Inspection on 09/05/05 for St John`s Residential Care Home

This inspection was carried out on 9th May 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 22/06/05

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 9 May 2005 09:00 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 V225385 090505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service St Johns Residential Care Home Address 66 Hawthorn Bank Spalding Lincolnshire PE11 1JQ 01775 710567 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 N/A 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 V225385 090505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Dementia (22), Mental disorder, excluding learning disability or dementia (4), Old age, not falling within any other category (29) Date of last inspection 8th December 2004 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’. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V225385 090505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 7 hours, it was unannounced and was carried out by three inspectors. A tour of the premises was conducted, service users care records and staff records were inspected. Inspectors spoke with the acting manager, the area manager and the owner. Two staff, three service users and one relative were interviewed. An investigation visit was made to the home 03/03/05 and 18/03/05 as part of the most recent Adult protection investigation. The overall investigation findings and action required to be taken by the home is included within the report. What the service does well: What has improved since the last inspection? What they could do better: Some issues were identified, which could put service users at potential risk. Procedures regarding the admission, assessment and care of service users are not being followed by carers, in particular service users with challenging behaviour are not having their needs met. Systems must be put in place to ensure that service users receive their prescribed medication. Service users need to be offered a choice of menu and have their individual likes and dislikes met. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V225385 090505 Stage 4.doc Version 1.30 Page 6 When recruiting staff the correct procedures must be followed to ensure that staff have the skills and experience to do their job. There must be enough staff on duty and they must be fully supervised by the senior staff and manager. 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 V225385 090505 Stage 4.doc Version 1.30 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 V225385 090505 Stage 4.doc Version 1.30 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) 2, 3, 4, Procedures for the assessment of service users and admission to the care home are not being followed, therefore service users cannot be assured that their care needs will be met. EVIDENCE: A written Terms and Conditions for a service user was seen in a file, this had not been signed by either the service user or relative. There was evidence that service users were assessed prior to admission, however the detail within the assessments is not sufficient to inform a detailed plan of care, there was no date on some of the assessments and they had not been signed. During the most recent adult protection investigation some assessment information regarding service users was missing and information did not fully identify service users care needs. There was no written confirmation given to service users stating that the home was able to meet their care needs. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V225385 090505 Stage 4.doc Version 1.30 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) 7,8,9, 10 Service users with challenging behaviour are not having their needs met, this is having an impact on their care and is also having a detrimental effect on other service users residing in the care home by putting them at risk of harm. The medication procedures are not being followed; this is resulting in some service users not getting the medication they are prescribed. The care plans and risk assessment actions are not being followed by carers, the service users assessed care needs are therefore not being met. EVIDENCE: One relative described how she was happy with the care her husband was receiving, she was observed to have a good relationship with the staff on duty. The care plans seen did not include any reference to meeting the service users needs with challenging behaviour. Although risk assessments identified some risks they did not all state any actions to take to minimise the risk. One service user recently admitted to the home had eight accidents resulting in injuries in the last 6 weeks. Although it was clearly identified in the risk assessment that staff should supervise her at all times and encourage her to use a walking stick St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V225385 090505 Stage 4.doc Version 1.30 Page 10 the service user was observed to be mobilising around the home independently, both the acting manager and a senior carer were aware of this. The acting manager did explain how she had been liaising with a Community Psychiatric Nurse about the changing needs of a service user. One service user was described by the care staff as being regularly incontinent; there was no clear plan of care indicating how this should be managed. One service user was refusing to take medication on a regular basis, over the last 4 days 16 tablets had been refused, there was no evidence that the GP had been informed and no record of this in the care plan or daily contact sheets. There was no indication in either the care plan or the risk assessment of how to manage this, although the Medication Administration Record recorded whether the service user had refused. An item of medication that was regularly prescribed for a service user had been out of stock for 2 weeks, it could not be clarified whether this had been requested at any point. One carer had recorded that a service user had refused medication when she stated that there had been no