CARE HOMES FOR OLDER PEOPLE
St John`s Wood Care Centre 48 Boundary Road London NW8 OHJ Lead Inspector
Ms Franki Solomon Unannounced Inspection 29th November 2005 10:00 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 Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St John`s Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St John`s Wood Care Centre Address 48 Boundary Road London NW8 OHJ 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) 020 7644 2930 020 7644 2940 Lifestyle Care PLC Ms Pamela Jane Brown Care Home 100 Category(ies) of Old age, not falling within any other category registration, with number (86), Physical disability (14) of places St John`s Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. For the provision of General Nursing Care for up to 14 young people aged 18 to 65 years with physical disabilities (No more than 6 beds to be used in this Unit for people over 60. People over 60 placed in this Unit should be mentally alert and produce a written letter or equivalent not to be placed in the Frail elderly unit The staffing Notice For the provision of General Nursing Care for up to 86 people aged 60 and over. From the day that the home receives the certificate of variation that a registered nurse be on duty for all shifts, viz (24 hours). 21st July 2005 2. 3. 4. Date of last inspection Brief Description of the Service: St Johns Wood Care Centre is a registered care home providing 24-hour support and nursing by registered nursing staff and trained carers. The home is owned by Lifestyle Care who are established in the development and management of Nursing homes and is the “Registered Provider” for St John’s wood Care Centre. St John’s wood Care Centre is purpose built and was first registered in February 2001. The home is set out as follows: *Lower Ground Floor: up to 14 Young Adults (18-65 yrs) with physical disabilities – YPD (Nursing). * Ground floor : up to 23 Older People (OP) Nursing Care. * First Floor : up to 27 Older People – Nursing Care. This includes one double bedroom for a couple, but used as a single room only. * Second Floor: up to 18 Older People – Nursing Care. * Third Floor : up to 16 Older People – Nursing Care. The home has a large well-laid out roof top area for residents and their visitors and is accessible to wheelchair users. The home provides nursing care for up to 100 residents. The home is situated in a prime residential area in North West London – St John’s Wood, close to
St John`s Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 Page 5 Swiss Cottage and approximately ten minutes walk to local amenities in Finchley Road and public transport. Parking is limited. St John`s Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second statutory inspection for the year April 2005 – March 2006. The inspection was unannounced and took place over one day, lasting 6 hours. The inspector met with the Deputy Manager (Head of Care) who was on duty in the morning and with the Registered Manager in the afternoon. The inspection was to check on the previous requirements made at the last inspection, those key standards not inspected at the last inspection, and to meet with residents and staff. The majority of the time was spent speaking with residents and relatives and touring the premises. The remainder of the time was spent examining records and speaking with the manager. The inspector would like to thank the residents, their relatives, staff and management for their hospitality and co-operation during this meeting. What the service does well:
The home has had a Variation to the Conditions of Registration to have all nursing care. The Registered Manager and Provider have been diligent to ensure that the existing residents’ stay was not disturbed or threatened and the change-over is being phased in gradually. Discussions with relatives and residents proved that the staff work well as a team and residents feel safe, well cared for and supported. Relatives expressed trust in management and staff. Relatives felt staff worked hard to provide a good service. Relatives were particularly satisfied that they could visit at any reasonable time and for any length of time. Relatives also commented that the office staff, registered manager and assistant manager were approachable and made them feel their parent/ relative was in good hands. Most residents said they liked the food. Where they did not, it was because they were under doctor’s orders about their diet. The home complies with regulations and ensures that residents have their rights respected, and that residents and relatives are consulted and involved within a risk assessment. Residents are made as comfortable as possible. St John`s Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 Page 7 Given the size of the home which is large, it is smart and well furnished. The home is well equipped with aids, facilities, and mobility aids to ensure the safety, comfort and dignity of service users. Records were generally well kept, given the format of the forms in care plans. Care Plans were up to date and gave a good description of residents’ needs. What has improved since the last inspection? What they could do better:
Laundry is still a problem. There is a need for some soiled clothing to be washed at high temperatures. This means that pleats are spoiled, colours run and the life of clothing is shortened. Further consideration should be given as to how this problem can be overcome. Care Plans should indicate the wishes of residents, for instance, particularly residents who are confused or have dementia. The written assessment should involve relatives and the information gained as to how the person used to live and dress. Residents’ Lifestyle and wishes on co-ordinated dress for example, should be observed. There are residents who have to remain in bed permanently and who find the under sheets uncomfortable. The home should explore having cotton sheets when specially requested.
