Inspection on 13/09/06 for St Nicholas

This inspection was carried out on 13th September 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 Nicholas 15/11/07

St Nicholas 09/02/06

St Nicholas 11/10/05

St Nicholas 22/03/05

St Nicholas 05/10/04

St Nicholas 30/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Clover House

Langrigg House

Parkside

Dystlegh Grange

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE St Nicholas 21 St Nicholas Drive Netherton Liverpool Merseyside L30 2RG Lead Inspector Lorraine Farrar Unannounced Inspection 13th September 2006 10:00 X10029.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 Nicholas DS0000017273.V303826.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 and Care Homes for Adults 18 – 65*. 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 Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Nicholas Address 21 St Nicholas Drive Netherton Liverpool Merseyside L30 2RG 0151 931 2700 0151 932 1216 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) www.bupa.com BUPA Care Homes (CFHCare) Limited Irene Marsden Care Home 176 Category(ies) of Dementia (30), Learning disability (26), Old age, registration, with number not falling within any other category (120) of places St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 120 OP, 26 LD, 30 DE. 2 named out of category service users under pensionable age. This condition applies only to those named service users, should they leave the home, then the condition will be amended/removed. That the Home provides care with nursing to no more than 146 service users. 12th July 2006 3. Date of last inspection Brief Description of the Service: St Nicholas is owned and operated by BUPA a large national organisation who provide a variety of care and health services across the country. The home is in a residential area of Netherton and is well located for accessing local shops and transport links. There are six care units across the site and a main administration block which houses the manager and deputy, administrators, a main kitchen, laundry, hairdressing salon and staff room. Outside there are large grounds, both Brocklebank and Gladstone units have enclosed gardens, the other units have identified courtyard areas. Each unit has single bedrooms, sufficient bathrooms, a large living / dining room, small kitchen, medication room, sluice and office. The units are dotted around the site and accessed by covered walkways. Alexandra, Canada, Langton and Huskinson units all provide care with nursing for older people. Brocklebank provides care with nursing for adults who have a learning disability and Gladstone unit provides care without nursing for people with dementia. There are staff available 24 hours a day, meals and basic laundry are included in fees, activities co-ordinators work part time on the units and the Manager has introduced the role of hostess on some of the units. This member of staff is based in the lounge and supports residents with their meals, drinks and general support needs. St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Due to the size of the home this site visit was carried out over two days. Two Inspectors visited on the first day and three Inspectors on the second day. Information for this inspection was gathered in a number of different ways. This included an unannounced site visit where time was spent reading records, talking with Residents and staff, observing life in the home and looking at the building. ‘Case tracking’ was used as part of the visit. This involves looking at the support a person gets from the home including their care plans, medication, money and bedroom, time is also spent meeting with the Residents and with Staff about how they meet the persons needs. Case tracking was used to look at life in the home for ten of the people living there. Discussion also took place with 13 Residents, 8 Visitors and Relatives and 16 members of staff. In addition comment cards were sent out before the visit, 8 Relatives and 7 Residents returned these and their views are incorporated within this report. A further 6 care plans or records relating to Residents were viewed as part of the visit. The Manager was given the opportunity to provide information about the service prior to the inspection. Since the last full inspection of the service in February 2006 the CSCI has received information about the home, this includes, complaints, a random inspection carried out in July 2006 and information forwarded by the Manager. All of this information has been taken into account in producing this report. A copy of the letter relating to the random inspection carried out in Brocklbank in July 2006 can be obtained from the home Manager. Fees for living in the home are; Gladstone Unit (none nursing support for people with dementia) £389.50 – £452 Brocklbank (support with nursing for people with a learning disability) £446 Alexandra, Canada, Huskinson, Langton (Support for older people with nursing needs) £397.50 - £604 What the service does well: St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 6 Residents spoken with were generally happy with the service provided, one new Resident stated, “Its brilliant, staff are fantastic, I love it” whilst a Resident who had lived in the home for some time said “If anyone doesn’t like it here they are hard to please “ Before anyone moves into the home an assessment of their needs is carried out and they and their Relatives are given information about the home and invited to visit. Relatives confirmed that they were involved in this process and that staff told them everything that they needed to know before the Resident moved in, explaining, “ We’re delighted”. Visitors are able to call throughout the day and are always made welcome. The exception to this is mealtimes were the home operates a ‘protected mealtimes’ policy. This gives Residents the chance to have peace and quite, relax and enjoy their meal. Professionals are asked not to visit at these times and families are asked to avoid if possible. However the Manager states family are able to visit and sit quietly with their Relative. Mealtimes are generally relaxed occasions with a choice of meals served, many of which are