CARE HOMES FOR OLDER PEOPLE
St Judes Nursing Home 29-31 Mayfield Road Sutton Surrey SM2 5DU
Lead Inspector Alison Ford Unannounced 17 May 2005 09:30 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 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 Judes Nursing Home Version 1.10 Page 3 SERVICE INFORMATION
Name of service St Judes Nursing Home Address 29-31 Mayfield Road, Sutton, Surrey, SM2 5DU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8643 1335 020 8643 9999 Churchill Residential Care and Nursing Homes Ltd Mrs Brenda P Bluett CRH 41 Category(ies) of N Care home with nursing registration, with number of places St Judes Nursing Home Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20/10/05 Brief Description of the Service: St. Judes is a care home that provides care for forty-one older service users. Their registration allows for 21 residents with dementia and 20 requiring general nursing care. It is situated in a residential area of Sutton and is within walking distance of the town centre.The home was 2 large houses that have been joined to form one large home and accommodation is spread over the three floors of the building. The home has two passenger lifts and two stair lifts. There is a range of communal space comprised of four lounge areas a quiet room,library,hairdressing salon and two dining rooms. There are twentythree single bedrooms, nine double bedrooms nine with en-suit facilities. There are seven bathrooms and fourteen toilets and two shower facilities on various floors to meet the needs of the service users. There is an extensive garden that is well maintained and is accessible to everyone. . There is a large kitchen area and adequate space for food storage and a well-equipped laundry area that launders all service users’ clothes except for those that are required to be dry-cleaned. There is limited car-parking space available to the front of the home.The home is staffed twenty-four hours seven days a week by staff with various qualifications and experience St Judes Nursing Home Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes first statutory inspection of the year 2005/6 and was an unannounced visit. The inspection commenced at 11.00am and lasted three and a half hours. During this time a partial tour of the premises was undertaken. Fifteen of the thirty-seven residents currently living in the home were spoken to along with five members of staff. The deputy matron was on duty during the visit although both the registered manager and registered owner were present for a part of the time. Four care plans, and four staff personal files were assessed at this visit, the complaints book, accident book, and records of staff supervision and appraisals were seen. A previous fire in the home has provided an opportunity for a complete refurbishment and modernisation of the property and this is now in its final stages. Some areas can still not be used although some of the more able residents are enjoying seeing the work progress and in talking to the workmen. They were all in agreement that “ it was going to be worth it in the end”. Great care is having to be taken in order to maintain the safety of both residents and staff. What the service does well:
This home generally provides a safe clean environment for its residents although some problems are being experienced during the refurbishment programme. Notices have been put up throughout the home to ensure that everyone remains fully informed throughout the process. Care is being taken to ensure that areas currently being worked on are not accessible to the residents. Some new residents have been admitted since the last inspection and there is evidence that care is taken prior to their admission to ensure that the home can meet their assessed healthcare needs. All residents have an individual and comprehensive plan of care, which is subject to regular review and contains assessments to minimise the risk of the development of pressure sores, the promotion of mobility and maintenance of a varied and interesting daily life. Activities are provided which suit the needs of the residents and the food served within the home is nutritious and well presented and residents confirmed that there was always a choice. The cook visits residents on a daily basis to ensure their satisfaction. Several residents said that they “ really liked
St Judes Nursing Home Version 1.10 Page 6 the dinners “ and two told how much they appreciated the early morning cup of tea. Visitors are always made welcome in the home and residents are encouraged to bring in possessions from home in order to personalise their bedrooms. Recruitment procedures were generally robust although there had been recent issues with the employment of staff from other countries. Staff training is ongoing however a requirement was issued in relation to increasing training in dementia awareness for all staff. 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Judes Nursing Home Version 1.10 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 Standards Statutory Requirements Identified During the Inspection St Judes Nursing Home Version 1.10 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 standard(s) 3,6 Full and comprehensive assessments are made of potential new residents to ensure that their healthcare needs can be met by the home, prior to their admission. This home does not offer intermediate care. EVIDENCE: Care plans were seen of three recently admitted residents. These contained full and comprehensive pre-admission assessments covering all aspects of their physical and social healthcare needs. They included manual handling assessments, medication profiles and risk assessments and they formed the basis for subsequent care planning. A senior member of the nursing staff or the registered manager always undertakes these assessments. Care managers assessments were also seen in these plans. St Judes Nursing Home Version 1.10 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 standard(s) 7,8,10 All residents have an individualised plan of care, which ensures that their healthcare needs are met. At all residents in this home felt that they were treated with respect and dignity. EVIDENCE: All residents have a care plan and four of them were assessed at this visit. They contain assessments of risk, moving and handling, skin integrity and activities. They are well maintained and regularly reviewed. Nursing staff make daily entries regarding health and well being and visits from the GP and other healthcare professionals are documented. All the residents are registered with the same doctor, who visits weekly, and staff spoke highly of her involvement and care. Although staff were seen treating residents with kindness at this visit, some residents complained that sometimes they were impatient or sharp with them. At lunchtime it was observed that staff supporting residents to eat did not always talk to them or explain what was on their plates. These issues must be addressed, and a requirement is also made in relation to standard 30 to increase training in awareness of the problems associated with dementia for all staff.
