Inspection on 23/05/06 for St John`s Residential Care Home

This inspection was carried out on 23rd May 2006.

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 Residential Care Home 21/05/07

St John`s Residential Care Home 22/06/05

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 John`s Residential Care Home 66 Hawthorn Bank Spalding Lincs PE11 1JQ Lead Inspector Mick Walklin Key Unannounced Inspection 23rd May 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St John`s Residential Care Home DS0000002421.V296089.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 Residential Care Home DS0000002421.V296089.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St John`s Residential Care Home Address 66 Hawthorn Bank Spalding Lincs PE11 1JQ 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) 01775 710567 01775 720072 www.countrycourtcarehomes.com Mr Abdul Kachra Helen Finlay Care Home 55 Category(ies) of Dementia (22), Mental disorder, excluding registration, with number learning disability or dementia (4), Old age, not of places falling within any other category (29) St John`s Residential Care Home DS0000002421.V296089.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide personal care for up to 55 service users of both sexes whose primary needs fall within the following categories:Dementia (DE) (22) Mental disorder, excluding learning disability or dementia (MD) (4) Old age, not falling within any other category (OP) (29) The maximum number of service users to be accommodated is 55. Date of last inspection 22nd June 2005 Brief Description of the Service: St Johns Residential Care Home is a large Victorian building, formerly known as the Old Vicarage, which has been extended to provide additional accommodation. The accommodation is located on two floors, which are run as separate units. The home is registered to provide care for 55 service users in the dementia, mental disorder and old age categories. 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 large grounds laid to lawns and flower- beds, with car parking situated to the side and rear of the property. The aim of the home is stated as to provide a customer focused service, meeting individual needs and preferences. Information provided in the pre-inspection questionnaire confirmed that current fees are £335 - £500 per week. St John`s Residential Care Home DS0000002421.V296089.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was undertaken using a review of all the information available to the inspector regarding the service history of St Johns, and through undertaking a visit to the home. The fieldwork visit took place over 8 hours. The main method of inspection used was called case tracking which involved tracking the care three residents receive, through the checking of their records, discussion with them and the care staff and observation of care practices and interactions. A tour of the premises was conducted with a trainee manager. Documentation relating to the management of the home was also inspected. A pre-inspection questionnaire was received, together with two residents feedback forms. What the service does well: What has improved since the last inspection? What they could do better: Care plans still require further work to make sure that they fully reflect the care needs of residents. Medication records should be fully completed, to St John`s Residential Care Home DS0000002421.V296089.R01.S.doc Version 5.2 Page 6 ensure that medication errors do not occur. Accident records must be stored in a confidential manner, and staff must ensure that residents are safe when being hoisted. Staff supervision should be more regular, to ensure that they are properly supported. 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 Residential Care Home DS0000002421.V296089.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 Residential Care Home DS0000002421.V296089.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The procedures for assessing residents before they are admitted ensures that their needs can be met. EVIDENCE: One resident that was case tracked had been admitted to the home three weeks ago. She said that it had been an emergency admission, and her son and daughter-in-law had visited the home, but she had been unable to because of her circumstances. Although she said that “It all happened very quickly and it’s all been a bit strange”, she confirmed that staff had been supportive in helping her settle in. Because the admission had been an emergency, there was evidence that the manager had received information via the telephone in order to complete the pre-admission assessment, and a letter had been sent, confirming that the home could meet her needs. A further assessment had been carried out on admission, and a plan of care prepared. The home does not provide intermediate care. St John`s Residential Care Home DS0000002421.V296089.R01.S.doc Version 5.2 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): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans contain a good range of information, but some do not fully reflect the needs of residents. There are good arrangements with local health care providers, but medication administration records are incomplete. EVIDENCE: Care plans contain a good range of information about residents needs, including a range of assessments, and social services community care plans. There are risk assessments for falls, manual handling, pressure sores and nutrition, as well as general risk assessments. Of the three care plans inspected, one clearly reflected all the assessed needs of the individual resident. The other