Inspection on 12/03/07 for St Mary`s Nursing Home

This inspection was carried out on 12th March 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Mary`s Nursing Home 11/03/09

St Mary`s Nursing Home 21/01/06

St Mary`s Nursing Home 19/09/05

St Mary`s Nursing Home 20/12/04

St Mary`s Nursing Home 26/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE St Mary`s Nursing Home Montilo Lane Harborough Magna Rugby Warwickshire CV23 0HF Lead Inspector Peter Dawson Key Unannounced Inspection 12th March 2007 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 DS0000004410.V331167.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. St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Mary`s Nursing Home Address Montilo Lane Harborough Magna Rugby Warwickshire CV23 0HF 01788 832589 01788 832216 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) Mr Simon Northover Mrs Beatrice Gooch Francine Halcrow Care Home 77 Category(ies) of Dementia - over 65 years of age (28), Old age, registration, with number not falling within any other category (49) of places St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The Registered Manager must undertake and complete the Registered Managers Award by January 31st 2007. The Registered Manager must attend some accredited dementia training by December 31st 2005. Within the total of 77 beds St Mary’s may also care for up to five service users between the ages of 55 to 64, whose nursing or social care needs outweigh age considerations. 21st January 2006 Date of last inspection Brief Description of the Service: St Mary’s care home is set in its own grounds near to the village of Harborough Magna, 5 miles from Rugby. The care home has been developed from the old maternity hospital, and retains some of the character. St Mary’s care home is registered for frail elderly, and older people with dementia. Intermediate care beds are provided to enable rehabilitation for people prior to returning to their own home. The accommodation is purpose built and is on two floors with all rooms being single en-suite. There is a shaft lift to the first floor and adequate assisted bathing facilities. The environment meets the National Minimum Standards. The home offers a service for people with a range of physical and dementia care needs. . Care is provided by qualified nurses and care staff that have received training in dementia care. There is a small terrace from the dining room, where service users can sit out, looking across open land. Due to the rural situation the nearest village is approximately 1 mile away. Public transport to the home is limited. Fees for residence at St. Mary’s are £500 - £580 per week. St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced inspection on one day A pre-inspection questionnaire was provided by the service and also considerable other written information which provides a basis of information in this report. Written feedback was received directly by the Commission from 9 residents and 9 relatives. Three relatives were spoken to at length during the inspection and also a visiting GP There was an inspection of all communal areas of the home and a sample of bedrooms on both the frail elderly and dementia care units. A sample of records were seen including care plans, risk assessments, staff files, medication records and other records relating to the inspection process. The Registered Manager was on holiday at the time of this inspection, which was carried out with considerable help from the two senior nurses in charge of the two units. The provider was present during the inspection and provided helpful information and discussion about the operation of the home. All staff on duty were spoken with and made a positive contribution to the inspection process. Written feedback from residents and relatives indicated an overall satisfaction with the care provided at St Mary’s and included the following comments: “My mother is very happy at St Mary’s and the staff are all very kind and helpful. If she has any problems they are dealt with promptly” “Staff are very caring and approachable, they seem to have great feeling for the residents and understand their needs” “We are very happy that the care mum receives is good and appropriate for her needs. Staff are very approachable & caring, always happy to discuss her condition and deal with it well. We are able to speak with the Manager and owner at any time, they are fully aware of the condition of all residents and know them all”. Three relatives spoken with during the inspection further confirmed the written comments above. A visiting GP said that staff were pro-active about health care issues and there was a very positive and professional dialogue between the home and the practice. All agreed outcomes were documented by the GP and carried out by the home. St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 6 Two areas of concern relating to involvement in care planning and deployment of staff are dealt with in detail in this report. What the service does well: What has improved since the last inspection? There were 13 requirements arising from the last inspection and 10 of those had not been addressed from the previous inspection in September 2005. All requirements with the exception of two had been addressed at the time of this inspection. Care planning information had improved considerably and plans clearly stated current need and how that was to be met. There has been an improvement in menu planning and choice of food. There are now choices of main dishes, the menu has been revised with resident input. Residents and relatives confirmed they were satisfied with food provision. The previous mal-odours in the home have been well managed and there was no indication of unpleasant smells in the home on this visit. Doors to the two kitchenettes have been fitted with self-closing devices to improve protection against fire. St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 7 A shower lead in an en-suite area has been replaced