Inspection on 10/06/08 for St Mary`s Nursing Home

This inspection was carried out on 10th June 2008.

CSCI found this care home to be providing an Excellent service.

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 Mary`s Nursing Home 23/10/08

St Mary`s Nursing Home 16/11/06

St Mary`s Nursing Home 08/02/06

St Mary`s Nursing Home 19/07/05

St Mary`s Nursing Home 10/01/05

St Mary`s Nursing Home 19/07/04

St Mary`s Nursing Home 25/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE St Mary`s Nursing Home Margaret Street Stone Staffordshire ST15 8EJ Lead Inspector Yvonne Allen Unannounced Inspection 10th June 2008 09:30 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 Mary`s Nursing Home DS0000022372.V366112.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 Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Mary`s Nursing Home Address Margaret Street Stone Staffordshire ST15 8EJ 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) 01785 813894 01785 819474 English Dominican Congregation (Stone) Charitable Trust Mrs Anne Clark Care Home 54 Category(ies) of Physical disability (54), Physical disability over registration, with number 65 years of age (54), Terminally ill (3) of places St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 54 Physical Disabilities (PD) - Minimum age 60 on admission Terminally Ill (TI) - over 60 years Registration is dependent upon: the Care Home having a nurse employed at the Home holding the Care of the Dying Course ENB 931 or the University Course K260 Death 7 Death & Dying. This should be achieved within the next 6 months. The category TI is for over 60 years only. One day care place as discussed Date of last inspection 16th November 2006 Brief Description of the Service: St Marys Home is a 54-bedded Care Home offering Nursing Care situated in Stone. It comprises of a three-storey purpose built building, built in early 1976. The current Proprietors The English Dominican Congregation has run the home since 1976. There is a new Registered Manager in place at the home, Anne Clark who registered in January 2008. Ann previously worked as Deputy Manager at the home. The home is set in a town location, however service users benefit from extensive views of large and beautiful gardens, which lead down to the fenced area alongside the canal. The home has 55 single bedrooms and one double bedroom. Some bedrooms have en-suite WC facilities. Facilities/services include a hairdressing salon, laundry services, social activities, library and religious services. There is a summerhouse in the grounds and all areas of the home have access via stairs, ramps and passenger lifts. The visiting GP’s attend weekly or as required, and access is offered to the visiting dentist and chiropodist. The main emphasis of the home is to create a Christian environment, where every opportunity is given for the enhancement of the spiritual, physical and St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 5 social well being of each individual. The Nursing staff and care staff encourage all of the people who live in the home to remain as independent as possible respecting individuality, autonomy and personal privacy. The range of fees charged by the home are outlined in their Statement Of Purpose but as a guide fees range from £420 to £328. The reader may wish to contact the provider for up to date and current information about the fees. St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The Overall quality rating for this service is 3 stars. This means that the people using the service experience excellent quality outcomes. We, the commission, undertook this unannounced Key inspection visit over 5 hours. Prior to the inspection visit the Providers had completed a self-assessment tool, which is known as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to under-take a self-assessment, which focuses on how well outcomes are met for people using the service. It was completed to a good standard and gave detailed information about the services offered at the home. We also received 10 surveys back from residents and their relatives. Many of these contained valuable comments and information about the home and about what it is like to live in the home. We have included these comments in this report. We have received no concerns about this home since the last inspection. All of the Key minimum standards were assessed and for each outcome a judgement has been made, based on the evidence gathered. These judgements tell us what it is like for the people who live in this home. During the inspection visit we looked at relevant records and documentation. We also spoke with a visiting General Practitioner. We spoke with a number of people who live in the home. We also spoke with some staff members including the manager of the home. We walked around the home and looked at all the communal rooms and a random selection of bedrooms. We observed staff interaction with the people who live there including care practices. We took lunch with the residents, sampling the main menu of the day. At the end of the inspection visit we discussed our findings with the manager and made her aware of what we found the home did well and areas where the home could improve. This was a very positive overall inspection with all the Key minimum standards either fully met or exceeded. St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 7 Outcomes for the people who live at this home are either good or excellent. What the service does well: These are some of the comments we received from residents and their families about the home – “Thank goodness for St Mary’s.” “Overall, the care given to Mum is of a high standard, delivered by people who know what they are doing and show their willingness to do it. This home has its heart in the right place.” “They