CARE HOMES FOR OLDER PEOPLE
St John`s Nursing Home White House Lane Fishtoft Boston Lincs PE21 0BE Lead Inspector
Julie Western Unannounced Inspection 1st February 2006 09:30 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 John`s Nursing Home DS0000002568.V282150.R01.S.doc Version 5.1 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 John`s Nursing Home DS0000002568.V282150.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service St John`s Nursing Home Address White House Lane Fishtoft Boston Lincs PE21 0BE 01205 366059 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) Lifeline Nursing Services Limited Mr Roy Riseborough Care Home 31 Category(ies) of Dementia (31), Dementia - over 65 years of age registration, with number (31) of places St John`s Nursing Home DS0000002568.V282150.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Category DE is for persons aged 50 years and over. Date of last inspection 27th September 2005 Brief Description of the Service: St John’s Nursing home is situated on the outskirts of the town of Boston in the suburb of Fishtoft. The home has a registration for 31 beds, providing longterm personal and/or nursing care for residents of both sexes over the age of fifty, who have been diagnosed as having a dementia. On the day of the inspection 29 residents were being accommodated. The purpose-built single storey building was originally owned by the Local Health Authority and was built and managed by Lifeline Nursing Services Ltd., a company owning two other homes in Lincolnshire. Accommodation is offered in nine single and ten twin-bedded rooms. There are enclosed gardens and a patio area for residents to sit out in good weather. Car parking is available at the front of the home and a regular bus service passes the home to and from the centre of Boston. St John`s Nursing Home DS0000002568.V282150.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 5 hours. Two inspectors were present, one as a part of her induction process. A tour of the building took place and care records were inspected. The main method of inspection used was called ‘case-tracking’; this involved selecting three residents and tracking the care they received through the checking of their records, discussions with residents and care staff and observation of practices. Policies and procedures were examined and some of the records concerning the safety of the home were also seen. Four of the 31 residents, 3 care and ancillary staff and two visitors were spoken with. The Manager was present throughout the inspection. What the service does well: What has improved since the last inspection?
Improvements to the building have included Since the last inspection report, the activities co-ordinator’s hours have been extended to 25 weekly; this has allowed her to give more time on an individual basis to those residents who are confined to bed or wheelchair. Recent decoration has included the re-carpeting of the entrance area and the positioning of air fresheners to help keep this area smelling fresh. The kitchen has now acquired a new bain-marie, which will keep food hot and enable residents to choose their own portions, and a new dishwasher. New slings have also been purchased. St John`s Nursing Home DS0000002568.V282150.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St John`s Nursing Home DS0000002568.V282150.R01.S.doc Version 5.1 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 John`s Nursing Home DS0000002568.V282150.R01.S.doc Version 5.1 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): 1-5 The home clearly sets out what it intends to do for its residents and this information is freely available to residents. Prospective residents or their supporters are encouraged to take time before the decision is made to move into the home on a permanent basis. EVIDENCE: The statement of purpose was examined and was comprehensive. The residents’ handbook contained appropriate information. The Manager confirmed that either himself or the Deputy Manager carried out the preadmission assessments of residents, either in their own homes or in a hospital or care setting. Some residents were admitted from outside the county. Following the assessment, a letter was sent to advise that the home could or could not meet the reeds of the prospective resident. The Manager said that if required, visits by prospective residents would be made to the home before admission and a visitor described how relatives were invited for lunch and evening meals, which helped the residents in settling into the home.