as required. A lockable facility has been provided in all bedrooms for storage of valuables and any medication. Locks on bedroom doors have been provided where necessary for some residents, after discussions with residents and relatives. Some aspects of hygiene previously identified in the laundry area have been improved/addressed. Staff records inspected showed that all required information and checks under Schedule 2 of the regulations have been obtained and were on staff files. Unused bathrooms used as storage areas have now been cleared. Regular checking in accordance with the management of Legionelleas is carried out as required. What they could do better: All self-funding residents must have written contracts. Relatives must always be informed of accidents to residents and all events affecting their health and welfare. Where fluid intake is being monitored those residents should be given drinks to improve hydration by night staff if they are awake during the night. Where there are concerns about weight loss residents should be weighed weekly to enable close monitoring of their condition. Personal care records should always be completed on a daily basis. A protocol must be obtained for the use of rectal diazepam PRN. All eye-drops/creams must be dated when opened and discarded after 28 days. It is recommended that the pharmacist be asked to provide printed MAR sheets to ensure accuracy and save staff time. A programme of suitable activities must be provided for all residents on a daily basis and a record of involvement in those activities. Pastoral care must be provided in the home to meet all residents’ preferences. Quality Assurance should be further developed to provide feedback about the service provided and this information made available to all. St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 8 Fire doors must not be wedged open. Suitable self-closing devices must be fitted to improve protection for residents in the event of fire. Washing powder must not be stored in resident areas. Review the arrangements for intermediate care as outlined in this report. Review communication systems between the units where there is shared care of a resident. Also provide a recording system for informing relatives of accidents and other significant events. 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 DS0000004410.V331167.R02.S.doc Version 5.2 Page 9 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 DS0000004410.V331167.R02.S.doc Version 5.2 Page 10 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): Standards 1 – 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Pre admission information and needs assessments are good. Self-funding residents are not provided with contracts as required. Some clarity is required in relation to facilities for intermediate care. EVIDENCE: The home provides a very detailed Statement of Purpose/Service Users Guide, which has recently been updated. The information allows an informed decision about the service provided. Pre-admission visits by potential residents and relatives are welcomed. In written feedback 2 relatives gave the following information: St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 11 “We visited several care homes in the Leicestershire/Rugby area before we decided upon St Mary’s. We were given a tour of the home by the owner and manager and all our questions & concerns were fully answered” “We were given plenty of time and opportunity to get the feel of the home. All questions were answered frankly. Unlike some other homes, we were not subject to a ‘hard sell’ but felt that we had the undivided attention of the staff who talked with us” Several admission assessments, some in relation to recently admitted residents were seen and were comprehensive covering all areas of potential need. This information was used as a basis for establishing care plans. Contracts are provided by sponsoring Local Authorities, however 3 relatives of self-funding residents indicated in written feedback that they had not been provided with a written contract of terms & conditions for their relatives. This must be provided for all self-funding residents. The home has 2 beds for intermediate care and 2 “District Nursing” beds. These are located on the first floor (frail elderly) but the accommodation does not have dedicated space and staffing as defined in the standards. At the time of this inspection there was some confusion about 2 people admitted to these beds. One person was admitted for rehabilitation from hospital following fractured femur and had Parkinson’s disease and early diagnosed dementia. She was admitted to the dementia care unit on the ground floor. She was to have a weekly input from physiotherapist and CPN but the objective was to develop/improve mobility with regular assistance from 2 staff. This had only taken place twice each day since her admission. Her suitability for placement on the dementia care unit was questionable. St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 12 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): Standards 7 – 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning information was accurate, current and good. Health care needs are well known, documented and actioned. There is a safe system of medication in the home. EVIDENCE: Requirements were made on the last 2 inspections relating to inadequate recording and updating of care plans. This has improved since the last inspection through discussions and staff meetings within the home. On this visit improvements were evident and the standard of recording in care plans was generally satisfactory. Some minor shortfalls were seen but information was basically accurate and current. St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 13 Six care plans were inspected. All were based upon assessed need. There were assessments relating to continence, nutrition, and waterlow with care plans to address risks and meet needs in those areas. One relative had commented prior to