provide a caring, homely atmosphere.” “Couldn’t find better care. I have been here 11 years and cannot find fault.” “St Mary’s Nursing Home does very well caring for a large number of people with differing needs. It also looks after their dignity and respects their wishes.” We found that this home promotes dignity, privacy, respect, and treats people as individuals. The routines, activities and plans are person centred and reflect diverse needs of individuals. They are regularly reviewed and are responsive to individuals changing needs, choices and wishes. Residents can access and enjoy the opportunities available in their local community. The service is committed to the principles of inclusion and promotes and fosters good relationships with neighbours and other members of the community. There is a special interest in meeting the religious and spiritual needs of individuals. Residents and their families are able to enjoy regular Church services and Holy Communion both in the home and in the adjoining Church. The meals served to residents are good. The food is wholesome and nutritious and menus offer choice and variety. Meals and mealtimes are flexible to suit the needs of individuals and can be taken in the dining room or in private. The dining room is conducive to eating and the whole experience of eating meals is pleasurable. The people who live in this home can be assured that their personal and nursing needs will be met and that their health care needs will be monitored. Access to professional health care is actively sought when required and all care is planned and delivered with dignity and respect. St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 8 The physical environment of the home provides for the individual requirements of the people who live there. The environment is peaceful, homely, clean, safe and comfortable. As well as a large communal space where activities take place, the home also offers smaller, more private sitting areas where individuals can find quiet seclusion or meet with their visitors in private. The outdoor space provided is very pleasant and residents with mobility problems can access the gardens. This area also provides for privacy and seclusion. The staff team is dedicated, caring, professional and long standing. Staff usually stay at the home for many years, which offers continuity of care for the residents who live there. Attention is given to staff training and development to ensure that staff have the knowledge and skills to meet the needs of the residents in the home. The home is well managed and is run in the best interests of the people who live there. The manager has a clear understanding of the key principles and focus of the service, based on organisational values and priorities. What has improved since the last inspection? What they could do better: The following comments were received from the residents who live at the home and their representatives “Can they improve? – No.” “No improvement needed.” “In an ideal world, to have more permanent staff would enable Mum to have one to one company when family are not available. To have increased human contact other than at times of care.” We found few areas where the home needed to improve but we did identify that the Quality Assurance system could be further developed in order to ensure that the views and suggestions of the people who live at the home are taken into account. Care plans are of a good standard but there is some room for further improvement with documentation. This is so that all staff delivering care are St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 9 able to refer to and understand each plan of care. The manager was in the process of improving the care plans at the time of the visit. There is a need to provide another member of kitchen staff over the evening period. This would help provide more care staff on the floor and would mean that care staff would be free to attend to the care needs of residents rather than carrying out kitchen duties. 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. The summary of this inspection report can be made available in other formats on request. St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 10 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 Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 1, 3 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clear information is provided in order for individuals to make a decision about the home and an assessment of individual needs is carried out prior to offering a placement. EVIDENCE: Before the inspection visit we received surveys from the people living in the home and their families. The following are some of the comments received – “My mother was unable to make a choice of care home. As her daughter it was up to me to find the best placement. I visited on 2 occasions and was given a St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 12 full tour. Full discussions re facilities available for my mother. The initial impact of a clean caring environment enabled me to make St Mary’s our first choice”. “Have been at St Mary’s many times for respite”. “I was shown around the home on 2 separate occasions”. “St Mary’s home and level of care was highly recommended to us”. In their AQAA the Providers tell us – “Families and the service users are invited to visit the home before admission. They are encouraged to walk through the home unaccompanied, to get a feel of the home. We have an outstanding reputation in the area for our excellent quality of care. We make every effort to create a homely atmosphere, looking at the resident holistically, taking in their spiritual and bodily needs and recognising the fact that they have a past as well as a future. We always treat our residents with respect and dignity. All new service users have