CARE HOMES FOR OLDER PEOPLE
St Joseph`s Hospice Ince Road Thornton Liverpool Merseyside L23 4UE Lead Inspector
Mrs Trish Thomas/Lorraine Farrar Unannounced Inspection 22nd February 2006 14:00 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 Hospice DS0000017272.V285088.R01.S.doc Version 5.1 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 Hospice DS0000017272.V285088.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service St Joseph`s Hospice Address Ince Road Thornton Liverpool Merseyside L23 4UE 0151 924 3812 0151 931 5727 jacintacannon@jospice.org.uk 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) St Joseph`s Hospice Association Miss Jacinta Ann Cannon Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (12), Physical disability (3), Terminally ill (10) of places St Joseph`s Hospice DS0000017272.V285088.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Service users to include up to 12 OP and up to 10 TI and up to 3 PD. The service should employ a suitably qualified and experienced Manager who is registered with CSCI. Service users in the category TI must be in the age range of 19 years and above. 30/09/05 Date of last inspection Brief Description of the Service: St. Joseph’s is a care home, with nursing, for 25 Service Users. The home is owned by St. Joseph’s Hospice Association (Jospice International) and the manager is Mrs. Miss Jacinta Cannon. The home is registered in the following categories, 12 Elderly, 3 Physical Disability, 10 Terminal Illness. The home was founded within a Catholic ethos and this is reflected in the character of both the interior and grounds of St. Joseph’s. There are two chapels on site, one is integral to the main building and the second is adjacent and can be easily accessed. St. Joseph’s is not exclusive to those of the Catholic faith and all denominations and non-believers are eligible for admission, subject to nursing assessment, and their wishes are respected. The service is provided in two buildings, The Academy and San Jose, which provide a variety of lounge and sitting areas, dining room and conservatory. Both single and double bedrooms are provided and 8 bedrooms have en-suite facilities. There are extensive and beautiful grounds consisting of woodland, gardens and car parking facilities. The grounds sustain a variety of wildlife and are accessible and enjoyed by residents of the home and their visitors where seating is placed for their convenience. The home is situated on a main bus route between Southport and Liverpool with the busy shopping centre of Crosby a five-minute car journey away. St Joseph`s Hospice DS0000017272.V285088.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The methods used in this inspection were primarily, discussion with residents, the manager and staff. A tour of the premises was carried out and the medication storage room was visited. Four care plans were tracked and medication and personal allowance records were read. This was the second unannounced inspection for the year 05/06. For a full account of National Minimum Standards assessed during the year, this report should be read alongside that of 30th September 05. What the service does well: What has improved since the last inspection?
A complimentary therapist has been appointed, who attends St. Joseph’s twice a week to provide aromatherapy, reflexology and massage. The home’s ongoing training programme has progressed. St Joseph`s Hospice DS0000017272.V285088.R01.S.doc Version 5.1 Page 6 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 Hospice DS0000017272.V285088.R01.S.doc Version 5.1 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 Hospice DS0000017272.V285088.R01.S.doc Version 5.1 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): Not assessed EVIDENCE: St Joseph`s Hospice DS0000017272.V285088.R01.S.doc Version 5.1 Page 9 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): 7,8,9,10,11 The home works well with residents, their representative and health care professionals to formulate a plan care which is designed to meet the individual’s needs and preferences. Residents’ health care needs are met through visiting G.P.s and qualified nursing staff. Medication brought into the home is very well managed, although staff must make sure that all medication in use is labelled. Staff treat residents with respect, and their right to privacy is upheld. EVIDENCE: Individual care plans are in place for all residents of the home. Staff use a system based on ‘core care plans’. These are pre-printed sheets that list the care required for a particular health or personal care need. Good practice was noted in that staff had altered these, and added information to meet the resident’s individual needs, choices and circumstances. Plans, which were read, had been reviewed and updated by staff, at least monthly, to take into account any changes in the resident’s needs. The home works with the
St Joseph`s Hospice DS0000017272.V285088.R01.S.doc Version 5.1 Page 10 resident/their relative, and their wishes are recorded. A general review is carried out at least once a year, which involves the resident or their representative. The home works well in meeting residents’ health needs and liaising with other healthcare professionals. Each week, a communication meeting is held between the GP and staff, to review and update the care needed for residents, as appropriate. In addition, a meeting is held once a week with senior nursing staff to update the manager, discuss plans for the week and individual residents’ support needs. Residents have access to paramedical services, as documented in their care plans. The home works closely with the GP, pharmacist and police to manage medication and dispose of unused drugs. The manager carries out routine medication audits, as result of which, a discrepancy in the controlled drugs held was identified, and appropriate action taken. There are medication rooms in both buildings and medication was looked at within San Jose. The majority of medications