Inspection on 25/05/06 for St Mark`s Nursing Centre

This inspection was carried out on 25th May 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 Mark`s Nursing Centre 23/10/07

St Mark`s Nursing Centre 15/12/05

St Mark`s Nursing Centre 06/07/05

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE St Mark`s Nursing Centre 110 St Marks Road Maidenhead Berkshire SL6 6DN Lead Inspector Amanda Longman Unannounced Inspection 25th May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000062781.V289830.R02.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. DS0000062781.V289830.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Mark`s Nursing Centre Address 110 St Marks Road Maidenhead Berkshire SL6 6DN 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) 01628 582800 01628 582899 ANS Homes Limited Rebecca Temperton Care Home 80 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (80) of places DS0000062781.V289830.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th December 2005 Brief Description of the Service: This nursing home is newly built and completed in 2005. The decoration and furnishings are of good quality and provide a very attractive environment. The home is built next door to the local hospital and is accessed via the Hospital grounds. The home is arranged to provide four wings, one is a recently registered dementia unit, one is a rehabilitation unit, provided under contract to the Primary Care Trust and two are care home with nursing units, offering care to a mixture of privately funded service users and service users funded by the local authority. All rooms are spacious and have en-suite facilities of a toilet, hand basin and shower. All four units have their own communal lounge and dining room, as well as a smaller lounge for private use. The home is arranged over two floors. There are gardens with seating arranged round the home. A separate, securely fenced garden is provided for the dementia unit. The home is close to the centre of Maidenhead, with a large shopping centre and other community facilities. St. Mark’s provides accommodation for up to 80 service users (20 per unit). The fees, at the time of the inspection, were in the range of £494 to £900 per week depending on the type of placement. Additional charges are made for services such as direct dial telephone, hairdressing and newspapers. DS0000062781.V289830.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. St. Mark’s Nursing Centre was inspected over a total of four days between 20 April 2006 and 25 May 2006, with a site visit to St. Mark’s taking place on 25 May 2006. Evidence of how St. Mark’s had met previous requirements was examined, their current policies and procedures and the newly registered manager’s plans for addressing areas of development were examined. During the site visit the inspector reviewed the care of four service users in detail, spoke with five service users, two care staff in detail, other care staff in passing, and five other staff: the manager, the head of care, the administrator, the chief and the house keeper. The manager and the head of care were spoken with in detail. The inspector spoke with one relative on the day of the site visit and one relative subsequent to the site visit. Service user surveys were received from 30 service users. What the service does well: What has improved since the last inspection? Previous requirements have been met. Care plans now contain photographs and details of pressure area care and all pressure area wounds are now monitored by the manager or the head of care, with a report being prepared monthly for head office. Medication records are up to date and now all contain a photograph of the service user and recruitment files also contain photographs. Training records have been updated and a central record of training is now being maintained. The home now has a registered manager and it is clear on staff rotas who is in charge of the home in the absence of the manager. Fire records are maintained and any significant events are now notified to the Commission. DS0000062781.V289830.R02.S.doc Version 5.2 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. DS0000062781.V289830.R02.S.doc Version 5.2 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 DS0000062781.V289830.R02.S.doc Version 5.2 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): 1, 2, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to the service. EVIDENCE: The home has an appropriate and up to date Statement of Purpose. It provides a Service User Guide, in the form of a Welcome to St. Mark’s guide, which contains all the required relevant information. The Service User Guide does need to be corrected as it currently refers to the Care Standards Commission, rather then The Commission for Social Care Inspection. The manager informed the inspector that service users financed by the Primary Care Trust or Social Services are not issued with contracts. This confirmed evidence from service user feedback received from questionnaires. All service users are provided with BUPA terms and conditions. Evidence from service user files showed that service users’ needs are thoroughly assessed. Service users referred solely for intermediate care are only admitted if their assessment indicates the goals of intermediate care can be met. This was witnessed by the inspector on the day of the site visit when two inappropriate referrals were turned down. The inspector spoke with three service users admitted for intermediate care who all DS0000062781.V289830.R02.S.doc Version 5.2 Page 9 confirmed that the intensive rehabilitation provided maximised their independence in order for them to return home. DS0000062781.V289830.R02.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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to the service. EVIDENCE: The four care plans reviewed were appropriate and up to date, including health care and contained photographs of each service user. Staff were familiar with, and contributed to care plans. Pressure area care has been reviewed, a new procedure ensures they are reviewed weekly by the Manager or the Head of Care. Records revealed that where service users had recently been admitted with pressure areas these had healed well through the care administered in the home. Two relatives spoken with over the period of the inspection both spoke highly of the quality of care. However one relative expressed night time care had gone through a poor phase but this had been adressed by the new manager and was now much better. One relative spoke very highly of the terminal care her parent had received which included care and support for the family. Staff spoken with demonstrated good understanding of dignity and respect including for example, assisting with getting up, with bathing and enabling private interaction with relatives. Service users spoken with spoke highly of the quality of care they receive and the inspector witnessed staff treating service users with dignity and respect both in the way they spoke to DS0000062781.V289830.R02.S.doc Version 5.2 Page 11 service users and how they administered care. Medication records were reviewed during the site visit, were seen to be up to date and all contained photographs of the relevant service user. DS0000062781.V289830.R02.