St John`s Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 Page 8 When residents are reluctant to “make a nuisance of themselves” by ringing the call bell for assistance, staff should be pro-active; state this in the care plan and ensure they make regular checks in that room as to whether any task should be undertaken to keep the resident’s dignity and comfort. The training of staff, in particular agency staff, should be checked on their start day of induction to ensure they know how to meet service users needs and to provide a service in a professional manner, such as to address residents and visitors appropriately. 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 Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 Page 9 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 Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 Page 10 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): Standard 1. St John’s Wood Centre has had a variation to their registration and changes are being made to their Statement of Purpose. EVIDENCE: The home had a Variation to their registration in December 2004 to have all nursing care. The change is to be phased in over time, which ensures permanence for the present residents who do not require nursing care. The Statement of Purpose is being reviewed to reflect the Variation. A requirement has been made. St John`s Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 Page 11 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. Care plans on the whole reflect service uses’ identified needs. This was with the exception of one example where for an identified need of a service user there was no plan of action to address such need. A requirement has been made. EVIDENCE: A random sample of resident’s care plans were examined. On the whole the care plans were well written. The care plans were very descriptive, but did not always indicate the action that needed to be taken. When the inspector interviewed staff, it was clear that staff were well trained and skilled and knew what action needed to be taken in terms of the need identified. However, since the home does use agency staff, it is advisable to have clear records. For example, where it indicates that a resident has difficulty swallowing and might choke on their food, the identified need was recorded but not the action to prevent this risk was not recorded. A requirement has been made. St John`s Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 Page 12 The wording in one care plan was inappropriate, causing concern about how the staff regarded their position of power with a service user. This was discussed with the manager. The wording could have been changed to read “encourage” and “advice”, and should reflect a professional yet equal relationship. A recommendation has been made. Interviews with staff demonstrated that staff were well informed of service users needs and how to respond and act upon those needs. St John`s Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Efforts to resolve issues with residents’ laundry have as yet not been totally successful. Permanent staff are generally skilled and have appropriate training to meet the lifestyle needs of service users. Not all agency staff understand about professional boundaries, respect and appropriate forms of address. In general the residents at St John’s Wood Care Centre have high needs and spend most of their time in their room. Within those limitations the home ensures service users experience a fulfilling life. EVIDENCE: The home has monthly residents meetings. At these meetings and in conversation with relatives, the issue of laundry was still a problem. For instance, coloured clothes were thrown in together and ruined clothes. Pleated items were put in hot wash and spoiled. The registered manager informed this would be further investigated to resolve the issue. A relative said they would like to see their parent dressed in co-ordinated clothing as they did before they became ill. A requirement has been made.
St John`s Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 Page 14 One resident on the lower ground floor, said they would prefer cotton sheets which were not so hot and which did not slip on their mattress. The registered manager said she would see how this could be resolved. A recommendation has been made. In general residents at the home have high needs and are unable to leave their bed without support from carers. Care Plans were set out clearly and in detail about residents’ needs and residents confirmed they were consulted about their needs and wishes. Staff demonstrated they were familiar with residents’ physical needs. In one room on the lower ground floor a bottle was left in an inappropriate place. This was discussed with the registered manager and a requirement has been made. One resident said ‘permanent carers are skilled’ and that the only weak spot was that the Agency staff were ‘not up to speed’. An agency worker unknown to the inspector, greeted the inspector with the form of endearment, “darling” and appeared not to understand the need to observe certain protocols in regard to working in a home. A requirement has been made. Those residents who had some mobility were encouraged and supported to undertake activities of their choice and within a risk assessment. One resident in a wheelchair goes out with the assistance of a friend to such places as restaurants of their choice. Residents spoke well of all staff and said they were very satisfied with the care and support. They commented on the food; how good the food was. Relatives and visitors were visiting throughout the day. Those relatives who agreed to talk with the inspector, had high praise for all staff and gave details about the acts of skill and caring they experienced. Because of residents’ mobility restrictions, activities were limited. St John`s Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17. The home ensures residents are consulted and exercise their legal rights. EVIDENCE: The home encourages residents and their relatives to participate and make decisions about their care and support within the framework of a risk assessment. The home has made arrangements for residents to vote through the postal voting system. St John`s Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24. The home provides accommodation to residents to ensure they are comfortable and treated according to their needs and wishes. EVIDENCE: All rooms are single with en-suite wash basin and W.C. Rooms were suitably equipped with necessary aids and appropriately furnished. Some residents had personalised their rooms others had not. Most of the residents have high needs and have impaired mobility. Some are unable to leave their bed without aids and assistance. The home has all the necessary equipment to assure residents’ privacy and comfort, such as special mattresses, hoists, special bathing equipment and wheelchairs. Call bells were placed within easy reach of residents who were in bed and those call bells inspected were working. Residents said that staff respond at all times when call bells are used – including night time.
St John`s Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 Page 17 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): These standards were not inspected at this inspection. EVIDENCE: St John`s Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected during this inspection. EVIDENCE: St John`s Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 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 2 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X X X X X X 4 X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X St John`s Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 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 OP1 Regulation 4(1)(a-c) Requirement The Registered Person must revise the Statement of Purpose to reflect the change of Conditions to Registration. The Registered Person must ensure the Care Plan clearly identifies the action to be taken regarding identified needs. The Registered Person must ensure; • Residents clothing are taken care of • Residents are dressed as they would wish • Residents rooms are checked regularly and kept tidy and hygienic. The Registered Person must ensure all staff have appropriate induction training, respect the wishes of residents, enquire how they would prefer to be addressed, and address residents and visitors appropriately. Timescale for action 07/01/06 2 OP7 15(1) 24/12/05 3 OP12 12(1)(ab) 12(2) 12(3) 24/12/05 4 OP12 12(5)(b) 24/12/05 St John`s Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 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 2 Refer to Standard OP12 OP37 Good Practice Recommendations To research and try out cotton under sheets to make the resident’s permanent stay in bed more comfortable. For staff to be aware of appropriate language, verbal and written, to use about service users and recording protocol in terms of professional yet respectful equal relationships with service users. St John`s Wood Care Centre DS0000010324.V269643.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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