Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 30/07/08 for St John`s Wood Care Centre

Also see our care home review for St John`s Wood Care Centre for more information

This inspection was carried out on 30th July 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

No requirements or recommendations were set a t he last inspection. The manager has a clear idea of the strengths and weaknesses of the service. Where staff require extra support and supervision to improve practice this is being given. It is a service that takes complaints seriously and will learn from the outcomes. There have been improvements to the environment.

What the care home could do better:

Although there has been improvements to some areas in the home because of its` size this is an ongoing project. On one floor scuff marks on walls and skirting boards were noted. A couple of carpets were marked and some of the laminate on the furniture was damaged. An area for improvement is the need for ventilation during hot or humid weather. Several rooms were recorded as "hot" on the thermometers and this can affect the hydration of older people quickly. There is an established assessment process but this inspection has shown that more consistency is required. Staff training in palliative care and the chronic disease management also needs to be refreshed and recorded. More attention needs to be paid to the setting for meal times so that it is relaxed and quiet especially for people with dementia.

CARE HOMES FOR OLDER PEOPLE St John`s Wood Care Centre 48 Boundary Road London NW8 0HJ Lead Inspector Pippa Canter Unannounced Inspection 30th July 2008 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.V368271.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 Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St John`s Wood Care Centre Address 48 Boundary Road London NW8 0HJ 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 manager.stjohnswood@lifestylecare.co.uk www.schealthcare.co.uk Southern Cross (LSC) Ltd Earl Elliott Care Home 100 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (60), of places Physical disability (14) St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide nursing care and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following categories:Old age not falling within any other category (Category OP) (no more than 60 persons). Service users with a physical disability who are aged 18 - 65 years (Category PD) (no more than 14 persons). Service users with Dementia who are over 65 years of age (Category DE[E]) (no more than 26 persons). The maximum number of service users who may be accommodated is 100. 3rd August 2007 2. 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 Southern Cross Healthcare who are established in the development and management of Nursing homes and is the Registered Provider for St Johns Wood Care Centre. The care home has block contracts with three London Boroughs, Camden, Brent and Westminster, therefore these local authorities set their level of fees. The home has a range of fees taking account of those people pay privately, are within the younger physically disabled category or who may be very frail. The manager gave the range of fees as £620 to £1,500 per week. . St Johns Wood Care Centre is purpose built and was first registered in February 2001. The home provides nursing care for up to 100 residents. The home is situated in a prime residential area approximately ten minutes walk to local amenities and public transport. The closest underground station is Swiss Cottage. Outside space is available in the form of a roof garden and a balcony on the first floor. . The home is set out as follows: * Lower Ground Floor - up to 14 Younger Adults (18 - 65yrs) with physical St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 5 disabilities - YPD Unit (Nursing). * Ground Floor - up to 23 Older People (OP) Nursing Care. *First Floor - up to 26 Older People with Dementia. *Second Floor - up to 18 Older People - Nursing Care. * Third Floor - up to 16 Older People - Nursing Care. St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people using this service experience good quality outcomes. This unannounced key inspection was completed over one day. A total of 8.5 hours were spent in the care home altogether. The Commission for Social Care (CSCI) has been made aware of concerns raised by two relatives, who had elderly parents in the home. Concerns were around the lack of care they had received. Whilst this was not the purpose of this key inspection to investigate the concerns raised as such, the concerns raised have been considered when assessing the relevant National Minimum Standards. The concerns have been investigated on behalf of the pertinent local authorities under their safeguarding procedures. Prior to the inspection, we reviewed the information that the Commission for Social Care Inspection had about the home. This included the Annual Quality Assurance Assessment (AQAA), which was completed and returned by the registered manager. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We reviewed and summarised the incident reports supplied by the home. Postal questionnaires were circulated for people living in the home, relatives as well as health and social care professionals. Fourteen (14) surveys were received from people living in the care home. Six (6) staff, two (2) care managers and one (1) health care professional also returned surveys. Unfortunately the surveys were not received until some time after the inspection but comments have been used to support evidence found at the inspection. We also got feedback from people during the inspection. We have looked at the information collected from the previous inspection and relevant information from other organisations. During the visit we looked at the premises and visited people in their own rooms with their permission. People living in the service and staff were spoken to and the serving of lunch was observed and there were other periods of observation throughout