the inspection that there had been no involvement in care planning. This was discussed on the day of the inspection with the residents visiting husband. The person had been admitted for intermediate care to a bed on the first floor. When this period ended the decision of the family was for the person to remain. Because the actual bed was required for another admission and no other bed on that unit available she was allowed to remain there but slept only on the dementia care unit on the ground floor awaiting a further bed on the first floor. Because of this situation the family had not been involved in establishing and reviewing the care plan and this will be addressed. Whilst reviewing these circumstances it became clear that the interim arrangements of being cared for over 2 units was not satisfactory. The person had a fall from the bed sustaining an injury - this was not communicated between units and the relative had not been informed. The communication issue within the home will be addressed but it is vital that relatives are informed of all accidents and incidents affecting the well-being of residents. Food and fluid intake charts were established where nutritional risk was established, these were completed and monitored daily and reviewed by the nursing staff. A resident with a reduced daily fluid intake of between 300 – 1000mls in recent days had been referred to the GP who saw the person during the inspection. Several residents required close monitoring in this area and staff were clearly attempting to increase inputs where possible. It was evident from the charts seen that fluids were not generally given by night staff. This meant that residents at risk were not given fluids between 9.30 pm and 8 a.m. Those residents awake during the night or receiving attention from night staff should be offered drinks to boost their daily intake. Residents are weighed monthly. The weight of a resident admitted 6 months previously showed a weight loss of 10 of body weight since admission. Although she had continued to eat and drink consistently, nutritional supplements had ceased upon her own request. Her relative seen during the inspection confirmed the weight loss and she was seen by the visiting GP during the morning in relation to this and other general health issues. It is recommended that where there are concerns about weight loss residents should be weighed weekly to closely monitor their condition and any deficits discussed with the GP to consider prescribed supplements. Tissue viability maintenance and care is good. High waterlow risk assessments were accompanied by care plans to ensure nutrition and provide identified pressure relieving equipment. The home provides a good stock of equipment including 22 alternating mattresses, 10 overlay mattresses and 30 pressure relieving cushions. At the time of this inspection there were 4 residents St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 14 requiring pressure area management. These were generally wounds assessed at grade 2 – one was grade 2/3 and one had healed but was covered for protection. Records included body mapping, measurements, grading and treatment. The indications were of early identification and prevention and successful wound care management and treatment. Several residents are bedfast on both units of the home. Records of personal care are provided in bedrooms of those people in one instance it was noted that there had been no entries upon the recording charts for 5 days over a recent period. These must be completed as care is given. Virtually all residents are registered with a local GP who provides an excellent service to the home visiting on Mondays & Fridays each week (and other days if required). He was seen and spoken to during the inspection and confirmed a very positive working relationship will all staff. He has responsibility also for the intermediate care bed contracts with the PCT. He gave examples of close team working with staff and the communication system in place for which both GP and home take responsibility. The outcome is an ultimate written account of the referral, assessment, diagnosis and treatment for each patient seen on the day. This is faxed to the home on the day of consultation. An open and relaxed dialogue was observed between staff and GP during his visit with a natural mutual professional respect. The medication system on both units was inspected. There is no selfmedication at this time, although where possible continued self-medication is provided for people having intermediate care to ensure continuity. The system is provided by local pharmacy and is not a Monitored Dose System. MAR (Medication Administration Records) is hand-written. These are well recorded but clearly open to error, although they are reported to be checked by a second nurse. Records were clearly written and accurate, there were no omissions. It is recommended that an approach should be made to the Pharmacist for printed MAR sheets or even printed labels, which can be used to ensure complete accuracy and save considerable time. On the frail elderly unit some eye drops and eye ointments had not been dated when opened as required. Their current status not clear - they should be replaced. On the dementia care unit rectal diazepam was prescribed PRN – this had not been used but there is no protocol for its administration, this should be obtained from the prescriber. Arrangements for preserving privacy and dignity were observed to be in place throughout the day in the actions of staff particularly when providing personal care in bedrooms. Staff were seen to speak to residents with warmth and respect at all times. St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 15 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): Standards 12 – 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The ranges of activities available are improving but need further development both internally and externally. This is a weak area of service provision, which can be