CARE HOMES FOR OLDER PEOPLE
St Joseph`s (Nazareth House) 111 London Road Southend On Sea Essex SS1 1PP Lead Inspector
Patricia Stanton Unannounced Inspection 7th March 2006 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 Joseph`s (Nazareth House) DS0000015549.V286050.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 (Nazareth House) DS0000015549.V286050.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service St Joseph`s (Nazareth House) Address 111 London Road Southend On Sea Essex SS1 1PP 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) 01702 345627 01702 430352 The Congregation of the Sisters of Nazareth Sister Mary Merriman Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places St Joseph`s (Nazareth House) DS0000015549.V286050.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Nursing and personal care to be provided to service users who are aged over 65 years. Total number of service users not to exceed 34. To provide care for a service user under the age of 65 whose name is known to the Commission 26th September 2005 Date of last inspection Brief Description of the Service: St Josephs Nursing Home forms part of Nazareth House, an established home in Southend, which is operated by the Sisters of Nazareth, providing residential and nursing care for older people. St Josephs is close to the town centre, bus routes, train station, seafront, and shops. The premises are on three floors and offer various spacious types of accommodation, ranging from single rooms with en suite, double rooms and flat lets with a lounge, galley kitchen and bathroom. The home benefits from an adjoined chapel where residents may attend mass/pray and a well-kept garden, which service users and visitors enjoy in summer months. St Josephs provides care to service users from all denominations and both genders. Plans are in progress to develop St Josephs into a care village and may be viewed in the home’s reception area. St Joseph`s (Nazareth House) DS0000015549.V286050.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The routine unannounced inspection took place on the 07/03/06. During the inspection the inspector spoke to seven residents, two relative, three staff members and the registered manager. Records and documents were looked at, including the previous recommendations from the last inspection. Time was spent in the lounge, dining room and residents rooms, chatting and taking note of the residents’ daily routine in the home. Residents’ staff and in particular the registered manager were most helpful and this was greatly appreciated. The inspector would like to thank residents, relatives and the staff for their time and cooperation during the inspection. What the service does well: What has improved since the last inspection?
Activities in the home have improved since the last inspection and the home offers residents more recreational facilities. Care plans have been redesigned to be more users friendly for staff to use and the registered manager has sought the views of residents in respect of food include social histories and preferences to help improve the service. Audits have been completed on accidents in the home to identify common patterns. The home has a full complement of staff. Residents’ appear happier with the food offered in the home. Staff are trained in diabetes mellitus and basic first aid. The home completes regulation 26 visits each month. Registered nurses are provided with bleeps to improve communication. The home has received four letters of thanks from residents’ and relatives for good care.
St Joseph`s (Nazareth House) DS0000015549.V286050.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 (Nazareth House) DS0000015549.V286050.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 (Nazareth House) DS0000015549.V286050.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): 6 The home does not offer intermediate care. EVIDENCE: St Joseph`s (Nazareth House) DS0000015549.V286050.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. Care plans have improved but do not always include all information. Appropriate health care appointments could be improved. Medication procedures protect residents. EVIDENCE: One care plans examined did not contain a social history or details of activities the resident participated in which were of interest to him. The social history was later found in a separate file and the registered manager was asked to include this in the care plan to assist staff understand residents individual needs. No records were seen of residents weight or inventory of personal processions on admission. The registered manager had completed an excellent audit for falls in the home to identify patterns and susceptible residents. However one file for a resident who had fallen did not contain a suitable risk assessment or manual handling assessment. Health care appointments are made for residents who see the doctor and consultants in hospital and medical aid summoned for residents in the event of
St Joseph`s (Nazareth House) DS0000015549.V286050.R01.S.doc Version 5.1 Page 10 an emergency but one relative stated her dad was admitted three years ago with a hearing aid which had been lost within 6 months of his admission to the home and her dad had not been able to communicate effectively since. The home did offer a replacement aid, which was not suitable there fore the family were left to arrange and pay for a new replacement hearing aid. Medication procedures in the home were examined and controlled drugs counted and found to be correct and in date. All recordings for dispensing were complete with appropriate signatures and medication returns signed for by the pharmacist. Photos of residents are kept on file and the home has access to an up to date British National Formulary. St Joseph`s (Nazareth House) DS0000015549.V286050.