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Inspection on 29/11/05 for St John`s Nursing Home Limited

Also see our care home review for St John`s Nursing Home Limited for more information

This inspection was carried out on 29th 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.

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

The opportunity was taken to talk briefly with several residents. In spite of the shortcomings in a number of areas, they all said that generally they were happy with the service they received.

What has improved since the last inspection?

Given that the home has now complied with ten of the requirements that were previously made, there has obviously been some improvement. In particular, the home has now greatly improved its recruitment procedures (the cause of two Statutory Enforcement Notices this year).

What the care home could do better:

As just over half of the previous requirements remain unmet, and five new ones have been made, there is clearly further improvement to be made. It was disappointing that so many remained outstanding, given that most were not difficult to achieve, and could have been resolved with minimal effort.

CARE HOMES FOR OLDER PEOPLE St John`s Nursing Home Limited St John`s Nursing Home 129 Haling Park Road South Croydon Surrey CR2 6NN Lead Inspector Margaret Lynes Unannounced Inspection 29th November 2005 09:50 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 Limited DS0000019041.V268157.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 Limited DS0000019041.V268157.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St John`s Nursing Home Limited Address St John`s Nursing Home 129 Haling Park Road South Croydon Surrey CR2 6NN 020 8688 3053 020 8649 9611 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) St John`s Nursing Home Limited Miss Jayanti Bhowanee Care Home 45 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (22) of places St John`s Nursing Home Limited DS0000019041.V268157.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th October 2005 Brief Description of the Service: St Johns is a 45-bed nursing home set in South Croydon. It lies within easy reach of the centre of Croydon, and a selection of public transport links. The home is registered to cater for elderly clients who require general nursing care, (22 beds) and also clients with dementia who require nursing care (23 beds). The stated aim of the home is to provide a safe and comfortable environment with a happy atmosphere. St John`s Nursing Home Limited DS0000019041.V268157.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was conducted over the course of 3 hours, and was the fifth visit to the home so far this year – a reflection of the concerns that the Commission has had. While improvements have been made, there remains further work to be done, so that the home can be said to offer a satisfactory level of service in all areas. The focus of this visit was to determine if the requirements that were contained within the report of the last full inspection visit (June 2005) had been met. Following that visit, some 20 requirements were made or were carried over from previous visits. Of these, nine have now been met, while it was not possible to assess one due to the manager being off duty. The remaining 10 have been repeated in this report, while five new requirements have also been made. What the service does well: What has improved since the last inspection? What they could do better: As just over half of the previous requirements remain unmet, and five new ones have been made, there is clearly further improvement to be made. It was disappointing that so many remained outstanding, given that most were not difficult to achieve, and could have been resolved with minimal effort. St John`s Nursing Home Limited DS0000019041.V268157.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 Limited DS0000019041.V268157.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 Limited DS0000019041.V268157.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): Not assessed on this visit. EVIDENCE: St John`s Nursing Home Limited DS0000019041.V268157.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): 9 and 10 Once again an error was found in the medication administration records. This means that the Inspector could not be satisfied that the service users well being was adequately protected in this regard. Clearly any mistakes in giving out medication can have serious consequences for the service users. From observation of the midday meal, the Inspector was not satisfied that service users were treated with as much respect as they should be. EVIDENCE: While the medication administration records had improved, a gap, where staff had failed to sign, was found in the records for the first floor. The manager needs to yet again reinforce to her staff the importance of ensuring that these records are correctly maintained at all times. The manager is also reminded that the home’s procedure for the disposal of medication needs to be updated so as to bring it into line with recent legislative changes. While walking around the home the Inspector was able to observe staff assisting residents with their meals. It was noted, in one bedroom, that rather than sit with the resident a member of staff was standing over them to assist St John`s Nursing Home Limited DS0000019041.V268157.R01.S.doc Version 5.0 Page 10 with the food. This shows a lack of respect for the service user, and implies that the carer does not have enough time to ensure that the service user receives their meal in an unhurried manner. St John`s Nursing Home Limited DS0000019041.V268157.