homemade. A Resident explained, “ I get three good meals a day, the food is wonderful”. Separate staff are employed to do activities with Residents throughout the week. Although not all Residents spoken with enjoyed the activities on offer one Resident explained, “ I join in if I want to, there’s always something going on and some one to talk to”. The home is well managed and there are enough staff working there to meet Residents needs. Checks are carried out on new staff to make sure they are suitable to work with Residents and all staff receive training in areas relating to their job. Staff treat Residents with respect and listen to their views. One Resident described the staff as “lovely” and another explained, “I get a choice.” What has improved since the last inspection? A Relative explained her Mum’s care plan was “on-going” and the family were regularly consulted about this. Evidence was available that staff have begun the process of involving the Resident and their family in agreeing their care plan. Mealtimes continue to improve on most units with Residents gaining weight and having the opportunity to enjoy a relaxed mealtime. On Canada unit, people who don’t eat in the lounge now have their meals served to them from beginning to end, rather than waiting for everyone to be supported with their main course before having their second course. St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 7 Staff morale in the home continues to improve and a member of staff advised that the team have confidence in their manager and receive recognition for good work. 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 Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA - 3, 4, 5 & 6 YA - 1 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Enough information is provided to people wanting to move into the home, so that they can decide if it is the right place for them to live. Staff usually, but not always, have the information they need to support new Residents. EVIDENCE: The home has an information pack for new Residents, which tells them, about the service provided, accommodation, staff working in the home and how to complain. Copies of this pack were seen in all Residents bedrooms. Good practice was seen in that a separate pack has been provided for the people living on Brocklebank. This is written in plain English and has pictures, which explain the information. St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 10 Residents said in their comment cards that they had received enough information about the home before they moved in. Discussions were held with a Resident and her family who had recently moved to Gladstone House. Relatives confirmed that staff had visited the Resident before they moved in and that they were provided with enough information to make the right choice. There is clear paperwork in place for staff to carry out assessments for potential Residents. These cover all areas of the persons support needs and choices and provide staff with enough information to make sure the home can meet the persons needs and choices and to plan their care. Pre – admission or recent assessments were in place for most of the Residents case tracked. During the visit to Langton a new Resident had been admitted that morning for respite care. She appeared distressed and unaware of where she was. Although a copy of her assessment was later found in the main office, no assessment was available on the unit, leaving staff with very limited information about how to reassure and support her. Files viewed showed that all Residents have their needs re- assessed on admission. However it would be useful if the pre admission assessment information was still available for people who had lived there some time, so that staff could track their changing needs St Nicholas does not provide an intermediate care service. St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): OP 7,8,9,10 YA 6,9,18,19,20 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home meets Residents identified health and personal care needs however further development of care plans is needed to ensure any potential health needs are quickly identified and acted upon. EVIDENCE: Care plans and healthcare The majority of Residents said in their comment cards and in discussion, that they always receive the care and support they need from staff, with one St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 12 stating, “staff are very helpful” and another explaining, “Yes I’m well looked after, I’m glad I came”. Most Relatives stated that they were consulted about the Residents care where needed, kept informed of important matters and were satisfied with the overall care provided. A Relative explained “we are fully informed, we wouldn’t have her anywhere else”. However on Canada unit a Relative explained that although most Residents are supported to use the bathroom before lunch those who are in bed are not. Staff were observed arriving to serve the Residents lunch, then spending time getting equipment and supporting him with personal care, this delayed his meal for some time. On Gladstone Unit some plans provided a lot of information about the person and good practice was seen in that Relatives had written information about the persons history. Other plans were brief and did not provide specific guidelines. For example one stated ‘observe for signs of deterioration in mental health’, however no information was recorded about the signs to look for. Good practice was seen in that a monthly review is recorded by the person’s Keyworker and a Social Worker had commented in a Residents review “ the work on this unit is incredible in the concentration on individual care and meeting Residents needs”. Care plans on Alexandra and Canada were up to date and had been reviewed, however the language used in some plans was very medical and may not be understood by everyone reading them, for example one plan stated the person had ‘expressive ayshasia’. Staff had completed health risk assessments such as risk of falls, malnutrition and development of pressure sores. Three care plans on Brocklebank were looked at. These did not fully cover all of the persons support needs, information about care that was