Inspection on 15/11/07 for St Nicholas

This inspection was carried out on 15th November 2007.

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

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

Other inspections for this house

St Nicholas 13/09/06

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 Ms Lorraine Farrar Key Unannounced Inspection 15th November 2007 11:00 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.V347855.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.V347855.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 marsdeni@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd 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) 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.V347855.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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. 13th September 2006 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. It is in a residential area of Netherton on the outskirts of Liverpool 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 and Langton 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. At the tie of the site visit Huskinson unit had been temporarily closed by BUPA with a view to refurbishing it and offering a different service. 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. It currently costs between £395 and £600 each week to live at St Nicholas. St Nicholas DS0000017273.V347855.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, on the 15th and 16th November 2007. Two Inspectors visited on the first day and one Inspector 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, visitors 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 five of the people living there. Discussion also took place with residents, visitors and members of staff on each unit. The Manager was given the opportunity to provide information about the service prior to the inspection by completing a self assessment form. Since the last full inspection of the service in September 2006 we have also carried out a thematic inspection at St Nicholas. This was in January 2007 and was part of an overall project we were carrying out in care services across the country. This revolved around information given to people regarding the service, fees and complaints. If you would like to see a copy of that report please ask staff working at St Nicholas. An easy to read summary of this report is available for the people living in Brocklbank. If you would like to see a copy please ask staff working there. What the service does well: Before anyone moves into the St Nicholas they meet with staff and a full assessment of their needs and choices is carried out. They and their representative are invited to visit the home and are given information about how the home works, This helps everyone to decide if St Nicholas can meet the person’s needs and choices and is the right place for them to live. St Nicholas DS0000017273.V347855.R01.S.doc Version 5.2 Page 6 The people living at St Nicholas are confident in the staff team, who they feel support them well. People are given support with their health and personal care and to access healthcare appointments when they need it. Visitors are welcome at the home at all reasonable times and say they are made to feel welcome and are involved in the care of their relative or friend. There are activities arranged by the home that people say they enjoy, these vary from board games and quizzes to themed nights that involved entertainment and different meals. At each mealtime people have a choice of two main meals or an alterative, meals are home cooked and people were complimentary both about the quality of meals and the choices they are offered. Staff receive training specific to the people they support and spend time talking with people as well as meeting their basic care needs. Staff interact well with people and displayed a good understanding of their role. St Nicholas’ has good management systems in place alongside systems for reviewing and improving the standard of care they provide. What has improved since the last inspection? Since the last inspection of St Nicholas the organisation have made sure that everyone living there, including people who are funded by the local authority are given copies of the terms and conditions of their stay. This helps to ensure everyone is as informed as possible about their rights and responsibilities New assessment and care planning records have been introduced. These provide clear information about the person and clear guidelines to staff about when a care plan is required. The majority of these are well completed and provide details to support the person effectively with both their health and personal care and their preferences. St Nicholas DS0000017273.V347855.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Nicholas DS0000017273.V347855.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.V347855.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 5 & 6 –older people 2 – adults (18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient information is provided to and obtained about new people to help everyone decide if the home is the right place for them to live and can meet their needs and choices. EVIDENCE: One of the people living at St Nicholas explained that her relatives visited the home first, she then visited and decided she wanted to live there, as “it felt peaceful”. Records and discussions with relatives show that it is common practice for people and their relatives to be invited to visit the service before a decision is made as to whether it is the right place for them to live. St Nicholas DS0000017273.V347855.R01.S.doc Version 5.2 Page 10 BUPA have recently introduced a new assessment form that is used before anyone moves into the home. This assesses the care and support people need along with their likes and dislikes. These are completed with the person and others involved in their care. The information then provides a clear basis for deciding if the home can meet the persons needs and their choices and to plan the support they will be given. A pack about the service is given to people living at St Nicholas and their relatives. This includes information about the service, the terms and conditions of their stay and how to raise concerns. During the themed inspection in January 2007 a relative explained, “they couldn’t be better, they answer any question honestly”. The level of information provided helps to ensure everyone is as informed as possible about the costs of the service and what they can expect from St Nicholas. St Nicholas does not currently provide an intermediate care service. Therefore standard 6 above does not apply to them. St Nicholas DS0000017273.V347855.