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to the service. EVIDENCE: The home has two activities organisers in post. The activities calender for May showed activities such as arts and crafts and gardenning, as well as outing and birthday celebrations. During the period of the inspection outings included a pub visit and a visit to celebrate Ascension day at church. 60 of service users who responded to the survey said there were usually or always suitable activites arranged in which they could partake. Feedback from a minority of respondents to the survey was that activities were arranged but they do not always wish to participate. Conversations with staff and service suers on the day of the site visit confirmed this, although one service users stated that more entertainment woul dbe appreciated. The care and interaction of staff and service users on the dementia unit was observed. They had been doing puzzles on the day of the inspection and staff informed the inspector that the previous day they had been doing craft and dominoes. Staff were observed providing very good interaction with service users on the dementia unit, including encouraging them to eat and drink and encouraging use of the safe graden provided seperately for this unit. DS0000062781.V289830.R02.S.doc Version 5.2 Page 13 Activites on the rehabilitation unit are as those for the whole home with the addition of physical therapies as part of their treatment. Service users spoken with on this unit praised the level of care, the food and the activities and confirmed they had choice and control over their daily routines. All viewed the home as affording them a good oppportunity of returning to their own home with an optimised level of independence. Two of the service users spoken with on the day of the site visit had attended the church service and thoroughly enjoyed it. Relatives were seen to be encouraged in to the home. Small lounges on each unit enable service users to entertain guests in private and small serveries enable service users or their visitors to prepare drinks and snacks. The use of these was confirmed by staff and service users spoken with. Service users spoken with confirmed that staff were polite and courteous and enabled them to exercise choice and control over their own lives, for example with regard to where and what to eat, times for getting up and going to bed and participation in activities. Service user surveys showed a general satisfaction with meals - 84 always or usually good. Menus reviewed showed a 3 week cycle and include choices of cooked food at breakfast and most days at tea, as well as at lunch. A small number of comments were received on the service user suveys which indicated some items were repeated and this was seen on the menu. This was raised with the manager who stated this was because these items were popular (for example cheesecake). The kitchen is staffed til 7.00 pm and the manager infromed the inspector that supper choices are wider than shown on menu as chief will do supper items such as omellete, poached eggs, jacket potato on request. This was confirmed by service users and staff on the site visit. The home currently has no formal input from service users in to menu planning but this is something the manager plans to address. A tour of the home at lunch time on the day of the site visit revealed a very popular and good quality lunch of roast chicken being served. All service users spoken with said the lunch was very good and was usually so. Staff were observed serving and assiting appropriately and actively encouraging service users to eat. The Head of Care stressed the importance of calorie intake for people with dementia and demonstarted suppliments used where necessary to help achieve this. The kitchen staff were spoken with and confirmed about 20 cooked breakfasts are requested everyday and these can be a variety of foods all of which are catered for. The variety of cooked breakfasts catered for was verified by service users and staff. A tour of the kitchen witnessed the variety of food prepared for tea plus home made cake for the afternoon. Service users’ plans contained nutritional risk assessments and regular weight monitoring. One comment was received to say there were sometimes too many buffets at tea time. DS0000062781.V289830.R02.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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to the service. EVIDENCE: The policy relating to the protection of vulnerable adults (POVA) was reviewed and was appropriate. POVA training has been arranged by the new manager and procedures relating to POVA and whistleblowing have recently been discussed with all staff. The complaints policy was reviewed and was appropriate and is contained within the Servic User Guide. 90 of respondents to the Service User Survey said they usually or always knew who to speak to if they were not happy and 84 stated they usually or always knew how to make a complaint. Two POVA investigations have been carried out since the last inspection. One of these has been satisfactorily concluded and the worker has been dismissed. One is on-going, the worker has been suspended and was due to attend a meeting two weeks after the site visit. Proper procedures have been followed in both cases. Staff spoken with were all clear about whistleblowing procedures and confirmed they would use them. A relative spoken with stated she had made a previous complaint about care which had been dealt with appropriately and the problem resolved. Records maintained for service users’ finances were examined and procedures seen to be in order. The complaints records were examined during the site visit: three recent complaints have been resolved and the manager has DS0000062781.V289830.R02.S.doc Version 5.2 Page 15 instituted procedures around communication and the logging in and out of personal possessions to address the issues raised in the complaints. Twelve written compliments have been received so far this year expressing great satisifaction with the level of care received. One relative spoken with whose relative had recently died in the home, spoke extremely highly of the level of care and attention provided to the service user and the excellent support provided to the relatives. DS0000062781.V289830.R02.