Inspection on 13/02/06 for St Nectans Residential Care Home

This inspection was carried out on 13th February 2006.

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

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

Other inspections for this house

St Nectans Residential Care Home 30/07/08

St Nectans Residential Care Home 14/08/07

St Nectans Residential Care Home 24/05/06

St Nectans Residential Care Home 09/08/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE St Nectans 3 Cantelupe Road Bexhill-on-sea East Sussex TN40 1JG Lead Inspector Kevin Whatley Announced Inspection 13th February 2006 10:00 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 Nectans DS0000063996.V267664.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 Nectans DS0000063996.V267664.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Nectans Address 3 Cantelupe Road Bexhill-on-sea East Sussex TN40 1JG 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) 01634 727422 St Nectans Residential Care Home Ltd Vacant Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places St Nectans DS0000063996.V267664.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That the number of registered places may not exceed thirty three (33). That the category of registration be old age, not falling within any other category. Service users must be older people aged sixty-five (65) years or over on admission. 9th August 2005 Date of last inspection Brief Description of the Service: St Nectans is situated on a residential street a short level walk from Bexhill town centre and railway station. The building has been adapted from four adjacent properties which are now interlinked. Accommodation is provided on four floors which are served by a shaft lift. The home is registered to accommodate up to 33 older people. St Nectans DS0000063996.V267664.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at St Nectans will be referred to as ‘residents’. The announced inspection took place on a weekday in February and lasted for approximately six hours. The inspection included a tour of the premises and it’s facilities, with many residents also consenting for their bedrooms to be viewed. Approximately five residents were spoken with individually, whilst several others commented on their care during lunchtime after the Inspector had been invited to join them for the meal. The proprietor/acting manager, the head of care, the homes general manager, the cook and several care staff were spoken with during the visit; whilst care staff were observed carrying out their duties. Six completed pre-inspection questionnaires from residents and their relatives were also viewed. A number of records and documentation required by registration were also inspected. At the time of the inspection the home was accommodating thirty residents. What the service does well: What has improved since the last inspection? St Nectans DS0000063996.V267664.R01.S.doc Version 5.0 Page 6 Since the last inspection the home have completed introducing a new system of care planning and review and a new format of menu planning now allows residents greater opportunity to choose what they wish to eat on a daily basis. The management team have also introduced an environmental risk assessment format and have carried out an Infection Control audit. Senior care staffing structures and responsibilities are now clearer and senior care staff commented that their roles have been developed further to offer them a more positive, focused and professional way of caring. The proprietor/acting manager has been working registered manager hours and has gained greater understanding of the ‘hands on’ expectations of being a registered manager, whilst he is due to complete the Registered Managers Award (RMA). 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 Nectans DS0000063996.V267664.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 Nectans DS0000063996.V267664.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 and 4. St Nectans provides prospective residents with appropriate information regarding the home and the services it offers. Residents are admitted only after having their care needs fully assessed. EVIDENCE: Since the last inspection the statement of purpose has been amended and up graded and subsequently this now allows prospective residents a more fuller picture of the services the home offers and the manner that these will be offered. The statement of purpose is written in a simplistic and understandable fashion and includes relevant contact details of advocacy support services and the Commission for Social Care Inspection (CSCI), whilst comments of how residents and relatives feel about the level of care at the home are included. Care plans confirmed that no resident is admitted to the home without first being assessed by the proprietor, who is currently acting manager, and his head of care or general manager. The proprietor acknowledged that he is striving to develop his competence in the pre-assessment of residents and to this end carries them out jointly with his senior staff. St Nectans DS0000063996.V267664.R01.S.doc Version 5.0 Page 9 A number of residents confirmed that they had been visited at their home or in hospital prior to being admitted. Records also confirmed that residents are encouraged to visit them the home if they are able prior to moving in, along with their relatives/carers or next of kin. St Nectans DS0000063996.V267664.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, 10 and 11. The home have adopted a comprehensive system of care planning, however to ensure all care needs are being met the recording of residents changing needs must be maintained more accurately and consistently. Residents are treated with respect, whilst the home addresses their final wishes with sensitivity. EVIDENCE: Since the last inspection all care plans have now been transferred into a new format. The care plans contained evidence of residents social, physical and health care needs being adequately assessed with details of how such needs should be met by care staff. Care plans also contained completed risk assessments for relevant areas of concern such as falls and medical issues. However several care plans were found not to be inaccurate, such as a monthly weight chart not being completed for several months and outcomes from a care plan review, concerning a health care matter, not being implemented into the existing care plan following the review. The home do not keep individual daily logs for each resident and instead have a daily correspondence book that only comments on individual residents if there are issues to raise. This subsequently made the tracking of events, issues or concerns regarding residents difficult. St Nectans DS0000063996.V267664.R01.S.doc Version 5.0 Page 11 Throughout the inspection it was clear that care staff treat residents with considerable care and respect, including knocking on residents doors. Residents commented very positively on the manner that they are treated by staff and stated that staff were ‘lovely’ and ‘patient’. Pre-admission records confirmed that residents have the opportunity to comment on their final requests in the ‘preference on death’ section. Staff have also received bereavement training and the approach taken by the home toward the death of residents was found to be sensitive and informed. St Nectans DS0000063996.V267664.