no longer relevant was still in the plans and no information was recorded about some of the persons current needs and how staff should meet them. For example it was recorded one Resident had MRSA, no care plan was available for this and staff spoken with were not sure if the MRSA was still present. Another Resident needs to be supported to eat in a particular way. Their plan had information from other professionals about this but did not have detailed guidelines for staff to follow. Daily records about how the care needs of one Resident were met were not available for two months. Therefore it was not possible to determine how staff had met the persons needs during that time. The majority of Residents said in their comment cards that they always or usually receive the medical care they need, and records showed that staff work with other professionals to support Residents with their health care. A Resident confirmed that staff always ask for a doctors visit if she is unwell. St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 13 Clear records were in place on most units for monitoring Residents’ healthcare needs, where required. This included blood monitoring and pressure area care. They also showed that Residents are supported to access specialist healthcare from other professionals. On Gladstone unit records of possible health complications were not always followed up. One Residents notes recorded that a superficial sore was present, however no further notes were made to say whether this had healed or needed medical help. A plan on Huskinson was found to contain a statement from a Residents Relative that no further intervention in care should take place. This must be fully explored and staff must be informed of the outcome to prevent confusion. A recent investigation about pressure sores for a Resident who lived on Brocklebank found that some areas of the care provided should have been of a higher standard. The home Manager has since provided an action plan to improve pressure area care on the unit, along with evidence that this is being put into place. During the site visit to Langton unit one Resident appeared distressed and was crying out. A letter on file from the consultant stated the Resident had “quite an advanced stage of dementia” and could be disturbing to other Residents. As the unit is not registered to care for people with dementia this was discussed with the Unit Manager and Home Manager. The Manager agreed to re-assess Residents to establish their mental health needs and refer them for a new social worker assessment where it was identified the home cannot meet these needs or are not registered to do so. Since the inspection the Manager has contacted the CSCI with evidence that these assessments are being carried out. Medication Each unit has a separate medication room with air conditioning available to maintain the temperature. Medication on Gladstone, Alexandra and Canada units was very well managed with all records completed and medications correctly stored. Medication on Huskinson unit was managed adequately however medicines were found to be stored in the fridge, which should have been stored at room temperature and only one member of staff had signed for the disposal of some medications. Medications on Langton House were stored correctly however some signatures were missing from the medication administration records for two Residents so it could not be determined whether the Residents were always receiving their medication as prescribed. On Brocklebank medication is not always given to the Resident by a member of staff who has had training to deal with this. When Residents go out their medication goes with them and is given by a Carer. During the site visit the St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 14 Inspector observed a Nurse giving out medication on the unit, this was passed to a Carer to give to the Resident. Registered Nurses are signing to say that they have given the person medication, although they have not personally given this or seen it being given. This practice means that Residents are at risk of not getting the correct medications. Privacy and Dignity Throughout the visit many staff were seen to talk appropriately to Residents. Taking time to chat with them and seek their views. Staff were able to explain how they support Residents to maintain their dignity and were seen to knock on bathroom and toilet doors before entering. On Alexandra unit staff were seen walking down the corridor wearing disposable blue gloves, prior to providing personal care for a Resident. This is an infection control risk and does not show respect for the Residents right to privacy and dignity. Staff on Brocklebank were seen to quietly speak to Residents about their personal care needs and meet these discreetly. They also spent time quietly chatting with Residents whilst supporting them with their meals. St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12, 13, 14, 15 YA – 12, 13,15,17 The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home supports Residents to make their own decisions about their daily lives and provides opportunities for them to spend their time engaged in activities of their choice. EVIDENCE: Activites in the home The home employs activities co-ordinators who work part time on each unit, with the exception of Brocklebank, which has full time co-coordinators. St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 16 Residents’ views on activities within the home were mixed. In their comment cards 5 Residents said there are usually or always activities arranged by the home that they can take part in, with the other two saying there are only sometimes or never suitable activities. Two Residents said, “there’s nothing to do, I’m bored”, with one explaining they would like to go out more. During the visit one Relative commented that there are good activities taking place and her Mum is always encouraged to join in and good practice was seen, in that, as well as group activities staff also supported one Resident to go to the local shop. A number of weekly group activities are arranged, these include, bingo and quizzes some of which were seen taking place during the visit, with some