Inspection on 14/05/07 for St Mary`s Nursing Home Hull

This inspection was carried out on 14th May 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 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 Hull 10/02/06

St Mary`s Nursing Home Hull 14/09/05

St Mary`s Nursing Home Hull 25/11/04

St Mary`s Nursing Home Hull 17/08/04

St Mary`s Nursing Home Hull 24/02/04

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Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE St Marys Nursing Home Hull 344 Chanterlands Avenue Kingston Upon Hull East Yorkshire HU5 4DT Lead Inspector Eileen Engelmann Key Unannounced Inspection 14th May 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 Marys Nursing Home Hull DS0000000954.V340149.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 Marys Nursing Home Hull DS0000000954.V340149.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Marys Nursing Home Hull Address 344 Chanterlands Avenue Kingston Upon Hull East Yorkshire HU5 4DT 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) 01482 348158 F/P 01482 348158 Private Medicare Limited Mrs Lyn Wilson Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48), Physical disability (48) of places St Marys Nursing Home Hull DS0000000954.V340149.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability - Code PD 2. The maximum number of service users who can be accommodated is: 48 Registration includes eight stroke rehabilitation patients and two intermediate care. 10th February 2006 2. 3. Date of last inspection Brief Description of the Service: St Marys Nursing Home is a single storey, purpose-built home, situated in its own extensive grounds in a residential area of west Hull. There are a variety of local community facilities close to hand. The home offers ample parking and a bus stop is very close to the home. The home offers long term care with nursing to a maximum of 48 older people of either gender. There are also two intermediate care beds and eight stroke rehabilitation beds which people occupy for relatively short stays. There is a rehabilitation kitchen for these individuals to help them to regain daily living skills before moving home. Accommodation is offered in 30 single bedrooms and nine double rooms all on one level. The home has pleasant wheelchair-friendly grounds for the enjoyment of the service users. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home, and copies are given to every new resident. The latest inspection report for the home is on display in the entrance hall and copies are available from the manager on request. Information given by the director on 27/03/07 within the Pre-Inspection Questionnaire and discussion with the manager on 14/05/07 indicates the home charges fees from £432.50 to £523.50 per week depending on the type of room required and the nursing input needed. Residents will pay additional St Marys Nursing Home Hull DS0000000954.V340149.R01.S.doc Version 5.2 Page 5 costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these is available in the service user guide, contract or from the manager. St Marys Nursing Home Hull DS0000000954.V340149.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Since the last visit in February 2006 the registered manager for the home has been promoted within the company and Lyn Wilson has been appointed to the post. Lyn has successfully completed her registration with the Commission For Social Care Inspection. This unannounced visit was carried out with the manager, staff and residents of St Marys. The visit took place over 1 day and included a tour of the premises, examination of staff and resident files and records relating to the service. Informal chats took place with the staff training officer and a number of the residents and relatives; their comments have been included in this report. Information was gathered from a number of different sources before the inspector visited the home. Questionnaires were sent out to a selection of staff, relatives and residents and their written response to these was good. The inspector received 8 back from relatives (45 ), 16 from staff (80 ) and 21 from residents (81 ). The owner completed a pre-inspection questionnaire and returned this to the Commission within the given timescale. Since the last visit in February 2006 the Commission for Social Care Inspection has received two concerns and two complaints about the care within the home. The concerns were looked at by the local Social Services Team and were resolved with no further action needed. The two complaints were given to the owner to investigate and this was done within the given timescales and in a robust manner. One relative was not satisfied with the response from the provider and asked the local Social Services Team to look at the response and do further investigation. They could find no wrong doing within the home. The manager and staff at St. Mary’s have worked hard to maintain high standards at the home and have exceeded the minimum standards in 7 of the 28 standards assessed in this report. There is a need for the management team to focus more on developing resident information into different formats so individuals understand what is written, and develop innovative ways that help residents to take part in the decision making processes within the home. What the service does well: The home has an enthusiastic team of people working within the service, who like doing their jobs and learning more about how to do it well. The people working in the home want to make sure that the people who live in the home receive good care. St Marys Nursing Home Hull DS0000000954.V340149.R01.S.doc Version 5.2 Page 7 All of the people spoken to are positive about the home and like living there. Two individuals said they love living at the home and the care is very good. People living in the home and relatives expressed their satisfaction during this visit regarding the care given, service received and the living environment of the home. Staff are hard working and do their best to meet the needs of those living in the home People being cared for have good access to professional medical staff and are able to access external services such as dentists and opticians. People in the home are provided with a warm, safe and comfortable environment that welcomes visitors and makes them feel at home. The home is clean and staff work hard to make sure the building is odour free. People said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by St Marys Nursing Home Hull DS0000000954.V340149.