two, although containing detailed information about residents care needs, did not fully reflect all their needs. For example, one had diet controlled diabetes, and the other had leg ulcers, but there were no specific care plans relating to either of these. Care plans are reviewed on a monthly basis, and key workers said that they now are more involved in their preparation and review. The manager has St John`s Residential Care Home DS0000002421.V296089.R01.S.doc Version 5.2 Page 10 endeavoured to involve residents, or their representatives, and a letter has been sent to all relatives inviting them to contribute to the care planning process. Residents confirmed that their health needs are well met. They said that doctors are contacted promptly if they have a problem, and that podiatrists, opticians and dentists visit. One resident complained about her false teeth that had been broken, but the manager had not been made aware of this. Another resident had been admitted to hospital on the morning of the inspection, after complaining that she felt unwell. As she was diabetic, staff had recognised symptoms, and contacted the paramedics promptly. A visiting District Nurse said that she has a good working relationship with staff, and that there had been “big improvements” in the home over the past few months. Medication is stored on both floors, and the storage and administration records on the ground floor were inspected. The home uses a pre-packed administration system, and storage and stocktaking arrangements were found to be satisfactory. However, there were gaps in the administration records for two residents, where staff had omitted to sign them. Residents confirmed that staff respect their privacy and dignity. Several residents choose to lock their bedroom doors during the day. St John`s Residential Care Home DS0000002421.V296089.R01.S.doc Version 5.2 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, 13, 14 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are a range of activities for residents to participate in, to ensure that they have a stimulating and enjoyable timetable, but this could be extended to be more varied. Standards of catering are good, and reflect individual choices. EVIDENCE: Care plans contain personal preference sheets, which outline their likes, dislikes and preferred routines. However, some activity records on care plans appeared to be incomplete. Residents gave conflicting information about the level of activities available in the home. During a group discussion, one resident commented that there is “little or nothing going on”, and another said, “I sleep a lot”. However other residents gave examples of activities that they had undertaken over recent days, which they said that they have enjoyed. There is an activity timetable, which outlines activities available in the afternoons, but this could be expanded to offer more variety over mornings/afternoons/ evenings. The manager said that they are looking into employing an activity co-ordinator, and residents said that they are getting out more into the community. St John`s Residential Care Home DS0000002421.V296089.R01.S.doc Version 5.2 Page 12 Residents confirmed that they have good contact with their relatives, who are able to visit at times convenient to them. It was not possible to interview any relatives at the time of the inspection. Two cooks are employed, and residents praised the standards of catering. A menu is displayed, and residents are asked for their choices prior to serving, and individual choices were observed to be catered for. One newly admitted resident said that she does not eat meat, and alternatives are provided. Another resident said, “we had a lovely dinner today, but every day is good”. The kitchen was inspected by the Environmental Health Officer in December, who awarded the home the ‘Two Tulip Award’ (good) for standards of cleanliness. St John`s Residential Care Home DS0000002421.V296089.R01.S.doc Version 5.2 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): 16 & 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have confidence in the complaints procedure, but the home’s adult protection guidelines are misleading, and have been removed. EVIDENCE: There have been two complaints to the home since the last inspection. One was a concern from a resident about her evening routine, and the other was a concern from a relative, both of which the manager resolved. A resident said that “Staff are very helpful, and they try to sort any problems out. I have complained about one or two little things, but they have been sorted”. Another resident said, “If anything goes wrong, the staff will sort it out”. Staff have received training relating to adult protection, and those interviewed demonstrated a good knowledge of the procedures. Copies of relevant guidance are available for reference in the office. However, the homes own policy gives incorrect advice to staff about investigating allegations, prior to reporting to Social Services. The manager agreed to remove this policy, and replace it with the Lincolnshire Adult Protection Committee Guidelines, so no requirement was made. St John`s Residential Care Home DS0000002421.V296089.R01.S.doc Version 5.2 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 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable environment for residents to enjoy. EVIDENCE: The home presented as clean and well maintained, with a good standard of decor. All residents interviewed were happy with the standard of their accommodation. The previous inspection identified that hoists had not been serviced, and that there