Inspection on 13/11/06 for St Mary`s Residential & Nursing Home Scunthorpe

This inspection was carried out on 13th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

CARE HOMES FOR OLDER PEOPLE St Mary`s Residential & Nursing Home Scunthorpe St Mary`s Court, Speedwell Crescent Scunthorpe North Lincolnshire DN15 8UP Lead Inspector Eileen Engelmann Key Unannounced Inspection 13th November 2006 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 Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Mary`s Residential & Nursing Home Scunthorpe St Mary`s Court, Speedwell Crescent Scunthorpe North Lincolnshire DN15 8UP Address 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) 01724 865461 01724 277750 www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Tracy Atkins Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47), Physical disability (37), Physical disability of places over 65 years of age (37) St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th March 2006 Brief Description of the Service: St Mary’s is located in a quiet residential area on the outskirts of Scunthorpe town; there is a regular bus service to the town centre however the home is close to a number of local amenities. The home provides care for up to 47 service users who require nursing and residential care support. There are 41 single rooms and 3 double rooms. The accommodation is based on one floor; there are three lounge areas, an activity room and a dining room. Furnishings and fittings are of a high standard. There is a very secluded and pleasant courtyard in the central area of the home, which contains raised flowerbeds, mature shrubs, seating and a large pond. There are lawns to the side and rear of the home. Ample car parking is provided to the front of the home. 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. A copy of the latest inspection report for the home is on display in the reception area of St. Mary’s Nursing Home. Information given by the manager on 01/08/06 within the Pre-Inspection Questionnaire indicates the home charges a range of fees from £312.00 to £465.00 per week, these fees include the nursing band payment (where applicable) for nursing care. There is a ‘top-up’ fee of between £18.00 and £30.00 per week depending on the room type and facilities within it. Residents will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these can be obtained from the manager. St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit was carried out with the registered manager, staff and residents of St. Mary’s Nursing Home. 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. Two of the staff on duty, one visitor and nine of the residents were spoken to; 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 relatives and residents and their written response to these was good. The staff response to the questionnaires was poor and the reasons for this were looked at during the inspection. The inspector received 9 back from relatives (75 ), 1 from staff (5 ) and 7 from residents (58 ). The manager completed a preinspection questionnaire and returned this to the Commission within the given timescale. Since the last visit in March 2006, the Commission has received one formal complaint about the care given at the home. The formal complaint was passed to the Provider to investigate, and the inspector is waiting for their response. What the service does well: Residents are given up to date information about the facilities and services available to people living within the home, and the staff and manager will also talk through the information with those who find reading difficult. Residents have good access to professional medical staff and are able to access external services such as dentists and opticians. There is a good choice of social activities that offer residents stimulating and enjoyable entertainment, which families and friends are encouraged to join in with. Residents are provided with a warm, safe and comfortable environment that is homely and welcoming. The home is clean and staff work hard to make sure the building is odour free. Residents said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 6. Quality in this outcome area is good. 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose, service user guide and a copy of the last inspection report (March 06) are on display in the reception area of the home. These have been updated since the last visit and give the residents clear and informative advice about the home and its service. All residents are provided with a copy of the Service Users Guide and there is a monthly newsletter giving individuals more information about events taking place within the home. Copies of the newsletter are available in the reception area of the home. Information from the surveys showed that all the residents who responded had been provided with written information about the service before they came into St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 9 the home. These individuals have also received a contract/statement of terms and conditions from the home. One individual said ‘I came into the home on two weeks respite, and decided to stay due to my continuing poor health. I was given sufficient information to read through before making my decision to become a permanent resident’. 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 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 NHS registered nurse from the local Primary Care Trust, to determine the level of nursing input required by each individual. Staff members on duty were knowledgeable about the needs of each resident and had a good understanding of their specific problems/abilities and the care given on a daily basis. Discussion with the residents showed that they were satisfied with the care they receive and have a good relationship with the staff. 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 not all staff are up to date with their basic mandatory safe working practice training. The manager is aware of this and she said that a new training officer for the home is in place and will be starting a regular training day each week within the home to bring everyone up to date. Checks on the staff files, indicates that staff support and guidance through supervision is carried out using training sessions and staff meetings as discussion and feedback opportunities, as well as more formal 1-1 time with individual staff. 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. Information from the Pre-Inspection Questionnaire and discussion with the residents indicates that the majority of the residents are white/British nationality. Those who are from other ethnic groups were spoken to during this visit and were very satisfied with their care, and said that their communication and religious needs were being met. However, they felt that the food could be improved as it lacked the Italian style and flavour they were used to. Changes to the menus to introduce new meals including pasta dishes and curries have been made, but the process is only just starting. St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 10 The home employs five staff from India and South Africa. These individuals offer staff an insight into the daily life and beliefs of different cultures and ethnic groups. 