Inspection on 25/10/06 for St Nicholas

This inspection was carried out on 25th October 2006.

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

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

Other inspections for this house

St Nicholas 10/07/09

St Nicholas 11/09/08

St Nicholas 14/03/08

St Nicholas 26/01/06

St Nicholas 07/09/05

St Nicholas 05/01/05

St Nicholas 06/09/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE St Nicholas Harepath Hill Seaton Devon EX12 2TA Lead Inspector Michelle Oliver Key Unannounced Inspection 25th October 2006 09:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Nicholas Address Harepath Hill Seaton Devon EX12 2TA 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) 01297 20814 01297 20814 Mrs Karen Roberts Care Home 3 Category(ies) of Old age, not falling within any other category registration, with number (3), Physical disability over 65 years of age (3) of places St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th January 2006 Brief Description of the Service: St Nicholas is registered to provide personal care for up to 3 older people who may also have a physical disability. The property is a detached bungalow set in a third of an acre of land on the outskirts of Seaton. The accommodation consists of three bedrooms one of which is en suite. There is also a kitchen diner, separate dining room and lounge. There is parking on site and pleasant level gardens both to the front and rear of the property. The home is owned and managed by Mrs K. Roberts. The home’s statement of purpose and service user guide, which includes details about the philosophy of the home and about living at the home, is available at the home on request. A copy of the most recent inspection report is available in the entrance hall. Information received from the home indicates that the current fees are £380£395 weekly. Services not included in this fee include hairdressing, chiropody, toiletries, videos, transport and some continence aids. . St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on Wednesday 25th October 2006 over a period of 3 hours. All three residents contributed to the inspection, as did the manager and a member of staff. Prior to the inspection questionnaires were sent to all residents[3] and staff members[3]. All responded positively. Six were also made available to relatives, visitors and health care professionals. Two were returned with positive responses. As part of the inspection, three people were case tracked, this means that three residents were asked about their experience of living at the home, their rooms were visited and the records linked to their care and stay inspected. During the inspection, a tour of the building took place and records including fire, care plans, staff recruitment, training and medication were looked at. Time was spent talking to residents individually What the service does well: What has improved since the last inspection? St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 6 A requirement was made at the last inspection that all staff should ensure that they were unto date with current information related to the prevention of and actions to be taken in the event of a fire at the home. this has been complied with and training has been, and will continue to be, carried out 6 monthly. The home has recently had CCTV cameras installed. This is restricted to the entrance areas for security purposes only and does not intrude on the daily life of residents’. 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 DS0000022038.V303472.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 3 & 6 Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. Residents benefit from a thorough assessment process which ensures that their needs can be met at the home. EVIDENCE: People are not admitted to the home until a full assessment of their needs has been undertaken. By The manager said she visits people in their homes or hospital to introduce herself , carry out the assessment and give information about St. Nicholas. A summary of any assessment undertaken by other health care professionals is also requested to ensure that information is comprehensive. Because St Nicholas has only three residents living there at any time the manager discussed the importance of ensuring that current residents are included in the process of agreeing to a person moving to what is essentially their home. People are invited to visit the home as often as they wish, meet the residents, have a meal and meet the staff. St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 9 Three residents plans of care were looked at during this visit; all included a comprehensive assessment of their health, welfare and social care needs carried out before they decided to move to St. Nicholas. The home does not admit people who need rehabilitation. St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Op 7, 8, 9 & 10. Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. Individual care plans have been developed and all aspects of health; personal and social care needs are identified or planned for. Medication is generally managed well. Residents are treated with respect and their dignity and privacy is maintained. EVIDENCE: All residents have individual plans of care which are comprehensive and provide information to enable staff to meet residents identified care needs. The manager continues to develop the information to include details of individualised care so that staff know just how residents want everyday needs carried out, for example, bathing and dressing. This ensures that individual, person centred care is a priority at the home. Staff were aware of the details of residents individual preferences and residents said that they were satisfied with the care. None of the residents currently look after their own medication. The manager said that resident’s ability and wishes are assessed before moving to the home St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 11 and if they wish to look after the own medicines they would be encouraged and supported by the staff. All residents spoken to during this visit said they were happy that the staff were looking after their medicines and