Inspection on 20/02/07 for St Joseph's Convent Nursing Home

This inspection was carried out on 20th 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.

Other inspections for this house

St Joseph's Convent Nursing Home 17/02/06

St Joseph's Convent Nursing Home 06/09/05

St Joseph's Convent Nursing Home 01/12/04

St Joseph's Convent Nursing Home 21/07/04

St Joseph's Convent Nursing Home 12/01/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE St Joseph`s Convent Nursing Home Lichfield Road Stafford Staffordshire ST17 4LG Lead Inspector Joanna Wooller Key Unannounced Inspection 20 February 2007 09:00 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 Joseph`s Convent Nursing Home DS0000022371.V312930.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 Joseph`s Convent Nursing Home DS0000022371.V312930.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Joseph`s Convent Nursing Home Address Lichfield Road Stafford Staffordshire ST17 4LG 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) 01785 251577 01785 223836 clunystaff@btinternet.com www.sjc.ie Sisters of St Joseph of Cluny Mrs Frances Knight Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (12), Physical disability (33), Physical disability of places over 65 years of age (33), Terminally ill (3) St Joseph`s Convent Nursing Home DS0000022371.V312930.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 33 Physical Disability (PD) - Minimum age 60 years on admission All agreed policies and procedures to be submitted to NCSC within 3 months. All staff involved in the care of service users who are TI must receive appropriate training. The care home should employ a nurse who has achieved the Care of the Dying ENB 931 or University Course K260 Death & Dying - within 6 months. TI - minimum age 60 years. Date of last inspection Brief Description of the Service: St Josephs Convent was converted as a nursing home and first registered in 1989. It is situated within easy walking distance of Stafford Town centre, with good road and rail links and located in extensive, well-tended gardens and grounds adjacent to a newly built Catholic Parish Primary School. There is limited parking at both the front and rear of the building. Service users of any denomination are cared for and welcome to all the facilities offered by the Home. St Josephs Convent emphasises the importance it places on individual and personal care provided by a professional team. There are three floors with a shaft lift facility and an exit ramp. The home has 33 single bedrooms, five of which are en-suite. There are no double rooms. The home is well suited to meet the needs of the stated categories of service users. Many rooms are well appointed, personalised, and some with views of the impressive garden; all are well equipped and pleasantly furnished. At present plans are being finalised to extend the home and its facilities into the old school area, which has recently been rebuilt as a separate, stand-alone building. Fees £410 to £500 St Joseph`s Convent Nursing Home DS0000022371.V312930.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Lead Inspector carried out this Unannounced Key Inspection. The Home Manager was on duty supported by two registered Nurses and eight Carers. The inspection included the following elements; A tour of the building, Observation and inspection of records relating to provision of care, Discussions with several service users, Discussions with several of the staff members on duty, Observation and sampling of other services provided such as catering and laundry, and an inspection of the managerial aspects such as staffing issues and health & safety. The Inspector was made very welcome in the home and all assistance was given to gain the evidence required for the report. Commission For Social Care Inspection local office had dealt with no complaints. Service Users spoken to at the visit were complimentary about the home as were the comments received on the many feedback cards returned to the inspector. Comments included: “I am treated wonderfully” “I take part in activities if I feel like it.” “All very kind and helpful and the food is excellent.” “The activities are usually available but if one does not wish to take part there is no pressure to do so.” “Delightful caring talk prior to admission, most helpful and reassuring.” “Nothing is too much trouble both day and night.” “Presentation of the food is good and because I am a poor eater this is a great asset.” “All staff will listen when called upon to do so. The young girls are very understanding.” What the service does well: The home management and staff offer high quality nursing and personal care in a caring, safe environment. The home is staffed with professional, welltrained, competent staff. St Joseph`s Convent Nursing Home DS0000022371.V312930.R01.S.doc Version 5.2 Page 6 One lady commented, “I was amazed how quickly I felt that St Joseph’s was home and I still felt like an individual. I definitely made the right choice.” The Manager accepts only the highest standards of care, attention and professionalism from all her staff. The care staff were evidenced to support the Service Users in a compassionate way promoting their independence as far as possible and protecting their privacy and dignity. The self-audit system allows monitoring throughout the year maintaining high standards and monitoring Service Users, relatives and staff satisfaction. What has improved since the last inspection? 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. St Joseph`s Convent Nursing Home DS0000022371.V312930.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 Joseph`s Convent Nursing Home DS0000022371.V312930.