access to the homes Statement of Purpose and a Service User’s Guide. Before admission the home carefully considers the needs assessment of the individual and focuses on positive outcomes and ensures that any specialist equipment or treatment is readily available to meet the needs of the service user. The service user’s bedroom is decorated and made to look and feel comfortable to create a homely and friendly environment. Once admitted all residents have a contract, either a funded or complex one which outlines the fees, services offered and the terms and conditions on which have been agreed. All new service users’ have a thorough pre-assessment. If the service user is to be funded by Social Services a thorough care management assessment and care plan is obtained before admission. If privately funded a registered nurse will visit the service user and undertake a thorough needs analysis, involving both the service user and their family/representative. On admission the service user is assigned a key worker who gives information and special attention to them to make them feel at welcome and help settle into their new surroundings. We have a highly trained ancillary and catering staff who work together to ensure the comfort of the service user. Some service user’s are admitted for intermediate care and after a period of time whereby they have gained their independence they are discharged with the reassurance that our services are always available if they ever need them again.” We looked at the updated Statement Of Purpose and Service User Guide – both of which are made available to prospective residents and their families. The manager commented that she was in the process of completing these and St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 13 then each resident would receive new copies. The documents are informative and individual to this home. We looked at some individual care plans and all contained a copy of a preadmission assessment. Also there were two copies of pre-admission assessments on the manager’s desk. We discussed these with her and they were in respect of two individuals who had very recently been assessed with a view to coming to live at the home. These had been done on the new documentation forms, devised by the manager. These assessments are more thorough and comprehensive and an improvement on the old forms. We asked some of the people who live in the home if they felt that their assessed needs were being met and all stated that they were – one lady said “We couldn’t be in a better home” and another said “They see to our every need”. St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at all the standards for this outcome. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The people who live in this home can be assured that their personal and nursing needs will be met and that their health care needs will be monitored. Access to professional health care is actively sought when required and all care is planned and delivered with dignity and respect. EVIDENCE: In their AQAA the Providers tell us – “After admission a thorough assessment is again undertaken and an individual care plan is drawn up to cover all aspects of care, respecting the service user’s preferences. This care plan is reviewed monthly and altered accordingly to St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 15 reflect any changing needs of the service user. To ensure that respect is maintained, the service user is always addressed by their title, unless they otherwise request to be called by their Christian name and then only in the privacy of their room. If assessed as capable the service user can self-administer their own medication, provided the appropriate paper work as been completed. The medication is stored in a locked cupboard in their bedroom. Staff continue to observe the service user and inform the GP if there are concerns about the service users abilities to self administer their drugs. We have a sustained record of compliance with the administering, safe keeping. storage and disposal of drugs, including controlled drugs .we have an efficient medication policy with regular audits by the local pharmacy. A nutritional screening is carried out on admission, which is reviewed monthly, any changes are acted on accordingly, i.e. referral to the dietician. We have good links with the community with local chiropodists, opticians, dentists and physiotherapists. The home works closely with external and specialist nurses for advice and support. On induction staff are instructed on how to treat the service user with respect and dignity at all times. Staff are continually undertaking study days and courses including continence training, tissue viability, nutrition, infection control and fire training. The home provides care and sensitivity to both the service user and family at the time of death. Leading up to death a Dominican sister will stay and pray with them until death. The Parish Priest is on call day and night when needed. Facilities are provided to allow families to stay with the service user until they feel ready to leave. If no family is available a member of staff will sit and comfort the resident until death. After death, the service user is taken to the homes mortuary where the body can remain until arrangements have been made with the undertaker. Family and friends are welcome to visit the deceased if they so wish. Sister Conleth and staff are always on hand for bereavement counselling. Staff always attend the funeral of the deceased to express their condolences.” During the course of the inspection process the above information contained in the Provider’s AQAA was found to be substantiated and accurate for this outcome. We received a number of service user comment cards back and all, without exception, contained positive