Inspection on 09/01/08 for St John`s Nursing Home Limited

This inspection was carried out on 9th January 2008.

CSCI found this care home to be providing an Adequate service.

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 Limited 18/05/07

St John`s Nursing Home Limited 06/03/07

St John`s Nursing Home Limited 25/04/06

St John`s Nursing Home Limited 29/11/05

St John`s Nursing Home Limited 20/06/05

St John`s Nursing Home Limited 25/10/04

St John`s Nursing Home Limited 13/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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 Limited St John`s Nursing Home 129 Haling Park Road South Croydon Surrey CR2 6NN Lead Inspector Janet Pitt Key Unannounced Inspection 10:40 9 and 14th January 2008 th 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.V353985.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 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 primecare@hotmail.co.uk 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 ****Post Vacant**** 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.V353985.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th May 2007 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. It 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. At the time of this inspection St John’s had an acting manager, who is not yet registered. The home provides information about its services in a Service User Guide, which is made available to current and potential Service Users. Additional information can be found in the home’s Statement of Purpose. The current weekly fees range from £525 - £650. St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience adequate quality outcomes. Two inspectors undertook this unannounced inspection. Two site visits were made which lasted a total of eleven hours. People who live in the home and staff were spoken with during the site visits. The inspectors also spoke with some relatives of people who live in the home. Care records, medication records and staff files were examined. A tour of the premises was undertaken and lunch was observed on one day. Information from the home’s Annual Quality Assurance Assessment (AQAA) was also used to inform the inspection process. What the service does well: What has improved since the last inspection? Mealtimes have improved considerably since the previous inspection. One visitor commented that they were pleased with the new dining room, as their relative now takes meals there. Another visitor also confirmed this. Mealtimes are now more of a social event and people are able to eat in a relaxed environment. St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 6 Staff awareness of giving people choice is now more evident in their day-today practice. Care planning processes are starting to reflect the person’s individual needs and wishes. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use the service receive adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Assessments of people are starting to include information on their social needs, as well as health needs. Full completion of ‘life histories’ will make sure that people can be confident that they will be able lead a fulfilling life. Care must be taken to involve people in this process. The home does not offer intermediate care. EVIDENCE: The AQAA states that visits are encouraged to the home prior to making a decision on whether to live there. The home provides a Service User guide that details what is included in the service. St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 9 One person said that they had chosen St John’s, as they knew the home from when another relative lived there. They said that standards of care had dropped but this was starting to improve. Examination of care files indicated that assessments are carried out prior to a person being admitted and on admission. It is important that the home consistently evidences involvement of the person or their representative. People’s information on pre admission information is staring to be included in the home’s own assessment as required at the previous inspection. All assessments must be fully completed to make sure that all needs are identified. On some assessments personal detail sheets were not completed and there was a lack of information on a person’s lifestyle. The assessments are beginning to be person centred with information on personal preferences such as what clothes a person likes to wear. One person was noted to have particular dietary choices and when observation was made at lunchtime this person had food of their choice. St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 People who use the service receive adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Care plans have improved significantly and are beginning to be person centred. There are some gaps in information contained within care plans, but staff are able to provide care in a person centred way. The home understands the need to comply with safe medication procedures, but needs to make sure that these procedures are followed. Staff are aware of the need to treat individuals with respect and to consider dignity when delivering personal care. EVIDENCE: People in the home have care plans that reflect how care should be given in order to meet need. There has been significant improvement in making the plans person centred and specific instructions are in place to enable care to be consistent. Information on social history has improved, and where ‘Life History Diaries’ are used good information is available to assist in planning a persons day. The St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 11 person or their representative had completed some diaries. Further work is needed to make sure that detailed social history’s are in place. Information was available on a person’s religion, but this was not consistent. One person was noted to have no religion, but attended services