the day. Staff were observed going about their duties and interacting with residents. We followed the care for four (4) people who are currently living in the care home. The care plans were compared with the care being given. The choice of care plans reflected people’s gender, specific health care conditions and cultural needs. The inspection focused on aspects of personal care, daily St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 7 activities, staffing levels, complaints and adult protection. Staff recruitment and training records were looked at as well. Samples of health and safety records were seen. All those who have contributed to the inspection process are thanked for their input. What the service does well: What has improved since the last inspection? St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 8 No requirements or recommendations were set a t he last inspection. The manager has a clear idea of the strengths and weaknesses of the service. Where staff require extra support and supervision to improve practice this is being given. It is a service that takes complaints seriously and will learn from the outcomes. There have been improvements to the environment. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 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.V368271.R01.S.doc Version 5.2 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. 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. People’s assessments need to be consistently completed to make sure all needs are identified. If initial assessments are completed accurately, this provides good details of how to plan a person’s needs. EVIDENCE: Four case records were examined. The records chosen for inspection concerned people who had been admitted since the last inspection. Where possible, people were asked to comment about their experience during the admission process. Assessments of needs are undertaken prior to and on admission. All four care records examined contained pre-admission assessments. Those referred by Social Service Departments had copies of assessments and care plans under St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 11 the care management process but the home had also completed pre-admission documentation. Generally feedback from care managers is that the care homes’ assessment arrangements ensure accurate information is gathered so that the right service is planned for each individual. However there has been a “discrepancy between the hospitals’ recommendations” and the action taken by the staff in the home. On another occasion “the provision for a specialist bed, which was required had not been identified until the client had been discharged to the home.” Other feedback received from a health care professional was, “Care service needs to be more careful in assessment of patients who come to the home to ensure that they can provide the required services to support the resident” Comments from people who use the service confirmed that they had enough information about the service although from different sources. Each resident has a copy of the service user guide in his or her room. This also includes the complaints’ procedure. Feedback from people, who have moved into the home, is that they received enough information about the service before admission. This enabled them to make an informed decision about the home was suitable for them. Comments from people living in the home included: “I came to visit before my wife came. I was shown around and was made very welcome.” “Yes we were very impressed and made a quick decision.” “I liked the home – loved the roof top. Staff showed me around.” “We had information from the social worker and we visited the home for us to see the place and to have an idea of how they care.” A requirement has been set regarding a need for consistency in the quality of assessments. Assessments of people who live in the home must include sufficient detail to form a holistic view of that person’s need. Please see requirement 1. St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11- Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal care in this home is offered in such a way as to promote and protect service users’ privacy and dignity. The health care needs of people living in the home are being met with evidence of multi-disciplinary working taking place. EVIDENCE: Peoples care plans were seen to lead from the assessment of need. More detail is needed on the care plans to make sure that needs can be met consistently. An example to support this was a persons’ care plan on nutrition, which did not reflect safe swallowing guidelines to prevent inhalation of food. There was some information on person preferences, but this should be evident across all plans. The actual documentation provided by Southern Cross does not seek to address areas of equality and diversity. Ethnicity is not asked for and marital status does not include to civil partnerships. However feedback is that “Staff and managers have always been sensitive to the cultural St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 13 needs of the clients”. The provider needs to review documentation. A requirement has been made. Please see requirement 2. All the care plans checked were considered sufficiently robust to meet the personal care needs of the residents. This included oral hygiene, personal hygiene, moving and handling and mobility needs. Equipment is provided in all these areas. One care plan examined evidenced an understanding of the holistic needs of the person. The plan included: mobility, independence/choice, spirituality, activities and personal care. However it was observed that instructions from the Speech and Language Therapist about “hand over hand assistance with drinking” was not being followed at the lunchtime meal. The care worker assisting the person to eat and drink, made sure they held the glass and did not support the resident to do so. Care plans should be seen as “live documents” so that consistent care can be