comments about this outcome – “Overall, the care given to Mum is of a high standard, delivered by people who know what they are doing and show their willingness to do it. This home has its heart in the right place”. St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 16 “The general standard of care is very high, I am very impressed with the way they have helped to get my mother over major surgery. That goes for all members of staff; kitchen, carers, nursing staff. I am most content now I can see how well my mother is looked after”. “They care for individuals as people with an holistic approach to their needs. Also they are supportive of family and try to keep good communication”. “If they have any concerns they always get in touch”. “More support and care than I expected and am most grateful for”. “Over the past 5 months mother has been really poorly. The staff have been wonderful – regularly washing, toileting, turning her so as to make her comfortable at all times”. A total of 4 care plans were examined during the visit. These were based on an assessment of needs. There was emphasis on Privacy and Dignity and Autonomy and Choice. Plans are Person Centred and Individual. Risk assessments had been developed. The manager was carrying out nurse duties when we arrived at the home -she was changing a dressing for a service user. There was also a second nurse on duty. The Care Plans are being developed further and the manager commented that she had been working toward this since taking up post. A nutritional assessment called the “MUST” tool was seen and the manager stated that this was to be incorporated into the plans to replace the current nutritional assessment. This will be an improvement on the current assessment tool. The assessment for skin integrity “Waterlow” was found to be incomplete in one of the care plans, in that the assessment had been carried out and dependency identified but then no care plan had been devised and written for this. In practice the resident was on a special mattress and was being nursed according to her needs but this should be documented in order for staff to follow. We looked at three other individual plans and these evidenced that the above specific care plans relating to “Waterlow” are in place. There was evidence seen, throughout the care plans, of interaction with other health care professionals such as the Chiropodist, the Dentist, the Optician, the Nurse Specialist for Tissue Viability, and the Nurse Specialist for Palliative Care. For individuals nearing the final stages of their life “Advanced Care Planning Discussion” forms were seen. The GP and next of kin had signed these and St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 17 discussions had been held with the residents and/or their next of kin about their wishes for the end of life. One of the General Practitioners was visiting the home at the time of our visit and he spoke with us. He was very positive about the home and praised the high level of nursing care. He stated – “This is a very good home with good basic nursing care”, and, “I would place my own parents here”. A number of staff were spoken to and could easily identify the importance of maintaining dignity and respect for the people who live at the home. They explained how they did this daily during the course of delivering care. Staff were observed to be polite and respectful towards individual residents – this was particularly noticed during the serving of lunch in the dining room. We also heard staff (who were unaware of our presence) interacting in a courteous and respectful manner towards residents as they went about their duties. We observed the administration of lunchtime medication. We looked at Medication Administration Record (MAR) charts. The nurse administrating had signed for all medication given. We were told that there was currently one person self-medicating and when we looked at her care plan this lady had a suitable risk assessment in place. Medication was being received, stored, administered and disposed of according to the home’s policies and procedures and according to the guidelines laid down by the Nursing and Midwifery Council. St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at all the standards for this outcome. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The people who live in this home can be assured that their right to live an independent and meaningful life will be promoted. Any religious and spiritual needs that individuals have are actively encouraged and facilitated. The surroundings of the home are conducive to maintaining contact with family, friend and the local community. EVIDENCE: In their AQAA the Providers tell us – St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 19 “St. Mary’s is very flexible and responsive to the individual needs of the service user, promoting their right to live a meaningful and ordinary life. Service users are encouraged to furnish their rooms with their own processions. Routines, activities and care plans are patient centred and reviewed regularly to meet the changing needs and wishes of the patient. Family and friends are always welcomed into the home and encouraged to participate in activities and take their relatives out of the home for visits. Families are invited to have meals with the service user on special occasions. A well-balanced and nutritious diet is provided and special diets are catered for also. Service users are encouraged to take their meals in the dining room as this then becomes a social occasion. We ensure that they are not rushed and allowed to take time to enjoy their food and company. If they so wish for whatever reason to stay in their rooms, the meal will be served to them there. Patients who need support (chewing or swallowing difficulties) are given their food in their