CARE HOMES FOR OLDER PEOPLE
St Mary`s Nursing Home 19 Dunstable Road Luton Bedfordshire LU1 1BE Lead Inspector
Sally Snelson Unannounced Inspection 23rd November 2005 5:50 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Mary`s Nursing Home DS0000017693.V267338.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Mary`s Nursing Home DS0000017693.V267338.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St Mary`s Nursing Home Address 19 Dunstable Road Luton Bedfordshire LU1 1BE 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) 01582 438200 01582 484116 BUPA Care Homes (Bedfordshire) Ltd Vacant Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places St Mary`s Nursing Home DS0000017693.V267338.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home can accommodate a maximum of 60 service users of either sex. OP 60. Service users admitted prior to 01/06/05 may have a diagnosis of dementia. 1st July 2005 Date of last inspection Brief Description of the Service: St Mary’s Care Home is a purpose built nursing home situated in central Luton on the site of an old hospital. The home provides single bedroom accommodation for service users over the age of 65years. The original building has been extended to provide 60 bedrooms on two floors accessed by a shaft lift. There is an open courtyard area with seating where in the summer plants provide interest and colour. The bedrooms are varied; some in the older part of the building have retained their original features. A number of communal rooms provide service users with a choice of seating areas. There is adequate staff and visitor car parking space. Staff are divided into two teams to deliver care, each team covering one floor. The staff teams are made up of qualified nurses, carers and senior carers supported by teams of housekeeping and administrative staff. St Mary`s Nursing Home DS0000017693.V267338.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection of St Mary’s was unannounced and took place on 23rd November 2005 starting at 17.50 hrs. The inspection of the home was the third for the year and provides the second inspection report, therefore this report should be read in conjunction with the report for the home dated 1st July 2005. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views of the services provided. The process considers the home’s capacity to meet regulatory requirements and minimum standards of practice. This short inspection focused on the core standards that had not been assessed during past inspections and the progress that had been made to meeting the requirements of the last inspection report. During the inspection two service users on the first floor care were ‘case tracked’, this involved looking at the care they received and the documentation that supported their care. These and other service users were spoken to as well as many of the staff who were on duty. Because of the time of the inspection it was not possible to look at many of the management standards The inspector would like to thank the staff and service users for their help with this inspection. What the service does well:
Despite the inspection being unannounced and taking place at an unconventional time the staff welcomed the inspector and there was a relaxed atmosphere in the home. A number of the service users confirmed that they stayed in the lounge until they were ready for bed and could chose when this was. It was noted that care staff spoke appropriately to the service users when providing care and spent quality time with them. Throughout the inspection carers were seen to be sitting chatting to service users in their bedrooms or in the lounges. One of the service users stated, “this is a good place to be, all of the staff are so kind”. St Mary`s Nursing Home DS0000017693.V267338.R01.S.doc Version 5.0 Page 6 Service users spoke of the activity person who provided a range of entertainments during the week. One service user said “she is so much fun we always have a laugh”. 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. St Mary`s Nursing Home DS0000017693.V267338.R01.S.doc Version 5.0 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 Nursing Home DS0000017693.V267338.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5,6. Service users and/or their families were given the opportunity to visit St Mary’s so that they could make an informed decision about moving into the home. The manager, or her deputy, assessed the service users before they were admitted to ensure that the staff team had the necessary experience and qualifications to care for them. EVIDENCE: The two service users spoken to were aware that their families had looked at a number of homes in the area and had chosen St Mary’s on their behalf. Neither of these service users were aware of the Service Users Guide, however it was noted that this was displayed in the home for service users and visitors. This document was thorough and included all the information that a service user would need to feel settled in the home, for example the times that meals were served, how to make a complaint and what was and was not provided as part of the contract. St Mary`s Nursing Home DS0000017693.V267338.R01.S.doc Version 5.0 Page 9 The registration certificate was displayed. A new certificate was written as part of the inspection to reflect the change of ownership and responsible individual and will be forwarded to the home. Service users documentation confirmed that all the service users had been assessed prior to moving into the home and that information from this initial assessment had been used to form the basis of the care planning process. Staff confirmed that their training programme met their own needs, and also reflected the needs of the service users. The home did not provide intermediate care. St Mary`s Nursing Home DS0000017693.V267338.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9,10,11 Care plans reflected the care needs of the service users and ensured that staff were aware of the care they needed to provide. EVIDENCE: The care plans sampled had been written in detail and provided a guide to staff on meeting care needs. The documents had been reviewed and updated monthly. The information in the documents had been personalized to demonstrate individual abilities, needs and preferences in most instances. Because there had been work on improving the standard of the care plans and ensuring that the care needs reflected assessed needs, it was now necessary for staff to look at the documentation and find a way to reduce the amount of paperwork and to archive some of the original documents that had been superseded by more appropriate ones. Staff reported that they were aware that there was now some duplication in the documentation, however they were expecting a change to the paperwork when the new BUPA paperwork was introduced to the home. St Mary`s Nursing Home DS0000017693.V267338.R01.S.doc Version 5.0 Page 11 Care needs could now be ‘tracked’ for example it was obvious when a catheter had been changed and how long it was to remain in situ before being changed again. Medication records were looked at for the chosen service users. It was noted that there were some instances when the charts had not been signed even though a medication had been given; there was also some confusion with the codes used if a medication was not given. One medication chart had been hand written and there was no audit trail as to how the drug had come into the home. The manager confirmed that medication was audited monthly and there had been a lot of improvements but still a need for more care. Service users who contributed to this inspection confirmed that all who worked in the home treated them with kindness and respect. No unmet needs were reported. Care files still did not provide sufficient information as to how a service user wished to be treated at the time of sudden illness or death. St Mary`s Nursing Home DS0000017693.V267338.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14 There was a range of activities provided by the activity co-ordinator that service users could participate in. Service users made choices within the limitations of the home’s routines and their own abilities. EVIDENCE: Because the inspection took place in the evening there were limited activities taking place. It was noted that a group of service users were watching the TV and were very interested in the forecast for snow for the next few days. The service users were able to discuss a game of bingo they had joined in with that afternoon and the prizes they had won. Others were watching TV or videos in their own bedrooms and one service user was ‘surfing the net’. The Christmas activity programme had recently been distributed which included a range of activities including religious services, shopping trips and entertainment. A service user reported that she made all the decisions she wanted to, for example what she would wear, what she would eat and when she would go to bed. Service users were being served with supper during the inspection. It was noted that service users were only offered tea and a sandwich or biscuit and did not have the option of a milky drink at the end of the day.
