CARE HOMES FOR OLDER PEOPLE
St Judes Nursing Home 29-31 Mayfield Road Sutton Surrey SM2 5DU Lead Inspector
Alison Ford Unannounced Inspection 25th October 2005 11:30 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.V258480.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 Judes Nursing Home DS0000019126.V258480.R01.S.doc Version 5.0 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.V258480.R01.S.doc Version 5.0 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. 17th May 2005 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 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 wellequipped 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 DS0000019126.V258480.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes second statutory inspection of the year 2005/6 and was an unannounced visit. The inspection commenced at 11.30am and lasted three hours. During this time a partial tour of the premises was undertaken and fifteen of the thirtynine residents currently living in the home were spoken to, along with three members of staff. Two relatives were also spoken to. The registered manager and her deputy were on duty and the registered owner was also in the home. A previous fire in the home had provided an opportunity for a complete refurbishment and modernisation of the property and this is now finished. A small amount of electrical work still remains to be finished. Prior to the visit, comment cards had been received from five service users and the registered manager had submitted a pre-inspection questionnaire. ` During the two inspections this year, all of the standards that the commission considers to be key to the inspection process have been assessed and this report should be read in conjunction with the one produced following the inspection on the 4th April 2005. No complaints have been received about the service since the last inspection What the service does well:
This home provides a safe clean environment for its residents and the extensive refurbishment programme has improved both communal areas and resident’s bedrooms. Several residents commented on “how lovely the home was now “and “what nice bedrooms they had “. Some new residents have been admitted since the last inspection, and although care plans were not assessed at this visit, relatives confirmed that care is taken prior to 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 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 on a daily basis, to ensure their satisfaction with the food. Several residents said that they “ really liked the dinners “ Visitors are St Judes Nursing Home DS0000019126.V258480.R01.S.doc Version 5.0 Page 6 always made welcome in the home and regular meetings are held to involve them in the running of the home. 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Judes Nursing Home DS0000019126.V258480.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 Judes Nursing Home DS0000019126.V258480.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): 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 not assessed at this visit however, relatives confirmed that pre-admission assessments were undertaken to ensure that residents care needs could be met and these had been seen last time. St Judes Nursing Home DS0000019126.V258480.R01.S.doc Version 5.0 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): 9,10 Medication procedures are not always adhered to so residents cannot be certain that they are protected from errors in drug administration. Residents in this home are treated in a manner, which ensures that their privacy and dignity are respected. EVIDENCE: Assessment of medication procedures revealed an error in the administration process, which was discussed with the registered manager. A pharmacy audit had been undertaken earlier in the month, which had been satisfactory and new arrangements were being put into place for the disposal of waste medication. It is recommended that the nursing team compile a policy, detailing how this procedure will be undertaken, to prevent any possible risks. Staff were observed treating residents in a kindly and respectful way and several residents commented on how good they were. There has been some recent training undertaken in dementia however, in view of the advanced stages of dementia of many of the residents, as detailed in standard 30, an action plan must be produced to illustrate how this will continue and include all staff. St Judes Nursing Home DS0000019126.V258480.R01.S.doc Version 5.0 Page 10 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): 12,13,15 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. 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; the registered manager explained how the home is able to accommodate those who wish to exercise some degree of choice over their activities of daily living. 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. The homes cook displayed an enthusiasm for working with his client group and explained how she visited them 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.
St Judes Nursing Home DS0000019126.V258480.R01.S.doc Version 5.0 Page 11 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): These standards were not assessed at this visit, however no complaints have been received about the service since the last inspection. EVIDENCE: St Judes Nursing Home DS0000019126.V258480.R01.S.doc Version 5.0 Page 12 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 Residents live in a clean, safe and well-maintained environment, which meets their individual and collective needs. EVIDENCE: A tour of the home was undertaken. The areas that have been refurbished have been completed to a high standard in line with health and safety regulations and are comfortable and homely. Residents all agreed how much improved it all was. There is a well-maintained garden to the rear of the property. The home was clean and free from odour on the day of the inspection, C.O.S.H.H. policies are in place and checks for legionella are about to be undertaken. St Judes Nursing Home DS0000019126.V258480.R01.S.doc Version 5.0 Page 13 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): 27,30 There are sufficient, staff on duty in the home however, an increase in training would ensure that residents could be certain that their needs will be met EVIDENCE: On the day of the inspection the home was staffed with a mixture of trained nurses and care staff according to previously agreed standards. The off duty rota’s showed this to be always the case. There has been recent training for care staff including health and safety, dementia and understanding and responding to challenging behaviour. In view of the advanced stages of dementia of many of the residents, there must be an emphasis on training in theses areas. The registered manager must submit an action plan detailing how staff will continue to access training in dementia awareness so that all of them are able to attend and to keep updated on a regular basis. St Judes Nursing Home DS0000019126.V258480.R01.S.doc Version 5.0 Page 14 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): 31,33,36,38 Residents can be sure that the home is run in their best interests by an experienced person however, there must be a check on some health and safety procedures to ensure that they are always protected. EVIDENCE: The Registered Manager, a trained nurse, has been in post for some time and is familiar with the problems experienced by this client group. She has undertaken recent training in line with the commission’s regulations. Relatives are invited to regular meetings so that their views can be sought on how the home achieves its goals and policies and procedures are reviewed regularly, in line with legislation. Supervision is occurring for care staff, and is recorded but not on a regular basis. The Registered manager must ensure that this happens at least six times a year. St Judes Nursing Home DS0000019126.V258480.R01.S.doc Version 5.0 Page 15 According to the pre-inspection questionnaire maintenance certificates were up to date however there have been no recent visits from a health and safety representative or a fire safety officer and the manager was asked to arrange these. There has also not been any fire safety training for staff for more than a year and this must be provided. St Judes Nursing Home DS0000019126.V258480.R01.S.doc Version 5.0 Page 16 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 X 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 X X X X X 2 St Judes Nursing Home DS0000019126.V258480.R01.S.doc Version 5.0 Page 17 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 OP9 Regulation 13 (2) Requirement The Registered Manager must ensure that all staff comply with the correct procedure for administering medication The Registered Manager must develop an action plan detailing how all staff will receive ongoing training in dementia awareness. The Registered Manager must ensure that there is evidence that all care staff are receiving supervision six times a year. The Registered Manager must arrange for the home to have a visit from the Fire Safety Officer. The Registered Manager must arrange for the home to have a visit from the Health and Safety representative The Registered Manager must arrange for all staff to have fire safety training. Timescale for action 25/10/05 2 OP30 18(1)(I) 31/01/06 3 OP36 18(1)(i) 31/01/06 4 5 OP38 OP38 23(4) 13(4)(a) 31/01/06 31/01/06 6 OP38 23(4)(e) 31/01/06 St Judes Nursing Home DS0000019126.V258480.R01.S.doc Version 5.0 Page 18 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations It is recommended that the Registered Manager should compile a policy detailing the procedure to be followed when disposing of waste medication. St Judes Nursing Home DS0000019126.V258480.R01.S.doc Version 5.0 Page 19 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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