rooms, where staff is discreet and sensitive to their need, allowing them time to finish their meal comfortably. Soft diets are presented in an attractive manner to make the food more appealing. Menus are made available to the service user offering o choice of meal. We have an in-house hairdresser who visits twice weekly, but arrangements can be made for her to attend for special occasions. Service users own hairdressers can also visit. Religious services are held in the home- Roman Catholic services are celebrated twice weekly, and Church of England services are held monthly. Service users can attend a daily Mass in the adjoining church if they so wish. Social and recreational activities are varied, which include bingo, bowls, arts and crafts, tai cha and musical exercises, a programme of activities is on the notice board. Guest performers are invited along to the home; also the children from the adjoining school often come along to entertain the residents. Weather permitting, service users can be taken into Stone, keeping them in touch with the outside environment, or they can sit in the pleasant gardens in the home. A number of residents have enjoyed trips to the holiday home in Llandudno”. Care plans identify that activities take place on a regular basis and are geared around meeting individual needs and preferences. Discussions with residents during the visit confirm that activities and entertainment are good. The home excels at ensuring that religious and spiritual needs are met. The home is linked to the local Catholic Church and the Priest visits regularly. Mass is held daily in the home (lounge). There is also a Church of England Holy Communion held monthly and residents spoken to confirmed this. The St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 20 manager confirmed that arrangements could be made to meet the needs of individuals of other denominations and with other spiritual needs. We saw several parts of the home dedicated to quiet peaceful communal areas and the garden offered peace and tranquillity in a pleasant and attractive setting. We saw lots of quiet private areas to sit with visitors. We saw some family members visiting their relative sitting in the garden with them. The home is located in the centre of Stone and, as such, has close links with the local community. The local amenities are very accessible for the people who live in the home and shopping trips and trips to local avenues are a regular occurrence. Residents chatted to us about the trips out they had been on over lunch. We sampled the lunchtime meal as we dined with the residents. The dining experience was observed to be pleasurable, relaxing and conducive to eating. The quality of the meals served was very good. There was soup to start, then a choice of main meal, one being homemade meatballs in gravy with a choice of vegetables and potatoes. The food was very tasty and hot. For desert there was a choice, we chose the fresh fruit salad, which contained various fruits. Some residents had coconut sponge and custard. The residents chatted to each other over lunch and told us that the food was “always of a high standard”. They said, “They also cater for special diets here.” During lunch the residents also told us about the holiday home in Llandudno with one of the residents saying that she was looking forward to going there for a weeks’ holiday. This holiday home is a very good asset for the home to offer and residents are able to enjoy this facility throughout the year. Residents also confirmed that they have a choice about whatever they do in the home. One lady said – “I go to bed when I want to and get up when I want to – just like I did at home”. Care plans documented choices and preferences throughout all of the activities of daily life. We received a number of comments from service user surveys before the inspection visit these are some of those comments – “Bingo, Tai Chi, visiting singers, Morris men, school choirs. Hairdressing facilities are arranged on a weekly basis. In the summer carers escort wheelchair bound patients into Stone town or round the garden. We have enjoyed 4 wonderful Christmas lunches here so that our family can be together.” St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 21 “Carers assist residents unable to feed themselves. Alternatives are available e.g. soft diets; fruit etc if the set menu doesn’t suit.” “My mother is unable to participate in any activities but the staff do spend time talking to her and any concerts at the home the staff see that she can attend.” “My mother is given her meals by staff members and enjoys her meals.” “In my opinion and from observation everyone is treated as an individual.” St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an open culture where individuals feel able to express their views and concerns in a safe and understanding environment. EVIDENCE: In their AQAA the Providers tell us – “We have a very open atmosphere with visitors feeling free to come and go as they please. Family and friends are greeted openly and in a friendly manner. The ethos of the home is that it welcomes suggestions and uses these positively. Service users say they feel safe and protected. All our staff are actively encouraged to talk to the patients whilst carrying out all aspects of care. Some service users may find it easier to talk to the carer than the trained nurse. Any issues are immediately reported and dealt with in a sensitive manner. People with limited skills are observed carefully, a blink of an eye or a smile can show they understand. St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 23 The complaints procedure is displayed openly and also included in the service user’s guide. Staff are trained in safeguarding adults and know how to respond if an incident arises. Staff are encouraged