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 This quality outcome is excellent. This judgement has been made using available evidence including a visit to this service. No Service User moves into the home without their individual needs assessed and agreed to being met in the home. EVIDENCE: One lady commented “I was given plenty of time for discussion and to ask questions before I decide to move into the home, I also had a tour of the building. I had a brochure to take away and study aswell.” A social worker commented that she places Service Users in the home because the staff focus on person centred care for each Service User, which results in the people feeling valued and empowered. One lady wrote on a feedback card that choosing a home was something she never wanted to do but she was confident that she had chosen the right one. All members of staff are very competent and efficient but also very caring to both my mum and myself. All member staff are very approachable and I feel that I can ask a question anytime. Fran and the nursing staff have always gone St Joseph`s Convent Nursing Home DS0000022371.V312930.R01.S.doc Version 5.2 Page 9 out of their way to discuss mums’ care with me. They have also given me great emotional support. Service Users records showed clear evidence that Service Users were met prior to admission and their individual needs were assessed and confirmed in writing that their needs could be met at the home. On one of the many feedback cards a relative commented that they had been extremely impressed with the care that their mother had always received. Another relative said that in the year that their mother had been at the home they were very pleased with the care given to her and the support given to the whole family. They wrote that they are always made to feel welcome and important matters are discussed. St Joseph`s Convent Nursing Home DS0000022371.V312930.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 This quality outcome is excellent. This judgement has been made using available evidence including a visit to this service. The Service Users health, personal care and social care are all individually assessed and written in a care plan. Service Users are protected by the medication policies and procedures. Service Users commented that they do feel they are treated with respect. EVIDENCE: Through case tracking Service Users were identified to have excellent experiences of support prior to admission. Visits to the home were encouraged and each Service User had had a pre admission assessment and receives a letter that their needs could be met at the home. Each Service User had a care plan with long and short-term acre plans within it. These were updated and reflected the current condition of the individual. The care records were personalised and well written. Intervention by the GP and nurse specialist were encouraged as necessary to ensure the best care was offered to the Service Users. St Joseph`s Convent Nursing Home DS0000022371.V312930.R01.S.doc Version 5.2 Page 11 One lady commented that she loved the home for its peaceful atmosphere and sense of caring. One lady commented “Staff are always very patient when listening to various ‘moans and groans’ and take appropriate action, always taking my views into account.” A relative commented that she was very satisfied with her husbands care. Staff were evidenced to be compassionate to the Service User and they were very relaxed in their manner which the Service User said made them feel more at home. Medication administration was examined and found to be in order. The nurse on duty told the inspector that the medication policies and procedures are followed to ensure the safety of the Service Users. One lady was selfmedicating. Service Users told the inspector that they were offered respect and their privacy and dignity was upheld. They said the staff was all very compassionate. One visiting relative told the inspector that during the time his wife had been at the home she had been well looked after in all respects and he could not express fully enough his praise of all the staff. St Joseph`s Convent Nursing Home DS0000022371.V312930.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 This quality outcome is good. This judgement has been made using available evidence including a visit to this service. Service Users lifestyles experienced in the home did meet their expectations. Service Users maintained close contact with their families and friends. Service Users felt they had a view in the home and it was listened to. Service Users received a well balanced diet. EVIDENCE: Service Users felt that were plenty of activities arranged in the home. They are encouraged to join in but under no pressure. One lady was encouraged to continue with hobby of handicraft and other Service Users joined in with her. Many Service Users appreciate the library service. Two sessions of activity to music are planned each week along with art and craft and daily Mass. Entertainment from outside is arranged to ensure a variety of activities are enjoyed. Themed days and meals are organised for special events such as Easter, St David’s Day and more. A recent questionnaire sent out resulted in the findings being that the Service Users were very happy with the level of activities offered. St Joseph`s Convent Nursing Home DS0000022371.V312930.R01.S.doc Version 5.2 Page 13 The Service Users commented that the meals at the home were very good. Every effort is made to cater for individual likes and dislikes. Special dietary needs are met as required. The set menu is followed daily however a choice of meals is available daily to ensure Service Users have the food they prefer. The Environmental Health Officer visited the home in May 2006 and no requirements were made. St Joseph`s Convent Nursing Home DS0000022371.V312930.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 This quality outcome is excellent. This judgement has been made using available evidence including a visit to this service. The home follows their complaints policy and procedure and this was evidenced on display. In house training takes place to protect Service Users from abuse. EVIDENCE: The inspector looked at the complaints book, the relevant policy and procedure documentation, and had a discussion with staff and service users, and this evidenced that complaints were listened to and continue to be dealt with in the correct manner. One Service Users told the inspector that they found the complaints procedure easy to understand. The Commission For Social Care Inspection had received no complaints since the last inspection. No incidents of neglect or abuse of any kind has been reported. Staff training and observations of service users ensured that they are protected from all forms of abuse. A large number of thank you cards from service users relatives were on display on the many notice boards. St Joseph`s Convent Nursing Home DS0000022371.V312930.