improved. Pastoral care must be available to all Family contacts are good. Residents are given choices of routines and care. Food provision has improved and there is quality and choice. EVIDENCE: Two activity organisers (AO) are employed each is allocated to a unit working over 3 days per week. At the time of the last inspection activity provision was poor and a requirement made to provide suitable activities on both units on a daily basis and maintain clear records of activities. Although efforts have been made significant improvements have not been made and the requirement is repeated in this report. St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 16 Both AO’s work as carers also, although specific time is allocated for the activity role. One AO was seen, clearly committed to the role and engaged in activities for 2 hours per day over 5 days. She is presently involved in NVQ study and dementia care training bi-weekly for a 3 month period. There are gaps in the provision – sometimes care staff shortages have to take priority and one AO recently been off for 1 month. Individual resident records seen showed patchy provision. One resident’s records showed 3 activity inputs over 2 months, but nothing for the past 2 months, another showed inputs for one day for each month January – March 2007. Many activities are necessary and provided 1:1 on the frail elderly unit due to high physical dependency and on the dementia care unit due to limited concentration spans and also physical needs. Small group activities are limited but foot, hand, shoulder massage and reminiscence therapy is used, together with walks or short trips in the summer months. Dog therapy is provided with regular visits and enjoyed by many residents. At this time access to the local community is not established. This was a recommendation of the last report. Contacts with family/friends are promoted and several visitors seen in the home during the inspection confirmed that they were made welcome and can visit at any time. There has been staff training in dementia care. Nursing staff have completed Person Centred Dementia Care course (David Sheard 4 days) and subscribe to the person centred approach. Care staff have completed Dementia Care training with the Health Care Trust a 2 day certificated course. Whilst there have been training opportunities for staff its applications are limited. There is an excellent document completed by all relatives called “Getting to know you”. This provides considerable personal information about the background of residents (social histories and more). This is vital information particularly, in providing a person centred approach for people with dementia and can be used to provide a more informed approach and service to people with dementia care needs. The activity for the greater part of the day of the inspection seemed to be TV viewing with many residents asleep or clearly disinterested, although on one unit the AO later provided some activity 3pm. Care staff have responsibilities in this area also but morning is a peak time for personal care and activities become a lower priority. The theories of activities being an integral part of care duties and the role of AO being a lead and enabling role in activity are known but do not seem to work in practice Entertainment is brought into the home approximately 2 monthly, perhaps this could be increased. The AO reports the entertainer knows residents by name St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 17 and positively engages them in musical activities that they respond to and enjoy. It was clear that pastoral care was not provided in the home at this time. This must be arranged. Attempts should be made to provide a service to the home to meet the needs of all residents. The home is attempting to resolve some of these issues but this area remains weak and improvements can be made. Meals are provided from the main kitchen area on the ground floor to a kitchenette on each unit. Meals to the first floor unit are provided in hot trolley via the lift. In compliance with a previous requirement the menus have been changed and reflect greater resident choice. There is now a choice of main dishes. At the start of the inspection some residents were seen in the main dining areas and being given choices for breakfast by staff. This consisted of choice of cereal with either toast or toasted crumpets with butter and jam, many were enjoying the latter. Three residents spoken to and able to express a view stated they liked the food, it was cooked and served well and they had choices. Some residents have meals served in their bedrooms from choice or for dependency reasons. Mainly those requiring assistance with eating were assisted in the privacy of their bedrooms individually. The dining areas are bright and have excellent views of the countryside. The large rectangular dining tables seating 6 residents detracted from the overall appearance of the rooms and would certainly benefit from improved appearance and choice of company/seating if smaller round tables were substituted and giving a more homely appearance. , There is clearly a cost implication for this. The kitchen was inspected although an inspection by the Environmental Health Officer in April 2006 had not produced any requirements and a Gold Award certificate awarded. A range of current diets include diabetic, pureed and liquidised were available. There was a list of likes/dislikes in the kitchen area and known to the catering staff. The husband of a Hindu resident had been consulted about food and restrictions only advised about meat, she has a good appetite and unrestricted choice of all other foods. St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 18 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): Standards 16 – 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure in place, which is used and tested. The home responds satisfactorily to all complaints made. Staff have knowledge of and access to procedures for reporting