were stored appropriately and recorded correctly. Some medications, including creams, had been stored out of the pharmacy container, as a result of which there was no label giving the resident’s name. The staff must make sure that all medication in use is correctly labelled at all times. For residents who are terminally ill, there are suitable care plans in place, which also record their wishes at time of death. Staff follow Care Pathways in care of the dying. St.Josephs provides family support nurses and a bereavement counsellor, who will support the resident, their family and the staff team. In addition several nurses have palliative care qualifications. The home works well with the GP to provide effective pain relief, and with local religious ministers who will visit residents as preferred. Residents are cared for in their bedrooms and the manager said that families are welcome to visit at any time, and arrangements can be made for them to stay overnight. There are some double bedrooms, where screening is provided to ensure privacy. St Joseph`s Hospice DS0000017272.V285088.R01.S.doc Version 5.1 Page 11 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): 12,14 The level of activities on offer has improved since the last inspection and this is an area of the service, which is being developed. Residents are supported in exercising control over their lives and their wishes are recorded on their care plans. EVIDENCE: The manager confirmed that a complimentary therapist is now employed and attends St. Josephs two days a week to provide aromatherapy, reflexology and massage for residents. An activity log was in the development stage at this time. Residents spend their days as they choose, those who are able, take advantage of the beautiful grounds where there are walk-ways and seating areas with wheelchair access. Residents’ preferences are recorded on their care plans and staff work closely with them, their family and/ or representatives, in providing a service, which is relevant and to their preference. A resident said “I have all I need, and my wife is here to see me.” Another said, “I have no complaints, they’re looking after me.” St Joseph`s Hospice DS0000017272.V285088.R01.S.doc Version 5.1 Page 12 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): Not assessed. EVIDENCE: St Joseph`s Hospice DS0000017272.V285088.R01.S.doc Version 5.1 Page 13 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, 26. There is an ongoing maintenance programme and the home is in generally good condition. The home was clean and hygienic in the areas which were visited. EVIDENCE: There is a maintenance programme, which is planned to cause as little disruption as possible to the residents and home’s routines. A resident said that he was very comfortable in his bedroom and he had all he needed. Refurbishment of bedrooms takes place as rooms become vacant. The building was clean and odour free in the areas which were visited. The home employs agency domestic staff who are vetted. There are procedures in place for Control of substances hazardous to health (C.O.S.H.H.) and infection control procedures. The laundry is separate to the main buildings and is well equipped and hygienic.
St Joseph`s Hospice DS0000017272.V285088.R01.S.doc Version 5.1 Page 14 St Joseph`s Hospice DS0000017272.V285088.R01.S.doc Version 5.1 Page 15 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): 28 Staff are provided with specialist training, to meet residents’ health and care needs, and which is in keeping with the service aims and objectives. Staff are consulted as to their personal development needs, in the planning stage of training programmes. EVIDENCE: A variety of training is provided by to develop staff skills in meeting both basic and specialist health care needs. Two staff are qualified NVQ assessors. A member of staff explained that the manger has been planning training for the next few months. Every member of staff was asked to identity their training needs and state their training preferences. As a result, personal development plans include training for care staff in basic observations and tracheotomy care, and further training for nurses in palliative care and symptom control. St Joseph`s Hospice DS0000017272.V285088.R01.S.doc Version 5.1 Page 16 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): 33,35 The home is managed in a way, which protects residents’ welfare, and their financial interests are safeguarded. EVIDENCE: There was evidence in care files that consultation with residents and their representatives is ongoing, from the initial assessment, in care planning, ongoing reviews, and throughout their life in the home, through satisfaction questionnaires. The home does not take responsibility or act as appointee for residents. The service is funded by Primary Care Trusts under Terminal Care or NHS funded Continuing Care. For those residents who lack capacity, relatives or their representatives, manage their personal monies. Residents, who have no representatives, have access to local advocacy services. In instances where
St Joseph`s Hospice DS0000017272.V285088.R01.S.doc Version 5.1 Page 17 personal allowances are held on behalf of residents, this is recorded on their care plan. St Joseph`s Hospice DS0000017272.V285088.R01.S.doc Version 5.1 Page 18 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X X St Joseph`s Hospice DS0000017272.V285088.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? Yes Recommendation Standard 12. 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 OP9 Regulation 13 Requirement The manager must ensure that all prescribed medication is labelled with the individual resident’s name. Timescale for action 25/03/06 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 The manager should develop a planned activities programme and maintain an activities diary. St Joseph`s Hospice DS0000017272.V285088.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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