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Marys Nursing Home Hull DS0000000954.V340149.R01.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 Marys Nursing Home Hull DS0000000954.V340149.R01.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): 1, 2, 3, 4 and 6. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All residents undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met by the service. EVIDENCE: The statement of purpose and service user guide is given out to new residents on admission and copies are available from the manager. Each of the packs is produced in a clear print version, and these are detailed and informative. Given the wealth of information in the documents the inspector queried how many of the residents are able to take in and use the information provided. It is recommended that the home consider producing more appropriate formats that use innovative methods to make the information they give meaningful and interesting, for example using photographs, leaflets, visual or audio versions. St Marys Nursing Home Hull DS0000000954.V340149.R01.S.doc Version 5.2 Page 11 The majority of residents and relatives said they received sufficient information to make an informed choice about the service before accepting the placement offer. These individuals have also received a contract/statement of terms and conditions from the home. One individual said ‘my son arranged everything for me and I am very satisfied with the home’. Four residents care and records were looked at as part of this visit, they each have been provided with a statement of terms and conditions/contract on admission and these are signed by the resident or their representative. These documents give clear information about fees and extra charges, which are reviewed and kept up to date. Each resident has their own individual file and four of those looked had a need assessment completed by the funding authority and the home has also completed its own needs assessment before a placement was offered to the resident. The homes needs assessment for self-funding individuals is comprehensive and includes risk assessments as part of the information gathering process. Discussion with the manager indicated she carries out a needs based assessment on all residents prior to admission, except the stroke rehabilitation and intermediate care individuals, who have the assessment completed by the specialist community care team. The home develops a comprehensive care plan from the assessments, identifying the individual’s problems, needs and abilities using the information gathered from the resident and family. Those residents at the home who receive nursing care have undergone an assessment by a registered nurse from the local Primary Care Trust, to determine the level of nursing input required by each individual. It is recommended that the manager should make sure that the admission process is looked at as part of the quality assurance audits to determine the level of resident satisfaction with their experiences of these processes within the home. This will help the manager to assess if the home and staff are achieving the aims and objectives for the service. Residents and relatives are very pleased with the care and support given by the staff, they said ‘ the staff are very efficient when giving care, residents needs are always taken care of and they do their best to listen to you and act on your suggestions’. The home employs six staff from overseas. These individuals offer staff an insight into the daily life and beliefs of different cultures and ethnic groups. The staff said they work well together as a team and are committed to providing a high standard of care. Residents are able to make a limited choice of staff gender when deciding who they would like to deliver their care, as the home has three male staff who work night and day shifts, as well as the female members. The manager said St Marys Nursing Home Hull DS0000000954.V340149.R01.S.doc Version 5.2 Page 12 that she would discuss this with prospective residents during the assessment process. Information from the Pre-Inspection Questionnaire and discussion with the residents indicates that all of the residents are of white/British nationality. The home does accept residents with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. The staff training files and the training matrix show that new staff go through an induction before starting work and that the home has a training programme in place. Information from the files and matrix indicates that the staff are up to date with their basic mandatory safe working practice training, and have access to a range of more specialised subjects that link to the needs of the residents. The employment records show that the manager is using a selective approach to recruitment; ensuring new staff have the right skills and attitude to meet the needs of the residents. The home has two intermediate care beds and eight stroke unit beds (two double rooms and six singles). These are located together at one side of the home and the unit facilities include a small sitting room, one shower room and a bathroom. There is a kitchen provided for residents to enable them to practice their domestic skills, and this is open to visitors when not being used for therapy purposes. Physiotherapists and an occupational therapist visit the home most days and involve the staff working within the stroke unit in some of their therapeutic techniques, enabling the staff to undertake certain therapies in their absence. Discussion with the manager indicated that most people admitted onto the stroke unit stay on average around 6-8 weeks, but this can be extended if needed. A computer has been installed in the stroke-unit lounge and the manager said that it is being used to provide speech and language therapy as well as other activities. St Marys Nursing Home Hull DS0000000954.V340149.R01.S.doc Version 5.2 Page 13 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): 7, 8, 9, 10 and 11. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of the residents are clearly documented and are being met by the service and staff. The medication at the home is well managed promoting good health. EVIDENCE: Since the last visit in February 2006 the home has changed the format of its care plans, all documents have been up dated and reviewed and information transferred onto the new paperwork. The care plans are very detailed and contain a lot of nursing information. This could make them difficult for the residents to read and understand without staff support and guidance. The manager should look at how the plans can become more ‘resident friendly’. Individual care plans are in place for all residents and the four examined set out the health, personal and social care needs identified for each person. The plans looked at have been evaluated on a monthly basis and any changes to the care being given is documented and implemented by the staff. Risk St Marys Nursing Home Hull DS0000000954.V340149.R01.S.doc Version 5.2 Page 14 assessments were seen to cover pressure sores, nutrition, moving/handling and activities of daily living. Information about the resident’s social interests, likes and dislikes, spiritual needs and wishes regarding death and dying are included within the individuals care plan. The funding authorities are carrying out yearly reviews of the care plans and the minutes of these meetings show that residents have input to this process (where possible), and family/representatives are also invited to the reviews with the resident’s permission. Residents or their representative have signed the care plans at the point of their being written to show they agree with the content, however there is little evidence that residents are consulted on a regular basis about their care, especially when staff are completing the monthly evaluations. This was discussed with the manager and she said she would look at how staff could use a variety of different and creative methods to help people using the service to contribute to their own care plan. Residents said that they have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Comments from the residents and relatives indicate they are satisfied with the level of medical support given to the people living at the home. Entries in the care plans specify where individuals have dietary needs, including PEG feeds, supplement drinks and pureed diets. The staff weighs everyone on a regular basis and evidence in the plans show that dieticians are called out if the home has particular concerns about an individual. Discussion with two residents indicated that they are very happy with the hygiene care at the home; they stated that ‘staff ensure we receive regular baths and we can access a hairdresser in the home’. The nurses within the home carry out specialist tasks such as PEG tubes/feeding regimes and wound dressings. Pressure areas are monitored carefully and proactive measures include risk assessments and special mattresses and seat cushions. Information from the pre-inspection questionnaire and discussion with the manager indicates that currently there are three residents with pressure sores, their wounds are documented in their care plans and wound care is given as appropriate. The nursing staff are skilled and knowledgeable about wound care and this is evidenced in the progress notes of the residents. One resident said ‘ I neglected myself before coming into the home and if it had not been for the wonderful care I have received from the staff I do not think I would be here today’. Checks of the wound care records showed these were detailed around the type of dressings used and the progress of the wound. The staff ask the tissue St Marys Nursing Home Hull DS0000000954.V340149.R01.S.doc Version 5.2 Page 15 viability nurse for advice, where required, and documented any changes as necessary. Relatives commented that they are kept informed of their relative’s wellbeing by the staff; they are regularly consulted (where appropriate) on their care and feel involved in their lives. Overall there is a good level of satisfaction with the care being given to the residents. At the last visit in February 2006 a requirement was made for improvements to medication record keeping, and two recommendations were made for the manager to audit the medication records regularly and the medication policy and procedure to be updated. Information and observation at this visit shows these have all been actioned and completed. The medication policy for the home says that individuals can self-medicate if they want to and after a risk assessment has been completed and agreed. All of the residents spoken to prefer to have staff administer their medication. Checks of the medication records showed these are up to date and accurate, including those for controlled drugs and refrigerated items. One resident said ‘I appreciate the regularity that I receive my medication, it is delivered on time and when I need it’. Resident and relative comments show they are very satisfied with the care and support offered by the staff. Chats with the residents revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. One person said ‘ there are occasional delays in responding to the buzzer, but on the whole staff are efficient and supportive’. Two other residents said ‘ the staff are very good, they help us to mobilise and keep our spirits up’. Discussion with the manager and staff indicated the home continues to follow the Liverpool Pathway of Care for the Dying. This process has been in place for some time and focuses on the needs of the individual person and ensures they are able to die with dignity, with their wishes and choices being respected at all times. St Marys Nursing Home Hull DS0000000954.V340149.R01.S.doc Version 5.2 Page 16 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): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with choice and diversity in the meals and activities provided by the home. Individual wishes and needs are catered for and people have the option of where, when and how they participate in both eating and leisure activities. EVIDENCE: The manager said that she is in the process of recruiting an activities