they had no wish to do so themselves. Records are kept of all medications received, administered and leaving the home. Records seen were up to date and in good order. Residents are protected by the homes’ policy that only appropriately trained staff administer their medicines. Staff training records were looked at and two included certificates confirming that safe handling of medicines training had been undertaken. Residents’ privacy and dignity are met and promoted by the staff and manager at the home. Residents said that staff respect their privacy and they feel safe and comfortable at the home. The manager and a carer described good standards of respecting residents’ privacy and promoting their dignity and examples of this were seen during this visit staff knocked on doors and waited to be invited in before entering, a resident was asked whether they would like a bath and were then assisted gently with respect being paid to their dignity. St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Op 12, 13, 14 & 15. Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. Social needs and meals are generally well managed. A varied balanced diet is provided served in a pleasant atmosphere. Residents are encouraged to maintain contact with their families or friends as they wish and to take control of their lives whilst living at St. Nicholas. EVIDENCE: The daily routine, including getting up and going to bed and mealtimes, appeared to be flexible. At the time of this visit a resident had been served breakfast in bed and decided to read a daily paper before being assisted to bath. The resident said they chose to “stay up late” watching TV so liked a “lie in”. All residents said staff were kind and helpful. None of the residents spoken to were involved in local social or community activities. Residents’ interests and preferences had been recorded in their care plans. Staff spent time with residents, chatting and assisting them generally. The home is run as a family home and staff and residents interact well. Residents are involved in all aspects of daily life. During this visit the manager’s young granddaughter visited and the residents were very obviously delighted when she “visited” them. The manager has pets which all the St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 13 residents said they “love”. Games, books, videos magazines and playing cards are available in the lounge and staff said residents will ask to play games when they feel like it. Two residents said that sometimes they “just want to do nothing”. The home is surrounded by pleasant gardens and one resident spoke of their pleasure in sitting out during the summer and simply sitting in their room or the lounge “bird watching” during the “colder months”. Residents may have visitors whenever they choose and may see them wherever they wish in the home. A visitors book, kept in the entrance hall of the home, confirmed that several visitors come to the home at varying times. All residents spoken to said they enjoyed meals and mealtimes at St.Nicholas. Residents are given the choice of where they have their meal but usually they choose to have them in their rooms. One resident chooses to have their evening meal in the kitchen diner enjoying the far reaching country views. The home also has a spacious dining room where residents may have their meals if they wish. Staff prepare the homely meals and residents are asked daily what they would like. A record is kept not only of the meal served but also of what individual residents actually eat. This ensures that a good level of nutrition is maintained for all residents. St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Op 16 & 18. Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. The home has a satisfactory complaints process. Staff have a good knowledge and understanding of the forms of abuse thereby ensuring that residents are protected at the home. EVIDENCE: No complaints have been made to either the home or the Commission since the last inspection. Three residents’ questionnaires stated that they always know how to make a complaint and always know who to speak to and that staff always listen and act upon what they say. At the time of this visit residents said that if they had any concerns they would feel comfortable speaking to any of the staff at the home. There was nothing to suggest that residents are anything other than well cared for at the home. Residents said that staff were very helpful, respectful and that nothing was ever too much trouble for them. Staff have undertaken Adult Protection training and were able to discuss different forms of abuse. They all said that they would not hesitate to report any suspicion of poor practice. St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19 & 26. Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to the service. Residents live in a safe, comfortable and generally clean environment that is well maintained. EVIDENCE: St. Nicholas is well maintained, with homely and comfortable accommodation including a lounge and a dining room. Decoration is ongoing at the home. The home was clean and free from offensive odours throughout. A domestic is employed at the home for 2 hours a week. All staff undertake general cleaning duties throughout the day. The home has a contract with professional cleaners who ensure that carpets throughout the home are cleaned regularly. The home has recently had CCTV cameras installed. This is restricted to the entrance areas for security purposes only and does not intrude on the daily life of residents’. St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 16 The laundry facilities have recently been moved from the kitchen to an outside garage. At the time of this visit the laundry area was cluttered, walls and floor were not easily cleanable, and needed cleaning, and no hand washing facilities were available. Laundry is carried through the kitchen to the garage. This was discussed with the manager in regard to the increased risk of infection this poses to residents. She confirmed that plans were being carried out to partition the laundry area and upgrade the facilities to ensure that residents are protected from the risk of infection. The manager and staff confirmed that all laundry taken through the kitchen is contained in sealed bags. Work on the laundry was taking place at the completion of this visit. St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27, 28, 29 & 30. Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. The number of staff on duty throughout the day and night meets current residents’ personal and health care needs. Residents benefit from being cared for by staff who are qualified and competent and are protected by the robust recruitment practice followed at the home. EVIDENCE: Residents said they were satisfied with the care they receive and that their needs are generally met. The staff rota showed that the allocation of staff on each shift was adequate to meet the need of the current residents. The home is managed as a homely family unit and all staff undertake domestic chores as part of their daily duties. The home employs a domestic for 2 hours a week. The manager is usually on duty between 9am-5pm and there is always a carer on duty throughout the day. The manager lives at the home and undertakes sleeping night duty. Arrangements are in place for residents to call during the night if they need assistance and all were able to confirm this at the time of this visit. Residents confirmed that they were given all the help they needed and that they did not feel rushed or hurried in anyway. St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 18 All staff have job descriptions and when spoken to were clear about their role and what is expected of them. Residents said that staff knew what they were doing and that they felt safe being cared for by them. The home operates a good recruitment procedure that clearly highlights the processes to be followed. Three staff recruitment files were looked at during this visit. The documentation was consistent with evidence of a safe and robust recruitment process being carried out before a person is employed at St. Nicholas. This protects residents, as only people who have undergone this robust procedure will be employed to work at their home. All staff confirmed in questionnaires that they had all undergone a thorough, robust recruitment procedure. Information received from the manager, prior to the inspection, indicates that 50 of staff hold NVQ 2 or above. This will protect residents by ensuring that they are cared for by competent staff. Training provided during the last 12 months includes fire safety and manual handling. The home has not employed any staff since 2004.The manager confirmed that all newly employed staff would undergo a period of training when they start working at the home to enable them to get to know the residents, the home’s philosophy of care, safety procedure, care procedures, and the general layout of the home. The time taken to complete this training will depend on past experience and individual ability. Comments written in response to questionnaires sent to staff included “Have plenty of time for the residents”, “ Lovely home to work” and “ being a small home we have plenty of time to look after each resident and the manager is always here to help if needed”. St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 31, 33, 35 & 38. Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. The home is well managed, run in the best interest of residents, and their health and safety are properly attended to. EVIDENCE: Residents and staff benefit from the experience and competence of the manager/owner. The manager has attained a nationally recognised qualification, NVQ level 4 in care and has recently completed a Registered Manager’s award. The staff team have regular individual formal supervision with the manager when the philosophy of the home, training needs and personal development are discussed and recorded. Each member of staff has a development plan, which identifies their training needs. St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 20 Quality assurance measures have been developed to enable residents, families and visitors to give their views on the home. The manager intends to further develop this to include other stakeholders in the home, such as staff and social and health care professionals. Staff meetings are held regularly, providing an opportunity for the manager to give and receive information about the home although because of the domestic nature of the home this is usually achieved on a daily basis. This ensures that standards of health, social care and welfare needs will be maintained and a programme of continuing improvement developed at the home. Residents will benefit by being assured that the home is working towards delivering high standards of care. No residents’ finances are looked after by the home. Accounts for any items not covered in the weekly fee are calculated monthly and sent to the resident or their representative. Residents’ records are securely stored and would be made available to them, or their representative with the resident’s consent. Records show that staff undertake training in the prevention of fire, and fire alarm tests have been carried out regularly. An assessment of identified hazards and associated risk relating to the environment, including fire hazards, has been undertaken which contribute towards ensuring that St Nicholas is a safe place to live at the time of this inspection. St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 22 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 OP26 Regulation 13[3] Requirement Timescale for action The registered person shall make suitable arrangements to prevent infection, toxic conditions and 26/01/07 the spread of infection at the care home. This relates to the laundry area not being clean and hand washing facilities not being available. It is noted that work has been started to improve the existing facilities. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Nicholas DS0000022038.V303472.R02.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Devon Office Unit D1, Linhay Business Park, Ashburton Devon TQ13 7UP 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 DS0000022038.V303472.R02.S.doc Version 5.2 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!