given. Some of the care plans evidenced a person centred approach. They included personal preferences such as preferred name, likes and dislikes for food, preferred rising and retiring times. This is an area that the manager has acknowledged needs to address. Therefore a requirement has not been set. Generally feedback from people living in the care home confirmed that they always receive the medical support they need. Feedback from visiting professionals included, “Clients placed at the home have their needs monitored and appropriate referrals to services have been made accordingly.” “The care service is very much in tune with the needs of the residents and makes every effort to accommodate those needs. They liaise efficiently with support services.” From looking at the care plans and feedback from people visiting the care home, the person or their representative was not always involved in the formation of the care plan. Evidence is needed of involvement of the person and their representatives. People’s wishes in relation to end of life care and death and dying are being recorded. This makes sure that their views are respected and acted upon. However a comment from a health care professional identifies that nursing staff may need further training in this area. The comment was, “More training of nursing staff especially in palliative care and management. Being able to support the dying patients without panicking and sending into hospital is important”. St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 14 People who live in the home are protected from harm by medication procedures. It was noted that medications were stored securely; there were no gaps in the administration records. The medication administration records checked as part of the inspection did record any known allergies. The receipt, administration and disposal of medication is being recorded therefore an audit trail is apparent. St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 14 & 15 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the care home are being supported to attend a variety of social opportunities. Further development should be considered in this area to make sure that residents enjoy individual activities. Links with the community are being developed for the benefit of the residents. Improvements should be made to meal times to make sure that people living in the care have a relaxed and social eating space. EVIDENCE: The care home has two activities organisers. One is allocated to cover three floors and the other covering two floors. We were able to talk to both during the inspection. We looked at care plans and key working notes. We received feedback from people living in the care home and visitors. Each floor had a programme of activities on display. The programme covered the varied trips that were planned for the summer. A comment from a visiting professional was that trips outside the home should be increased. Feedback from people using the service confirmed that trips into the community could also be on an individual as well as group basis. St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 16 Progress is being made on developing life history books but this information is not being fed into the activities programme. Activity provision is about the ways in which residents are supported to do all things throughout the whole day, not just in structured groups in traditional activity programmes. It should meet each individual’s activity needs in a range of areas including physical, intellectual, sensory, spiritual, social and emotional. The care home provides a service for older people, for people who have a diagnosis of Dementia and younger physically disabled therefore a culture should prevail that recognises that activity is the responsibility of all the staff including ancillary and catering staff as well as the activity organisers and the care staff. The activity organisers and care staff need to build on the work they have started by developing activities appropriate for varying degrees of illness and supporting all staff to be involved. Staff need to build on information gathered at assessment and ongoing contact with the residents to develop life history/life-story book that helps in getting to know the whole person and this enable the service to support their interests. A recommendation has been made. Please see recommendation 1. People living in the care home who sent back surveys had mixed viewpoints on the availability of activities. All recognised that these were available but not always suitable for them as individuals. The information is life history books should be used to develop individual activity programmes that are part of their everyday routine. This can take account of peoples’ preferences such as reading a newspaper, political and religious interests, listening to music or watching television. If someone enjoys watching television, his or her preferred programmes should be recorded with times. If they like listening to music then staff should be recording favourite programmes and artists. Staff should be more proactive in making sure that leisure pastimes are recorded and that their key residents are participating in their preferred pastimes. Feedback from visitors is that the care home continues to have an open visiting policy and promote active family involvement. The care home makes visitors and relatives feel welcome as well as maintains a good level of communication with families. A comment to support this was “The home provides a caring and reassuring environment for clients with complex needs. Support for families is excellent.” However there was a response from one person who had not felt welcomed into the home. A comment made was, “I think the managers go out of their way to please the residents and meet their needs. I have not had the same experience with the unit sisters. The ones I have dealt with have been visibly indifferent and abrupt.” The management team have recognised that some staff require training and development