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): 12 and 14 In spite of previous requirements, there did not appear to have been any increase in the amount of activities made available to residents. This means that their social, cultural, religious and recreational needs are most probably not being met. The Inspector was greatly concerned to find that one service user was being denied free movement around the home. While this was documented in the care plan, it was felt, nevertheless, that staff needed to give more thorough consideration to the difficulties posed by the resident, and find more acceptable solutions. It was not evidenced, therefore, that services users were being helped to exercise choice and control over their lives. EVIDENCE: Concerns had been previously expressed, by both the Inspector and relatives, that there was an insufficient amount of activities provided for service users. On this visit there was no evidence of any social activities (albeit it is accepted that the Inspector was not at the home all day, and the afternoons are traditionally when activities are made available), and senior staff were very vague about activity programmes. St John`s Nursing Home Limited DS0000019041.V268157.R01.S.doc Version 5.0 Page 12 On walking around the home the Inspector was perturbed to find one resident unable to exit from their bedroom because of a strategically placed armchair. On investigation it appeared that junior staff had no idea why the chair was blocking the doorway, while senior staff pointed to the agreement for this set out in the care plan. While it is accepted that wandering residents can be a danger to themselves and indeed to others, the solution is not to prevent them from exiting their rooms, but to ensure that their surrounding environment is as safe as possible. This would be determined by carrying out appropriate risk assessments, and then taking any remedial action necessary. St John`s Nursing Home Limited DS0000019041.V268157.R01.S.doc Version 5.0 Page 13 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 In spite of previous requirements for amendments to be made, the adult protection and restraint procedures were still incorrect, and would not offer sufficient protection to service users. EVIDENCE: On a number of previous occasions, the manager has been informed that the adult protection procedure must be revised, so as to bring it into line with the multi-agency (Local Authority) procedures. A revised procedure was produced however it seems to have been mislaid, and was not contained within the staff handbook. The restraint procedure still states that any decision to use restraint will have been previously discussed and the duration of the restraint agreed. This is impractical as restraint is usually used as a last resort and in an emergency to prevent harm to service users or staff. The procedure must be amended to reflect this. St John`s Nursing Home Limited DS0000019041.V268157.R01.S.doc Version 5.0 Page 14 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, 22, 24 and 26 In total nine requirements were made with regard to this section in the last report. As four remain outstanding, and one new one has been added, the Inspector was not satisfied that the environment was as well maintained as it could and should be. EVIDENCE: Previous requirements relating to the need for emergency bell cord pulls to be within reach, the need for additional transfer slings, the need for clinical waste bags, once full, to be removed from bathrooms, the need to regularly clean the extractor fans and the need for staff to have access to disposable gloves have all been met. Action is still needed with regard to the need to fix diffusers to all fluorescent lights, to ensure that the interior of the microwave is regularly cleaned, to ensure that all over-bed light cords are within reach of the bed and the need to repair the sink surround in bedroom S2. St John`s Nursing Home Limited DS0000019041.V268157.R01.S.doc Version 5.0 Page 15 While the ground and first floors were pleasant and odour free, the same could not be said of the second floor where there was a very strong smell of urine. This must be rectified. St John`s Nursing Home Limited DS0000019041.V268157.R01.S.doc Version 5.0 Page 16 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, 29 and 30 The rota provided indicated that staffing numbers were below the minimum levels previously agreed. This means that the needs of service users cannot always be attended to promptly. Following on from two Statutory Enforcement Notices, the recruitment practice has finally improved and on this visit it was felt that service users were being supported and protected by the recruitment practice. On this visit it was evidenced that new staff (in line with a previous requirement) were receiving an induction and this was being recorded. This means that service users should be cared for by appropriately trained staff. EVIDENCE: The rota provided indicated that while there were always the requisite numbers of trained staff on duty (albeit it was not possible to determine if there was always an RMN on duty (as previously required) as the rota did not indicate qualifications). Of concern was the failure on most occasions (during the day) to ensure that there were enough care assistants on duty. This is an issue that has been frequently raised with the proprietor, and it is disappointing to have to raise it again. Previously agreed staffing levels are 3 qualified staff (one RMN) plus 7 carers in the morning; two qualified (one RMN) plus 6 carers on in the afternoon/evening; and two qualified (again one RMN) plus 3 carers at night. St John`s Nursing Home Limited DS0000019041.V268157.R01.S.doc Version 5.0 Page 17 The files of two new staff were inspected. With the exception of one reference, which was still outstanding, the files contained all of the documentation required in the Regulations (albeit the home was still waiting for full CRB’s, but had obtained POVA firsts). This is a notable improvement and it is to be hoped that this can be sustained. It was previously required that the manager ensure that all new staff undergo an appropriate induction and that this is recorded. The files inspected contained an induction programme that in both instances had been signed by the new member of staff. St John`s Nursing Home Limited DS0000019041.V268157.R01.S.doc Version 5.0 Page 18 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): 37 and 38 The Inspector was not fully satisfied that the rights and best interest of the service users were adequately safeguarded due to inaccurate record keeping in some areas. In spite of a previous requirement regarding the temperature of the hot water (in excess of that recommended), on this visit the hot water was again ‘too hot’, thus putting the safety of service users at risk. Two new requirements were also made regarding service user