CARE HOMES FOR OLDER PEOPLE
St Judes Nursing Home 29-31 Mayfield Road Sutton Surrey SM2 5DU Lead Inspector
Alison Ford Key Unannounced Inspection 23rd August 2006 12:30 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 Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 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 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) 020 8643 1335 020 8643 9949 Churchill Residential Care and Nursing Homes Ltd Mrs Brenda P Bluett Care Home 41 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (20) of places St Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A variation has been granted to allow four specified service users in the Care Home only service category to be accommodated. Date of last inspection Brief Description of the Service: St. Judes is a home that provides nursing 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 twenty-three single and nine double bedrooms. 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 Fees at the time of this inspection ranged from £552 - £700 per week. These would be agreed prior to admission along with any other charges payable. A copy of the latest inspection report could be obtained from the home, The Commission for Social Care Inspection or the internet. St Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection was an unannounced visit lasting five hours and conducted with the manager of the home and her deputy. During this time, a partial tour of the premises was undertaken and many of the 40 residents currently living in the home were spoken to. Three relatives, visiting at the time, were also spoken to. A previous fire in the home had provided an opportunity for a complete refurbishment and modernisation of the property and plans are underway for a celebration to mark the completion of all the work. Prior to the visit, comment cards had been sent out to residents of the home and their relatives and healthcare professionals who visit the home. Replies had been received from 1 resident, 10 relatives, the GP who attends the home and a care manager. In addition the registered manager had submitted a preinspection questionnaire and other documentation providing evidence of the care and services provided by the home. ` Two complaints were received by The Commission, about the service since the last inspection and were dealt with according to locally agreed policies. Both were unsubstantiated. What the service does well:
This home provides a safe clean environment for its residents and the refurbishment programme has been completed to a very high standard. Communal areas and resident’s bedrooms have been redecorated and new furniture has been provided. Several residents commented on “how beautiful the home is now “and “what nice bedrooms they had .One resident said “ its lovely to go into my room and know it’s my home.” Those residents that were able to exercise choices within their daily living all agreed that they were able to plan their days according to their own preferences and that staff were “very patient “ and “always willing to help them”. One commented on how nice it was to be waited on and not have to get everything ready for themselves. All residents have an individual and comprehensive plan of care, based on a pre-admission assessment, which is subject to regular review. These contain assessments to minimise the risk of the development of pressure sores, the promotion of mobility and maintenance of a varied and interesting daily life.
St Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 Page 6 Relatives, spoken to during the inspection, were appreciative of the time and trouble spent by the staff during the pre admission process to ensure that the home could meet the needs of the resident. Activities are provided daily 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 is very involved in the home and visits residents frequently, to ensure their satisfaction with the food. Several residents said that they “ really liked the dinners “ Visitors are always made welcome in the home and offered refreshments and regular meetings are held to involve them in the running of the home. Policies and procedures are in place to ensure the health and safety of both staff and residents and staff training is given a high priority in the home. All staff are able to access training appropriate to the work that they undertake in order to ensure that they are able to meet the needs of the residents. What has improved since the last inspection? What they could do better:
St Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 Page 7 During the inspection it was noticed that several bedroom doors had been left open, some propped open with wedges. To ensure residents safety, doors must be kept shut so that any fire would be completely contained. Any doors that residents or staff wish to keep open must be fitted with automatic door closers, which operate in conjunction with the fire alarm. The Registered Provider visits the home on a regular basis however, in line with Regulation 26, a more formal way of recording these visits must now be developed and available for inspection when required. These records show evidence that the provider has talked with residents and that they consider the home to be a pleasant place to live in that suits their needs. Their comments can then be used to influence future services that are provided. 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 Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 Page 8 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 Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Full and comprehensive assessments made of potential new residents ensure that the home will meet their healthcare needs and it will suit them. This home does not offer intermediate care; this standard does not apply. EVIDENCE: The care plans of four residents were seen at this visit. Comprehensive preadmission assessments had been undertaken to ensure that the home would be able to meet their needs. Any potential new resident would be visited by the homes manager or a senior nurse to make sure that the home will be able to provide the services required and an individual care plan is then developed. Relatives of a resident recently admitted, commented on how helpful the staff in the home had been throughout this process. St Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. All residents have an individual care plan so that all staff are aware of the support that they require and that their healthcare needs will be met. Residents are always treated in a manner, which ensures that their privacy and dignity are respected and medication policies and procedures are in place to protect them from errors in drug administration EVIDENCE: All residents have an individual care plan and four of them were assessed at this inspection. The support that is required is clearly identified and regular reviews are undertaken to make sure that it remains appropriate. All of the residents in the home are registered with one GP who takes an active interest in their healthcare needs and visits regularly. The care plans showed that advice is sought from other healthcare professionals as required and those at risk of developing pressure sores are monitored regularly. Suitable equipment is in use to promote tissue viability and continence. One resident was seen that now needs to stay in bed and looked clean, comfortable and well cared for.
St Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 Page 11 A sample of medication records and storage was seen and on this occasion no errors were noted. Appropriate procedures are now in place to dispose of unwanted drugs. Trained nurses administer all medication in the home and recent training has included safe handling of medicines. The aims and objectives of the home reinforce the importance of treating residents with respect and dignity and staff were observed being very kind towards them. Both residents and relatives commented on how caring staff were. One relative commented, “staff treat residents as well as if they were their own parents”. The majority of care plans now contain a life history of the resident. This allows care staff to have a deeper understanding of the needs of the people that they are caring for and understand some of their current behaviour patterns. Relatives confirmed that residents always looked clean and well cared for no matter when they visited and that they were always welcomed into the home. St Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service Residents in this home are supported to exercise choices in their lives as far as they are able so that they can maintain their independence. Contact with residents families and friends is encouraged, to provide them with interest and variation in their day and meals are well prepared and varied to ensure that nutritional needs are met. EVIDENCE: Many of the residents have advanced stages of dementia and appreciate a structured day however; they are encouraged to make choices, which affect their daily living as much as they can. Some residents confirmed that times for getting up and going to bed were flexible, an extra bath was always possible and choices could be made about the clothes that they wear and then food that they eat. The relatives that were spoken to during this visit confirmed that they were always made to feel welcome in the home and could visit whenever they wished. St Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 Page 13 The homes cook has always displayed an enthusiasm for working with this client group and she visits them regularly to discuss their preferences. The menus were seen and she was happy to provide cultural dietary needs when they were requested. The lunchtime meal was served during the visit and looked appetising. Residents confirmed that the food was always good. Activities, tailored to residents remaining abilities, are undertaken daily within the home in order to provide interest and stimulation. A recent outing was arranged for some of the residents and it is hoped that this can be repeated soon as it was so well received. A karaoke machine also provides fun for residents several of who said that they enjoyed musical entertainment. St Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service 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: Two complaints had been made since the last inspection one of which was investigated using the local authority procedures concerned with adult abuse. Both had been dealt with in a timely manner and found to be unsubstantiated. The complaints process is outlined in the service user guide, a copy of which is displayed in resident’s bedrooms. 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. The personnel file of the only member of staff employed since the last inspection was seen as evidence of this. Regular training for staff takes place to ensure that they are aware of actions to be taken if they suspect that abuse is occurring.
St Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 Page 15 St Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 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): 19,26 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Residents live in an extremely well presented and clean environment, which suits their needs although care must be taken to ensure their safety in the event of a fire. EVIDENCE: A partial tour of the premises was undertaken. The home has been redecorated and refurbished to a very high standard. Several residents commented on how lovely it all looked now. One commented on how much she enjoyed looking at it and knowing it was her home. Aids and adaptations have been provided and new stair lifts have now been installed. Bedrooms are bright and well furnished and residents have been encouraged to personalise them. Bathrooms have been refurbished and equipment is in place to ensure that safety of staff and residents. The home was clean and generally free from odour on the day of the visit.
St Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 Page 17 A fire safety officer’s inspection last year did not raise any concerns however, at this visit it was noticed that several bedroom doors had been left open. All bedroom doors must remain closed so that any fire would be totally contained. If a resident wishes their door to be kept open at night or if staff feel that it is necessary for a particular resident, an automatic door closer, linked to the fire alarm, must be fitted. This will ensure that the door will shut automatically if there is a fire. St Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service Residents can be sure that sufficient numbers of appropriately trained staff will be working in the home to meet their healthcare needs and that a robust recruitment procedure is in place to ensure their protection and safety. EVIDENCE: The home is staffed buy a mixture of trained nurses and care staff supported by ancillary staff in sufficient numbers to meet residents needs. Off duty rotas confirmed that this was always so. The majority of staff have undertaken an NVQ level 2 qualification and those who have not are enrolled onto the course. The manager and two senior nurses have completed an NVQ level4. Training has a high priority within the home and there is an ongoing development programme for all staff. Recent training has included dementia awareness, adult abuse, first aid and phlebotomy. This is in addition to statutory training relating to the health and safety of both staff and residents. The home has robust recruitment policies and procedures and all staff have received appropriate clearance from The Criminal Records Bureau prior to starting work there. St Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service Residents can be sure that an experienced person runs the home in their best interests and health and safety procedures are in place to ensure that they are always protected. EVIDENCE: The Registered Manager has been in post for some while and always demonstrates a good understanding of the needs of the residents in the home. At a meeting for residents and relatives, held earlier this year, there was unanimous praise for the work that she does in the home. She has recently completed an NVQ level 4 qualification and is committed to ongoing training and development. Relatives attend meetings held on a regular basis in the home and they are frequently invited to social events. The Registered Provider often visits the
St Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 Page 20 home and in the past has sent a report to The Commission for Social Care Inspection detailing outcomes of her visit. There must now be a more formal method of obtaining the views of residents in line with Regulation 26. Records of these visits should be available for inspection when requested. The home does not take responsibility for the finances of any resident in the home; they all have relatives or representatives to undertake this for them. Staff supervision now takes place on a regular basis and records are kept of the sessions. Each trained nurse has a group of care staff for which they fulfil this role. A selection of certificates relating to the worthiness of equipment and services in use in the home, and the accident book were seen and were all in order. Staff have received recent training in fire safety and other health and safety issues and kitchen records were all in order. St Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 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 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 St Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP19 Regulation 23(4) Requirement The Registered Provider must ensure that automatic door closers, which operate in the event of a fire, are fitted to any door that residents or staff wish to keep open. The Registered Provider must ensure that there is evidence available of visits made in accordance with Regulation 26 Timescale for action 30/11/06 2. OP33 26 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Judes Nursing Home DS0000019126.V308789.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 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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