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 home does not accept intermediate care placements so standard six is not applicable to the service provided. St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 11 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 and 10. Quality in this outcome area is good. Improvements to the staff performance around record keeping within the medication system must be made, to ensure the residents’ health and welfare are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home continues to produce and keep clear and well-written care plans for the residents. 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 assessments were seen to cover pressure sores, nutrition, moving/handling and activities of daily living and all of the care plans have been signed by the resident or their family. Information about the resident’s social interests, likes and dislikes, spiritual needs and wishes regarding death and dying are all included within the individuals care plan. St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 12 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. Six 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. Responses to the surveys indicated that the residents and relatives are satisfied with the level of medical support given to the people living at the home. Entries in the care plan 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’. One individual spoken to is a diabetic and they were pleased with the input they received from the diabetic nurse, eye clinic and GP service around the management of their condition. The nurses within the home carry out specialist tasks such as stoma care, 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 two residents with pressure sores, their wounds are documented in their care plans and wound care is given as appropriate. 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 viability nurse for advice, where required, and documented any changes as necessary. 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 that overall these are well maintained and kept up to date, however there were a few areas in which they could be improved. These included •Where staff are hand writing medication onto the sheets (transcribing), they are not following best practice. Staff must include the amounts of medication received or brought forward, and have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct. St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 13 •It was noted that medication already held in the home when a new delivery is receipted in is not added to the supplies on the medication record sheets. This should be done so as to ensure a running total is available at all times. •Staff must sign in all medication received into the home. Checks of the controlled drugs and register showed that these are up to date, accurate and well managed. Resident and relative comments show that overall 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 individual said ‘I am sometimes left on the commode for longer than I really want, but generally the staff are very good at attending to our needs’. Another resident said ‘the staff are lovely, they are always willing to have a chat with me and I enjoy living at the home’. One person commented that ‘the home is comfortable and staff are supportive, I am extremely happy with the care I receive’. The Commission has received a formal complaint from the relatives of one resident living in the home (October 2006). Their issues relate to the care of their relative and these have been passed on to the provider who is investigating the concerns. St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 14 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. Quality in this outcome area is good. Improvements must be made in the way residents food choices are obtained and recorded, to promote clarity and understanding of the meals on offer each day for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Nine residents were spoken to during this visit and all of them said they thoroughly enjoyed the activities provided by the home and usually had something to keep them busy most of the day. One gentleman had been playing dominoes in the morning and said that this was a regular event within the home. Another resident said he liked to go out to the pub and was able to go around the local area for daily walks. Two individuals spoken to were more dependent with regards to their mobility and they kept busy by watching television, reading, playing bingo and listening to the radio. The home has an activities co-ordinator who organises and runs a weekly programme of social events; information about this is on display in the reception area. There is a monthly newsletter distributed throughout the home and resident/relative meetings are held every 3-4 months; these are used as St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 15 an opportunity for individuals to express their ideas of what activities and trips out they want and to give their feedback on events that have taken place. Entertainers from outside to the home are booked on a regular basis to come in and perform for the residents and the home hires specialist transport when a trip out is organised. Discussion with the staff indicated that they would like to see the home have its own transport as the residents get a lot of pleasure from going out into the community. Good records are kept of all the social interactions going on in the home and evidence seen at this visit indicates that residents are encouraged to celebrate festivals such as Halloween, November the fifth and Christian events such as Birthdays, Easter and Christmas. 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. One visitor said ‘the staff keep me well informed of my relatives care and progress, they talk to me when I visit or will ring me if necessary’. Information from the residents’ files indicates that there are a number of individuals who follow different spiritual faiths, including Methodist, Catholic and Church of England. The manager said that there are regular church services (fortnightly) within the home and the catholic priest visits weekly to give communion to those who want to partake. Information about advocacy services is on display in the home and 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. Six 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. Residents spoken to are satisfied that they can access their personal allowances when needed. All the residents said that the home encouraged them to bring in small items of furniture and personal possessions to decorate their bedrooms. Discussion with the residents showed that they are aware of their care plans and able to contribute to them and access them through their key workers. Since the last visit to the home (March 2006) the home has taken over the running of the kitchens and is responsible for all aspects of this service. Residents and relatives were asked at their last meeting to give lists of food likes and dislikes, preferences and allergies to the staff so this information could be used to produce new menus. These are now in circulation and on the day of this visit seven residents were enjoying a curry, which is one of the new meals