Inspection on 27/09/05 for St John`s Nursing Home

This inspection was carried out on 27th September 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St John`s Nursing Home 16/01/07

St John`s Nursing Home 01/02/06

St John`s Nursing Home 05/02/05

St John`s Nursing Home 15/07/04

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

CARE HOMES FOR OLDER PEOPLE St John`s Nursing Home White House Lane Fishtoft Boston Lincs PE21 0BE Lead Inspector Julie Western Unannounced Inspection 27th September 2005 08:30 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.V253490.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 John`s Nursing Home DS0000002568.V253490.R01.S.doc Version 5.0 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.V253490.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Category DE is for persons aged 50 years and over. Date of last inspection 5th February 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 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. There are enclosed gardens and a patio area Accommodation is offered in nine single and ten twinbedded rooms. 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. The home also provides a mini-bus for service users. A sensory room is available in the home, which offers stimulation and/or tranquillity to service users, dependent upon need. St John`s Nursing Home DS0000002568.V253490.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 4 hours. A partial 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. 2 of the 29 residents, 3 of the 37care 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? What they could do better: Although the home in general is free from smells, the entrance area does smell of urine and the carpet is faded in some areas. The issue of unpleasant smells is one that has been recorded over the last two inspections. Policies and procedures have not been updated for some time and the statement of purpose also needs updating to included recent information about the management structure. St John`s Nursing Home DS0000002568.V253490.R01.S.doc Version 5.0 Page 6 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.V253490.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 John`s Nursing Home DS0000002568.V253490.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): The home clearly sets out what it intends to do for its residents and this information is freely available to residents. The statement of purpose needs updating. 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 but needed updating to reflect the changes made within the management and staffing structures. The residents’ handbook contained appropriate information. The Manager confirmed that either himself or the Deputy Manager carried out the pre-admission assessments of residents, either in their own homes or in a hospital or care setting. Most residents were admitted directly from the Mental Health Unit at Boston Hospital. The Manager said that if required, visits by prospective residents would be made to the home. St John`s Nursing Home DS0000002568.V253490.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): 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. EVIDENCE: The three care plans looked at in depth contained clear and comprehensive assessments and were reviewed on a monthly basis. Because of the complex needs of this service user group, they are unable to participate meaningfully in the care planning process and care plans were therefore signed by relatives or advocates. Since the majority of the residents were admitted from hospital, care plans contained assessments from hospital teams and social workers. There was a clear medication policy and the pharmacist visited regularly. The staff team 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 all staff are aware of. St John`s Nursing Home DS0000002568.V253490.R01.S.doc Version 5.0 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): The range of social activities is well promoted and there is a 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: Twenty hours were allocated weekly for an activities co-ordinator, who was responsible for producing a programme of events. The home has a sensory room, but staff members said there was not a lot of time for one-to-one sessions with residents. Recent events had included a garden fete and a Harvest Festival church service at the home. 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 one assisted her husband daily at lunchtime. Two visitors said they had Sunday lunch at the home regularly; one said ‘the kitchen staff are brilliant’.. The Manager said that the home had a mini-bus but that it was not used often, due to the physical frailty of the present residents. St John`s Nursing Home DS0000002568.V253490.R01.S.doc Version 5.0 Page 11 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): The home’s complaints procedure is clear, although it needs updating and gives residents and their 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; this needed updating to include the new title of the CSCI. There was a clear adult protection procedure, which was linked to the Local Authority procedures. All staff members spoken with had received n-house training on adult abuse from the Manager and were knowledgeable about complaints. St John`s Nursing Home DS0000002568.V253490.R01.S.doc Version 5.0 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): The residents live in a generally comfortable and safe environment with both private and communal space being on the whole 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. Recent improvements to the home have included the redecoration of two bedrooms including the replacement of the carpets, the replacement of one of the six boilers, three new chairs and new laminate-style flooring in one of the living/dining areas. There was a smell of urine in the entrance foyer and the carpet was faded in some places. All rooms are en-suite and the home has three separate bathrooms and one separate shower. There are ten shared rooms. One of the bathrooms has a fibre glass bath; this is marked in two places on the roll top where a hoist has damaged it and, although safe, looks unsightly. The flooring is also marked from a previous hoist. Overall, the standard of decoration was generally good and afforded residents a satisfactory degree of comfort. St John`s Nursing Home DS0000002568.V253490.R01.S.doc Version 5.0 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): Staff numbers are in sufficient quantity for them to be able to care for the residents. Staff members are suitably trained, qualified and competent; they undergo an induction programme before commencing their duties. EVIDENCE: The visitors were very positive about the care their relatives/friends received from the staff. One said ‘I couldn’t fault the staff at all’. The most recent staff member to be appointed confirmed that she had given two references, which were followed up, a CRB check and undertaken an induction programme before commencing work. The business plan for training showed that all statutory training was programmed to be completed by the end of 2005. the Manager conducted much of the training in-house and staff also undertook distance learning training. Recent specialist training had been in Adult Protection with three staff having recently completed the Alzheimer’s Society Course ‘Time to Care’. Five staff members had National Vocational Qualification at Level 2 with four currently undertaking it and one had the NVQ at Level 3 with another one working towards it. 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 spoken with thought there were enough staff and staff confirmed this. St John`s Nursing Home DS0000002568.V253490.R01.S.doc Version 5.0 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): 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. Policies and procedures need updating. EVIDENCE: 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. Visitors spoken with said there had been some issues with the Manager’s attitude towards them but this had improved since the commencement of regular meetings with him. The home is applying for the Investors in People award. Letters from residents’ relatives showed that they felt very much a part of the home and questionnaires showed that their views were sought. St John`s Nursing Home DS0000002568.V253490.R01.S.doc Version 5.0 Page 15 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 2 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 3 3 3 X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 X X X 2 3 St John`s Nursing Home DS0000002568.V253490.R01.S.doc Version 5.0 Page 16 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 Requirement The registered person must update the statement of purpose to reflect management and staff changes. The registered person must update the complaints procedure to reflect the new title of CSCI. The registered person must repair the chips in the top of fibreglass Arjo bath. The registered person must arrange for the faded carpet in the entrance foyer to be replaced. The registered person must update all policies and procedures. Timescale for action 23/11/05 2 3 4 OP16 OP19 OP26 22 23 16 23/11/05 23/11/05 23/11/05 5 OP37 17 23/11/05 St John`s Nursing Home DS0000002568.V253490.R01.S.doc Version 5.0 Page 17 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 12 Good Practice Recommendations It is a recommendation that the role of the activities coordinator is increased to allow those residents who cannot leave the home to have more individual attention. St John`s Nursing Home DS0000002568.V253490.R01.S.doc Version 5.0 Page 18 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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