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 This quality outcome is good. This judgement has been made using available evidence including a visit to this service. Service Users live in a safe wellmaintained environment, which is clean, pleasant and hygienic. EVIDENCE: The home is well maintained and appears very clean and tidy. One Service User commented they wanted to make special mention to the excellent laundry service. All repairs are actioned quickly by the maintenance staff. Redecoration of bedrooms occurs as they become vacant and some new carpets and curtains have been purchased. The inspector commented that the home was in need of refurbishment in some areas as identified on the visit. The bathrooms and some bedrooms were also identified. One bathroom had been upgraded to a very high standard. St Joseph`s Convent Nursing Home DS0000022371.V312930.R01.S.doc Version 5.2 Page 16 The home was exceptionally clean and tidy. The Service Users said that the home was always immaculate. “There is a high standard of cleanliness.” One lady commented “It would be good to have an ensuite in my room.” This request may be addressed in the new rooms being refurbished in the home. St Joseph`s Convent Nursing Home DS0000022371.V312930.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 This quality outcome is good. This judgement has been made using available evidence including a visit to this service. Service Users identified needs are met by the staff that are suitably trained for their role. The homes recruitment policies and procedures ensure the correct persons are employed at the home. Service Users are protected from abuse by the policies and procedures carried out within the home. EVIDENCE: Staffing levels were being maintained, and staffing rosters and levels were checked and in order. The home employs adequate numbers of ancillary staff to carry out domestic and kitchen duties. The Service Users commented that staff are wonderful and always available when they wanted them. “I am treated wonderfully” said one lady. The relatives commented that they had much praise for the home, the staff and the care that their relatives received. There were no changes in the homes recruitment policy, procedures and documentation. New staff had been subject to POVA/CRB comprehensive checks, and these were being recorded. Statutory training had been given a high priority and the training records of individuals were seen along with individual supervision records. St Joseph`s Convent Nursing Home DS0000022371.V312930.R01.S.doc Version 5.2 Page 18 NVQ training continues in the home and almost 50 of care staff are trained in NVQ2 some staff were completing NVQ 3. The deputy manager has recently completed a Health and Safety awareness refresher course. The records evidenced that all staff had benefited from ‘in house’ and external training, which had covered the needs of the client group. Training had again been provided for staff in the awareness and management of dementia related conditions and palliative care. St Joseph`s Convent Nursing Home DS0000022371.V312930.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 This quality outcome is excellent. This judgement has been made using available evidence including a visit to this service. Service Users live in a well managed home, which has the Service Users best interests at the forefront of the individualised care. The health, safety and welfare of all the Service Users and staff are protected. EVIDENCE: From observations made by the inspector and discussions with the manager and staff, it was evident that the home was being run in the interests of service users. Relatives commented very highly of the Management at the home and felt that the Manager continued to be very open and approachable. The Inspector checked all relevant records required meeting the National Minimum Standards and a discussion with both Service Users and representatives evidenced that all service users had the opportunity to handle their own finances and all Service Users and their families had chosen to do so. St Joseph`s Convent Nursing Home DS0000022371.V312930.R01.S.doc Version 5.2 Page 20 The documentation evidenced by the Inspector for servicing and examination of machinery and equipment was all correct and up to date. Health and safety issues are given a high priority and the evidence seen by the Inspector supported this. The records requested by the Inspector with regards to Health and Safety standards were well kept, in order and up to date. The home has recently been awarded the Platinum Award for a Smoke Free Stafford by banning smoking in and around the premises of the home. St Joseph`s Convent Nursing Home DS0000022371.V312930.R01.S.doc Version 5.2 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 4 X X 4 St Joseph`s Convent Nursing Home DS0000022371.V312930.R01.S.doc Version 5.2 Page 22 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 OP19 Regulation 16 (c) Requirement The registered person shall ensure that routine renewal of fabric and decoration of the premises is completed to a high standard of appearance. This is with regard to the need to refurbish some areas of the home. Timescale for action 20/05/07 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 Joseph`s Convent Nursing Home DS0000022371.V312930.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Joseph`s Convent Nursing Home DS0000022371.V312930.R01.S.doc Version 5.2 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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