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, 13 and 15. The home have implemented a suitable and positive activities programme and support and encourage residents to lead an active lifestyle. The dietary needs of residents are adequately met. EVIDENCE: Since the last inspection and following feedback received from residents as part of the homes own quality assurance process the home have employed a member of care staff to be a dedicated activities co-ordinator. The co-ordinator now runs events within the home three times a week, these include interactive events such as bingo and quizzes, exercises and painting. Residents commented that you can attend any of these events if you wish to, whilst forthcoming events are advertised around the home. The co-ordinators role is to also arrange events and trips away from the home, such as outings to local sites of interest and trips to shows and pantomimes. The home also facilitate monthly communion visits from the local priest and fortnight services by the local vicar. The home have a relaxed visitors policy and the visitors book confirmed that many residents receive regular visits from relatives and friends. The home has a dedicated cook to plan and prepare the monthly menu. The menu was seen to offer residents a diet that included choice, variety and St Nectans DS0000063996.V267664.R01.S.doc Version 5.0 Page 13 balance. The cook stated that she does not have a restricted budget to purchasing meat and groceries and confirmed that the home uses fresh local produce. The cook has a suitable system for recording the individual likes and dislikes of each resident and their special dietary requirements. Residents have copies of the menu in their rooms and can choose alternative meals on the morning of each day. The Inspector was invited to join residents for the lunchtime meal, this was found to be well prepared, home cooked, well presented, tasty and nutritious. Residents noted that food at the home was ‘very good indeed’. The proprietor stated that he is committed to maintaining a ‘very high’ standard of meal provision and has recently had several ‘supper cooks’ employed on a trial basis with a view to permanently employing one that has the necessary skills and experience. St Nectans DS0000063996.V267664.R01.S.doc Version 5.0 Page 14 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): 16 and 18. The home has a suitable complaints procedure in place and residents and others are encouraged to comment on the level of services offered by the home. Residents are protected from the risk of harm, neglect or abuse. EVIDENCE: The complaints procedure offers residents and others a clear guide on how their concerns and complaints will be addressed, though the details of the Commission for Social Care Inspection (CSCI) needs to be altered. A copy of the complaints procedure is kept in the entrance to the home and a book is available for complaints to be made by any visitor to the home and can be made anonymously. Several complaints had been made to the home since the last inspection, these all concerned the standard of meal provision and are currently being addressed (see also standard 15). The CSCI have not received any complaints since the last inspection. The adult protection policies and procedures outline the definitions of harm and abuse and the manner that any suspicion of harm, neglect or abuse must be addressed by the home including ‘whistle blowing’. These details are also included in staff contracts of employment. Staff spoken to displayed a clear and knowledgeable understanding of key adult protection issues. St Nectans DS0000063996.V267664.R01.S.doc Version 5.0 Page 15 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): 19, 20, 25 and 26. The home is well maintained both inside and out and improvements have been made to outstanding health and safety concerns within the building, whilst new environmental risk assessment processes have been introduced. The home must ensure that fire safety is addressed as a matter of importance. The home is clean, tidy and hygienic. EVIDENCE: A tour of the premises confirmed that the home is well maintained both inside and out with the building in a seemingly good structural order, whilst the décor appeared in a reasonably good condition being furnished in a domestic and homely fashion throughout. Residents rooms were found in a good condition and were seen to have been individualised with personal items such as pictures, photos and ornaments in evidence. The previous inspection report made several requirements regarding health and safety concerns in the building, these have now all been addressed and work to fit window restrictors and thermostatic valves to hot water outlets and a radiator cover in a residents room have been completed. The home have also St Nectans DS0000063996.V267664.R01.S.doc Version 5.0 Page 16 introduced an environmental risk assessment and have recently undertaken a comprehensive check. The assessment identified a number of areas where the home could improve the environment and the proprietor acknowledged that a new development plan is being compiled to implement the findings of the assessment. The home have also recently carried an infection control audit, though no concerning issues were found. Records kept in relation to health and safety confirmed that in general the home strive to keep residents and staff alike safe within the home, such as regular servicing of fire fighting equipment being carried out under a service contract and weekly fire alarm checks. However there was no evidence of the last time that the home carried out a fire drill or evacuation, whilst the recording of the emergency lighting checks was not up to date. St Nectans DS0000063996.V267664.R01.S.doc