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, 20, 21, 24 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a site visit to the service. EVIDENCE: All safety checks for the home relating to, for example, gas, electric and fire safety provisions were reviewed and seen to be up to date. 100 of respondents to the service user suvey said the home was always or usually fresh and clean. The tour of the home revealed it to be extremely fresh and clean. All bedrooms are spacious and have en-suite, suitably designed shower rooms with toilets and wash basins. Rooms contained service users’ own possessions. Communal indoor and out door facilties are very good. Each of the four units has its own large lounge and dining room, as well as a small lounge for entertaining or for peace and quiet and a servery suitably equiped for service users or their relatives to make drinks or snacks. Service users and relatives spoken with confirmed they felt the home was very confortable. DS0000062781.V289830.R02.S.doc Version 5.2 Page 17 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to the service. EVIDENCE: Staffing ratios for the home equate to one nurse and four care worker to every 15 service users, in adition to management, therapists (specifically working on the rehabilitation unit) and domestic, catering and administrative staff. There are also two activities co-ordinators and the manager is recruiting a training co-ordinator. The use of agency staff is low (one nurse for five nights the week before the site visit). 34 of the care staff are qualified nurses, the remaining 66 are care workers of which 38 hold NVQ level 2 or above, with a further 7 currently enrolled for the qualification. Although a concrete training plan does not currently exist the manager is awaiting confirmation for another group of care workers to commence their NVQ level 2 training and has organised training for all staff in the area of abuse. A central record of training undertaken has been compiled. Interviews for a training co-ordinator were due to take place the day after the site visit. Staff files examined during the site visit revealed that only a ten year employment history is routinely asked for and one of four files examined contained unexplained gaps in the employment history. One out of the four did not contain two suitable references, another contained 2 references but both DS0000062781.V289830.R02.S.doc Version 5.2 Page 18 from the same previous employment and one contained a reference not authenticated by headed paper, company stamp or other verifiable means. Evidence of induction being booked was seen on three of the four files and staff spoken with confirmed they had received induction. Staff observed working appeared competent and anecdotal evidence from service users indicated staff were suitably trained to do their jobs. DS0000062781.V289830.R02.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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to the service. EVIDENCE: The current manager is registered with the Commission. She is a senior manager within BUPA and has been placed in the home on a temporary basis. In the absence of the manager the staffing rota clearly showed who carried responsibility for the home. On the day of the site visit the manager operated an open door policy which was confirmed by service users, staff and relatives as normal practice. Service users and staff spoken with confirmed that the manager is very approachable and that she visits all four units and talks with service users and staff daily. Relatives spoken with confirmed that the current manager is approachable and sensitive to service users’ and relatives needs. This was pertinately illustrated DS0000062781.V289830.R02.S.doc Version 5.2 Page 20 by one service users relative whose parent had recently died at the home who praised the support and skills of the management and staff in offering relevant and supportive paliative care. Other quality assurance measures included residents/relatives meetings. The minutes from the most recent one were seen. During the site visit the manager illustrated how points from this meeting were being addressed, for example car parking, unwanted ringing of phones and the pratical functioning of the front doors. Records relating to the management of service users’ personal finances were examined and seen to be up to date and appropriate. These expense accounts are managed by the home’s administrator to cover daily expenses and such things as hairdressing and other sundry expenses. Health and safety policies were seen to be in order. Electrical, maintenance and fire equipment inspections are up to date. A fire risk assessment has been done and a log is maintained in reception. Service users enjoy private ensuite facilities, but the home also has a number of bathrooms with suitable lifting apparatus. Staff spoken with were competent in using these and service users spoken with stated they enjoyed their baths. The laundry, kitchen and COSHH cupboard were all viewed and were all seen to be appropriate with regard to health and safety, including infection control. The house keeper was spoken with and demonstrated appropriate knowledge of health and safety and infection control measures. In line with a previous requirement, significant events are now notified to the Commission. DS0000062781.V289830.R02.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 3 3 3 X X 3 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 3 4 4 X X 3 X X STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000062781.V289830.R02.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action 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 3 Refer to Standard OP15 OP29 OP29 Good Practice Recommendations To improve the involvement of service users it is recommended that the registered manager request input from service users in menu planning. To ensure the safety of service users it is recommended that the two references obtained for potential employees are obtained from different sources. To ensure the safety of service users it is recommended that the registered manager requests that candidates for positions at the home provide a full employment history on their application form In order to ensure the welfare of service users, it is recommended that the registered manager arranges training to ensure 50 of care workers hold an NVQ level 2 or above. 4 OP30 DS0000062781.V289830.R02.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA 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. Extracts may not be used or reproduced without the express permission of CSCI DS0000062781.V289830.R02.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!