safety. EVIDENCE: It has been commented on in previous reports that the home does have comprehensive risk assessment documentation in place, but that it had not been thoroughly reviewed for over a year, in spite of previous requirements to St John`s Nursing Home Limited DS0000019041.V268157.R01.S.doc Version 5.0 Page 19 this effect. On this visit it was not possible to determine if the risk assessment had been revised, as the manager was not on duty. Following on from a previous requirement regarding risk assessments for the service users, it was evident that regular assessments were being carried out with regard to pressure areas and also re moving and handling. What could not be evidenced, however, were behavioural risk assessments. These are of particular importance when caring for residents who may be confused. The hot water temperature was recorded in excess of 50°C (this was the upper limit on the thermometer, and the water became too hot to touch). This is dangerous for service users and must be rectified as a matter of urgency. In spite of comments made at one of the proprietor’s other home’s regarding inappropriately wedging open doors, it was noted on this visit that one bedroom door was being held open with a slipper. This was surprising, as some of the bedroom doors had been fitted with doorguards, in line with fire safety recommendations. Evidently more of these devices need to be purchased/fitted, and a requirement had been made to this effect. It was also noted that service users were being transported around the home in wheelchairs that did not have foot rests attached. Staff could be heard telling service users to “lift their feet”. This is potentially dangerous, for both service user and staff and can easily be rectified. St John`s Nursing Home Limited DS0000019041.V268157.R01.S.doc Version 5.0 Page 20 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 ENVIRONMENT CHOICE OF HOME Standard No Score 1 2 3 4 5 6 Standard No 19 20 21 22 23 24 25 26 Score X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 X X 3 X 2 X 1 STAFFING Standard No Score 27 1 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X 2 2 St John`s Nursing Home Limited DS0000019041.V268157.R01.S.doc Version 5.0 Page 21 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 OP9 Regulation 13 Requirement The manager must ensure that medication administration records are accurately completed at all times. The previously set timescale has not been met. The manager must ensure that staff take the time to sit with residents to assist them with their meals. The manager must ensure that an adequate number of activities are provided for service users. The previously set timescale has not been met. The manager must ensure that the staff team promote choice and independence amongst the service users, and that this is not intentionally restrained in any way. The POVA and restraint procedures must be amended. The previously set timescale has not been met. A number of fluorescent lights require diffusers. The previously set timescale has not been met. Staff must ensure that the inside of the microwave oven is DS0000019041.V268157.R01.S.doc Timescale for action 21/06/05 2. OP10 12 29/11/05 3. OP12 16 31/07/05 4. OP14 12 29/11/05 5. OP18 13 31/07/05 6. 7. OP19 OP19 23 16 31/07/05 21/06/05 St John`s Nursing Home Limited Version 5.0 Page 22 8. OP24 23 9. OP24 23 10. 11. 12. OP26 OP27 OP37 16 18 17 13. OP38 13 14. OP38 13 15. OP38 13 16. OP38 13 regularly cleaned. The previously set timescale has not been met. Staff must ensure that all overbed light cords/switches are within reach of service users whilst they are in bed. The previously set timescale has not been met. The sink surround in bedroom S2 must be repaired/replaced. The previously set timescale has not been met. The manager must ensure that the home is free from offensive odours. The proprietor must ensure that minimum staffing levels are met at all times. The manager must ensure that the required records are maintained to a satisfactory standard, this includes the need to have a photograph of each service user. The previously set timescale has not been met. The manager must ensure that a risk assessment is carried out re the premises and that this is regularly reviewed. (it was not possible to assess this, the requirement is therefore repeated) The manager must ensure that the bath hot water temperature does not exceed 43°C (on this visit it was measured at 50°C ). The previously set timescale has not been met. Bedroom doors must be wedged open. Appropriate, fire safety approved, devices must be fitted. Staff must ensure that foot rests are fitted to wheelchairs before being used to transport residents. 31/07/05 30/12/05 30/11/05 29/11/05 30/12/05 30/12/05 29/11/05 31/12/05 29/11/05 St John`s Nursing Home Limited DS0000019041.V268157.R01.S.doc Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard OP3 OP7 OP15 OP22 OP22 OP22 OP32 Good Practice Recommendations It would be good practice to review the pre-admission methodology to seek ways of making it more comprehensive. The manager should ensure that all care plans are regularly reviewed, and that this is recorded. It would be good practice for staff to sit with, rather than stand over, service users when assisting them at mealtimes. It would be helpful to service users if handrails could be fitted in all corridors. It would be beneficial to both service users and staff if the home purchased an additional hoist. There remains an onging need for more hospital type beds to be purchased. The manager should consider ways of delegating more responsibility to senior staff so that they have a better understanding of the complexities of the role of manager and can feel better prepared to deputise in the managers absence. The manager should ensure that she has a copy of the report of each Regulation 26 visit. The proprietor should obtain a reclining armchair so that a service user (identified to the care staff) can sit out of bed in comfort. 8. 9. OP37 OP8 St John`s Nursing Home Limited DS0000019041.V268157.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 John`s Nursing Home Limited DS0000019041.V268157.R01.S.doc Version 5.0 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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