to attend updates and lectures on Protection of Vulnerable Adults. New members of staff are instructed in abuse and whistle blowing during their induction. This is reiterated during staff appraisals. Staff are CRB checked before given a permanent contract and all references are followed up before employment. Polices and procedures are available to all staff.” Prior to the inspection visit we received some comments via service user surveys “As my mothers representative I would always feel free to speak to the person in charge.” “You can always speak to staff, however, often this initiative comes from myself or family. You can actually visit and not see senior staff as they are busy. However, with arrangements they are always willing and approachable.” “There have been no concerns as yet.” We have not received any concerns or complaints about this home since the last Key inspection. We observed the complaints procedure displayed on the wall in the entrance to the home. We also saw the same procedure contained in the Service User Guide. The details of the CSCI local area office will need amending to include our new address, telephone number and fax. This will enable people to contact us if they need to. Discussions with the manager identified that she does not keep a log of complaints because “we have not had any” and “we talk to residents or their families if they have any concerns and sort them out immediately”. Further discussions with the manager identified that she would start to log concerns, including the action taken to address them. We spoke with three members of staff at length and asked them about their understanding of safeguarding and Protection Of Vulnerable Adults (POVA). They were all aware of how they would address this and stated that they had received training in this area. We looked at the training records for these staff members and it was documented that this training had taken place. St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 24 St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at all the standards for this outcome. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The physical environment of the home provides for the individual requirements of the people who live there. The environment is peaceful, homely, clean, safe and comfortable. EVIDENCE: In their AQAA the Providers tell us – “St Mary’s has a comfortable, homely atmosphere. All service users are happy and content. Families’ feedback tells us that their relatives are safe and well cared for. One of the most frequent St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 26 statements we hear is “there are no smells” We have an on-going redecoration programme and refurbish as necessary. Many of our rooms have recently been totally redecorated and extended to add en-suite facilitates. Our qualified handyman carries out all the general maintenance. There are two lifts to each floor to allow residents access to both floors. There are also ramps at the entrances of the home. Lifts, gas appliances, electric appliances, kitchen equipment, water and fire systems are maintained and serviced on a regular contract. All other specialist equipment (hoists, baths etc) are also serviced regularly. There are two comfortable lounges with access to extensive gardens for service users and visitors to use. Call bell systems are fitted in all bedrooms, toilets, bathrooms and sitting areas. Service users are invited to personalise their rooms with their own furnishings and furniture. Domestic staff are trained to NVQ standards and updated regularly. We have a fully equipped laundry, where the staff repair residents clothing as required.” We walked around the home and looked at a random selection of bedrooms. These had all been personalised and adapted to suit individual needs and requirements. Rooms are clean and well presented. Some bedrooms had been redecorated and refurbished since the last inspection. We saw special equipment being used such as air mattresses and cushions and electric profiling beds. We visited all the communal areas and found these to be homely and welcoming. As well as the main lounge there are several smaller lounges and sitting areas where individuals can go for privacy and quiet. The corridor that links the home to the Church provides an attractive peaceful sitting area. We visited the main dining room where individuals were taking lunch. This provides for a very pleasant attractive area and the small tables and seating arrangements encourage socialisation. One resident said – “We can do what we want to but I like to stop in my room for breakfast and then come down for lunch and then there is usually something going on in the main lounge during the afternoon.” We spoke with another resident who is a pianist. She told us that she plays the piano in the lounge most afternoons after lunch. St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 27 The gardens are extensive and attractive and lead down to the canal. These have sitting areas and are accessible to individuals using a wheelchair. There is a car park at the rear of the home. The home fronts on to Stone town centre with the shops and other amenities nearby. The home is very clean throughout and we met with some of the domestic staff who obviously work hard to maintain the level of cleanliness. We visited the laundry where it was observed that infection control guidelines are being adhered to. We also visited the kitchen, which was found to be clean and well presented. The cook showed us the records relating to the cleaning schedules. The home also has its own chapel of rest, which has recently been refurbished. Sister Conleth stressed the importance of maintaining dignity in death as well as life. The comments we received about the environment included – “They provide a caring, homely atmosphere” “Bedding, rooms, patients cleanliness is outstanding. Beds are changed on a daily basis (more frequently if necessary). Residents are washed regularly. Rooms are cleaned, carpets shampooed on a regular programme – daily or monthly as appropriate. Cleanliness is a strength of St Mary’s – outstanding.” “The initial impact of a clean caring environment enabled me to make St Mary’s our first choice.” St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at all the standards for this outcome. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in this home are cared for by a devoted staff team who have the skills and expertise to meet their needs. EVIDENCE: In their AQAA the Providers tell us – “Staff are recruited to ensure they have the necessary competence and professionalism to give a high standard of care to the service user. References are obtained before commencement of employment and CRB checks are obtained. Staff have a probationary period to ensure competence in their position. There is always a trained nurse on each floor on every shift, well supported by care staff. Nurses are trained in specialist areas such as continence, wound care, palliative care and moving and handling and continue to update to promote current good practises within the home. St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 29 All staff are trained in fire evacuation procedures. There is always a member of staff on duty who is trained in first aid. Domestic staff are trained to NVQ standards and updated on COSSH regulations. Kitchen staff have food hygiene certificates and updated regularly. Many carers are NVQ trained to either level two or three, with further staff enrolled on courses at present. We feel that the quality of staff delivers the quality of care.” Discussions with the manager of the home identified that there was a total of 53 residents accommodated in the home, all with nursing care needs. The number of staff on duty was as follows – 2 nurses on duty, one of who was the manager. 12 care assistants, a team of domestic staff, the cook and a kitchen assistant and a maintenance person. The activities person was on annual leave. The manager confirmed that she usually works supernumery but also covers some shifts as the second nurse on the floor. Examination of the staff duty rota confirmed the above staffing numbers. We spoke with three staff members at length about what it is like to work in this home. We interviewed a qualified nurse, a senior care assistant and another care assistant. Without exception all of these staff members stated that they were happy working at the home and felt very supported by Sister Conleth and the manager Anne Clark. They all felt that their training needs had been met very well and the care assistant brought in her training folder as evidence of this. The staff members also felt that there was a good staff team at the home and staff usually stayed for a long time. All three of the staff members spoken to had worked at the home for several years. The staff members also confirmed that staff meetings are held regularly at the home. When we asked them if their suggestions, comments or concerns were listened to they all said that they were. They also stated that they could approach the manager on a one to one basis if they wanted to. We spoke to the qualified nurse about the training courses she had attended and we then looked at her training file and saw the certificates to confirm this. This training has included Mental Capacity training and a Palliative Care update as well as the usual mandatory training of Moving and Handling and Fire Safety. We spoke with the senior care assistant who had worked at the home for nine years. She has obtained NVQ levels 2 and 3 in care and produced her training St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 30 folder, which contained an abundance of certificates of different training and study sessions. We spoke with another care assistant who has worked at the home for seven years. She has obtained NVQ level 2 in care whilst working at the home. She stated that she had also undertaken training in First Aid, Moving and Handling and Fire Safety over the last twelve months. She also confirmed that she had received a thorough induction training and that all new staff undergo a planned induction training programme and work alongside a mentor. Discussions with the staff members highlighted a concern about a lack of provision of kitchen staff in the evenings over teatime. Staff felt that it was unfair that care staff should have to attend to kitchen duties such as washing up and serving food when they were needed on the floor to help residents. This was discussed with the manager at the end of the inspection visit. She did confirm that they were currently in the process of recruiting another kitchen assistant for evening duties. We looked at the recruitment files of the above three staff. There was evidence that the recruitment procedure is robust. Each staff member undergoes a Criminal Records Bureau check and his or her name is checked against the Protection Of Vulnerable Adults list prior to being offered employment at the home. There were also two written references in place for each staff member. Below are some of the thoughts and comments received from residents and their families about the staff who work in the home “The matron and nursing staff listen and act at all times liaising with medical practitioners as appropriate. The carers relay messages to the nurses so immediate action is taken. Positive teamwork.” “The staff are always willing to give assistance.” “Occasionally new, younger staff need to get experience of dealing with elderly people. They are guided well.” “More support and care than I expected and am most grateful for.” St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 31 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. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 31, 32, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run and managed in the best interests of the people who live there. EVIDENCE: In their AQAA the Providers told us “We have an open and transparent ethos in all areas of running the home we listen to the views of people who use and St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 32 visit the home and act accordingly. Management staff are always available to both service users, families and friends. We have a clear understanding of the principals and focus of the service we provide. All risk assessments, policies and procedures are in place to ensure the health and safety of both the service user and staff. We promote equal opportunities, good communication skills and understand the importance of care and well being of the resident.” The manager of the home registered with us in January of this year having worked at the home for a number of years as deputy manager. She possesses all the required skills and expertises to manage the home and has a great deal of experience working with older people. The manager demonstrated to us how she maintains her post registration requirements with the Nursing and Midwifery Council (NMC) and keeps herself updated with her clinical knowledge. Discussions with the manager identified that she has made some positive changes and improvements to the systems in place at the home. She has recently been working on the care plans and fire risk assessments. The manager commented that she runs an open door policy and that staff, residents and visitors are welcome to approach her anytime on a one to one basis. She said that she listens to their concerns and welcomes any suggestions they might have. She also organises regular staff meetings. The staff and residents confirmed this during the visit and the following comments were documented on the surveys, which we received prior to the visit – “Open discussions regarding my mothers care programme are a regular occurrence. All queries and questions are answered by Sister Conleth her nursing team and carers regularly. I have a close relationship with the professional staff which offers both me and my mum emotional support and security.” “The matron and nursing staff listen and act at all times liaising with medical practitioners as appropriate.” There is a Quality Assurance system in place and from what staff, residents and relatives have told us, their thoughts and suggestions are listened to and acted upon. This should now be documented in order to be able to evidence where improvements have been made as a direct result of suggestions or concerns raised. There was some evidence of auditing; this was seen with care plans and accidents. This system should be developed in all areas in order to ensure that St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 33 quality is monitored and outcomes for the people who live at the home are maintained and where required, improved. This should involve obtaining the views of the people who live in the home. The AQAA contains clear, relevant information that is supported by a wide range of evidence. The AQAA lets us know about changes the Providers have made as well as where they still need to make improvements. It shows clearly how they are going to do this. The data section of the AQAA is accurately and fully completed. The people who live at the home are encouraged to manage their own finances wherever possible either personally or through a representative. The home provides a secure facility for keeping small amounts of monies and/or valuables. We looked at the system in place for managing this and were satisfied that this was open and transparent and that there is a clear audit trail of monies received and spent for each individual. Residents are able to access their monies whenever they wish to. The manager ensures the health and safety of residents and staff alike. There is a Health and Safety policy in place and we saw documentation to confirm that this is maintained. The equipment used in the home is regularly serviced and tested and staff receive regular updates in mandatory Health and Safety training. Since the last inspection the Providers have installed a new fire safety system. We saw documentation of fire drills and staff fire safety training. Staff also told us that they receive regular updates in fire safety. The manager was in the process of developing and updating individual fire risk assessments in accordance with the fire safety regulations. All the above helps to ensure that the residents and staff are kept safe from harm or injury. St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 34 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 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 4 3 3 3 4 4 4 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x 3 x x 3 St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 35 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. 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 Refer to Standard OP7 OP27 Good Practice Recommendations It is recommended that the documentation in care plans be further developed in order to ensure that instructions in plans are clear and consistent for staff to follow. It is recommended that a member of the kitchen staff be employed for the evening to ensure that care staff do not have to carry out kitchen duties but are able to remain on the floor to meet the care needs of the residents. St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 St Mary`s Nursing Home DS0000022372.V366112.R01.S.doc Version 5.2 Page 37 - 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. 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