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): 12,13,14,15. The home offers suitable social cultural and religious services but could improve recreation for personal interests. Residents maintain good contact with relatives and friends and encouraged to exercise choice and control of their lives. The home offers wholesome nutritious food but this is not always prepared to a high standard. EVIDENCE: The home has improved the activities programme in the home for residents following feedback from residents; however there did not appear to be many activities for the male residents and one resident stated he enjoyed boxing and watching sport. One relative stated it would be nice if the home offered a themed activity i.e. films from the 40s and 50s and musicals. Residents are encouraged to give feedback regarding preferences in food and activities and are included in reviews to help plan care. Relatives are included in reviews but two relatives stated we do not see the new registered manager very much as she is always busy in meetings, however we are always welcome to the home by the staff. St Joseph`s (Nazareth House) DS0000015549.V286050.R01.S.doc Version 5.1 Page 12 The home does not hold regular forums for residents to come and see the registered manager to give their views and opinions. The food in the home has improved since the last inspection and all residents spoken to stated how they enjoyed the food but some residents and relatives stated it is not always prepared to a high standard. One relative stated an omelette prepared for her husband looked like custard. At inspection it was noted residents enjoyed their meals and menus examined confirmed they had choice. Fresh fruit and vegetables were available but it was noted the jacket potatoes served at lunch did not have any side dish or salad garnish. One resident stated “it would be nice if the registered manager came to eat in our dining room once a month.” The home does not keep records of residents weight to monitor possible health concerns. St Joseph`s (Nazareth House) DS0000015549.V286050.R01.S.doc Version 5.1 Page 13 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): 16,18 Complaints are taken seriously by the home and residents are protected from abuse. EVIDENCE: The home has received no complaints since the last inspection and only one incident regarding a staff member who no longer works in the home. The registered manager had investigated the incident appropriately. The home has received four complements from relatives regarding the high quality of care from staff. All staff receive updates in protection of vulnerable adults (POVA) training and at inspection a course for POVA was being held in the homes main hall for the local health care workers. St Joseph`s (Nazareth House) DS0000015549.V286050.R01.S.doc Version 5.1 Page 14 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): 26 The home is clean, pleasant and hygienic. EVIDENCE: The home is clean, hygienic and comfortable suitable to meet the needs of residents accommodated. Rooms are redecorated for new residents who are admitted. The home has plans for a new care village in the grounds of the home and plans were currently being submitted for approval at inspection. St Joseph`s (Nazareth House) DS0000015549.V286050.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): 27,29 The numbers and skill mix in the home meet residents’ needs and recruitment practices are robust. EVIDENCE: The home currently has no vacancies. The staff rota matched the number of staff on duty, which appeared to meet the needs of residents accommodated. The registered manager had encouraged carers in the home with NVQ level 2 or above qualifications to take more responsibility with regard to care, completing activity programmes, social histories and daily recordings. Staff receive regular training and recently completed a course in diabetes mellitus, hypoglycaemia and basic first aid. More staff are undertaking NVQ level 2 and 3 training. Recruitment procedures are robust and files examined confirmed all appropriate checks are completed. It was noted the application forms did not have sufficient space to record all employment history details. Comments from relatives and staff were varied but mostly praising staff for their hard work. One resident stated, “They always come when you buzz and work hard but one relative stated, “Staff only do what they have to. “ St Joseph`s (Nazareth House) DS0000015549.V286050.R01.S.doc Version 5.1 Page 16 At inspection staff were observed to be kind and caring to residents. Communication between staff and residents was positive and respectful and residents looked clean and well cared for but one relative stated she did not know who the key worker was for her relative and thought it would be nice to see the same person attend to her husband as staff were not trained in the use of her husbands special chair. St Joseph`s (Nazareth House) DS0000015549.V286050.R01.S.doc Version 5.1 Page 17 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): 31,36,39 The registered manager is qualified to run and manage the home effectively. The welfare of residents is protected. EVIDENCE: The registered manager has worked hard to develop the home and offer residents a high standard of care. Staff stated the registered manager is approachable and records evidenced staff are supervised. The home completed regulation 26 visits each month, which are detailed and informative. The home notifies the appropriate professionals and CSCI regarding all serious incident in the home. St Joseph`s (Nazareth House) DS0000015549.V286050.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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 X 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 3 17 X 18 3 X X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 3 X 4 St Joseph`s (Nazareth House) DS0000015549.V286050.R01.S.doc Version 5.1 Page 19 no 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 OP7 Regulation 15 Requirement Care plans must include details of residents’ health and social care needs. This refers to records of residents weight, inventory of possessions, risk assessment for fall and manual handling. The home must arrange health care appointments. This refers to the audiologist. Staff should be trained in how to use specialist equipment Timescale for action 01/06/06 2 3 OP8 OP27 12 1 (a) 18 1 (a) 01/06/06 01/06/06 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. 3 4 Refer to Standard OP4 OP8 OP12 Good Practice Recommendations Assessments should include residents’ social history and assessments signed and dated by staff completing them. The home should replace lost items for residents. The home should use the information gained in care plans and social histories to promote individual personal interests.
DS0000015549.V286050.R01.S.doc Version 5.1 Page 20 St Joseph`s (Nazareth House) 5 6 7 8 9 10 OP12 OP15 OP29 OP27 OP13 OP13 The home should consult with male residents and provide appropriate recreation for individuals’ interest and hobbies. This refers to boxing videos and sport viewing. Food should be cooked to a consistent high standard. Employment application forms should give adequate space for completion of employment history. Minutes of staff meeting should evidence staff views and opinions. A communication book in residents’ rooms could be considered for residents who are not able to verbalise. Relative forums should be arranged to seek their views and opinions. St Joseph`s (Nazareth House) DS0000015549.V286050.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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