introduced. St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 16 Discussion with one resident who is from another country found that they were struggling to find meals that they enjoyed on the menu, their relative said that this was mainly because the resident had very specific tastes and was used to cooking in their own style. One problem highlighted by a number of residents is that they cannot remember what they have ordered for their meal, from the day before. Staff are asking for their choices and residents are getting confused, thinking that what they have ordered is for the same day. This has resulted in individuals getting upset and annoyed with the staff. This was discussed with the manager and it was recommended that the home consider ways in which residents could be reminded of their choices in a tactful and discreet way. Comments from the surveys received from staff, residents and relatives indicate that overall there is a good level of satisfaction with the meals provided by the home. Four individuals said ‘the food could be better’, but seven individuals spoken to in the dining room 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’. It was noted that there were some problems with the equipment in the kitchen, the hot trolley was not mobile due to wobbly wheels and sticking doors, the dishwasher was out of action because of a problem with the salt dispenser and staff were having to hand wash the crockery and pans, the fridge door seal is broken and the door was difficult to keep closed. These were discussed with the manager who immediately chased up the repairs and parts needed to correct the faults. St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 17 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. Quality in this outcome area is good. Improvements must be made to promote the complaints and whistle blowing processes within the home, to increase staff, relatives and residents confidence in using the systems and protect residents from potential risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Commission has received one formal complaint in October 2006, which has been passed onto the provider for investigation. At the time of this visit this investigation was still being completed. Checks of the complaints records in the home showed that the manager has dealt with three internal issues since the last visit in March 2006. These issues were around care and equipment 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. Seven 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’. St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 18 Survey responses show that there are a number of relatives who remain unaware of how to use the complaints system or that it is in place. Staff should to be more proactive about telling people visiting the service how they can make their views and opinions known to the management team. The staff on duty displayed a good understanding of the vulnerable adults procedure and nine residents spoken to said they ‘felt safe at the home’. Discussion with the manager and checks of the staff files indicated that the home provided staff with Protection of Vulnerable Adults training in the past, and a number of individuals now need an update and refresher course. It is recommended that the manager ensure that staff are able to access this information on an ongoing basis. The manager said that this was one of the first training sessions to be undertaken by the new home trainer when she starts the rolling training programme. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, management of service user monies and finances, physical intervention and restraint. St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 19 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, 21, 22, 24 and 26. Quality in this outcome area is good. The standard of environment within the home is good, providing residents with an attractive and homely place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has a record of the ongoing maintenance and renewal programme and this indicates that the provider is committed to improving the facilities and environment within the home. Since the last visit in March 2006 the home has purchased an additional two profiling beds, bed rails and bumpers, new bedroom furniture for two rooms, a new front door and replaced the curtains and furniture in the reception area. New carpets have been fitted to the front entrance and three bedrooms, new lighting has been put into all the corridors, a new medication trolley and fridge have been provided in the treatment room and there is ongoing decorating and refurbishment throughout the home. St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 20 Work was taking place within the home to convert the existing staff room into a smaller staff room and a nursing station, as the nurses are currently using one of the bedrooms as their office. All areas seen by the inspector were found to be clean and tidy and there were no malodours within the building. Bathroom 7 has a broken bath hoist and discussion with the staff indicated that this has been out of action for some time. The manager said there was another fixed hoist bath in use and two others available for use with a mobile hoist. Discussion with the manager, staff and people living at the home indicates that the provision of a shower facility would be beneficial to the residents and meet the needs of certain individuals more than the current bathing facilities. The provider should consider getting the bath hoist fixed or converting this bathroom into a shower room, to enable better choice for residents over their bathing facilities. Inspection 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, 2 stand aids, slide sheets, turntables and handrails. No changes have taken place since the last inspection to the criteria of standard 24. Bedrooms have been fitted with door locks, but these are not key operated and can be overridden by anyone using a coin in the outer slot to turn the lock. The inspector expressed concerns over the safety of the residents as anyone could access their bedrooms even if an individual has locked their door. In the last report (March 2006), it was recommended that the provider consult with the local fire service over the different types of lock systems available, to identify one that protects residents safety, promotes privacy and which is easy and safe to use in the event of a fire emergency. This recommendation will remain in this report. The environment is warm and comfortable and no malodours were present. One person commented in the surveys that ‘my room is dusty and untidy’, but five others said ‘ the home is kept spotlessly clean’. Three individuals spoken to on the day of 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’. Residents were also 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’. St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 21 St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.