Inspection on 02/02/06 for St Josephs Home

This inspection was carried out on 2nd February 2006.

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

The inspector 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 Josephs Home 05/06/07

St Josephs Home 21/07/05

St Josephs Home 15/03/05

St Josephs Home 01/07/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE St Josephs Home 66 Cotham Hill Cotham Bristol BS6 6JT Lead Inspector Sam Fox Unannounced Inspection 09:30 2 February 2006 nd 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 Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 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 Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Josephs Home Address 66 Cotham Hill Cotham Bristol BS6 6JT 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) 0117 9733815 0117 9466786 The Little Sisters of the Poor Sister Catherine Mckinlay Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places St Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate up to 6 persons receiving nursing care. May accommodate up to 35 persons aged 65 years and over, requiring personal care. Manager must be a RN on Parts 1 or 12 of the NMC register Date of last inspection 21st July 2005 Brief Description of the Service: St Joseph’s Home is operated by the Little Sisters of the Poor. It is registered to provide accommodation and personal care for up to 41 residents who are 65 years and over. Within this they can provide support for up to six people who also require nursing care. Sister Catherine McKinley (known as Sister Marie) is the current registered manager. Whilst there is an ethos of Catholicism within the home, it is nondenominational and all religious beliefs are respected. There is a convent located on the top floor of the premises where the nuns live. St Joseph’s is situated in a busy residential area of the city and close to local amenities and bus routes. The home is modern, well decorated, with facilities over three floors which are accessible via a lift. There are numerous aids and adaptations for people with physical disabilities. St Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report follows an announced inspection that took place over one day. The main purpose was to ensure that residents were continuing to receive a good standard of care and that they were satisfied with the services on offer. In addition to this several key records were examined, including health and safety documents, recruitment and training files. Evidence was gathered through discussion with staff, examination of records and observation. In addition to this ten residents were interviewed and opportunity was taken to join residents with their lunchtime meal. Not all standards were assessed and this report should be read in conjunction with others so a fuller picture of the home can be gained. What the service does well: What has improved since the last inspection? All policies and procedures have been reviewed and updated, these give good guidance for staff to promote residents well being. The home continues to maintain previously good standards in many of service provision. St Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 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 Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 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 Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 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): 2,3,4,5, There is an effective admissions procedure so new residents can be confident that the home will have the skills and resources to meet their needs. They are given opportunities to become familiar with the house so they can make more of an informed choice. EVIDENCE: Opportunity was taken to view four personal files. These all included an admissions summary with essential medical details and emergency contact numbers. In addition to this Sister Marie has developed a pre-admissions assessment form which she uses prior to new residents moving in. These were found to be detailed and provide a good tool for the home to ensure they have the resources and skills to meet individual needs. This is good practice and meets with the requirements of the legislation. One file contained a re-assessment by social services requested by the home for one person who had had a residential place but now requires nursing care. This indicates that the home obtains the appropriate specialist advice to help them determine need. St Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 Page 9 St Josephs can offer up to six places for people who are more dependent and who require nursing care. Residents consulted with said they were pleased about this because it meant that if there needs increased they would not have to move. This gave them a great source of comfort. Residents confirmed that they were able to go and look around the home prior to moving there and a prospective new resident was observed being shown around during the inspection. Two residents said they had previously worked in a voluntary capacity at the home, or had friends there, so they were able to get to know it well before making a decision to move there. All residents are issued with a statement of terms and conditions on taking a place. This meets with requirements of the legislation. St Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 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, 8,10,11 Staff are respectful so residents can be confident that their right to privacy and dignity will be upheld. They can also be re-assured that their wishes will be respected at the end of their lives. Some care plans and health assessments need to include more detail to ensure consistency. EVIDENCE: Residents’ files were found to contain numerous information including care plans. These highlighted areas where individual support was needed and assistance to be provided by staff. They covered emotional, social and physical needs and evidenced that the home tales a holistic approach to the provision of care. It was noted that some care plans could have benefited from updating, this was particularly the case for one resident who has moved from requiring residential to nursing care. The plan did not reflect this persons increased need and did not give an accurate picture of what support the home actually provides on a day-to-day basis. St Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 Page 11 Care plans are regularly reviewed and residents are fully involved in this process. It was noted that they had signed their agreement to a number of documents. Records provided evidence that residents are supported to see the relevant health professionals. St Josephs have their own Doctor who visits on a weekly basis. Some residents explained, however, that they chose to retain their own GP. It is good practice that they have the choice in this respect. Health care appointments are fully recorded. There were continence, nutritional, pressure sore and pain assessments on file. These provide a good tool for assessing the risks to residents’ health in all these areas. It was noted, however, that some assessments indicated a medium to high risk but this was not translated in to an action or care plan. For example, there was no detail of specialist equipment to be used if residents were assessed as being at risk of developing pressure sores. It was also noted that one resident was assessed as having a moderate risk in a nutritional