and have arranged customer service courses for them. This is clearly identified in the training records and professional development meetings. St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 17 The menus are on display on each floor. These were noted to be varied and offer a range of choices. The menu reflected peoples’ choices as meat eaters, vegetarians and varying cultural tastes. Records kept by the catering staff identified people who had requested alternatives to the main meals. Feedback about the food was mixed. Seven people were asked whether they liked the meals at the home. Two people said that they always enjoyed their meals whilst others said they usually enjoyed the food. A comment received was “The meals are good but not always liked by the person”. Another comment was, “The meals are sometimes horrible. I would suggest (once more) the chef follow my order as much as he can” Forums are in place for people to discuss their individual likes and dislikes such as the residents’ committee, the reviews and satisfaction surveys. However when staff look at nutrition, it is not only important to look at nutritional intake for a balanced diet but there are other factors to consider especially when caring for people with Dementia. By the every nature of the illness, peoples’ manual skills decline and some people may find it hard to sit long enough to eat a meal. Research has shown dining rooms, which are quiet and relaxing, provide a social eating space. During the inspection we observed meals in one of the dining rooms. The radio was on but not tuned into the station correctly, which created an irritating buzz. Food from plates was being scrapped into a bowl and placed on a trolley just in side the door but close to people eating. Staff need to be more aware of the environment of the dining room to make sure that it is a quiet and relaxing place. Please see requirement 2. St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints’ system with evidence that service users views are listened to and acted upon. EVIDENCE: The care home has a robust complaints and comments procedure. Complaints, incidents and accidents are being recorded. These records were crossreferenced with the care records of the people being case tracked. Feedback from people using the service and their relatives all confirmed that they knew how to make a complaint and felt comfortable about approaching the staff with any concerns. The accident reports were compared with the Regulation 37 notifications sent by the service since the last inspection. The number of Regulation 37 notifications have remained at a low level. The staff team continue to take a proactive approach to falls prevention and increased monitoring has been identified as the key. There is a clearly defined whistle blowing policy. There are clear policies and the prevention of abuse and the protection of vulnerable adults. Staff receive training and have a good understanding of what constitutes abuse. Since the St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 19 last inspection there have been two safeguarding meetings held at the home. The service has managed each incident within the interagency adult protection procedures. The management team have co-operated in the investigations. Where areas for improvement have been identified the service has responded. St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within the home is good however areas of improvement are required with particular reference to the need for natural ventilation. EVIDENCE: The inspector visited every floor in the home and sixteen of the bedrooms from number 19 to number 36. Two of these belonged to people who were being case tracked. Where possible permission was sought from the people concerned. Generally the home is well presented however some of the rooms sampled were in need of attention. Examples were, St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 21 • • • • • • • Carpet marked. (Room 22 & 35) Skirting boards and walls badly marked (Rooms 28 & 29) Television left on in the bedroom but the resident sitting in the lounge. (Room 21) Rooms with thermometers were checked and found to be hot (Rooms 22 & 19) The heating was on in rooms 33 & 19 despite the humid conditions. The inspector was told that because of the changeable weather, storage radiators had to be left on in order for the heating system to be responsive. The laminate on bedroom furniture was scuffed or missing (Rooms 30, 34, 19) Guidelines and instructions relating to exercises and communications were on display in Rooms 19, 36 & 20. However there was no record in the key working notes that these were being followed. The heat in the home was of concern. Although there is access to outside space, there is little natural ventilation in the communal areas, corridors and some bedrooms. Older people can become dehydrated quickly and although extra fluids are available, these may be insufficient given the humidity in the home. Please see requirement 3. Bedrooms afford ample room and service users and relatives are being encouraged to personalise them. The home provides a safe environment. A nurse call system is installed throughout the home and there is a fully integrated fire alarm system. Both systems are maintained by regular servicing. Overall the home was found to be clean and tidy. The home has an infection control policy. Clinical waste is stored in suitable containers and collected on a regular basis through contractual arrangements by a reputable collection agency. Bottles of hand cleanser are available, together with protective clothing such as disposable gloves and aprons. St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although staff have a good understanding of service users’ support needs further training in illnesses affecting older people would be of benefit. EVIDENCE: We looked at the annual quality assurance assessment and sampled staff recruitment and selection records as well as supervision and training records. During the inspection