was an unpleasant odour in some areas of the home, but both these issues have been resolved. One of the downstairs toilets requires a soap dispenser to be installed, and the wheelchair storage in one of the upstairs shower room requires reviewing to prevent the risk of residents tripping when they are going to the toilet. St John`s Residential Care Home DS0000002421.V296089.R01.S.doc Version 5.2 Page 15 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, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are well trained, and recruitment and selection processes are robust to protect residents. EVIDENCE: Six staff are employed on each shift, three covering each floor. The manager works as supernumerary, and two cleaners, a laundry assistant, a cook and kitchen assistant are employed. Both staff and residents confirmed that staffing levels are adequate, and one resident said, “The staff are ever so good”. The home has well organised training records to ensure that staff receive regular updates, and staff praised the level of training that they receive. One said, “Things have really improved – we didn’t used to get much, but we are doing so much training now, including NVQ’s. (National Vocational Qualifications). A number of staff have undertaken, or are undertaking NVQ training, and some staff have been recruited from overseas, who hold a nursing qualification in their own country. The organisation employs a trainer who holds a nursing qualification. The previous inspection identified that staff were not receiving an adequate induction, but new staff confirmed that they had received a thorough induction, and induction checklists were seen on staff files. St John`s Residential Care Home DS0000002421.V296089.R01.S.doc Version 5.2 Page 16 The files of four newly employed staff were inspected, and all contained evidence of a robust recruitment and selection procedure, with the necessary documentation to protect residents. St John`s Residential Care Home DS0000002421.V296089.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well managed and organised, but some health and safety issues were identified, which could potentially put residents at risk. EVIDENCE: The manager recently attended a fit-person interview with the Commission, and has now been approved as Registered Manager. Staff and residents said that the home is well managed, and the manager was described as supportive, with an open door policy. One member of staff said, “We are doing the same work, but there is not the strain that there was – everybody is much happier”. The owner pays regular visits to the home, and quality monitoring questionnaires are sent out every six months to residents and relatives, to ascertain their satisfaction of the service. The last questionnaire was sent out St John`s Residential Care Home DS0000002421.V296089.R01.S.doc Version 5.2 Page 18 in March, and 11 responses were received, which were overwhelmingly positive. The results were collated into a chart for the information of residents, relatives and staff. A residents and families meeting was organised in March, but no relatives attended. However, residents were given the opportunity to contribute ideas and views, and those interviewed during the inspection said that they are well consulted. There are satisfactory procedures for dealing with residents finances, and two balances were checked and found to be correct. Health and safety documentation is well organised, with regular checks being conducted. However, during a tour of the building, some hazardous dishwasher tablets were found unlocked in the kitchen. These were removed immediately to the COSHH cupboard. It was also observed that whilst staff were using a mobile hoist to transfer residents from wheelchairs to armchairs, the residents appeared to be uncomfortable, apparently slipping downwards in the hoist when being transferred. This was discussed with a senior member of staff, who confirmed that staff were using the wrong type of sling for the transfer. The manager agreed to resolve this as a matter of urgency. St John`s Residential Care Home DS0000002421.V296089.R01.S.doc Version 5.2 Page 19 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 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x 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 3 x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 x 2 St John`s Residential Care Home DS0000002421.V296089.R01.S.doc Version 5.2 Page 20 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 OP7 Regulation 15 Requirement The registered person must ensure that care plans fully reflect the needs of service users. (Original timescale of 9/5/05 not met, but progress has been made). The registered person must ensure that medication administration records are fully completed. The registered person must ensure that all records of accidents are stored in accordance with the Data Protection Act. (Original timescale of 20/6/05 not met, but progress has been made). Timescale for action 31/07/06 2. OP9 13(2) 31/07/06 3. OP38 17 (1) (a) (b) 31/07/06 4. OP38 13(4) & (5) The registered person must 30/06/06 ensure that there are safe systems for moving and handling service users St John`s Residential Care Home DS0000002421.V296089.R01.S.doc Version 5.2 Page 21 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 OP36 Good Practice Recommendations It is recommended that staff should receive supervision 6 times a year. St John`s Residential Care Home DS0000002421.V296089.R01.S.doc Version 5.2 Page 22 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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