Inspection on 15/07/05 for St Johns Nursing Home

This inspection was carried out on 15th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 Johns Nursing Home 08/01/10

St Johns Nursing Home 27/02/07

St Johns Nursing Home 23/02/06

St Johns Nursing Home 01/02/05

St Johns Nursing Home 27/06/04

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE ST JOHNS NURSING HOME St Peters Walk Droitwich Worcestershire WR9 8EU Lead Inspector Nick Richards Unannounced 15 July 2005 - 8:00 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 and Care Homes for Adults 18 – 65*. 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 NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service St Johns Nursing Home Address St Peters Walker Droitwich Worcestershire WR9 8EU 01905 794506 01905 794792 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) Shaw Healthcare Limited Mrs Julia Patricia Roberts CRH 40 Dementia - over 65 Mental health Mental health - over 65 40 14 14 Category(ies) of DE(E) registration, with number MD of places MD(E) ST JOHNS NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1 February 2005 Brief Description of the Service: St John’s nursing home is currently registered for 40 residents. The home specialises in providing 24 hour nursing care for residents with a degree of mental illness and dementia. The home is registered to accept residents from the age of 55 years onwards. St John’s nursing home is part of the Shaw healthcare (Homes) limited. The Responsible Individual for the home is Mr P J Nixey. St John’s moved into a purpose built building in October 2002. The home was further extended in May 2003 to provide accommodation for an additional 17 residents. The home is conveniently located in Droitwich, close to the town centre and public transport. The home provides plenty of car parking spaces for visitors. The home is spacious and well facilitated for the residents. All bedrooms are single occupancy with en suite toilet and shower facilities. The home provides lounges, dining rooms, and specialist bathrooms. The garden room contains a kitchenette for the use of visitors to make drinks. Meals for residents are prepared in a central kitchen in the original building. The home has been attractively furnished throughout. There is a safe, enclosed garden for the benefit of residents. ST JOHNS NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 5 hours, and was carried out to assess how effective care was during the morning period and to find out what residents thought about the service being provided by the home. A tour of the premises took place and staff and care records were inspected. Six staff on duty and three of the residents were spoken to. Many of the residents possessed mental health problems or memory loss problems, and were, therefore, unable to give any specific and meaningful information about the home, or their experiences within the home. What the service does well: What has improved since the last inspection? What they could do better: Further attention needs to be provided to the recording of medication administered to residents by nursing staff, and to the further enhancement of ST JOHNS NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 6 care plans. By further developing recording, residents welfare and protection can be further enhanced. 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 NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) ST JOHNS NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4. The admission procedure remains comprehensive to ensure that there is a proper assessment prior to people moving into the home. This helps to ensure that care needs can be met. EVIDENCE: The admission procedure was effective to guide staff on the actions to be taken to ensure that new residents’ needs are properly assessed and planned for. Individual records are kept for each of the residents, and inspection of the records for five residents had full assessment information recorded. Staff members on duty were spoken to, and knew about the care needs of the residents. ST JOHNS NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 9 One visiting relative was overheard expressing their appreciation of the service provided to their next-of-kin, and how well the home had met their relative’s needs. The home does not contract to provide intermediate care, therefore Standard 6 is not applicable to the home. ST JOHNS NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are 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 and 10. There is a clear and consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet residents’ needs. The health needs of residents are well met with evidence of good multidisciplinary working taking place on a regular basis. EVIDENCE: Individual plans of care are available, and progress has been made to ensure that aspects of health, personal and social care needs are identified and planned for. Plans were, generally, detailed, up to date and had been regularly reviewed, although there still exists room for improvement in relation to ST JOHNS NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 11 ensuring that care plans effectively and clearly provide instruction and guidance to care staff in a manner that is easily understandable. Significant events in the home had been recorded, daily entries into case records had been made and entries available gave an indication of the actual care given. Two residents who were spoken to were happy to confirm that their care needs were being met by staff within the home in a dignified and respectful way. Staff were seen providing care sensitively and discretely to residents, and discussions with staff confirmed that they were aware of residents’ care needs, and how the care was to be provided. Nursing staff were observed administering medication to residents. Medication was administered safely and sensitively to ensure that the right medication was administered to the right person, at the right time and in the right dose – thereby promoting the safety and well-being of residents. The homes medication records were examined, and were being managed well. There were, however, some discrepancies in medication records such as; (1) One resident was prescribed an antibiotic. 