less regular activities such as outings and an entertainer also being arranged. In some instances staff had included information on how Residents like to spend their time and what interests they enjoy within their care plan. However this was not available in all plans viewed. On Brocklebank three Residents were leaving the home for the day for a trip to Southport, which they were looking forward to. Holidays for some of the Residents have been arranged and there are plans for holidays to be a regular occurrence. Residents visitors A number of visitors were in and out of the home throughout the day and a Relative explained, “we can visit whenever we want to, they are very flexible”. This was confirmed in all Relative comment cards received. Visitors are able to sit in communal areas or the Resident’s bedroom, as the Resident and themselves choose and on Gladstone House were seen to support the Residents with taking part in activities. The home does ask visitors not to visit during mealtimes if possible, in order to promote a suitable environment for Residents. However the Manager explained that if they visit at that time they will be provided with a table to sit with their Relative, so as not to disturb others. One Relative explained that her Dad had been invited to Christmas dinner in the home and that this had ‘made the transition’ of her Mum moving to the home, easier. Residents are able to choose to sit in communal areas or their rooms and to have some of their personal possessions in their room. Good information is provided in welcome packs and via notice boards about local advocacy and support groups. The organisation acts as appointee for some Residents benefit monies but encourages all new Relatives or their Relatives to take on this role. St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 17 Meals in the home The home has a central kitchen, which provides all main meals for Residents and supplies the smaller kitchens on each unit with food for snacks, drinks and lighter meals. A lot of the meals are homemade including soup, cakes and pies. Residents are asked to choose from the menu on a daily basis the meals that they want the following day and staff were able to explain how they provide alternatives to individual people. Some special diets are catered for including vegetarian diets and semi-solid meals. Menus showed that Residents are offered a nutritional diet and that they are encouraged to choose what they would like to eat. The exception to this is meals provided for people having a semi- solid diet for whom, there is currently no choice of meal. The home provides a cooked breakfast each morning with the main meal being served in the evening. Following a pilot scheme with the local Primary Care Trust (PCT) the home have introduced “protected meal times” on all units with varying degrees of success. This is based in the idea of protecting Residents’ rights to peace and quiet and an uninterrupted mealtime and includes closing doors, asking professionals not to visit at those times and switching the TV off. The home has won a national BUPA award and been visited by a representative of the Department of Health regarding the success of this project. Mealtimes on most units were seen to be quiet affairs with staff taking time to sit with Residents and quietly encourage them to eat. Records show that since the introduction of the project Residents, who needed to, have gained weight. Other good practice was observed around mealtimes. This included, the use of pictures to help people chose their meals on Gladstone, staff on Langton being aware of the type of cup people like, explaining one man liked a particular, large mug whilst a lady liked a china cup. On Canada unit, trays are now used to take meals to people in their bedrooms, improving on previous practices of people waiting for each course for some time. A Resident said, “I can honestly say the food is good, well cooked” and 6 Residents comment cards stated they always or usually like the meals. On Alexandra unit the ‘protected mealtimes’ was not fully in use and a number of distractions were observed at this time. These included, TV on, a drug round taking place before the end of the meal and the corridor doors open leading to Residents and staff wandering in and out. St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP – 16 & 18 YA 22 & 23 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home has clear policies for dealing with complaints and adult protection issues and Residents are made aware of how to use these. The Manager deals well with any issues raised, however staff do not always refer issues to her promptly. EVIDENCE: During the inspection one Resident raised concerns about a member of staff. These were passed to the home Manager who acted quickly in referring the concerns to Social Services for investigation. An issue was identified on another unit were one Resident was acting in a manner which could be distressing for other Residents. Staff were aware of this but had not taken appropriate action regarding their concerns. Both matters were referred to the Manager who took immediate action to appropriately address them. The Manager and the organisation have carried out detailed investigations into any complaints made about the service, referred them for outside investigation if needed and respond quickly and positively were issues are identified. St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 19 Copies of how to raise a concern are available in the service users guide. This is clear and details how the home would address concerns and how quickly they intend to investigate. Training in the protection of vulnerable is undertaken as part of all staff inductions, therefore all new staff have awareness of how to look for and address any issues as they arise. Staff spoken with understood the ways to raise concerns and were aware of outside agencies involvement such as Social Services and the police. However staff on one unit had not taken appropriate action in identifying and dealing with concerns regarding one residents’ actions. A full policy and procedure as to how the home would deal with these adult protection issues was