suspected or actual abuse. EVIDENCE: There is a complaints procedure on display in the home available to residents and visitors. It is clear and concise and meets the requirements of Regulation 22. Three complaints have been received by the home in the past year. These have been dealt with and responded to by the home satisfactorily. They relate to issues concerning aspects of care where detailed explanations have been given and actions taken by the home to improve the service where possible. There has been training for staff in the protection of vulnerable adults in the past and further training planned to ensure all staff including those recently appointed have received training. St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 19 Issues of possible restraint have been raised since the last inspection in relation to a resident who was resistant to personal care. Training was arranged for staff, but the resident has since been transferred to another placement. St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 20 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): Standards 19 – 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A good environment, which meets the National Minimum Standards. There are adequate toilet/bathing facilities and specialist equipment. Bedrooms are well furnished and personalised. Standards of hygiene are satisfactory. Fire doors must not be wedged open. EVIDENCE: Six requirements relating to the environment were made in the last report. All have been satisfactorily addressed as follows: Unpleasant smells on the St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 21 dementia care unit have been eliminated. The 2 kitchenettes areas have been fitted with appropriate door closers. A shower lead in en-suite has been replaced. There is a lockable facility in bedrooms where needed for storage of valuables/medication. Bedrooms doors have locks fitted where residents need this facility. Hand-washing facilities in the laundry are clean and useable. On this visit all communal areas on both floors of the home were seen and a sample of bedrooms on each. There was good decoration of most areas with colour identified corridors on the dementia care unit. All bedrooms meet minimum space requirements, have en-suite facilities and are for single use only. Bedrooms seen were well-furnished and equipped and personalised reflecting the interests and identity of the person. The dining areas are small but bright with good views of the surrounding countryside. Access, choice and space could be improved in these areas with provision of smaller tables as mentioned earlier in this report. In one dining area there were some holes in the plaster and flaking paint that require remedy and repainting. Generally the standard of furnishings, fittings and décor throughout the home are good. Several bedroom doors were wedged open. The explanation was resident choice and the monitoring of highly dependent residents. This practice must cease. It presents a risk to residents. Self-closing devices must be fitted to bedrooms where doors need to be left open. The laundry door was wedged open. This is an area of high fire risk and should be closed until fitted with a self-closing device. As stated above self-closing devices have been fitted to the kitchenette areas since the last inspection. A visitor had raised the question of fire doors wedged open prior to the inspection. There is an excellent safe garden area, which residents can use during the summer months. There are handrails in all corridor areas and in toilets and bathrooms. Bathrooms have assisted facility and there is adequate moving equipment in the home. The laundry area was seen and there has been improvement in the standards of hygiene and cleanliness. Soiled and other items of laundry are separated adequately. All bed linen goes to external laundry. St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 22 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): Standards 27 – 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff is good. Recruitment procedures protect residents. Staff competence and training is satisfactory. NVQ training should be extended. EVIDENCE: The two units on separate floors each cater for 28 people. Each unit is separately staffed and run. Staff recruitment is for a specific unit. In each unit there are 6 staff on duty throughout the day (including 1 nurse) and 5 at varying periods from 4 pm. There is a nurse and night care assistant on duty in each unit from 9.30 pm – 8.00 a.m. This appeared adequate for the numbers and care needs of the residents seen. Peak times are very busy for staff but this eases as the day progresses. Additionally there is a Manager and support staff including domestic, catering, laundry, maintenance and administrator. The weekly number of care staffing hours was given as 1242. St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 23 A sample of staff files were inspected. All contained required information under Schedule 2 including POVA/CRB checks (this had not been the case on the last inspection). A staff training matrix was not available on this visit. All statutory training has been provided including training in Dementia Care for most staff. Updates were needed in relation to training in Adult protection and this is planned. NVQ training for care staff presently falls below the recommended level of 50 of staff. This is presently only 30 . Four staff are currently involved in NVQ study. A relative in written feedback commented that “most care workers are from overseas and I feel they need more training to UK standards of care” Observations during the inspection revealed several staff were from overseas as stated but all had excellent command of English, showed good engagement with residents/levels of competence and had completed relevant training as all staff. Overseas nurses had completed required conversion courses to meet UK standards prior to working at the home PIN numbers (Registration