held at the home. Another person did not have a religion noted, but their diary stated that they used to go to church regularly. It is important that people are enabled to continue their religious or spiritual practices, if they choose. Night care plans detail routine and times for rest and waking up. Daily records are starting to reflect how a person has spent their day. The entries were seen to be dated and timed, but required legible signatures. There was evidence of whether a person had had a shower or a bath and visits by relatives or friends were also recorded. Visits from other health professionals are recorded. People who have wounds or pressure sores need to be sure that these will be monitored correctly. Photographs are taken routinely if a person consents and there was evidence of each dressing change, however measurements of wounds and times for dressing changes must be specific. Advice from tissue viability nurses had been followed. One person had been noted to have bruising, this was recorded on a body map, but there was no evidence of how it might have occurred. One person was noted to be declining to have their blood glucose monitored. It was not clear from their records why this needed to be done. This was discussed with a member of staff who said that the person had diet control diabetes. An alternative method, such as urine testing could be more appropriate, thus decreasing stress for the person, but maintaining safe monitoring of the person’s condition. People need to be confident that there is safe handling of medications into and out of the home. Medications were inspected and it was concluded that there was not an auditable trail of medications. The majority of medications are supplied in blister packs. However, staff need to make sure that a record of receipt of all medications is made, either on the Medicine Record Sheet (MAR) or in a specific book. When examining the MAR sheets it was noted that one person had apparently had some of their medication discontinued, but there was not record of a visit from the general practitioner to evidence this. The manager stated that the Primary Care Trust would be visiting St John’s to undertake an audit of the medications. St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 12 Some people’s end of life wishes were noted to be recorded, but this needs to be consistent. St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People who live in the home are able to plan how to spend their day and are supported to lead active lives. Support is given to people who need assistance with eating and meals are taken in comfortable surroundings. People are able to chose what they eat and staff make sure that choices are available. Improvement is needed to make sure that social needs of people are met fully. EVIDENCE: People who live in the home are able to enjoy their meals in pleasant surroundings. Lunch was observed in two areas of the home. Both areas had tables that were attractively laid with condiments, large cloth napkins and suitable cutlery. People who live in the home were given a choice of what hot meal they wished to have. Other people opted for sandwiches that were freshly prepared. Portion size was seen to be adequate and people were offered more food it they were still hungry. One person was asked if they would like ‘second helpings’ and was given another meal, which they were seen to enjoy. St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 14 Another person had only eaten part of their hot meal and was offered some sandwiches as an alternative. Pureed diets were presented attractively and staff made sure that the separate foods were not mixed together. Each table had jugs of cranberry juice and orange squash. In one area people were offered hot drinks after their meal, but this needs to be offered in both areas. One person decide to leave the table after eating their main meal, staff made sure that this person did not want more food or drink. Staff were noted to be interacting positively with people who live in the home during the meal. They made sure that time was given to allow a person to eat at their own pace and patiently explained the choices available. It is recommended that heated trolleys are purchased to make sure that food is kept hot prior to serving. The home’s Annual Quality Assurance Assessment indicated that activities provided need to be improved on. The plans are to involve staff more in the provision of activities, not just the activities co-ordinator. People who live in the home are asked about their interests and are able to have visitors and go out with their families. A photo board was prominently placed in the front lobby; this had photographs of Christmas activities and staff photos with their names to make identification easier. St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People who live in the home can be confident that their concerns will be listened to and acted upon. Staff have become more aware of the importance of Safeguarding Adults and have changed their practice as a result of this. EVIDENCE: The home is developing an open approach to concerns or complaints. Examination of the complaint records showed that outcomes were present. The home’s AQAA stated that a ‘conscious effort is made to get to know relatives.’ This was evident when speaking with visitors in the home. It was noted that visitors were welcomed and offered refreshment. We were able to view a folder containing complainants the staff and home have received. Staff within the home have changed their practice as a result of Safeguarding Adults investigations in the past year. St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People live in a home that is clean and tidy and maintained. There are sufficient areas of the home for people to relax and socialise if they chose. EVIDENCE: The AQAA states that improvements have been made to the environment, with new carpeting in communal areas and rooms are to be redecorated when they become vacant. Staff who are employed as domestic will have the opportunity to undertake NVQ training in cleaning. The manager is in the process of developing a practical cleaning schedule for the home. On the site visits the home was found to be clean and tidy, with no malodours. St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 17 The décor and maintenance was of a good standard and the garden was seen top be well kept and accessible. More use is being made of the two lounges downstairs, use of the front lounge as a dining room has improved the ambience of the home and enables people who live there to socialise if they chose. This has also made it easier for visitors to sit with people who live in the home. The works on the kitchen have been completed and the food preparation areas were observed to be clean and organised. The home has been awarded a Food award from the council since the previous inspection. St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Recruitment practices have improved and only a few issues around references and work history need to be addressed. Appropriate checks are carried out on staff prior to them commencing employment. Training is focus to make sure that practice is changed if needed. Rota and observations on site visits indicate that there are sufficient numbers of staff to support people. EVIDENCE: Examination of staff files indicated that the recruitment process has been tightened up to make sure people in the home can be confident that staff are appropriately recruited. However, some further work is needed to make sure all information is available. Care must be taken to make sure that references from the previous employer is obtained and a full employment history is detailed. The majority of staff files had a recent photograph of the employee. Care is needed to make sure that an application form is completed prior to an interview. St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 19 Concerns have been brought to our attention regarding the availabity of staff and their working hours. On the two site visits there were adequate numbers of staff. Staff spoken with did not raise any concerns about working hours. Staff were welcoming and routinely offered refreshments or assistance with the inspection if needed. Examination of the staff signing in book showed that the majority of staff did not stay for unreasonable times after their shift ended, there were only a few occasions in a four month period where this had happened. The duty rota showed that were not exceeding working time directives. The home acknowledges in their AQAA that staff need to be appropriately trained to do their job and has reviewed training offered. Training is now provided by a variety of internal and external trainers and checks are made to make sure staff have received mandatory updates. St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use the service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Staff and people who live in the home have a proactive manager who is aware of the need to involve all relevant people in the running of the home. Comments to improve the service are acted upon and evaluated. People are able to maintain control over their personal finances if they chose to. EVIDENCE: The manager was in the process of registering with CSCI and was due to have her fit person interview. In the AQAA she identified areas for further improvement, such as trial periods to enable people to make a choice about whether they wished to live in the home. St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 21 She acknowledges the need to continue to improve staff files, training provision and the keyworker system, to make sure that people receive appropriate support and their needs are met. Information from the AQAA shows that people are able to retain control of their finances or their relatives give support. Surveys have been distributed to people and their representatives to gain their views on the running of the home. The manager stated that she intends to make sure that relative/residents meeting are held on a regular basis, to enable progress to be continued. No health and safety issues were identified at the time of the site visits. St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 23 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 OP9 Regulation 13 (2) Requirement There must be an auditable trail of medications into the home and evidence available if changes are made to people’s treatment. Timescale for action 30/08/08 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 Refer to Standard OP3 OP7 OP7 Good Practice Recommendations It is recommended that assessments consistently evidence involvement of the person or their representative. The progress already made in this area should be sustained. It is recommended that care plans are formulated with the involvement of the person or their representative. The progress already made in this area should be sustained. It is recommended that care plans include details of how religious needs are to be met and particular interests of people who live in the home. The progress already made in this area should be sustained. It is recommended that skin integrity is monitored and recorded accurately. The progress already made in this area should be sustained. DS0000019041.V353985.R01.S.doc Version 5.2 Page 24 4 OP8 St John`s Nursing Home Limited 5 6 OP15 OP29 It is recommended that a hot trolley is purchased to maintain the temperature of food prior to serving. It is recommended that application forms are reviewed to make sure the relevant information is requested. St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St John`s Nursing Home Limited DS0000019041.V353985.R01.S.doc Version 5.2 Page 26 - 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. 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