available. St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP – 19 & 26 YA 30 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home is clean and tidy with sufficient space for Residents, Visitors and Staff. Planned refurbishments will benefit the overall appearance of the units. St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 21 EVIDENCE: St Nicholas is based within a Residential area of Netherton within easy reach of local shops and transport. The home consists of 6 separate units, each with a small kitchen, bathrooms, single bedrooms, office and communal lounge / dining room. In addition the main block has, offices, laundry, hairdressers, staff rooms, maintenance and a kitchen. Each unit has a small courtyard and there are large grounds surrounding the buildings. During the site visit Canada unit was being refurbished, it was noted that this was being carried out in a way that minimised disruption for Residents. The main kitchen and laundry were viewed. Both had cleaning schedules available and the Kitchen has a copy of the best practice guidelines from Environment health, which they were using on a daily basis. Overall the home was clean and tidy and smelt pleasant with bedrooms personalised by Residents. Some units had made the units feel like home by displaying pictures. Other units had displayed information that was more appropriate for staff than Residents giving the impression that the unit belonged to staff and not to Residents. For example, one unit had displayed poems about getting older which although very moving should be considered, as they would not usually be displayed in a domestic home. Some areas would benefit from redecoration, however the Manager was able to explain that this is now being carried out on a rolling programme. Staff are supplied with equipment to control infection, including gloves, aprons and liquid soap. All areas such as bathrooms toilets and sluices were found to contain these items. St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Op – 27,28,29 & 30 YA – 32,34 & 35 The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Sufficient, skilled and experienced staff are working in the home to meet residents needs and choices. EVIDENCE: Staff working in the home Throughout the inspection staff were generally seen to interact with Residents taking time to sit with them, talk and respond positively to requests. On Gladstone unit Inspectors observed a situation were several Residents were gathered outside the office and could have easily become agitated with themselves and each other. Staff, demonstrated their skills and knowledge by remaining calm, talking respectfully to each Resident and distracted them. This resulted in the atmosphere remaining calm and cheerful and Residents appearing happy in themselves. However on Canada unit staff were seen to talk to a Relative rather than the Resident about the personal care they were about to provide. St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 23 7 Residents said in their comment cards, that there are always or usually enough staff to give them help when needed. During the visit staff, although busy, were seen to respond quickly to requests. Staff rota’s showed that each unit employs a regular team of staff, who are familiar with Residents. Numbers of staff changed according to the number of people living on the unit. It was noted that through their own choice some staff are working 4 twelve-hour shifts on the run then having 3 days off. This should be considered as staff could become short tempered if they are tired. Staff spoken with said that they feel morale in the home has improved, and this was noted by the Inspectors in discussions with the staff team. They also said that they receive suitable training, with one member of staff explaining if they ask for training the Manager always tries to arrange this. Staff training and recruitment BUPA run a scheme called “personal best”, which is a set of learning sessions to promote best practice for each staff member. A member of staff spoken with had achieved her personal best award and found the scheme encouraging and a good way of acknowledging staff’s good practice. 50 of the staff team have achieved a care qualification designed to help staff be aware of and promote the care needs of Residents. A further 19 staff are currently working towards this qualification and another 8 are waiting to start. Staff files contained a variety of training certificates these included, dementia training, health and safety and moving and handling. Palliative care training has been commenced for the nursing staff. Although the training records of staff were difficult to review the Manager is aware of how to check for staff training to keep them up to date. Other individuals within the organisation also regularly check that training for staff is up to date. All staff spoken with said that they felt supported to undertake training as and when they needed. As part of a large organisation the home has training input from many areas and can access training internally and externally. Staffing files were viewed, these all contained evidence that staff undergo appropriate checks such as a police check, and suitable references are obtained before they start work. All new members of staff undergo induction training and records are available in the home that reflect this and state exactly what training the staff member received at this time. The variety and amount of training for staff helps them to keep up to date and meet the needs of Residents. St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP – 31,32, 33,35 & 38 YA 37,39 & 42 The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home benefits from a clear management structure and is run in the best interests of Residents. St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 25 EVIDENCE: The Manager and management of the home There are clear lines of accountability within the home and the organisation. Mrs Irene Marsden is the registered Manager of the home, she is supported by a deputy Manager, both work flexible hours but are not directly part of the care teams on the units. In addition each unit has an identified Manager and deputy Manager. The registered Manager has