Inspection on 21/07/05 for St Nicholas House

This inspection was carried out on 21st July 2005.

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 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 House 11/12/06

St Nicholas House 08/12/05

St Nicholas House 01/03/05

St Nicholas House 15/07/04

St Nicholas House 23/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE St Nicholas House Littlefields Dereham Norfolk NR19 1BG Lead Inspector Ruth Hannent Announced 21 July 2005 9.30am st 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 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 House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service St Nicholas House Address Littlefields, Dereham, Norfolk, NR19 1BG 01362 692581 01362 699418 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Norfolk County Council Miss Joanne Marie Bolton Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places St Nicholas House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The accomodation is not suitable to people who need a wheelchair to assist with mobility at the point of admission No service user who relies on a wheelchair to assist with mobility should be accomodated on the first floor due to the size of the lift. It is recommended that the home is registered to 32 Service Users who are Older People, not falling within any other category. Date of last inspection 1st March 2005 Brief Description of the Service: St Nicholas House is a two storey, residential care home providing accommodation and care for thirty-two older people. It is owned and run by the Local Authority, is situated within a short walk of all facilities and the town centre of Dereham and stands in it’s own, well kept grounds. All bedrooms are single, contain a washbasin, are arranged on both floors and are a mix of above or just at the minimum standard in size. On each floor there is a communal bathroom containing adapted bath and toilet and separate toilet facilities. The home has a passenger lift to the first floor that is not able to accommodate service users who use a wheelchair. There are four, large, communal lounges and several small sitting areas around the home and service users have the choice of eating in a large, downstairs dining room or in one of the lounges or their bedroom. A hairdressing facility is available and an independent chiropodist also visits the home. The gardens offer service users pleasant areas to sit and there is parking to the front and side of the building. St Nicholas House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, which took place with the Manager over a period of six and a half hours. As part of the inspection discussions were held over the pre inspection questionnaire, fifteen comment cards from relatives/visitors and the ten comment cards from residents. Two staff members and five residents were spoken to in detail. Records looked at included health and safety, recruitment/personnel/training files of staff and care plans of residents. A tour of the building took place and a meal was eaten with the residents in the dining room. What the service does well: What has improved since the last inspection? The Home has tried hard to include all residents in the decisions made in what type of activities they would prefer. The Home ensures discussions between the resident and their family takes place for clear instructions on the wishes of the individual person at the time of their death and is noted on their information records. St Nicholas House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 Page 6 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 House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection St Nicholas House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 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 standard(s) 3and 5 The assessment process for potential residents is in place and suitable to ensure the service available is appropriate and that the persons needs can be met. Families and friends are actively involved to ensure the Home is suitable for the care required. EVIDENCE: A blank format for assessing peoples needs to ensure suitability for St. Nicholas House was seen alongside a large print easy read version designed by the Manager to assist the understanding of the process by the older person. One completed form for a gentleman on the waiting list was also seen and appeared appropriate for the care offered at this Home. (This assessment needed to be comprehensive as this person was moving from a nursing environment to residential care). On talking to two residents about how they first came to live at St. Nicholas they both talked of the involvement of their families in choosing the right place for them. They came to look around and discussed any questions with the St Nicholas House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 Page 9 Manager. They were also offered a pack of information that they could share and discuss together. St Nicholas House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 and 10 The care plans are written and a simplified version ensures staff are able to carry out the care tasks as required. The good support of the health professionals ensures the health needs are met. On the whole the medication procedures are in place but a few small adjustments need to ensure it is as safe as it can be. Residents are treated with the respect that is appropriate and their right to privacy is upheld. EVIDENCE: Two care plans were seen. The documents were spread in a folder which, although had all the content required, was difficult to follow clearly. The manager explained that each resident had a simplified version of care requirements inside each wardrobe so care staff who may not be as familiar with the resident can see at a glance the care required. Residents spoken to said their care needs were met and it was noted that the residents sign a copy of the care plan. (One was out on the desk and waiting to be signed). St Nicholas House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 Page 11 On the day of the inspection the community nurse was in the building. Some residents require daily dressings and have the nursing support for this offered by the local GP practice. The doctor also called in to see patients in the morning and was assisted by the care staff. Clear record notes of the visits are recorded on each residents file. Medication is administered by the care co-ordinators and senior staff at appropriate times throughout the day. The lunchtime administration process was observed and carried out correctly with