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 – older people 6,9,16,18 19 & 20 – adults (18-65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s health and personal care needs are met within the home. However records are not always sufficient to ensure unfamiliar staff could provide the support the persons needs. St Nicholas DS0000017273.V347855.R01.S.doc Version 5.2 Page 12 EVIDENCE: In discussions with some of the people living at St Nicholas and their relatives they said that they receive support with their personal and health care when they need it. One relative commented the care from staff was “spot on” and another that “we can’t fault them, we are not sure what we would do without them”. One of the people living at St Nicholas said, “I couldn’t fault any of them. They are very good, thoughtful and caring, always asking do you want this or that”. Records showed that people are supported to access health care appointments and referred for further examinations if needed. For example one person who had recently moved in had been referred for a hearing test, as a result of which she now had a hearing aid in place. Individual care plans are in place for everyone living at St Nicholas and records showed these are discussed with the person and their representative. Some of those examined where up to date and contained a plan for all areas of support the person needed. However a care plan for someone who had recently moved into the home had not been fully completed, as a result it lacked guidance for staff to follow to ensure they meet the person’s needs. Care plans for another person had been regularly reviewed, however information about recent changes to his condition and therefore the support that was being provided, were not recorded. This could lead to the persons not getting the care and support they require all of the time. Care plans for the people living on Brocklbank follow the same format as those for everyone living at St Nicholas and staff advised they are not able to add other documents to the plan. As the people living on Brocklbank are younger adults who may need more support with communication, how they interact and informing others how to support them. The format provided does not ‘tell the persons story’ and could impact on how unfamiliar staff interact with them or lead to all their choices and lifestyle wishes not being noted and acted upon. Medication is generally well managed across the site and observations of a medication round showed that staff follow their policies and procedures to ensure this is carried out safely. However two different types of medication sheets were in use. These used different codes to record if medication was not given and the reason why. On St Nicholas DS0000017273.V347855.R01.S.doc Version 5.2 Page 13 one sheet codes had been recorded that did not correspond to that sheet. This could lead to confusion and an unclear audit trail of peoples’ medication history. Where medication is handwritten on occasion only one member of staff had signed the sheet. It is good practice for handwritten entries to be signed by two staff to help prevent errors occurring. The audit trail for one person’s anti-biotics was unclear whether he had received these as prescribed or not. Clearer codes on MAR sheets would help prevent this occurring. Throughout the site visit staff were seen to take time to talk with people and interact with them on a social as well as care level. It was clear that support had been provided to people to look after their appearance and records showed that people can choose when they wish to get up or go to bed. Staff were respectful of peoples privacy, knocking on bedroom doors and speaking politely with them. St Nicholas DS0000017273.V347855.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 14 & 15- older people 12,13,15 & 17 adults (18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported to make their own decisions about their daily lives and provided with opportunities to spend their time engaged in activities of their choice. St Nicholas DS0000017273.V347855.R01.S.doc Version 5.2 Page 15 EVIDENCE: Each unit has part time support from an activity co-ordinator, with the exception of Brocklbank who has full time support from 2 activities staff. The people living at St Nicholas said that there are activities such as entertainers, bingo and quizzes that they can join in with when they wish. During the site visit a group of people on Alexandra unit were playing dominos and on Brocklbank a group of people were taking part in a sewing circle. No organised activities were taking place on Gladstone, however the people living there and staff were engaged in conversation and one lady told us, “they are all lovely (Staff), we have a real laugh with them, we are always happy here”. Staff arranged ‘themed’ nights with the kitchen and activities staff, recent themes have included bonfire night and a casino night. Photos of events are displayed on some of the units and show good participation from everyone. Throughout the site visit there were many visitors