coordinator who will work between the two homes in Hull. There are activities and events going on within the home, which are suitable and in keeping with the fact that many residents are bed bound or very frail. Out of the twentyone residents who completed surveys only two felt there were no activities that they could participate in, everyone else felt that they had sufficient things to do to keep them busy and occupied. Those spoken to said they enjoyed the monthly entertainers who visit the home, they kept up to date with the newspapers, magazines and television programmes, and some enjoy listening to music in their own rooms. One resident was out at his club during this visit and returned late in the afternoon; two gentlemen said they enjoyed watching sport on television and going out with their families. St Marys Nursing Home Hull DS0000000954.V340149.R01.S.doc Version 5.2 Page 17 Each resident receives a card and cake from the home for their birthday and staff do their best to help residents celebrate all major Christian events throughout the year, such as Christmas and Easter. There are no in-house church services, but the Roman Catholic Priest visits weekly and home visits or local services can be arranged on request. Relatives are on the whole very positive about the home and its service. Individuals said they felt the home had very good staff, who maintain a friendly and caring ambience throughout the building. The home is bright, clean and cheerful and staff go out of their way to be supportive and welcoming. One individual said that ‘ I would like to see a regular news sheet giving information about the changes and events going on in the home, but the staff are very good at keeping you up to date with things that affect your relative in the home’. Discussion with the residents indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or staff would take them into the town. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly is a good relationship between all parties. Residents spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. Information about advocacy services is on display in the home and includes leaflets made available to the residents and relatives from the manager. Discussion with the manager indicated that no one at the home is currently using an advocacy service, although these have been accessed in the past. Discussion with the manager indicates that relative and resident meetings have not been held recently, but this is something she is hoping to restart in the near future. The owners, on a regular basis to those using the service, send out satisfaction questionnaires and the responses are analysed and used to change the practices and service within the home. Observation of the midday meal showed it to be well prepared and presented, and the kitchen staff had made an effort to provide soft/pureed diets in an attractive way. Staff were organised when serving the meal and a number of individuals were seen to offer assistance to residents who need help with eating and drinking. Residents and relatives are pleased with the quality and quantity of the meals served, saying ‘the menus are varied and interesting with adequate choices. The food is of good quality, well cooked and presented’. Two individuals said ‘the food is lovely, we can have our meals in our rooms or in the dining area and there is always a choice of meal on offer’. St Marys Nursing Home Hull DS0000000954.V340149.R01.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): 16 and 18. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a good complaints system with some evidence that residents’ views are listened to and acted upon. Visitors and residents are confident about reporting any concerns and the manager acts quickly on any issues raised. EVIDENCE: Checks of the complaints records in the home showed that the manager has dealt with three internal issues since the last visit in February 2006. These issues were around care and the manager responded to each one and they are now all resolved. The home has a complaints policy and procedure that is included in the statement of purpose and service user guide. It is also on display within the home and can be found in every bedroom. Fifteen out of the twenty-one resident survey responses showed individuals have a clear understanding about how to make their views and opinions heard and those residents spoken to said ‘the manager comes round every day to see us and will discuss any problems at this time’. All eight relatives who completed a survey said that they felt the home responded appropriately if they raised a concern and minor issues were dealt with quickly. One relative said ‘the staff are very approachable, and try to deal with issues before they become a problem’. St Marys Nursing Home Hull DS0000000954.V340149.R01.S.doc Version 5.2 Page 19 The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of resident’s money and financial affairs. The staff on duty displayed a good understanding of the safeguarding of adults procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. Information in the staff training files showed that they all have received Safeguarding of Adults training and this is part of the ongoing staff development programme. St Marys Nursing Home Hull DS0000000954.V340149.R01.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): 19, 22 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of environment within the home is good, providing residents with an attractive and homely place to live. EVIDENCE: The home has an ongoing programme of routine maintenance and refurbishment. Since the last visit in February 2006 the main lounge has been re-carpeted and had new curtains put up and all the corridors and the entrance lobby have new carpets in place. The owner said that an order for 28 specialist-nursing beds is planned and this will improve the quality of life for many of the residents who spend a lot of time being nursed in bed. One of the bath hoists on the stroke unit side of the building is out of order; the manager said that this is not affecting the residents, as there remains St Marys Nursing Home Hull DS0000000954.V340149.R01.S.doc Version 5.2 Page 21 another assisted bath and a shower room in this area. The owner