10 tablets were recorded in, but the medication sheet possessed a nurse signature on 13 occasions (this means that a nurse had incorrectly signed the medication records on three occasions without having given the medication to the resident concerned), (2) Medication records had not been completed on several occasions. This means that the medication records did not confirm whether (or not) the prescribed medication had been given to residents, and (3) Some medication had been prescribed on a variable dose basis. Nursing staff had not recorded the actual dose administered on several occasions. This means that it is unclear what dose individual residents had received. ST JOHNS NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with asssistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15. Dietary needs of residents are well catered for with a balanced and varied selection of food available that meets residents’ tastes and choices. Social, recreational and leisure activities are being provided to enhance residents’ quality of life, and residents are able to maintain contact with family and friends. EVIDENCE: Several people living in the home were spoken to and everyone who commented on the food said how good it was and that they welcomed the daily ST JOHNS NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 13 choices offered. Menus were inspected and found to be balanced and interesting and meal time arrangements are also flexible enough to accommodate individual preferences. Care staff demonstrated a detailed knowledge and understanding of individual residents’ dietary preferences and requirements. During the inspection, some relatives were seen visiting people, and staff greeted visitors politely. Residents spoken to said that they could receive visitors at any time of the day, thereby maintaining links with family members. Residents confirmed that there were no restrictions on visiting. ST JOHNS NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) 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 examined at the time of inspection. EVIDENCE: These Standards were not examined at the time of inspection. ST JOHNS NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) 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, 23, 24, 25 and 26. A high environmental standard is maintained within the home, creating a comfortable and safe environment for those living there and visiting. EVIDENCE: ST JOHNS NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 16 The bedrooms are all single occupancy with en-suite facilities. Communal toilets and bathrooms are available throughout the home. Separate lounge and dining room facilities are provided on each floor of the Home. Systems were in place for the management of infection control, and the home was clean, tidy and free from offensive odours. Each bedroom seen had been furnished with residents’ personal possessions, thereby generating ownership and a sense of autonomy for individuals. The standard of the environment within the home is good, providing residents with an attractive and homely place to live. Residents confirmed that they appreciated the physical environment. Hot water temperatures have been risk assessed and had been regulated to prevent people being accidentally scalded when they have a bath, and radiators had been guarded and restricted to prevent people being accidentally burnt through intentional or unintentional contact All the windows located above first floor level had been restricted to prevent people from being injured through falling out of the windows (accidentally or deliberately). ST JOHNS NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30. Staffing levels and competencies are suitable to ensure that residents’ needs are identified and effectively met. EVIDENCE: There were suitable nursing and care staff on duty to provide care and support for the people who were resident in the home at the time of inspection. In addition to nursing and care staff, there were also ancillary staff on duty to support service provision. During the visit, call bells were activated, and staff responded speedily to them. The duty rotas confirmed that the staffing levels were stable, with little evidence of staff being absent through short-term sickness. ST JOHNS NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 18 Training has been provided to staff, and includes infection control, first aid and moving and handling. Training was identified as a result of the needs of residents, to ensure that care delivered was appropriate to and in response to the needs of residents. Residents said that they were being “well looked after”. ST JOHNS NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s polies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 33, 35 and 38 (Older People) and Standards 23, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36 and 38. There is clear leadership, guidance and direction to staff to ensure residents receive consistent care, resulting in practices that promote and safeguard the health, safety and welfare of the people using the service. ST JOHNS NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 20 EVIDENCE: The registered manager is competent and appropriately qualified and experienced to manage the service. Staff and residents spoke very highly of her, and significant diligence and action has been undertaken to maintain and further improve the quality of the service provided by the home since the time of the previous inspection. Residents interviewed clearly expressed their opinion that the home was being run in their best interests. Staff were being supervised in a positive manner. One member of staff had been allocated the role of supervising care staff, who were receiving formal supervision (to ensure that they are providing care to residents appropriately and safely) six times each year. The home is undertaking regular quality assurance exercises on various aspects of the homes functioning to ensure that (a) quality is maintained and (b) to improve standards whenever possible – thereby enhancing residents’ quality of life and well-being. ST JOHNS NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 21 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 x 2 x 3 3 4 3 5 x 6 N/A HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 3 3 3 3 3 3 3 3 Score Standard No 7 8 9 10 11 Score 2 3 2 3 x Standard No 27 28 29 30 3 3 3 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score x x x MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 3 33 3 34 x 35 x 36 3 37 x 38 3 ST JOHNS NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 22 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 7 Regulation 15 Requirement All care plans must effectively and clearly provide instruction and guidance to care staff in a manner that is easily understandable. All medication administered to residents must be accurately recorded onto medication administration record charts. Timescale for action 30/09/05 2. 9 15 Immediate and ongoing 3. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations ST JOHNS NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 Page 23 Commission for Social Care Inspection The Coach House John Comyn Drive, Perdiswell Park Droitwich Road Worcester WR3 7NW 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 NURSING HOME E52 S4138 St Johns NH V239231 150705.doc Version 1.40 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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