coming and going, relatives and friends told us that they can visit at all reasonable times and are made welcome. One relative explained staff had recently organised an anniversary party for himself and his wife, which he had greatly appreciated. St Nicholas has for some time been providing ‘protected mealtimes’. This involves ensuring mealtimes are quiet, people have time to eat their meal and are uninterrupted. This was observed to work well with people getting the support they needed quietly and discreetly. A new menu has been provided which gives two alternatives plus a selection of lighter alternatives provided at any mealtime. Comments from the people living at St Nicholas regarding the food were all positive and included, “we have what we want” and “its very very good, I have no complaints, I have a small appetite but get a choice”. On one unit people were served their cold drinks in plastic beakers. As tables were laid nicely and the mealtime was well supported by staff there did not appear to be any reason for this. Use of plastic beakers can appear ‘childlike’ and should be used only were identified in individuals care plans. The chef is very motivated and ensures kitchen staff visits each unit daily to receive feedback about meals. Homemade cakes, bread and soups are routinely served and birthday cakes are made for everyone. The Chef was able to explain the different diets people have and how these are prepared and served to look as appetising as possible. St Nicholas DS0000017273.V347855.R01.S.doc Version 5.2 Page 16 No record of planned activities was available on some of the units. This would help people to plan their day and be more aware of how the home is operating. Menus are displayed on each unit, however they are in small print, which may make it more difficult for people to understand them. St Nicholas DS0000017273.V347855.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 – older people 22 & 23 adults (18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at St Nicholas are aware of how to raise concerns and confident they will be dealt with effectively. EVIDENCE: During the themed inspection at St Nicholas in January 2007 people told us that they knew how to raise concerns and had been given written information about this. During this site visit evidence was seen that this information is given to all new residents and their representatives. The BUPA complaints policy is also displayed in the main foyer and on each unit. One person explained that she would talk to her ‘favourite nurse’ who would tell the manager and she was sure they would act on her concerns. St Nicholas DS0000017273.V347855.R01.S.doc Version 5.2 Page 18 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. Where concerns are raised the manager ensures these are referred to Social Services to investigate and co-operates fully in any enquiries. St Nicholas DS0000017273.V347855.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 – older people 24 & 30 – adults (18-65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. St Nicholas provides a clean tidy home for people to live in. Some areas require refurbishment and decoration to be of a standard acceptable in most domestic homes. St Nicholas DS0000017273.V347855.R01.S.doc Version 5.2 Page 20 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 some bedrooms felt cold and staff agreed that some rooms were colder than others. They agreed to report this so that the heating system could be examined. It is important that rooms are maintained at a comfortable temperature, as many of the people living at St Nicholas are immobile and may feel the cold more than others. Communal rooms were warm and comfortable and all areas seen were clean and tidy. Various equipment is provided through the home to support people, this includes, adapted baths, grab rails and portable hoists. All areas are on the ground floor and are easy to access for people with mobility difficulties. At the time of the site visit an accessible shower was being fitted on one unit and the manager advised others are planned, this will offer people more choices with their personal care. Some areas of the building would benefit from redecoration, for example flooring on Brocklbank was very marked and on Alexandra a bathroom lacked window coverings, had worn flooring and scrapes to the bath which could be an infection control risk. On Brocklbank the large lounge has been furnished with leather settees etc, however due to the size of the room it does not look homely. Staff advised that there are plans in place to refurnish the smaller lounges and rooms they have. This will offer people a choice of where to spend their time and enable them to have time away from large groups of people. Aerosol air fresheners were being sprayed as part of the cleaning regime. These may impact on the health of people, particularly those with breathing difficulties and should be reviewed. St Nicholas DS0000017273.V347855.R01.S.doc Version 5.2 Page 21 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.V347855.