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Inspection on 27/02/07 for St Johns Nursing Home

Also see our care home review for St Johns Nursing Home for more information

This inspection was carried out on 27th February 2007.

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

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

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

Staff have a good understanding of the individual needs of the people they support and have developed positive working relationships with service users and other agencies. The organisation is committed to providing a qualified workforce. The staff team functions cohesively and the home is very well managed. A stated aim of the provider is "to manage and develop people effectively. We wish to find out how we are doing now. We need to see what we are doing well and what we need to improve. As a result we will see the progress we have made." Service users are involved, as much as is feasible, in all aspects of decision making and attend regular service user`s meetings. They have access to an independent advocacy service and are provided with designated key workers for consistency and continuity of support. Results of a recent survey were mostly positive and service users were satisfied with the support they receive. The home is equipped to a high standard and soft furnishings are of good quality and provide people with a comfortable and homely place to live.

What has improved since the last inspection?

The home has a good track record of meeting the Key Standards and exceeding some. The quality of care in this home is strongly influenced by the calibre of the registered manager and her relationship with staff and senior management. The home`s ethos of providing evidenced based care provides the cornerstone for self improvement.

What the care home could do better:

It is considered that St Johns is currently performing very well, setting its own objectives for continual improvement.

CARE HOMES FOR OLDER PEOPLE St Johns Nursing Home St Peters Walk Droitwich Worcestershire WR9 8EU Lead Inspector Lorraine Briggs Unannounced Inspection 27th February 2007 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 Johns Nursing Home DS0000004138.V326491.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 Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Johns Nursing Home Address St Peters Walk Droitwich Worcestershire WR9 8EU 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) 01905 794506 01905 798258 Shaw healthcare Limited Ms Julia Patricia Roberts Care Home 40 Category(ies) of Dementia - over 65 years of age (26), Mental registration, with number disorder, excluding learning disability or of places dementia (14), Mental Disorder, excluding learning disability or dementia - over 65 years of age (14) St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home may also accommodate people with dementia illness between the ages of 55 - 64 years. Date of last inspection 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 a dementia type illness. The home is registered to care for residents from the age of 55 years onwards. St John’s is part of the Shaw healthcare (Homes) Limited. The responsible individual is Mr P J Nixey. The registered manager is Julia Roberts. St John’s moved into the home during October 2002. The home was then further extended in May 2003 to provide accommodation for an additional 17 residents. The home is situated in Droitwich close to the town centre and public transport. Car parking spaces are available at both the side and rear of the home for staff and visitors. The home is spacious. All bedrooms are single occupancy with en-suite facilities of a toilet and shower. Communal areas include lounges, dining areas and specialist bathrooms. The kitchen room contains kitchenette facilities for visitors; this room is to become an activities room in the near future. The home has enclosed gardens. Fees are available upon request. St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, previous inspection reports, quality assurance process, Fire Authority reports, Environmental Health Office reports, observation of care experienced by people using the service. What the service does well: What has improved since the last inspection? St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 6 The home has a good track record of meeting the Key Standards and exceeding some. The quality of care in this home is strongly influenced by the calibre of the registered manager and her relationship with staff and senior management. The home’s ethos of providing evidenced based care provides the cornerstone for self improvement. 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 Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. Prospective people who need a service and their representatives are supplied with information in order to choose a home, which will meet their needs. They have their needs assessed and information which clearly tells them about the service the will receive. This judgement has been made using available evidence including a visit to this service. St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 9 EVIDENCE: Admissions are not made to the home until a full needs assessment has been undertaken. For people whom are self funding and without a Care Management Assessment the assessment is always undertaken by a skilled and experienced member of staff. The assessment is conducted professionally and sensitively and involves the individual, and their family or representative, where appropriate. Where the assessment has been undertaken through care management arrangements the service insists on receiving a summary of the assessment and a copy of the care plan. All this information was seen on individual case files. Admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective service user. The staff management team consider the application together with other staff, where all information is shared, views, opinions, and comments are listened to and fully debated, before agreement is give for the admission. Prospective individuals are given the opportunity to spend time in the home. An individual member of staff is allocated to give them information and to help them understand how the home is organised and run and the facilities and services available. The allocated staff member will give them special attention, help them to feel comfortable in their surroundings, and enable them to ask any questions about life in the home. St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 10 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 and 10 Quality in this outcome area is excellent. Care-planning systems are in place to adequately provide staff with the information they need to satisfactorily meet service users assessed needs. Individuals are involved in decisions about their lives and play an active role in planning the support they receive. People living at the home receive excellent support so that they can take responsible