Version 5.0 Page 17 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, 28 and 29. The home deploys suitable numbers of adequately experienced and qualified care staff to meet the assessed needs of residents both night and day. The homes recruitment procedures ensure that residents are protected from the risk of harm, neglect or abuse. EVIDENCE: The rota confirmed that during the day there is always a senior member of care staff who leads each shift, being supported by a minimum of two care staff. The home also employs a full time cook and domestic cleaner. During night time hours the home is staffed by one ‘waking night carer’ who is supported by one ‘sleep in’ carer, whilst on-call support is provided via a rota basis by either the head of care or another senior member of care staff. The home have good and clear staffing structures in place where lines of responsibility are obvious and appropriate. The head of care noted that since the takeover of the home, the new proprietor/acting manager and his general manager has encouraged and supported her and her senior staff team to take on more responsibilities in line with their particular job descriptions and stated that this was a ‘very positive’ move that has generally improved the standards of care and practice within the home. Many staff at the home have worked within the care industry for many years and indeed have developed their care practices and experiences at St Nectans over a number of years. The current proprietor/acting manager has placed considerable importance on training and a robust system of staff training is in St Nectans DS0000063996.V267664.R01.S.doc Version 5.0 Page 18 place to allow all care staff opportunities to gain awards and qualifications in care related areas such as supporting them in the National Vocational Qualifications (NVQ) level 2 in care and beyond. The home have developed the in-house training programme and there was good evidence of care staff being required to attend relevant and necessary care related courses and lectures. A number of staff files were viewed, these were found to be suitably maintained and included necessary personal details, references and Criminal Records Bureau (CRB) confirmations. These files are now maintained on site and are stored appropriately in a lockable draw. St Nectans DS0000063996.V267664.R01.S.doc Version 5.0 Page 19 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, 32, 33, 36 and 38. The home must strive to address the outstanding requirement to have a registered manager put in post. The manner that the home is currently run encourages a relaxed, caring and open environment where resident’s needs are paramount. Care staff are supported to carryout their tasks. EVIDENCE: The proprietor/acting manager stated that it is his intention to apply to be the registered manager of the home in the next month or so. Since the last inspection he has been working predominantly at the home on a full time basis, as would be expected from a manager, and has been working closely with the homes head of care and general manager to gain the necessary ‘hands on’ experience of managing a care service such as St Nectans. He is currently undertaken the required Registered Managers Award (RMA) in Care and Management and is due to finalise his studies in April this year. The proprietor/acting manager stated that he has been undertaking joint preadmission care assessments with his head of care and noted that he is St Nectans DS0000063996.V267664.R01.S.doc Version 5.0 Page 20 developing his care related knowledge and practice. Care plans contained evidence that this was the case, whilst the new menu planning format was implemented by the proprietor/acting manager. The proprietor/acting manager displayed a reasonable understanding of care related issues within the home and clearly places the needs of residents first and foremost. The atmosphere within the home and amongst care staff was positive, relaxed and caring and all staff spoken to stated they felt ‘supported’ by the senior care staff, whilst residents commented that standards of care have remained good and in some cases had improved since the takeover. The home have a robust quality assurance system for reviewing the levels of care being offered. Questionnaires are given to residents and their carers/relatives to complete every six months and it was pleasing to note that improvements to the activities programme were brought about as a direct result of comments received by residents as part of this process. The senior management team have recently introduced an environmental risk assessment format that has enabled the home to identify any areas that are in need of improving or making safer in respect of health and safety. An audit has also been undertaken to review the homes infection control policies and procedures with the outcomes being subsequently recorded and acted upon. Records regarding fire safety confirmed that staff have received appropriate fire safety training whilst regular fire alarm and lighting checks are carried out, however no evidence could be found of the when a fire drill or evacuation was last carried out. St Nectans DS0000063996.V267664.R01.S.doc Version 5.0 Page 21 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 2 8 X 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 3 3 X X 3 X 2 St Nectans DS0000063996.V267664.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement That care plans must be maintained up to date and accurately, notably in respect of changing care needs being incorporated within the main care plan as and when necessary. That fire drills must take place on a regular basis, whilst outcomes must be recorded. That an application to register a new manager of St Nectans is submitted to the Commission for Social Care Inspection (outstanding from the previous inspection). Timescale for action 13/08/06 2. 3. OP19 OP38 OP31 23(4) 18(1)(a) 13/08/06 13/03/06 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 Refer to Standard OP16 Good Practice Recommendations That the correct details of the CSCI be added to the complaints procedure. DS0000063996.V267664.R01.S.doc Version 5.0 Page 23 St Nectans 2 3 OP18 OP19 That all staff should receive training regarding the processes associated with allegations of abuse, neglect or harm. That the home should keep records of regular hot water temperature checks. St Nectans DS0000063996.V267664.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 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. 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