assessment but in reality they needed to be fully supervised to eat otherwise they may become malnourished. The home should review these health care assessments and expand care plans if necessary. There were comprehensive manual handling risk assessments in place which were written to a good standard. All residents consulted with spoke positively about the service they receive and warmly of the staff who provide it. They said that they were respectful, kind and “could not do too much” for them. They particularly praised the sisters and said that they were never too busy to stop and chat with them and that they felt they were listened to. Relationships between staff and residents were observed to be respectful but friendly. There was a calm atmosphere within the home and residents were observed being discreetly supported with their personal care needs. A number of residents have their own telephone lines. They were observed to have their own style of dress and being addressed in their preferred term. Lengthy discussion took place with Sister Marie about arrangements in place for death and dying. The home has a clear policy about this, which states that there will be no active euthanasia; no residents will be left alone unless it is their wish and that beliefs and values will be acknowledged. This also includes arrangements to be made for people with different religions. This is good practice. St Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 Page 12 Sister Marie explained that many residents choose to have their funeral ceremony in the chapel on site which meant that other residents were free to attend. This was confirmed by residents who said they were kept fully informed if residents were seriously ill or dying and that they were pleased because it gave them a chance to pay their last respects. Sister Marie explained that the home provides support for residents needing palliative care and she displayed a good understanding of the specialist help available for support, including the McMillan nurses with whom she said the home had good relations. There were some records of residents’ wishes in the event of their death but these were not consistent. It is recommended, to fine tune existing good practice, that the home takes steps to more actively consult residents about their wishes and to record this. Clearly, however, this is an sensitive issue and may not wish to be discussed by some residents. St Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Residents are supported to retain their independence and lead active and interesting lifestyles. Visitors to the home are made welcome and links with family and friends are valued. EVIDENCE: Discussion took place with residents about their daily routines. It was apparent that they felt there were no unnecessary house rules and that they could do as they pleased as long as this did not negatively interfere with other people’s lives. For example one resident said she was able to have her breakfast in her room as she was a slow riser and liked to take her time. Another resident said they were up very early and liked to go to the dining room for all their meals. Residents can go to bed when they please. St Josephs is operated by the Little sisters of the Poor and as such there is a Catholic ethos within the home. There is a chapel, in which there is a daily mass and where other significant religious festivals are celebrated. Sister Marie, however, explained that the home offers places to people of all religions and that there was no pressure for residents to join in if they did not want to. St Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 Page 14 This was confirmed through discussion with residents who said they felt that they could attend church services when they wished. Two of the sisters spoken with said that, whilst they clearly had a strong personal faith, they would not wish to impose this on people living at the home as this was not part of the ethos of the Little Sisters of the Poor. All personal files seen included a social assessment which had details about personal histories, significant life events and interests. This is good practice. Residents explained that there were a number of planned activities throughout the week that they could choose to join in if they wished. This included a popular arts and crafts course. The home displays a weekly plan of activities in the main reception area and they employ an activities co-ordinator. It was apparent, through discussion that visitors are welcome to the home at any time and there are facilities for residents to make them snacks and beverages. Sister Marie said they also have a spare room which is used for relatives travelling a long distance or who need to be near sick residents. Residents said that there were no restrictions on accessing community facilities and a number of them are still able to do so independently. One resident still has her car, which she uses for short journeys. Residents are encouraged to retain autonomy over their lives according to their abilities and wishes. This ranges from being able to do their own laundry, to keeping their own medication and managing their financial affairs. This is good practice. Two residents said this has enabled them to retain their self-esteem and confidence. Opportunity was taken to join residents with their lunchtime meal. This was served in a sensitive and unhurried manner and was clearly viewed as a social occasion by residents. The food was tasty and serving bowls were used so residents could help themselves to their own vegetables. The menus provided evidence that residents are offered a wide variety of nutritious meals and that there were two main choices each day. All residents were positive about the quality and quantity of the food and confirmed that they were able to eat in private if they wished to do so. St Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not fully assessed during this visit and will be a focus of the next inspection. St Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 Page 16 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): 19,20,21,22,23,24,25,26 Residents’ benefit from living in a clean, comfortably furnished and homely environment. There are many aids and adaptations so residents can fully maximise their independence. EVIDENCE: St Josephs is located within a residential area of Bristol. It is an older building which has been modernised but is still in keeping with the locality. The house is situated within its own grounds and is secured by high walling and electrically operated gates. This provides additional security and privacy for residents. The home has extensive grounds which continue to be well maintained and a source of great pleasure for residents. In addition to this it has its own chapel which residents were observed using for daily mass. St Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 Page 17 The premises was refurbished five years ago and the décor has been maintained to a high standard. It has many communal areas, including several sitting rooms (one of which is a designated smoking area) which are homely in appearance and comfortably furnished. In addition to this there is a well resourced library. There are kitchenettes on each floor, which residents said they frequently use to make beverages and to entertain visitors. These were found to be well stocked. There are two dining areas, both of which are decorated to a high standard and which are bright and