attempt on that morning to actually administer the medication. One service user was prescribed an ‘as required’ medication, one carer was unable to give an accurate indication of when she would give this medication, there was no record of when to give the ‘as required’ medication in the care plan. The medication fridge temperatures had not been recorded on a daily basis. Two service users were observed mobilising around the home with bare feet. Staff said that this was usual. One service user sustained a cut to her left temple, which was dressed with steri strips on the 16th April, these were still in place 9th May. One carer said that she had asked the District Nurses when these should be removed but no action had been taken. Service users are not fully able to access supporting health services, for example, chiropody. Although it was stated in service users files that the care plans had been updated on monthly basis it was clear that the changes in service users needs had not been accurately reflected. The acting manager said that some of the service users could not be weighed on the scales available in the home and that she had requested that new ones be purchased. During the most recent adult protection investigation undertaken some medication records and care plan information was missing and records did not fully document how service users care needs were met or all medications as receipted into the home, as administered or disposed of. Records were not fully reviewed or updated as required. A complaint was upheld where a service users had not had there health care needs met. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V225385 090505 Stage 4.doc Version 1.30 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) 14, 15 Catering arrangements do not fully reflect or promote service users preferences and choices, although the quality of the food is adequate. Some service users enjoy the recreational activities provided. EVIDENCE: The wipe board upstairs did not have any detail of the menu for the day, the downstairs menu on display was incorrect, service users said that they did not know what was planned for lunch. Four service users and one relative stated that the food was generally good although residents are not fully notified that a choice of foods is available. Residents requested more variety of food although no suggestions were made. The homes meal records do not document the foods provided to each resident. Also, during the most recent adult protection investigation undertaken some care plan information and medication records regarding service users dietary needs was missing. The acting manager said that there had been no support to service users who wished to take part in the recent elections. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V225385 090505 Stage 4.doc Version 1.30 Page 12 Some activities were being organised and bingo had been planned to take place on the evening of the inspection. Information regarding forthcoming activities is displayed in the home although no records are maintained. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V225385 090505 Stage 4.doc Version 1.30 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 standard(s) These standards were not inspected during this visit. EVIDENCE: An investigation visit was made to the home 03/03/05 and 18/03/05 as part of the most recent Adult protection investigation. There have been several adult protection investigations within the past 12 months that the home have appropriately responded to. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V225385 090505 Stage 4.doc Version 1.30 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 standard(s) 19,20, 21,22, 24,25, 26 The standard of the physical environment within the home is satisfactory but some issues were identified, which could put service users at potential risk. Overall improvements in the decoration have been made since the previous visit. EVIDENCE: Many areas of the home had been re-decorated and re-carpeted since the previous inspection and this work continues. The home was generally clean and tidy. Service users said that they were happy with their rooms. Window restrictors are fitted to the majority of upstairs windows and bedrooms are fitted with a locking device. The floors in bathroom and toilet areas were worn and stained. The toilet door handle in room 16 was broken. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V225385 090505 Stage 4.doc Version 1.30 Page 15 Water temperatures are monitored and records maintained. A formal risk assessment has not been completed regarding legionella although tanks have recently been tested regarding this. Radiator protective covers are being fitted to all radiators in the home. A heater guard was not secured to the wall in the dining room, the heater was very hot to touch. There are 6 hoists in total, although on the morning of the inspection 4 of these were not working. Some odours were evident in two areas of the home. It was confirmed by the acting manager that care staff were living in part of the registered accommodation and the access is via some service users personal accommodation. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V225385 090505 Stage 4.doc Version 1.30 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 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, 28, 29, 30 The recruitment practices are not adequate, resulting in staff not having the skills and experience to carry out their role. Staff had not received sufficient training to enable them to meet the needs of service users. There are not enough staff on duty to meet the needs of service users having challenging behaviour. EVIDENCE: The staff rota demonstrates that 6 or 7 staff are allocated to work on each daytime shift, unless there are unexpected absences. Service users were not fully supervised, two service users were observed to be having an argument in the dining area just before lunch, and there were no carers around to manage this potentially difficult situation. Staff confirmed that there were often not enough staff on duty to meet the needs of service users. The staff files did not contain all of the required records to demonstrate that appropriate recruitment procedures had been followed. Although there is a training plan, this only identifies one course between November 04 and April 05. Two staff members had not received an induction; they had no previous experience working as carers. A senior carer reported that although she was responsible for overseeing the administration of medication she had not received training regarding this. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V225385 090505 Stage 4.doc Version 1.30 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 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) 36, 37, 38 The written and verbal communication systems in the home are not adequate. There are no systems in place to ensure that staff are appropriately supervised and working consistently as a team. EVIDENCE: There is an acting manager and a deputy manager who is supported by the area manager. The procedure to record accidents does not comply with the Data Protection Act, 8 records were not in individual service users files and were not kept in a secure area. The acting manager confirmed that that she did not always record discussions she had with relatives or professionals. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V225385 090505 Stage 4.doc Version 1.30 Page 18 Staff said that they are not receiving formal supervision and that the acting manager spent the majority of her time during each shift in the office. The acting manager stated that she was working 7 days a week to manage the home. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V225385 090505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 1 1 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 1 15 2 COMPLAINTS AND PROTECTION 2 2 2 1 x 3 2 2 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x N/A N/A N/A x x 1 1 1 St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V225385 090505 Stage 4.doc Version 1.30 Page 20 yes 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 OP2 Regulation 5 (1) (b) Requirement Timescale for action 20/6/05 2. OP3 14 (1) (c) and 13 (4) (c) and 12 (1) (a) and 15 (1) (2) 3. OP4 14 (1) (d) 4. OP7 13 (4) (c) and 14 (2) and 15 (1) (2) Service users must be provided with a statement of terms and conditions at the point of moving into the home. A full needs assessment must be 20/6/05 completed for all service users who are admitted. 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 timescale of 28/02/05 not met). The regisered person must 20/6/05 confirm in writing to the service user that the home can meet the care needs. 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. The plan for every service user must be reviewed each month and updated on a regular basis. Service users and their representatives (where appropriate) must be involved in Version 1.30 Page 21 St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V225385 090505 Stage 4.doc 5. 6. OP8 OP9 13 (1) (b) 13 (2) and Schedule 3 (i) (m) 7. 8. 9. OP10 OP14 and 15 OP19 12 (4) (a) 16 (2) (i) 16 (2) (j) and 23 (2) (p) and 23 (5) and 13 (3) (4) (a) 10. OP22 23 (C) 11. OP25 13 (4) 12. OP26 23 (2) (d) and 13 (3) the devising of care plans where possible. The home must meet each service users care needs. Service users must be able able to access supporting health services, including chiropody. The registered person shall make arrangements for the recording, handling and safe administration of medicines. Any medication that is not administered must be clearly recorded. A record of all medicines prescribed to each service user must be maintained. These must document all medicines as receipted into the home, as administered and as disposed of. Service users must wear their own clothes at all times. The home must provide and document a variety and choice of foods to service users. The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. Also, it is required that the heating system is fully serviced, including each radiator and that confirmation is received regarding this. (Initial timescale of 30.6.04 not met). Confirmation is required of the up to date servicing of the homes hoists and lifting equipment. A risk assesment to prevent legionella must be devised (Initial timescale of 28/02/05 not met). All radiators must be guarded or have low surface temperatures. All areas of the home must be clean and free of odours. 20/6/05 20/06/05 20/6/05 20/6/05 Immediate 20/6/05 20/6/05 20/6/05 St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V225385 090505 Stage 4.doc Version 1.30 Page 22 13. OP29 18 (c) (1) (2 and 19 (5) (b) 12 (1) (a) 14. OP30 15. OP31 8 (1) (a) 16. 17. OP36 OP38 18 (2) 17 (1) (a) (b) 18. OP38 26 Staff recruitment procedures must be followed to ensure that all staff have the qualifications, skills and experience necessary for the role. 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. All staff must receive regular supervision and records of these must be maintained. All records of accidents must be stored in accordance with the data protection act. For example, on each service users care file. The Registered Provider must visit the home at least once per month and prepare a written report regarding the conduct of the home, and supply a copy to the Commission. 20/6/05 20/6/05 20/6/05 20/6/05 20/6/05 20/6/05 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 OP17 Good Practice Recommendations Systems should be put in place to enable service suers to be able to vote during elections. St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V225385 090505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection CSCI, 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. Extracts may not be used or reproduced without the express permission of CSCI St Johns Residential Care Home C53 C04 S2421 St Johns Spalding V225385 090505 Stage 4.doc Version 1.30 Page 24 - 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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