we had general discussions with the staff and observed them interacting with the residents and carrying out tasks. Staff were described as “Very attentive”, “Staff on the Younger Physically Disablement Unit are always helpful and welcoming. They have cared for complex clients on a day-to-day basis to a high standard.” From the comments received above it is clear that some people have confidence in the staff that care for them. People visiting the service have remarked that the service appears to be short staffed on occasions. On the first visit to the home, the staff rota was checked and staff were mapped in the building according to the rota. The service has sufficient staff to meet the needs of the current number of people living in the home. The home does not rely on agency staff to cover vacant hours so the service and standard of care is consistent. The home does not rely on agency staff to cover vacant hours so the service and standard of care is consistent. St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 23 The service has a recruitment and selection procedures that meets the statutory requirements in respect of safety checks. Records show that these are in place and there is accurate recording at each stage of the process. A training matrix and individual training records were looked at and confirm that staff have access to health and safety training, safeguarding adults, fire safety, customer care, dementia awareness, challenging behaviour, medication administration and pressure area care. An inspection of the training records has highlighted that the nursing staff need to continually update their knowledge and skills in order to maintain their place on the nursing and midwifery register. The training matrix did not appear to include courses relating to chronic disease management and updating the qualified staffs’ knowledge in these areas. Training records need to identify that staff are maintaining the requirements of their professional development under P.R.E.P arrangements. Please see requirement 4. St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is supported well by senior staff in providing clear leadership throughout the home. There is a clear development plan for the home and this is being communicated to the staff. The manager has a good understanding of the areas in which the home needs to improve. EVIDENCE: The manager had completed an Annual Quality Assurance Assessment (AQAA) prior to this inspection. The information within the AQAA and further discussions with the manager during the site visit demonstrated a good level of awareness of the strengths of the service and the areas where improvements are necessary. St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 25 The judgements in preceding sections of this report have contributed to the judgement in this outcome area. The care home has a welcoming environment and promotes an open and transparent style of management. People using the service are protected by the policies and procedures. The service holds 3 monthly relatives meetings and satisfaction surveys are regularly sent out. Th results of these should be published. Individual consultation is via the 3 -6 monthly care reviews at which the resident and / or their representative is present. The manager holds a weekly surgery. The service has a well defined complaints policy and procedure. All the surveys returned by service users confirmed that they knew hopw to make a complaint. Where residents are supported to loook afetr their money, records are available that allow for an audit trail. The practice is underpinned by robust policies and procedures. A sample of health and safety records were looked at. These confirmed that the home is being managed responsibly with essential checks being made. The provider monitors health and safety in the home. There are robust procedures in place to monitor compliance. St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 26 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 1 2 3 4 5 6 Score ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14(1) Requirement All service users must have an assessment in place, which accurately details what their needs are in respect of their health and welfare. This will make sure that a holistic view of the person has been taken therefore all needs are identified. Staff must take steps to make sure that people living in the care home are able to enjoy meals in a quiet and relaxing environment. The care home needs to provide a comfortable and pleasant environment for the people who live there. Therefore attention must be give to the décor and furniture in some of the bedrooms but in particular to the need for ventilation. The reason why the heating system needs to be on during hot periods needs to be investigated and resolved. The staff training and development programme must ensure that staff are able to fulfil the aims of the home as well as DS0000010324.V368271.R01.S.doc Timescale for action 03/10/08 2 OP15 12(1)(a) 30/09/08 3 OP19 23(b)(d) (p) 03/10/08 4 OP30 18(1)(a) 03/10/08 St John`s Wood Care Centre Version 5.2 Page 28 meet the changing needs of the people who live in the care home. Senior staff must be familiar with the conditions/diseases associated with old age and chronic disease management. This will ensure the health and welfare of the people living in the care home. 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 OP12 Good Practice Recommendations Further development of the programme of activities is recommended. Following consultation with people who live in the care home and/or their representatives; life history books should contain sufficient details about peoples’ previous leisure interests, hobbies and occupations. This will ensure that activities, whether individual or in a group, reflect individuals’ wishes and preferences. St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St John`s Wood Care Centre DS0000010324.V368271.R01.S.doc Version 5.2 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!