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. Quality in this outcome area is good. Improvements to the team working system within the home would raise staff morale and ensure residents’ care is consistent and timely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Feedback from the staff, residents and relatives’ surveys mentioned concerns about staffing shortages that are impacting on the care being given in the home. Staff say they feel rushed and under pressure at times and commented that not all the staff work as a team, which creates problems and an unfair distribution in the workload. Poor communication and time management issues were also factors that resulted in staff feeling frustrated and misunderstood. Discussion with the manager indicated that she is aware of the issues mentioned above and is in the process of talking through these problems with the staff group to find solutions and create a better working environment. There are 38 residents in the home (20 nursing and 18 residential), and the staffing rotas show the number of individuals on duty are one or two nurses, one senior carer and five care staff each morning from 8am to 2pm, one nurse, one senior carer and four care staff from 2pm to 8pm, and one nurse and three care staff at night. St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 23 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 Forum Guidance and showed that the home provides more than the minimum hours asked for in the recommended guidelines. There is an induction and foundation course for new members of staff, and 27 of the care staff have achieved an NVQ 2 or 3. The home provides a mandatory staff-training programme and is beginning to add some more specialised training to help staff develop their skills and knowledge around diabetes, death and dying, palliative care. Discussion with the manager indicated that the new training officer for the home is hoping to improve access to specialist subjects and this should be more evident over the next 12 months. There is no evidence that staff have received training around equality, diversity and disability rights and this should be included in the rolling programme of staff training and development. Information from the staff-training matrix indicates that some staff require updates in their safe practice training, certain sessions have not taken place in the last 12 months or have a low attendance rate. The manager said that the training officer is making this her first priority and staff should be up to date within the next six months. 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 Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.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 and 38. Quality in this outcome area is good. 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last visit in March 2006 the manager of the home has successfully registered with the Commission. This was a requirement in the last report and the standard is now met. The manager is a Registered Nurse and has an active registration with the Nursing and Midwifery Council. She is in the process of completing an NVQ 4 in management, and although there has been some delay due to changes of St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 25 assessors she is hopeful about finishing this by April 2007. This was a recommendation in the last report and will remain so in this one. The home has recently been successful in achieving the North Lincolnshire Council’s Gold Award for Quality Assurance (17/10/06), and the manager has produced an annual development plan from the results of the satisfaction surveys sent out to residents, relatives and staff in the past year. Both these factors were requirements in the last report (March 2006) and standard 33 is now met. Meetings for the staff and residents are taking place; minutes are kept and are available for any interested parties to read. Policies and procedures are up dated and reviewed as an ongoing practice and action is being taken to ensure the requirements of the inspection reports are met. Checks of the finance systems within the home found that written records for the residents personal allowances are kept and up dated by the administrator on a daily basis. Discussion with the administrator indicated that the home is in the process of changing the personal allowance records from paperwork copies to a computerised system. This should be up and running within the next three months. Information from the pre-inspection questionnaire indicates the majority of residents have their families looking after their financial affairs, and checks of the system show their relatives top up the resident’s individual personal allowance account on a regular basis. Resident’s who have asked the home to look after their personal allowances are able to access their money on request, and receipts are kept for any transactions. All monies are kept safe and secure within the home and only the administrator or manager has access to the funds. 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 or are due to attend later in the year, and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, bed rails and daily activities of living. St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 3 X 2 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 17 Requirement Accurate records must be kept of all medications, received, administered, leaving the home or disposed of to ensure there is no mishandling. Timescale for action 01/02/07 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 2 Refer to Standard OP9 OP9 Good Practice Recommendations Transcribed medications should have two staff signatures on the MAR chart to indicate that the information written down has been checked and is accurate. Staff should ensure that medication already held in the home when a new delivery is receipted in is added to the supplies on the medication record sheets. This should be done so as to ensure a running total is available at all times. The manager should consider ways in which residents could be reminded of their menu choices in a tactful and discreet way. Staff should to be more proactive about telling people visiting the service how they can make their views and DS0000065941.V320632.R01.S.doc Version 5.2 Page 28 3 4 OP15 OP16 St Mary`s Residential & Nursing Home Scunthorpe 5 6 7 OP18 OP21 OP24 8 9 10 OP28 OP30 OP31 opinions known to the management team. The manager should ensure that staff are able to access POVA training on an ongoing basis. The provider should consider getting the bath hoist fixed or converting this bathroom into a shower room, to enable better choice for residents over their bathing facilities. The provider should consult with the local fire service over the different types of bedroom lock systems available, to identify one that protects residents safety, promotes privacy and which is easy and safe to use in the event of a fire emergency. 50 of care staff should have achieved a NVQ 2 in care by June 2007. Staff should receive training around equality, diversity and disability rights and this should be included in the rolling programme of staff training and development. The manager should achieve an NVQ 4 or equivalent in management by April 2007. St Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 29 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 Mary`s Residential & Nursing Home Scunthorpe DS0000065941.V320632.R01.S.doc Version 5.2 Page 30 - 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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