is looking at alternative uses for the bathroom. Some of the fitted furniture in the bedrooms is looking worn and well used: the owners should consider replacing this as the rooms are refurbished. Doorways throughout the home have been fitted with doorstops, which deactivate when the fire alarm sounds, enabling the doors to close in the event of a fire. All areas seen by the inspector were found to be clean and tidy and there were no malodours within the building. Observation of the home showed that it has been designed and built to meet the needs of disabled individuals. Wide doorways are in place to bedrooms and toilet/bathing facilities. Corridors are spacious and have enough room for two people in wheelchairs or with walking frames to pass comfortably. The home is built on one level with flat walkways inside and out, providing safe and secure footing for people with limited mobility. Discussion with the staff indicates that there is a wide range of equipment provided to help with the moving and handling of the residents and to encourage their independence within the home. This includes 3 mobile hoists, 4 stand aids, slide sheets and handrails. There have been some problems with the electric hoists and this is causing frustration amongst the staff: the manager is aware of the issues and is working with the manufacturers to resolve the matter. The home has two separate laundry areas, one for household linen from the kitchen and dining room and one for bed linen and clothing used by the residents. Residents are pleased with the laundry service at the home, two people commented that ‘the laundry is very good, our clothes come back clean and pressed and staff help us put things away’. Three individuals spoken to on this visit said that ‘ the domestic staff come round regularly to clean our rooms, they tidy up as they clean and do a good job’. Staff receive regular infection control training as part of the safe working practices in the home: gloves and aprons are available and hand gel for sanitising hands after care was also seen around the home. St Marys Nursing Home Hull DS0000000954.V340149.R01.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): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standards of induction and training of staff are very good with staff demonstrating a clear understanding of their roles, ensuring that residents are protected from risk and looked after by motivated and knowledgeable people. EVIDENCE: Comments from the residents, relatives and staff are on the whole very positive about the staffing levels within the home, and individuals feel that there is a high standard of care being given to the people living in the home. Survey responses said ‘the staff are kind, friendly and interact well with the residents’, ‘there is a caring environment, which involves residents families in the resident’s care and the staff are extremely professional and good at their jobs’. There are 45 residents in the home and the staffing rotas show the number of individuals on duty are two/three nurses, and nine care staff each morning from 8am to 1pm, one/two nurses and seven care staff from 1pm to 4pm, one/two nurses and five care staff from 4pm to 8pm and two nurses and three care staff at night. Information from the pre-inspection questionnaire about the number of staffing hours provided, and information gathered during the visit about the dependency levels of the residents, was used with the Residential Staffing St Marys Nursing Home Hull DS0000000954.V340149.R01.S.doc Version 5.2 Page 23 Forum Guidance and showed that the home provides more than the minimum hours asked for in the recommended guidelines. The home offers staff a wide range of training aimed at meeting the needs of the residents, in addition to a comprehensive induction and foundation programme, which meets the Skills for Care training targets and 56 of staff have achieved an NVQ 2 or 3 in care. Staff receive in excess of three days paid training per year and the home has individual staff training plans that are discussed through supervision and appraisal. Four staff files were looked at and they contained evidence of a variety of training events attended over the past year, including customer care, equality and diversity, palliative care, bereavement awareness, Parkinson’s disease, coping with aggressive behaviour, as well as those pertaining to safe working practices. Staff said that ‘the home offers staff good training opportunities and career structure. There is a new training officer in post who is hoping to build on the existing staff development programme, she has already spoken to all staff to find out their learning needs and is using this to produce a training matrix for the next twelve months. Nurses are supported in maintaining their own professional portfolio of practice in order to keep their Personal Identification Number (PIN) from the Nursing and Midwifery Council (NMC) up to date. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The manager said that she has tried to recruit more male carers in the past as she is aware that the majority of staff are female, but this has proved difficult as there have been few suitable applicants. She is aware that this may affect resident’s wishes regarding gender choice for giving of personal care, and this is discussed before an individual is offered a placement at the home. Comments from the manager indicate that the majority of the residents are from a white British background, but the home is able to offer a range of services when they are approached from someone of another culture or ethnic group. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. St Marys Nursing Home Hull DS0000000954.V340149.R01.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): 31, 33, 35, 36 and 38. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home regularly reviews aspects of its performance through a good programme of audits and consultations, which includes seeking the views of residents, staff and relatives. EVIDENCE: Since the last visit in February 2006 the registered manager has been promoted within the company and Lyn Wilson has taken her post. Lyn has successfully undergone registration as a manager with the Commission for Social Care Inspection and is completing her Registered Managers Award training: she hopes to have this finished by the end of December 2007. Lyn is St Marys Nursing Home Hull DS0000000954.V340149.R01.S.doc Version 5.2 Page 25 a qualified nurse with an active registration with the Nursing and Midwifery Council (NMC) and has extensive experience in caring for individuals with stroke and elderly care needs. Residents and relatives have given extremely positive feedback about the new manager and the changes she has brought about in the home. Individuals commented that ‘ the manager is very approachable, she receives things with interest and acts quickly to resolve issues’, ‘ the manager welcomes any input that will improve the home, she listens to all sides and deals with problems fairly’. Staff are also pleased with the new manager, one individual said ‘I feel I can go to the new manager with any problem and she will sit and listen to me, and take appropriate action’. The home continues to achieve the local councils quality award (QDS) parts one and two. Continuous monitoring and assessment of the home and its practice/service by the authorised body is an essential part of the process leading to the award being reaffirmed year after year. Staff have regular informal meetings with the manager and there are more formal sessions every two months where everyone is encouraged to join in with discussions and voice their opinions. Plans are in place to re-commence a residents and relatives forum and newsletter to help improve communication within the home. Residents and staff agree that they are able to express ideas; criticisms and concerns without prejudice and the management team will take action where necessary to bring about positive change. Policies and procedures within the home have been reviewed and updated to meet current legislation and good practice advice from the Department of Health, local/health authorities and specialist/professional organisations. The manager completes in-house audits of the home and its service on a monthly basis, and the registered individual does spot checks and completes the regulation 26 visits. The manager is in the process of producing the Annual Development Plan for 2007/8, gathering together the feedback and information from the satisfaction questionnaires and showing how the home has altered its service and/or practices in response to the comments from the people who use the service. The importance of the Commission’s document called Key Lines Of Regulatory Assessment (KLORA) was discussed with the manager, and how it is used in the inspection and report writing process. Discussion took place with the manager around the need to develop a crisis plan for the Flu Pandemic that may affect the country in or around 2009, this should be detailed and set out what the home must do to ensure the residents and staff receive the care and support needed in the event of a flu outbreak. Checks of the financial records for the residents’ personal allowances showed that the home keeps written account sheets for each individual and receipts are available for all transactions undertaken. Where individuals have their families looking after their finances, relatives who are unable to visit very often St Marys Nursing Home Hull DS0000000954.V340149.R01.S.doc Version 5.2 Page 26 are asked to send spending money for the residents as and when their personal allowance accounts show their monies are low. The home only keeps a limited amount of money within the safe, surplus monies are kept in a communal resident account, which does not pay individuals any interest. This information is put into the Service User Guide so all those coming into the home are aware of the homes arrangement, and can decide if they wish to make their own. Discussion with the manager and training officer for the home indicates that staff supervision has lapsed slightly over the past three months but this is being addressed and will be back on track by the end of May 07. The home is committed to ensuring residents are kept safe and are looked after by welltrained staff. The high staffing levels of the home are deliberate, so that every new employee is able to work with an experienced member of staff and is supervised constantly throughout their induction period. The training officer (who is a registered nurse) works with all staff members in order to observe their care practices, ensure standards are kept to a high level, and promote resident health, safety and welfare issues. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, cot sides and daily activities of living. St Marys Nursing Home Hull DS0000000954.V340149.R01.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 3 4 3 X 4 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 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 X 4 X 4 3 X 3 St Marys Nursing Home Hull DS0000000954.V340149.R01.S.doc Version 5.2 Page 28 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. Refer to Standard OP1 Good Practice Recommendations The home should consider producing the statement of purpose and service user guide in more appropriate formats, that make the information within them meaningful and interesting for the residents. The manager should make sure that the admission process is looked at as part of the quality assurance audits to determine the level of resident satisfaction with their experiences of these processes within the home. The manager should look at how the care plans can become more ‘resident friendly’ and easy for individual to read. The manager should consider how staff could use a variety of different and creative methods to help people using the service to contribute to their own care plan. The owners should consider replacing the bedroom furniture as rooms are refurbished. The owners should consider developing a crisis plan for the DS0000000954.V340149.R01.S.doc Version 5.2 Page 29 2. OP3 3. 4. 5. 6. OP7 OP7 OP19 OP33 St Marys Nursing Home Hull Flu Pandemic predicted for 2009. St Marys Nursing Home Hull DS0000000954.V340149.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Marys Nursing Home Hull DS0000000954.V340149.R01.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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