with NMC) had been checked and validated. All staff showed positive responses during the inspection, were open, helpful and co-operative. They were observed to speak warmly, sensitively and respectfully to all residents including those with repetitive and demanding behaviours. A member of the nursing staff was heard to provide help, support and exceptional reassurance to a concerned relative who phoned about the progress of an ill resident. There was an opportunity to see a total of 14 staff during this inspection and attendance at the 4.40pm staff hand-over was useful and informative. There was an update on all residents and discussions where there were concerns. St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 24 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): Standards 33 and 36 – 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are indications that the home is run in the best interests of residents. Staff supervision and training is good. Fire doors must not be wedged open. All other aspects of the health and safety of residents inspected were satisfactory. EVIDENCE: The Registered Manager was on holiday at the time of this inspection. She was therefore not seen nor is known to the inspector. It is not possible therefore on this visit to assess the management style and leadership qualities of the St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 25 Manager. Two conditions of her registration were that she completed the Registered Managers Award by 31/01/07 it was confirmed by a Director that this has been completed. She was also required to complete accredited dementia care training by 31/12/05 and certificate was seen for this. The home appeared well run and managed. All staff were open and helpful and made a valuable contribution to the inspection process. Two Senior Nurses were on duty and provided considerable information throughout the day. A Director was present in the home throughout the day also and was given feedback on the outcomes of the inspection. A requirement to provide a suitable Quality Assurance and monitoring system has produced some progress but more is needed. There is no written evidence that the home consults with residents concerning their daily lives. Questionnaires have been circulated to relatives and a relatives meeting arranged, the responses have been poor. In contrast CSCI had a positive written response with 9 completed questionnaires received prior to the inspection from relatives and 9 from relatives. The provider stated he would further pursue quality monitoring. The views of other stakeholders e.g. GP/healthcare professionals etc. should be sought. Results should be available to residents/relatives and others and form part of the Service Users Guide. There is a trained Moving & Handling trainer who provides training for all staff and annual updates. Fire records were not seen on this visit. Fire training is available to all at least annually – a notice in the home showed 2 fire training sessions arranged for 14/03/07. Several bedroom doors were wedged open and also the door to the laundry. This practice presents a risk to residents and must cease. Self-closing devices must be fitted to doors where there is a need to monitor residents or they request doors are left open. The laundry door must never be wedged open; it is a high risk fire area. Aspects of safe-working practices were inspected. Further training is being arranged in first aid. COSHH storage and recording was not checked but a large box of washing powder used solely for a resident with skin allergies was found in the en-suite area of his bedroom and must be removed to ensure safety. A sample of accidents and reportable incidents were seen and had been recorded and reported as required. Individual risk assessments seen in individual residents files covered all areas of daily living. St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 26 St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 27 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 1 3 3 3 2 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X 3 3 2 St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES 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 OP2 Regulation 5(1) (c) Requirement All self-funding residents must be provided with written contracts with stated terms & conditions. Where there are concerns about weight loss residents must be weighed weekly and closely monitored. Ensure personal care profile recording is completed daily. Where fluid intake charts are established ensure drinks are provided in the period 9pm – 8 a.m. for residents who are awake. Relatives must always be informed of events affecting the health & welfare of residents. Eye-drops/ointments must be dated when opened and discarded after 28 days. A protocol must be obtained from the prescriber for the administration of rectal diazepam PRN. Provide suitable activities for residents on both units daily and provide clear records of activities. Previous DS0000004410.V331167.R02.S.doc Timescale for action 31/03/07 2 OP8 12(10 31/03/07 3 4 OP8 OP8 12 (1) 12(1) 31/03/07 13/03/07 5 6 7 OP8 OP9 OP9 12(1) 13(2) 13(2) 13/03/07 31/03/07 31/03/07 8 OP12 15 & 16(2)(n) 31/05/07 St Mary`s Nursing Home Version 5.2 Page 29 9 10 OP12 OP33 16(3) 24 11 OP38 23(4)(a (b) requirements not met. Ensure appropriate pastoral care is available to all residents. Further develop suitable quality assurance and monitoring system with results available to all. Previous timescales not met. Fire doors must not be wedge open. Suitable self-closing devices must be fitted. 30/04/07 31/05/07 13/03/07 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 Pharmacist is approached to provide printed MAR sheets to avoid handwriting them. St Mary`s Nursing Home DS0000004410.V331167.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 DS0000004410.V331167.R02.S.doc Version 5.2 Page 31 - 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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