Inspection on 22/06/05 for St John`s Residential Care Home

This inspection was carried out on 22nd June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 Residential Care Home 21/05/07

St John`s Residential Care Home 23/05/06

St John`s Residential Care Home 09/05/05

St John`s Residential Care Home 08/12/04

St John`s Residential Care Home 05/05/04

Similar services:

Trevayler Residential Care Home

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

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

CARE HOMES FOR OLDER PEOPLE St Johns Residential Care Home 66 Hawthorn Bank Spalding Lincolnshire PE11 1JQ Lead Inspector David Bacon Unannounced 22 June 2005 09:30 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 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 Johns Residential Care Home C53 C04 S2421 St Johns Spalding V235360 220605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service St Johns Residential Care Home Address 66 Hawthorn Bank Spalding Lincolnshire PE11 1JQ 01775 710567 01775 720072 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr A Kachra Care Home 55 Category(ies) of OP Old Age Both 29 registration, with number DE Dementia Both 22 of places MD Mental Disorder Both 4 St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V235360 220605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The home is registered to provide personal care for a maximum of 37 service users of both sexes whose primary needs fall within the following categories:Old age, not falling within any other category (OP) (29) Dementia (DE) (22) Mental Disorder (MD) (4) The maximum number of service users to be accommodated is 37 and no further admissions are to be made without the agreement with the Commission. Date of last inspection 9 May 2005 Brief Description of the Service: St Johns Residential Care Home is a large Victorian building, which has been extended to provide additional accommodation. The accommodation is located on two floors. The home is registered to provide care for 55 service users in the dementia, mental disorder and old age categories. At present there are restrictions regarding the overall number of service users allowed to be accommodated and there can be no new admissions. The provider has agreed to the restriction to enable him to develop and implement systems to raise standards in the home. The home is situated approximately one mile from the centre of the market town of Spalding, which has a wide range of amenities. The home has grounds at the rear, laid to lawns and flower-beds, with car parking situated to the side and rear of the property. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V235360 220605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Three inspectors carried out this unannounced inspection, which took place over 5 hours. Inspectors spoke with the acting manager and the owner. Two staff, three service users and one relative were interviewed. Service users care records were inspected as were the homes accident records. An Adult protection investigation was undertaken during this visit following an allegation, which has not yet been concluded. What the service does well: What has improved since the last inspection? What they could do better: Service users are put at potential risk as a comprehensive assessment of each individual’s care needs is not undertaken and the care records do not clearly document and instruct staff regarding how these are to be met. Staff are not all aware of adult protection policies and procedures and care staff must receive statutory training to meet the assessed needs of service users. The homes aids and adaptations must be suitable to meet the needs of each service user. The home must, more adequately meet the care needs of service users having continence needs and must address the odours of urine within the home. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V235360 220605 Stage 4.doc Version 1.40 Page 6 A formal Social Work assessment must be undertaken of one service user to enable the home to be more fully aware of and to appropriately meet the individual’s care needs. 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 Johns Residential Care Home C53 C04 S2421 St Johns Spalding V235360 220605 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V235360 220605 Stage 4.doc Version 1.40 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 standard(s) 3 Procedures for the assessment of service users upon admission to the care home are not being followed, therefore service users cannot be assured that their care needs will be met. Risks regarding falls must be fully assessed and give clear details of the action required to be taken to minimise these. EVIDENCE: Some improvements had been made regarding the assessment of service users since the previous inspection although assessment information does not fully identify each service users care needs to create a detailed plan of care. One service user did not have their care needs accurately assessed. A service user having challenging behaviour did not have this documented within their care plan and an inadequate risk assessment resulted in other service users and staff being placed at risk. Also, there have on occasion been significant numbers of falls within the home. At present no service users are being admitted to the home due to restrictions being placed following concerns being raised regarding standards of care in the home. The provider has agreed to the restriction to enable him to develop and implement systems to raise standards in the home. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V235360 220605 Stage 4.doc Version 1.40 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 standard(s) 7, 8 Service users are not all having their needs met, this is resulting in other service users and staff being at risk of harm. The care plans and risk assessments do not contain sufficient information to enable care staff to appropriately meet each service users care needs. EVIDENCE: Some improvements have been made regarding the homes care recording systems and some records contain more information regarding service users needs. However, care records do not fully identify service users care needs or provide staff with sufficient information to meet these, which results in placing individuals at risk. The records of one service user having challenging behaviour, did not document this or the action required to be taken by care staff in the event of this behaviour being displayed. Another service user did not have their care needs accurately assessed, which would impact on the care they received. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V235360 220605 Stage 4.doc Version 1.40 Page 10 At least two service users have continence needs and a strong odour of urine was observed in an upstairs area of the home. The service users care records did not clearly detail how these specific needs were to be met. The care records seen had been updated on monthly basis although it was clear that the changes in service users needs had not been accurately recorded. Also, records did not demonstrate that service users, or their representatives where appropriate had been consulted with regarding the care plan. Some records of accidents could not be located although these records are now generally maintained within service users care records. Medication is being covertly administered to least one service user and although the acting manager said that permission had been given by the General Practitioner the written evidence giving permission for this practice could not be located. One relative confirmed that they were satisfied with how their loved one was treated in the home. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V235360 220605 Stage 4.doc Version 1.40 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 standard(s) These standards were not assessed on this occasion. EVIDENCE: St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V235360 220605 Stage 4.doc Version 1.40 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed on this occasion. EVIDENCE: An Adult protection investigation was undertaken during this visit, which remains unconcluded at the time of writing this report. There have been two adult protection investigations within the past 12 months. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V235360 220605 Stage 4.doc Version 1.40 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 26 The standard of the decorating, furnishings and carpets within the home is satisfactory although some issues were identified, which put service users at potential risk. EVIDENCE: Many areas of the home have been re-decorated and re-carpeted within the past six months. The home was generally clean and tidy although significant odours reminiscent of urine were apparent in the upstairs areas. One of the homes hoists was not working properly and one of the hoist slings was not appropriate for one service user. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V235360 220605 Stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 The recruitment practices are not adequate, resulting in staff not having the skills and experience to carry out their role. Staff are not sufficiently trained to enable them to fully meet the needs of service users. The managers have reviewed how staff are being deployed within the home with the intention of minimising risks to service users. EVIDENCE: The inspectors viewed the staff rota and spoke with staff who demonstrated that alterations were being made with how staff are deployed within the home to minimise risks to service users. For example, within lounge and dining areas. Service users were supervised throughout the inspection and staff confirmed that there were now more staff on duty during busy periods. The acting manager confirmed that staff files did not contain all of the required records to demonstrate that appropriate recruitment procedures had been followed, which had been identified during the most recent inspection. A training plan is in place although staff have not received all statutory training to meet service users care needs. Staff members do not receive an adequate induction upon commencing work at the home. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V235360 220605 Stage 4.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed on this occasion. EVIDENCE: St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V235360 220605 Stage 4.doc Version 1.40 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION x x x 2 x x x 2 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V235360 220605 Stage 4.doc Version 1.40 Page 17 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 OP3 Regulation 14 (1) (c) and 13 (4) (c) and 12 (1) (a) and 15 (1) (2) Requirement Timescale for action Immediate 2. OP7 13 (4) (c) and 14 (2) and 15 (1) (2) A full needs assessment must be completed for all service users admitted to the home. Care assessments must detail all items included within standard 3. Care records must demonstrate where service users are party to the devising of the care plan. A comprehensive risk assessment must be completed for each service user (previous timescales of 28/02/05 and 200605 not met). Also, the service user (name identified during the visit) must be re-assessed. A comprehensive care plan must Immediate be completed for each service user, which must clearly identify each service users needs and demonstrate how these are met. Service users and their representatives (where appropriate) must be involved in the devising of care plans where possible. The home must meet each service users care needs (previous immediate requirement during inspection 090505 not met). Version 1.40 Page 18 St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V235360 220605 Stage 4.doc 3. OP22 23 (C) 4. OP26 23 (2) (d) and 13 (3) 18 (c) (1) (2 and 19 (5) (b) 5. OP29 6. OP30 12 (1) (a) 7. OP31 8 (1) (a) 8. OP36 18 (2) 9. OP38 17 (1) (a) (b) 10. OP18 13 (6) Confirmation is required of the up to date servicing of the homes hoists and lifting equipment (previous timescale 200605 not met). Also, appropriate slings and moving and mobilising equipment must be provided to meet the individual needs of servce users. All areas of the home must be clean and free of odours (previous timescale 200605 not met). Staff recruitment procedures must be followed to ensure that all staff have the qualifications, skills and experience necessary for the role (previous timescale 200605 not met). Staff must receive an induction and ongoing training to give them the skills to promote and make proper provision for the health and welfare of service users. A registered manager must be appointed who is qualified, competent and experienced to run the home (previous timescale of 200605 not met). All staff must receive regular supervision and records of these must be maintained (previous timescale of 200605 not met). All records of accidents must be stored in accordance with the data protection act. For example, on each service users care file (previous timescale of 200605 not met). Staff must attend awareness training regarding adult abuse. Immediate Immediate 09/08/05 14/07/05 09/08/05 09/08/05 14/07/05 Immediate St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V235360 220605 Stage 4.doc Version 1.40 Page 19 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 Good Practice Recommendations St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V235360 220605 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection 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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