extensive experience in managing a large care home, she is a registered nurse and has obtained management qualifications, in addition to which she has further qualifications in dementia care and aspects of nursing. Mrs Marsden is motivated and enthusiastic in her goal to continually improve the service offered. She works well with the CSCI and other outside agencies, works hard to meet inspection requirements and regularly encourages staff to take part in projects and pilot schemes to improve the service. Quality assurance in the home BUPA has a quality assurance system, which regularly looks at the care and the management of the home from the Residents, their Relatives and the staff point of view. Questionnaires are sent out on some occasions for particular areas of interest such as meals and these results are published for all to read. A regular newsletter is produced by the organisation that discusses the areas they organisation would like to improve quality in and keeps people informed of good practice areas. Each unit keeps it’s own quality assurance records and these are looked at regularly by individuals from outside the home. The Manager said that the organisation had started to undertake a “case tracking” system, in which they follow the care needs of randomly identified individuals in order to find out what the experience of living in the home is like to the Resident. A central computerised system exists for all Residents’ funds. Records are clear and receipts are kept for all Residents spending. Arrangements on Brocklebank are different to the rest of the home. On Brocklebank money is sent to the unit weekly for use on trips out etc. Other units have small amounts of money made readily available for them for arranged trips and ad hoc trips out. Health and safety in the home Safety certificates for the home such as gas, electricity, Portable Appliance Testing, pest control etc were checked and were up to date. There are risk assessments available for all areas of the home including fire, general building and health and safety. Regular health and safety checks are carried out within the home, these include monthly tests of water temperatures and bedrails. St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 26 Each of the units were viewed and some areas of concern were noted as follows: Several of the units had gained permission from the Relatives to wedge open a bedroom door if the Resident wished. Although doors have catches which close if the fire alarm goes off this could impact on the persons privacy and safety and needs to be monitored regularly. On Huskinson unit a bedroom\ patio door was wide open. As this door faces the car park it could provide easy access for an intruder. The Manager must carry out a risk assessment of this process and act on any findings. Each of the units has a satellite kitchen and a sample of these were viewed. Generally staff were keeping these areas clean and tidy however it was noted that the wall tiles in this area on Gladstone looked unsightly with discoloured grouting and stains in places. These would benefit from steam cleaning. . St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 X 3 2 4 X 5 3 6 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 2 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 4 32 4 33 3 34 X 35 3 36 X 37 X 38 2 St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA 6 Regulation 13(4)(c) Requirement Brocklebank - the Manager must make sure that risk assessments relating to service users must be individualised and comprehensive. This was a requirement from previous inspections. Brocklebank - the Manager must develop care plans for a number of residents to include sufficiently detailed information on how to meet the individuals needs. This is a previous inspection requirement. Brocklebank – the Manager must ensure that all medications is recorded and signed for correctly. This is a previous inspection requirement The Manager must make sure that all Staff dealing with Residents medication have had suitable training. St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 29 Timescale for action 20/12/06 2. YA6 15(1) 20/12/06 3. YA20 13(2) 30/01/07 4. OP38 13(4) 5. OP38 13(4) 6. OP18 13(6) The Manager must carry out a 30/11/06 risk assessment for patio doors being left open. She must act on the findings of her assessment The Manager must carry out a 30/11/06 risk assessment for the practice of wedging bedroom doors open. She must act on the findings of her assessment The Manager must ensure all 10/12/06 Senior staff are aware of the action to take in the event that possible adult protection issues occur between Residents. 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 YA3 Good Practice Recommendations Brocklebank - The manager should consider commissioning specialised advice regarding learning disability services and current good practice in working with people who have a learning disability. This is a previous inspection recommendation 2 3 OP7 OP7 The Manager should introducing the use of plain English in writing care plans Gladstone - The Manager should discuss with Staff on Gladstone the reasons why records detailing unusual occurrences should be followed up in writing The Manager should review and fully explore any statements held on file in which Relatives state they require no further intervention for the resident. Canada - The Manager should review the personal care arrangements offered to Residents, prior to meal times DS0000017273.V303826.R01.S.doc Version 5.2 Page 30 4 OP8 5. OP8 St Nicholas 6. 7 OP15 OP27 The Manager should introduce a choice of meals for those on a semi solid diet. The Manager should review the pattern of hours staff work to ensure this does not have a negative impact on Residents Gladstone –The Manager should arrange for kitchen tiles of Gladstone unit to be deep cleaned. 8. OP38 St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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. Extracts may not be used or reproduced without the express permission of CSCI. St Nicholas DS0000017273.V303826.R01.S.doc Version 5.2 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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