risks. This judgement has been made using available evidence including a visit to this service. St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 11 EVIDENCE: The key principles of the home for delivering a quality service are based on the belief that service users should be able to take control of their lives, given their individual capacity ay any time. The staff of the home are strongly committed to supporting all service users including those with limited communication or intellectual skills to make informed decisions, understand the range of options which are available to them and have the right to take responsible risks. E.g one younger adult with enduring mental health problems does not want to always eat the homes meals and is enabled to shop and cook for himself. The service user plan is developed in partnership with the service user, based on an efficient assessment. The plan clearly sets out how specialist requirements will be met through positive and planned interventions. All care is based on up to date research, evidence of which was seen in those plans examined e.g. guidelines for nutritional support, spirituality in dementia care. The plan focuses on current needs, development of skills, and future aspirations of the individual. This follows the principles of person centred planning. Records show that staff have the necessary training and skills to support and encourage the individual to be fully involved. Where service users have limited communication, staff are skilled in using other methods of engagement. A key worker system provides additional support enabling one to one involvement. The care plan is used as a working tool and is understood by the individual and all staff, and can be used in an emergency by people who are not familiar with its content. Care plans include a comprehensive risk assessment. Management of risk takes into account the specialist needs and age of people who use the service, balanced with their aspirations for independence, choice and normal living. A reactive management plan was seen on the file of the one person reviewed whose can display challenging behaviours can challenge, to ensure that staff are consistent in their approach and that any behaviours are managed positively. Where there are limitations on choice or facilities, it is in the person’s best interest. The service user understands and agrees the limitations. Any limitations are fully documented and reviewed on a regular basis to ensure their ongoing relevance. Service users are actively consulted on how the service runs, and have developed service users groups to influence key decisions in the home. They are involved in decisions about day-to-day life, the environment, staff appointments and the development of the service. The home acts upon the St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 12 outcomes of consultation with the person who uses the service and their families and feeds this back to them. St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. People who use the service are able to make choices about their life style, and supported to develop their life and social skills. Rights and responsibilities are promoted and people provided with a varied diet in accordance with their personal preferences. This judgement has been made using available evidence including a visit to this service. St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 14 EVIDENCE: The manager spoke of the service’s strong commitment to enabling service users to develop their skills, including social, emotional, communication, and independent living skills. Individuals are supported to identify their goals, and work to achieve them. Service users have the opportunity to develop and maintain important personal and family relationships, and are able to access information and specialist guidance about issues such as intimate relationships. The practice of staff promotes individual rights and choice, but also considers protection of individuals, supporting people to make informed choices. Service users are involved in meaningful daytime activities of their own choice and according to their individual interests and capability; they have been fully involved in the planning of their lifestyle and quality of life. The service is committed to the principles of inclusion and promotes, and fosters good relationships with neighbours and other members of the community. The manager and service users will be having discussion about going on holiday. An activity room is provided and staff and service users were baking cakes. A mobile farm visits monthly. The manager spoke of plans to develop the garden to include greenhouses. Where appropriate service users are involved in the domestic routines of the home, they take responsibility for their own room, menu planning and cooking meals, making sure that they are able to enjoy the food they prefer and like. The menu is varied with a number of choices. It includes a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The meals are balanced and nutritional and cater for the varying cultural and dietary needs of the service users. St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. People who use the service are able to express their concerns, and have access to a complaints procedure so that they are protected from abuse, and have their rights protected. This judgement has been made using available evidence including a visit to this service. St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 16 EVIDENCE: The service has a complaints procedure that is up to date and easy to understand. It can be made available on request in a number of formats (including other languages, large print, etc) to enable anyone associated with the service to complain or make suggestions for improvement. The policies and procedures regarding protection of individuals are of a good quality and are regularly reviewed and updated. The service is clear when incidents need external input and who to refer the incident to. Training of staff in the area of protection is regularly arranged by the Home The home has an open culture, which enables service users to express their views, and concerns in a safe and none blame environment. St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 17 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 and 26 Quality in this outcome area is good. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 18 EVIDENCE: The home provides accommodation over two floors consisting of comfortable spacious rooms. An enclosed garden is provided at the rear of the property. The home provides a physical environment that is appropriate to the specific needs of the service users who live there and is based on research undertaken by staff and management, e.g. the paintwork is in bright colours to enable people with dementia to identify areas better. The manager spoke of plans to improve the premises further. The well-maintained environment provides specialist aids and equipment to meet the needs of the service users. St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 19 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 and 30 Quality in this outcome area is excellent. Staff in the home are being trained well and are in sufficient numbers to fill the aims of the home and meet the changing needs of service users This judgement has been made using available evidence including a visit to this service. St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 20 EVIDENCE: The service has a robust recruitment procedure that has the needs of people who use the service at its core. The recruitment of good quality carers is seen as integral to the delivery of this excellent service. The service is highly selective, with the recruitment of the right person for the job being more important to the filling of a vacancy. The result of this is a diverse staff team that has a balance of all the skills, knowledge and experience to meet the needs of service users. Evidence gained through discussion demonstrates a thorough understanding of the particular needs of the service users. Management prioritise training and facilitate staff members to undertake external qualifications beyond the basic requirements. A unit manager is studying for a degree at Bradford University. Three other staff are doing the registered managers award. 90 of staff have had dementia care training. Staff share skills and knowledge with colleagues. The service sees induction and any probationary period as being an extension of recruitment. There are contingency plans for cover for vacancies and sickness and there is little use of any agency staff. Where they are used there are well thought out systems for their induction and support and providing continuity of care. Staffing levels reflect the needs of the service users, and rotas are flexible to fit around the lifestyles of individuals. Key workers may have specific allocated time to spend with individuals. Rotas show that there is a high staff/service user ratio. Staff have the skills to communicate effectively with all service users. This includes all care staff and ancillary staff who come into regular contact with service users. Discreet observance of staff practice showed that they are treated with respect. Instead of telling people with dementia to do things, staff engaged in asking them “what would you like to do”. Staff meetings are used for consultation, training and the involvement of staff in the development of the service. Minutes are taken and made available to staff and service users. Individual supervision sessions take place regularly and staff say that they find them useful for their development. Notes are taken which include action plans. Staff are also surveyed about their knowledge of the service and how it enables them to fulfil the aims and purpose of their role. Examples of these were seen. St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 21 All staff recruited understands and are aware of the specific nature and uniqueness of the home, its aims and objectives and how care will be delivered. Staff and management are currently exploring the gold standard framework and care pathways for end of life care. St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 22 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 and 38 Quality in this outcome area is excellent. The manager is approachable and supportive, having a positive impact on service users and staff. Quality systems in the home ensure that staff, service users and stakeholders are provided with a forum to air their views. This judgement has been made using available evidence including a visit to this service. St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 23 EVIDENCE: The registered manager has the required qualification and experience, is highly competent to run the home and meets its stated aims and objectives. Discussions showed that the manager has sound knowledge of both strategic and financial planning and review, and provides value for money through effective management. The manager is visionary in her approach to the service and communicates a clear sense of direction. She is able to demonstrate through formal qualification, and or experience and ability that she is highly competent in a range of areas. These include service-specific good practice areas, current legislation and proposed developments, the quality assurance systems, equal opportunity issues, development and implementation of the service’s policies and procedures, good people skills, strong leadership of staff, responds to need and provides an excellent role model. Other professionals see the manager as an imaginative leader who consistently provides high quality services. The manager ensures that staff follow the policies and procedures. Staff have easy access to all documents, which are discussed during supervision, staff training and team meetings. Spot checks and quality monitoring systems provide management evidence that practice reflects the homes policies and procedures. There is strong evidence that the ethos of the Home is open and transparent. The views of both service users and staff are listened to, and valued. Quality assurance systems are robust and evidence of the latest audits were seen. These included surveys for relatives, staff, service users; minutes of staff meetings, service user meetings, relative meetings. All had agendas and action plans for any points raised. The manager works with a detailed business plan which gives a clear indicator of the success and efficiency of the business arrangements. The home has efficient systems to ensure effective safeguarding and management of individual’s money including records keeping. Service users have access to their records whenever they wish The home has a full range of policies and procedures to promote and protect service users’ health and safety. There is full and clearly written recording of all safety checks and there is no evidence of a failure to comply with other legislation. There is a good understanding of risk assessment and this is taken into account in all aspects of the running of the home. The quality assurance system confirms that the findings from risk assessments have been actioned and the home continuously improves its systems for health and safety. The systems are regularly reviewed and updated and are developed on the basis of experience in the home and learning from external developments. St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 24 Records show that all staff trained in health and safety matters and have regular planned updates. The manager reported that GPs, Social Workers and students have worked in the home to gain experience. St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 3 St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 26 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Johns Nursing Home DS0000004138.V326491.R01.S.doc Version 5.2 Page 28 - 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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