cheerful in appearance. Lighting in all communal areas are domestic in character and sufficiently bright to facilitate reading. Opportunity was taken to view a number of bedrooms, shown with residents’ permission. These were found to be personalised and to reflect individual tastes – indicating that choice and independence are promoted in this respect. They had ensuite facilities which included a toilet and shower facility. These include handrails and seating facilities and are fully accessible for people with mobility difficulties. There are a number of specialist bathing facilities and toilets have wide doorways, raised toilets seat and grab rails. There are other aids and adaptations throughout the premises to aid the physically impaired. For example, lowered light switches, adapted taps and a number of residents had specialist beds and mattresses. The doorways and corridors give sufficient width to allow for easy wheelchair access. In addition to this there is an occupational therapist on site who can advise and obtain specialist equipment. Residents said they had bedroom door keys and a number of them were observed using these. This provides them with a means to maintain their privacy and keep their personal possessions secure. All bedrooms seen were bright and naturally ventilated. Service certificates were seen to evidence that the heating and water systems are serviced at the appropriate intervals and that they are safe. Hot water temperatures are checked at regular intervals and a random hand test of hot water outlets indicated that temperatures are kept within a safe range. The home was found to be cleaned to a high standard and there were no unpleasant smells – something which was remarked upon positively by a number of residents. St Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 Page 18 All residents said they were satisfied with the laundry services available. There are also washing machines located in the kitchenettes so they can do their own. The home has a number of infection control policies but these were not looked at in detail during the inspection. There are sluicing facilities on each floor and these were found to be well equipped and clean. St Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Staff are well trained and residents can expect their needs to be met by a skilled team. Recruitment policies are robust and protect vulnerable adults. EVIDENCE: Staffing rotas indicated that there nine care assistants employed throughout the day and a registered nurse. In addition to this there are ancillary staff including several personnel staff, three sisters who are in charge of the meal service and an activities co-ordinator. These levels are sufficient to meet the needs of those residents accommodated. There are good systems in place for the induction and training of staff. The home employ a co-ordinator who is responsible for this. She displayed a good awareness of what induction should cover, the need to ensure all staff have statutory training and she implements an active national vocational training programme. The home are working towards the target of 50 of staff having their national vocational qualification. Opportunity was taken to view the staff file of the newest recruit. This included completed application forms, references and a criminal record check. They were well organised. St Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 Page 20 All but one staff have had a criminal records check, the former has had a povafirst check. This meets with a requirement made at the last inspection. The home was advised that they should only rely on povafirst checks in an emergency, for example, if they were very short staffed or waiting an excessive time for a CRB check. As a rule all staff should not be employed until a satisfactory CRB check has been obtained. In addition to the above Sister Marie was advised that if there were disclosures on a CRB check then she should interview the member of staff about this and fully record her findings. It was noted that St Josephs had a high staff turnover last year and discussion took place about the reasons for this. It is recommended that this is more formally analysed by the home. St Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 Page 21 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): 31,37,38 Residents’ benefit from a living in a well run and organised home, which places health and safety as a priority. Their best interests are safeguarded by up to date, relevant polices and procedures. EVIDENCE: Sister Marie has worked at the home in excess of three years. She demonstrated a good understanding of her responsibilities under the Care Standards Act and has acted promptly to address any requirements made. A number of residents singled her out for praise and said they felt the home was well run. She has recently undergone diversity training – this meets with a requirement made at the last inspection. St Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 Page 22 The home’s policies and procedure have recently been updated (December 2005) and these cover a wide range of issues. They were clearly written and were specifically aimed at work practice within St Josephs, including the philosophy that the Little Sisters of the Poor endeavour to adhere to. This is a positive development. All records requested during this inspection were readily available, written in plain English and well organised. The fire logbook was inspected and evidenced that the appropriate tests and checks of the systems take place at regular intervals and that staff get regular re-fresher training. In addition to this the home has conducted a series of fire drills at different time of the day. There was a detailed fire policy in place and the home carries out a monthly fire audit for additional safety. There were a number of health and safety risk assessments available, including a legionella risk assessment review, the monitoring of self-medication and fire risk assessment. This meets with requirements of the legislation. Certificates indicated that the lift and manual handling equipment are serviced at regular intervals. All portable electric appliances have been tested and there was an electrical safety certificate dated 30/01/06. The home convenes a quarterly health and safety consultation committee whose responsibilities are to analyse accidents and ensure that the home complies with the relevant legislation. This is good practice and provides an important, more formal, tool for monitoring safety. St Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 Page 23 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 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 4 4 4 4 3 3 3 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 3 x x x x x 3 3 St Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 Page 24 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. 2. Standard YA7 YA8 Regulation 15 12(1)(a) Requirement Ensure all residents have an up to date care plan Review and expand upon health care assessments Timescale for action 30/04/06 30/03/06 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. 2. Refer to Standard OP29 YA11 Good Practice Recommendations Analyse staff turnover Record residents wishes in the event of their deaths St Josephs Home DS0000020363.V263672.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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. 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