each resident receiving the correct medication, it being placed from the blister pack into a small cup, offered to the resident without being touched and then seen as swallowed before the chart was signed. All medication is stored in a locked room within locked cabinets or a trolley. On looking through past MAR sheets it was noted on one occasion a signature had not been written in the appropriate box. (Requirement) It was also noted that PRN medication is not recorded as offered to the resident by the evidence of a code placed on the MAR chart. (Requirement). Throughout the day of the inspection the latch on the controlled drugs double lock was being repaired. One key was working correctly but the second was not. While this lock was out of action the Manager had placed the controlled drugs in another locked cabinet for safe storage. All records for controlled drugs were accurate with two signatures recorded throughout the administration process. Throughout the day it was noted that staff and residents had appropriate conversations. The bedroom doors on entry were knocked on before entry and any care offered was in privacy, behind a closed door. When the community nurse arrived the residents were assisted to a designated room for treatment. St Nicholas House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 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 standard(s) 12 and 15 Although effort is being used by the Home to find suitable activities for the residents more energy should be used to find and help with the stimulation of residents to meet personal preferences. Although meals are wholesome and well balanced the choice and accuracy of what is offered needs to be clear to ensure residents know what they are choosing. EVIDENCE: Some of the comment cards and three of the residents spoken to feel there is not enough to do and they often just sit in their rooms or watch the television. They feel the staff are too busy to give them any time. One person would like to have more conversations with staff, another enjoys the activities but would like more and another feels because of her disability, would hinder others if she was taken out more. The manager showed the inspector minutes of meetings and a questionnaire where all residents were asked what activities they would like and what interests them. Some did feed back comments and some of these are being planned. Next month a coach trip is organised as also is a barbeque for the end of this month. Each resident needs to have, as part of their care plan identified information on what they enjoy and are stimulated by, which would be part of the daily recording practise along with care records. (Recommendation). St Nicholas House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 Page 13 The Inspector ate a lunchtime meal at a table with three residents in the dining room. The meal was steak and kidney pie with sprouts and suede or cheese omelette with salad. The dessert was sultana sponge and custard, yoghurt or ice cream. All residents spoken to the food was good and they never had to complain about the meals although one comment card did refer to the change since the cook left. Another comment stated in the minutes of residents monthly meetings was the issue of the weekly menu not being available for residents to plan their week. (Recommendation) On studying the menu’s it was also noticed that not every day was there a choice and that what choice there was involved a lot of cheese (cheese flan, cheese omelette, cheese pasty etc). (Recommendation) St Nicholas House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 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 standard(s) 16 and 18 Evidence seen and heard ensures the residents and visitors will be listened to and complaints acted upon in an appropriate manner. Residents are protected as much as possible by the correct systems in place to ensure they are protected from abuse. EVIDENCE: The pre inspection questionnaire told of 11 complaints since July 2004. The records seen by the Inspector showed the staff team had handled the complaints/comments/concerns in an appropriate manner. Records were clear of action taken and the one resident spoken to feels if she is not happy she can talk to the Manager who will, “soon sort it out”. The Home does issue a complaints procedure to all residents as part of the admission pack of information. All staff have the correct CRB clearance and all new staff are POVA checked. Nearly every staff member has attended the Protection Of Vulnerable Adults training with the last three staff members about to join the homecare team to complete this. Records of the training certificates were seen and on talking with one carer she was able to give examples of learning from the training session. St Nicholas House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 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 standard(s) 19, 20 and21 Residents do live in an environment that ensures their safety and is well maintained. The home is comfortable although a little plain in some communal areas with a lovely garden to sit and enjoy. There is inadequate facilities for bathing or showering within this Home. EVIDENCE: The records seen of the fire reports, which included the fire officers visit the alarm bell checks and the checks on date stickers of the fire extinguishers were all in place. Staff have attended training with a very recent planned event with firemen, tenders and staff taking part in an evacuation process. The grounds are well presented with a recently revamped fish pond and many hanging baskets and bedding plants making a nice colourful garden. This is helped to keep in the this condition by a resident who is very keen on gardening. St Nicholas House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 Page 16 The Home is well maintained with plans to redecorate bedrooms when they become vacant. The communal areas are clean and tidy but lack colour and stimulation. The Home has only two usable bathrooms and with the home accommodating 32 residents this number is inadequate. The home has areas within the building, which could easily accommodate another bathroom/shower room allowing choice with less distance to travel to get from bedroom to bathroom. (Requirement) St Nicholas House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Although the skill of the staff within the Home is good the numbers of staff is not adequate to meet the needs. The recruitment procedure is correct but some records need to be in place to ensure complete protection for residents. The