James Park Nursing Home DS0000020498.V264469.R01.S.doc Version 5.0 Page 19 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 OP7 Regulation 15(1)(2) Requirement Timescale for action 28/02/06 2. OP8 12(1) 3. OP10 12(4)(a) The registered person shall ensure that residents care plans contain sufficient detail to provide clear guidance to staff on the actions to be taken to meet their care needs Care plans must routinely evidence the involvement of service users and/or their representatives: the manager or key worker must clarify if the service user/or their representative would like a copy of the updated care plan. Timescale of 30th September 2005 not met. 28/02/06 The registered person must ensure that proper provision is made for the health care and where appropriate treatment of residents. Timescale of 30th September 2005 not met The registered person shall make 28/02/06 suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of residents. Cupboards must be supplied so that sundry items in regular use DS0000020498.V264469.R01.S.doc Version 5.0 St James Park Nursing Home Page 20 4. OP18 18(1) 5. OP19 23(4) 6. OP19 23(2)(b) 7 OP24 16(2)(c) 8. OP26 23(2)(d) 9 OP27 18(1)(a) 10 OP36 18(2) 11 OP38 17(1)(a) schedule 3 are stored more discretely in service user s rooms or ensuites. The timescale of 30.06.05 has not been met. All staff must be supplied with training relating to the identification and prevention of abuse. Timescale of 30th September 2005 not met The registered person must ensure that all fire doors close to latch. A letter was received by CSCI on 09/11/05 confirming that all doors now close to latch. The cause of damp in the activities room must be identified and eradicated and the wallpaper in the affected area must be made good. The registered person shall undertake an audit of the pillows used in the home and replace as assessed necessary. The registered person shall ensure all parts of the home are kept clean. Timescale of 30th September 2005 not met The registered person shall, ensure that at all times the numbers and skill mix of the staff deployed are sufficient to meet the needs of the residents. Timescale of 30th September 2005 not met The registered person shall ensure that persons working at the care home are appropriately supervised. The registered person must ensure that a complete record of any accident affecting the resident is maintained. 28/02/06 08/11/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 St James Park Nursing Home DS0000020498.V264469.R01.S.doc Version 5.0 Page 21 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 OP15 Good Practice Recommendations It is recommended that a snack is offered in the evening and the interval between this and breakfast the following morning should be no more that twelve hours. St James Park Nursing Home DS0000020498.V264469.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 James Park Nursing Home DS0000020498.V264469.R01.S.doc Version 5.0 Page 23 - 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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