St Mary`s Nursing Home DS0000017693.V267338.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The staff’s awareness of the signs of abuse and how to react to suspected abuse should safeguard service users. EVIDENCE: All of the staff spoken to reported that they had attended training on abuse and adult protection. The nurse in charge was able to state how she would deal with an unexplained injury. Past inspections confirmed that staff were recruited appropriately and did not start work until a Criminal Record Bureau check had been carried out. Recently the manager had requested that a staff member be permitted to start work under supervision with only a clear POVA check completed. This was permitted because of the associated risk from poor staffing levels. St Mary`s Nursing Home DS0000017693.V267338.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21,24,26 A clean and tidy environment provided service users with a homely safe place to live. EVIDENCE: These standards were not looked at in detail at this inspection. However as ‘grubby’ areas in the bathroom had been noted at the last inspection the bathrooms were looked at and found to be clean. There was still a need for some of the bathrooms to be made more homely and less stark, so that they were all in line with those that had been brightened up with framed pictures and fresh paint. More adjustable beds had been purchased but there remained some bedrooms that did not have these beds. The inspector discussed with the manager the need to risk assesses those service users that had divan beds and keep the situation under review until all the beds in the home were the adjustable type necessary for service users who required nursing care.
St Mary`s Nursing Home DS0000017693.V267338.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Staffing arrangements were sufficient to meet service users’ assessed needs. EVIDENCE: Records indicated that sufficient care staff had been on duty throughout the day and night to meet service users’ assessed needs. It was also noted that sufficient ancillary personnel, administrative, maintenance, catering, cleaning, and laundry were employed. On duty during the late shift was a nurse and four carers plus a supernumerary carer who was on induction. This team were caring for 24 service users. At the time of the inspection the home had a number of service user vacancies and staffing levels had been reduced to reflect this. A new carer who had started the day before reported that she had spent her first day off the floor looking at the policies, procedures and the ethos of the home and was today shadowing a member of staff. She had worked in care homes before and was looking forward to the opportunity of undertaking NVQ training. This new carer had been given an induction programme to complete for which she was being supported by a senior carer. St Mary`s Nursing Home DS0000017693.V267338.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,38 Staff allowing visitors into the home without asking for proof of identity could be putting service users safety at risk. EVIDENCE: These standards were not assessed in detail as part of this inspection. The manager, who had not been registered by the CSCI, had decided to leave and was working out her notice. The job and been advertised and first round interviews held. The home had informed the CSCI of the plan for a regional manager to support the deputy manager during the period that the post remains unfilled. The inspector had arrived at the home ‘out of hours’ and spent almost ten minutes outside ringing the night and day bell in order to admitted. Eventually a member of staff due to start work at 6pm had arrived and let herself and the
St Mary`s Nursing Home DS0000017693.V267338.R01.S.doc Version 5.0 Page 17 inspector in. The member of staff was from the ancillary team and had not asked for any proof of identity and had gone off to do her work leaving the inspector to find the nurse in charge. St Mary`s Nursing Home DS0000017693.V267338.R01.S.doc Version 5.0 Page 18 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 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X 3 X X 2 X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 St Mary`s Nursing Home DS0000017693.V267338.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 17 Requirement Medication charts must be completed accurately, including the reverse of MAR sheets if this is necessary. This requirement has been extended. Care plans must include details of the service users wishes for the time of sudden illness or death. Adjustable beds must be provided for all service users. Visitors must be asked for proof of identity and asked to sign into the home. Timescale for action 01/01/06 2 OP11 12 01/01/06 3. 4 OP24 OP38OP18 16 13 01/01/06 01/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP14 Good Practice Recommendations Staff should consider ways to reduce the amount of documentation in the care plans. Service users should be offered a choice of drinks at suppertime.
DS0000017693.V267338.R01.S.doc Version 5.0 Page 20 St Mary`s Nursing Home 3 OP24 All the bathrooms should be made ‘homely’ St Mary`s Nursing Home DS0000017693.V267338.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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