Home works hard to ensure staff are fully trained and competent to do the job they are employed to do. EVIDENCE: The rota was discussed fully with the manager. It was noted that three care staff were on duty on both the early shift and the late shift with a care coordinator or senior on one of the shifts. The time taken by the more senior staff with medication administration, record keeping, appointments with health professionals means they cannot be included as part of the hands on needs of residents. It was also noted that there was no staff member for the laundry and only one cleaner on duty for part of the week and this is only for half the day. Listening to the comments by many residents and the comments written by family members there is insufficient staff on duty to meet the whole needs of the service. (Requirement). Two recruitment files were seen. A thorough recruitment practise is followed as governed by the councils policy and procedure. It was noted on one of the files that the necessary I.D for the staff member had not been photocopied and retained for the personnel records. (Requirement). St Nicholas House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 Page 18 The Home actively encourages and hold records of certificates and induction processes that show staff are regularly updated and assisted with their own development with the role they are employed in. The most recent staff member who joined the Home in April this year was spoken to and stated she had completed her induction and had training in moving and handling, first aid and POVA with a place booked for her to begin her NVQ in September. St Nicholas House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 and 38 Although supervision is taking place it needs to be done regularly and recorded and stored in a lock unit to enable staff and line managers to ensure the staff member is achieving at their full potential. Generally the health and safety of all people who live, visit or work at St. Nicholas House is promoted with a shortfall in the writing of risk assessment for the chemicals used in the building. EVIDENCE: The Home has a supervision policy and supervision is recorded. The care coordinator explained and showed the dates of supervision of two staff members on the 13th July and another in June. She line manages six staff at present and has difficulty in covering all six with the amount of sessions required over the year due to service demands and trying to plan sessions with relief staff. The manager also is having difficulty in meeting on a one to one basis six times a year. (Recommendation). Records of supervision are held in sealed St Nicholas House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 Page 20 envelopes as the staff file is stored in a cupboard for all staff access. This is not good practise and the storing of confidential notes should be held and locked separately. (Recommendation). On walking the building it was noted that the storing of equipment was safe, equipment in the laundry was suitable and maintained, the pre inspection questionnaire showed dates of health and safety checks carried out over the past twelve months by the relevant departments except for the Environmental Health Officer who has not visited since June 2003. Certificates were checked and corresponded with the questionnaire. The risk assessments for any chemicals in the building have not been completed and need to be in place for the safety of any staff or residents. (Requirement) The most recent accidents forms were seen and recorded correctly. By checking the daily records and then the accident forms it showed dates, details of accident and times as being accurate. St Nicholas House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 3 2 1 x x x x x STAFFING Standard No Score 27 1 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x 2 x 2 St Nicholas House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 29 Regulation 13(2) Requirement The registered person is required to ensure all residents are asked if they require their PRN medication and that the appropriate box on the recording chart is completed The registered person must ensure all boxes on the medication recording charts are completed for all medication administered or a code for non administration. The registered person must putinto place a plan to ensure there are enough bathrooms available for the number of residents accommodated. The registered person must ensure there are staff employed to cover all aspects of the care required by employing staff to cover the duties in the laundry and co ordinators roles and not as part of the part of the hours of care. The numbers of hours for care in the building can then be counted appropriately as directed by the Residential Forum care hours in homes for older people.. The registered person must Timescale for action Immediate and ongoing 2. 9 13(2) Immediate and ongoing 3. 21 23(2)j j 30th November 2005 30th September 2005 4. 27 18 5. 29 19 Immediate Page 23 St Nicholas House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 6. 38 13(6) ensure that relevant paperwork for identification are held on the personnel file for all staff employed. The registered person must ensure risk assessments are in place for all cleaning chemicals in the building for health and safety of all users. and ongoing 30th September 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard 12 15 15 36 36 22 Good Practice Recommendations It is recommended that the recording of the stimulation and activities the residents have been involved in be recorded as part of the daily recording practise. It is recommended that the menu for residents is available for the whole week. It is recommended that the second choice of meals is always available and that thought into the content of this second choice is considere. (Not so much cheese). It is recommended that supervision is planned and adhered to to ensure the sessions are at least 6 times a year. It is recommended that the storing of supervision notes are in a locked unit for confidentiality. It is recommended that an appropriate sized lift is installed to allow people who live in St .Nicholas to remain in an upstairs room even if they require the use of a wheelchair (Previous requirement) It is recommended that staff are encouraged to enrol on the course for NVQ2 to ensure the 50 of required qualified staff is reached by the end of 2005. 7. 28 St Nicholas House I55 s34973 stnicholashouse v232577 210705 stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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