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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): 7-11 The home’s records give a clear picture of the care needs of residents and enable staff to meet their needs with sensitivity and regard for their privacy and dignity, particularly with regard to death and dying. EVIDENCE: The three care plans looked at in depth contained clear and comprehensive assessments and were reviewed on a monthly basis. They contained assessments from other professionals such as hospital teams and social workers. Because of the complex needs of this service user group, who were unable to participate meaningfully in the care planning process, signatures were often those of relatives or advocates. There was a clear medication policy and the pharmacist visited regularly, the most recent visit being December 2005, from which there were no issues. Staff members were observed carrying out their duties with kindness and sensitivity towards the residents, especially when attending to their personal needs. The home has a protocol on death and dying titled ‘end of life choices’, which staff members were aware of. St John`s Nursing Home DS0000002568.V282150.R01.S.doc Version 5.1 Page 10 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): 12-15 The range of social activities is well promoted, with an extensive variety of events and activities for the residents. The residents exercise choice about which activities, if any, they wish to participate in and what meals they want to eat. EVIDENCE: Following an increase in hours, twenty hours is now allocated weekly for an activities co-ordinator, who is responsible for producing a programme of events. The increase in hours has allowed extra time for activities with residents on an individual basis and to use the sensory room more. Activities for each resident were now recorded and there was a timetable of events, which was displayed in the entrance area. On the day of the inspection residents were doing jigsaw puzzles, colouring and listening to music. Visitors to the home said that the participation in any events organised was limited due to the residents’ abilities, but that there was ‘usually something going on’. They confirmed that they were able to visit at any time and several assisted their relatives with eating at lunchtimes. A visitor said relatives regularly ate meals at the home, including Sunday lunch. The home no longer used a minibus but on occasions two residents and two carers were driven into town for coffee or shopping. Menus would benefit from including a statement that an alternative to the main course was available upon request.
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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 The home’s complaints procedure is clear and gives relatives the confidence that comments and concerns will be listened to; there is a robust adult protection procedure. EVIDENCE: Residents and visitors to the home all said they did not wish to complain but knew how to make a complaint. The home had received two complaints in the last twelve months; these had been responded to appropriately and within the given time. The complaints procedure was displayed on the wall in the entrance foyer. St John`s Nursing Home DS0000002568.V282150.R01.S.doc Version 5.1 Page 12 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, 24-26 The residents live in a comfortable and safe environment, with both private and communal space being generally suitable for their needs. EVIDENCE: The home has a rolling maintenance rota and risk assessments are carried out on the premises to ensure that residents are safe from any potential hazards. Fire procedures have recently been updated. Recent improvements to the home have included the replacement of the carpet in the entrance foyer. All rooms are en-suite and the home has three separate bathrooms and one separate shower. There are ten shared rooms; this is a high ratio of double to single rooms, but the Manager said that this service user group was often more settled when sharing. Overall, the standard of decoration was generally good and afforded residents a satisfactory degree of comfort. A flickering light in one of the corridors was due to be changed the following day. St John`s Nursing Home DS0000002568.V282150.R01.S.doc Version 5.1 Page 13 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): These standards were not inspected EVIDENCE: Although these standards were not fully inspected, the staff rota showed that there were enough staff numbers according to the staffing matrix and shifts were staggered to accommodate the needs of residents; residents and staff thought there were enough staff members on duty to complete their tasks. St John`s Nursing Home DS0000002568.V282150.R01.S.doc Version 5.1 Page 14 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, 32, 38 The home is managed competently and the staff are supported and supervised in carrying out their respective roles. The views of residents and their supporters are listened to and they are involved in decisions affecting them. EVIDENCE: The Manager has spent a lifetime in the care sector and has managed this home for the last 10 years. Staff spoken with said that the Manager was available for guidance and direction and senior members of staff had an ‘open door’ policy whereby they were available to discuss issues at any time with residents, relatives or staff. One resident described the Manager as ‘a very fair bloke – he’d listen to what you were saying’. The home acquired the Investors in People award in November 2005. Comments from residents’ relatives showed that they felt very much a part of the home and questionnaires showed that their views were sought.
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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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 3 X X X 3 3 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X X X 3 St John`s Nursing Home DS0000002568.V282150.R01.S.doc Version 5.1 Page 16 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 Standard OP15 Regulation 12[2, 3] Requirement The registered person must ensure that the menu states that an alternative to the main meal is available Timescale for action 29/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St John`s Nursing Home DS0000002568.V282150.R01.S.doc Version 5.1 Page 17 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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