St Judes Nursing Home Version 1.10 Page 10 St Judes Nursing Home Version 1.10 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 standard(s) 12,13,14.15 Residents in this home would be supported to exercise choices in their lives as far as they are able and they would be encouraged to maintain contact with their families and friends to provide them with interest and variation in their day. Meals are, well prepared and varied to ensure that nutritional needs are met. EVIDENCE: There is a programme of activities for service users although organised events have been difficult while the building work has been going on and the carers undertake activities in the lounges with the residents in the afternoons. Since the last inspection, a book now details the activities being offered, and who participated in them and if residents chose not to, the reason why. This book would then be available to show relatives if necessary. The relative of one resident had supplied photographs of a previous sporting achievement that had enabled care staff to understand his previous life and it was recommended that this approach be adopted with other residents. Visitors are always welcome in the home and residents confirmed that their relatives were able to come at any time. There are usually quiet areas where they could go however the current work has restricted this at the moment. Residents are encouraged to exercise choices over the clothes that they wear and the food that they eat if they can, although there are several who have
St Judes Nursing Home Version 1.10 Page 12 advanced stages of dementia and benefit from a more structured and planned approach All the residents spoken to confirmed that they enjoyed the meals served in the home and lunch looked tasty and well presented. The cook was off sick on the day of inspection however the assistant cook was preparing the meals. Usually she would visit all the residents’ daily to try and discuss the choice of menu and their likes and dislikes and she would always prepare an alternative dish. One resident complained that his meal was cold and although it was appreciated that he was easily distracted while he was eating it, a recommendation is made that some method is explored to keep his meal warm. St Judes Nursing Home Version 1.10 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 standard(s) 16,18 Residents in the home and their families are confident that any complaints would be dealt with according to the homes policies and that they are protected from abuse. EVIDENCE: The complaints book was seen and the three complaints that had been made since the last inspection had all been dealt with in a timely manner and resolved. Outcomes were recorded in great detail. The complaints process is outlined in the service user guide, a copy of which is displayed in resident’s bedrooms. The home has an adult protection policy and staff displayed an awareness of the procedures involved. All staff have received clearance from the Criminal Records Bureau and new staff are not employed before checks are undertaken against the Protection of Vulnerable Adults Register. St Judes Nursing Home Version 1.10 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 standard(s) 19,26 Building work has disrupted the usual well-maintained environment of the home and accessibility is limited for residents. The management team in the home are endeavouring to ensure that residents continue to live in clean and pleasant surroundings. EVIDENCE: A tour of the home was undertaken. The areas that have been refurbished have been completed to a high standard with all of the requirements of the national minimum standards the however there is still a considerable amount of disruption to the home. On the day of the visit some areas were closed off to maintain the safety of residents and staff and signs were displayed so that visitors could enter the building safely. The management team are attempting to ensure that residents and relatives are kept fully aware of the progress, which has taken longer than originally anticipated. Some of the more able residents were enjoying the work and one elderly gentleman said, “ he was helping to supervise the workmen”. Domestic staff are still cleaning the home however there has inevitably been an increase in
St Judes Nursing Home Version 1.10 Page 15 dust and debris throughout the home. These standards will be reassessed at a later visit. St Judes Nursing Home Version 1.10 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 A robust recruitment procedure ensures the protection and safety of the service users. Although there is ongoing staff training within the home, there is a need to increase dementia awareness training to ensure that the staff are able to support and meet the needs of this client group. EVIDENCE: Off duty rotas were seen and confirmed that two trained nurses were on duty with six care staff. Ancillary staff were also on duty in sufficient numbers to ensure the safe running of the home. There is an ongoing training plan within the home and staff are generally competent to do their jobs. A requirement to improve the way that some staff address residents by increasing training in dementia awareness is made in relation to standard 10 Recent staff training has included medicines management, dementia, elderly care and chair based exercises. The majority of care staff have undertaken an NVQ level 2 qualification and 2 have an NVQ level 3. One newly appointed member of staff was able to describe the induction programme that she had been following. Staff files were seen of four recently appointed members of staff. Three of these had come from Poland and references had been difficult to obtain in some cases. Checks against the Protection of Vulnerable Adults Register had been made prior to employment commencing and Criminal Records Bureau Checks applied for. These members of staff had been initially employed in domestic roles until their communication skills had improved. The other staff file had been completed in accordance with the standards.
St Judes Nursing Home Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standard were not assessed at this inspection and will be inspected at the next visit. EVIDENCE: St Judes Nursing Home Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x x St Judes Nursing Home Version 1.10 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 10 Regulation 12(5)(b) Requirement Timescale for action 4/4/05 henceforth 2. 30 19(5)(b) The Registered Manager must ensure that rseidents are treatedwith dignity and respect at all time. The Registered Manager must 30/11/05 ensure that there is an incease in training of dementia awreness for all staff 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 15 12 Good Practice Recommendations The Registered Manager should explore a method for ensuring that residents meals are hot enough for them It is reccommended that residents key workers find some method to collate information about residents previous lives and inform their colleagues. St Judes Nursing Home Version 1.10 Page 20 Commission for Social Care Inspection 8th Floor, Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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