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 – older people 32, 34 & 35 adults (18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at St Nicholas are supported by an experienced staff team who can meet their needs and choices. EVIDENCE: Comments from the people living at St Nicholas and their visitors regarding the staff team were all positive. People said that they get the help they need and that they like the staff. Throughout the site visit staff were seen to provide the support people needed but also to take time to chat with people and create a positive atmosphere. Staff spoken with were able to explain their role and the support they offer. They said that they are supported by senior staff and feel they can speak openly about their views. They also said that they have benefited from the St Nicholas DS0000017273.V347855.R01.S.doc Version 5.2 Page 23 recent closure of one unit with more staff available to support the people living at St Nicholas. Over 50 of the staff team have a care qualification (NVQ) with others working towards obtaining it. This helps to ensure that staff have access to up to date information and knowledge about good care practices. Staff spoken with said that the level of training they receive is very good and they are able to attend a variety of courses. Records showed that staff attend basic courses such as food hygiene and moving and handling people as well as more specialist courses. These include the Mental Capacity Act, health related courses and courses in supporting people who have dementia or learning disabilities. This helps to ensure staff have a sound knowledge of good practice in the areas they work in and can support people safely and well. Prior to anyone starting work at St Nicholas a series of checks are carried out on them. This includes an interview process, obtaining references and Criminal Records Bureau (CRB) checks. These checks help to ensure staff are suitable to work with the people living at St Nicholas. St Nicholas DS0000017273.V347855.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 – older people 37,39 & 42 – adults (18-65) Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. St Nicholas is well managed for the benefit of the people who live there St Nicholas DS0000017273.V347855.R01.S.doc Version 5.2 Page 25 EVIDENCE: Mrs Irene Marsden is the registered manager of St Nicholas, she is experienced in management of care services and holds nursing and management qualifications. Mrs Marsden is supported by full time equivalent Clinical Lead Nurses. These posts are based in the main office and provide a management structure within the home. In addition each unit has a named manager and deputy. Staff spoken with said that they find the management structure works well and they receive the support they need. Mrs Marsden works well with other agencies and is clear in her role of supporting the staff team and continually improving standards. She supports staff in accessing training and in taking part in pilot schemes to improve the service. There are a number of systems in place within the home for checking the quality of the service offered. These include regular reviews of care plans for individuals. An external quality audit of the service is also commissioned, this was last carried out on August 07 and included obtaining the views of the people who use the service. St Nicholas was awarded a four star rating following this audit. In addition BUPA carry out a yearly audit, which includes sending surveys out to those who work in and use the service. These had just been sent out for 2007. However results for 2006 are available and these show an improvement in the service overall scores. Following the audit an action plan is drawn up so that future improvements are planned and can be followed up. A senior manager visits the home monthly and carried out an audit of the service, this includes speaking with the people living there and with staff and examining some part of the building and records. Again an action plan is given to the home to plan and follow up on any improvements. These quality checks help to ensure any issues are quickly identified and can be addressed. Wherever possible the service encourages people to manage their own money or receive support from a relative or friend to do so. They do however provide a bank account that people can keep money in if they wish. This is protected as the ‘residents’ account and does not form part of the company accounts. Clear records are kept of money spent and those checked tallied with receipts. St Nicholas DS0000017273.V347855.R01.S.doc Version 5.2 Page 26 Records and certificates showed that regular checks are carried out on the building and equipment to ensure they are safe. This includes checking hoists, fire systems and electrics. St Nicholas DS0000017273.V347855.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 3 3 3 4 X 5 3 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 2 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 3 St Nicholas DS0000017273.V347855.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2)(b) Requirement A system must be put into place to ensure changes to a person’s health are reflected in their care plan. This will ensure all staff are aware of the current support people need. The use of aerosols must be risk assessed to ensure they do not impact on peoples’ health. A record of room temperatures most be maintained and monitored. This will help to ensure the environment is comfortable for everyone. Timescale for action 15/01/08 2. OP19 23(1) 30/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations The care plan format for people living on Brocklbank DS0000017273.V347855.R01.S.doc Version 5.2 Page 29 St Nicholas should be reviewed to ensure it can provide all required information about the person and the support they need. This will help to ensure staff can fully support the person in keeping with their communication methods and lifestyle choices. - Staff should ensure codes used on medication sheets are clear and consistent. - Where medication records are handwritten two staff should sign these. These practices will help to lessen the risk of mistakes occurring. The use of plastic beakers at mealtimes should be reviewed. This will help to ensure peoples’ dignity is respected. Activity rotas should be displayed on each unit. - Menus should be provided in a large print format This will help to ensure peoples are as informed as possible about what is happening on any given day. 2. OP9 3. OP15 4. OP12 St Nicholas DS0000017273.V347855.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. St Nicholas DS0000017273.V347855.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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