Inspection on 08/12/05 for St Nicholas House

This inspection was carried out on 8th December 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 21/07/05

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 St Nicholas House Littlefields Dereham Norfolk NR19 1BG Lead Inspector Ruth Hannent Unannounced Inspection 8th December 2005 12.30p 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 House DS0000034973.V272082.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Nicholas House DS0000034973.V272082.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Nicholas House Address St Nicholas House Littlefields Dereham Norfolk NR19 1BG 01362 692581 01362 699418 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) Norfolk County Council-Community Care Mrs 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 DS0000034973.V272082.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The accommodation is not suitable to accommodate people who need a wheelchair to assisit with independent mobility at the point of admission. No service user who relies on a wheelchair to assist with mobility should be accommodated on the first floor due to the size of the lift. It is recommended that the home is registered to accommodate 32 Service Users who are Older People, not falling within any other category. 21st July 2005 ate of last inspection 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 its 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 DS0000034973.V272082.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over a period of three and a half hours with the Manager and two Care Co-ordinators. A tour of the building took place. Five residents were able to give their views on the service provided. Four staff members gave details of the work they do within the Home and some of those duties were observed. Many visitors were seen coming and going with one relative spoken to. Records were looked at such as accident forms, complaints, care plans, daily records and medication administration. What the service does well: What has improved since the last inspection? The Home has improved the way they inform residents of the meals available and offer more choice. Although the level of documented supervision for staff is not quite to the standard required it has improved. The Home now has a comprehensive monthly monitoring process for testing the water supply for legionnaire’s. There is now a designated staff member for the laundry tasks enabling care staff to concentrate on care duties. This is an increase in the staffing hours in the home. The Home has recently completed a building fire risk assessment that has highlighted some needs for change. St Nicholas House DS0000034973.V272082.R01.S.doc Version 5.0 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 DS0000034973.V272082.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Nicholas House DS0000034973.V272082.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. EVIDENCE: St Nicholas House DS0000034973.V272082.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 and 10 The residents have a care plan document that shows the basic care needs of the individual but there is some improvement to work on to make them more person centred. The Home does protect the residents by following the correct procedures for dealing with medication. Residents are treated with dignity and respect and their privacy is upheld. EVIDENCE: The care plans for three people were seen and gave some information that could ensure basic care needs could be followed. The development of more comprehensive care plans were discussed in some detail with the Care Coordinator who is working with other staff to improve the recording and ongoing reviewing of each care plan. (Recommendation) The Home does hold a summarized care plan sheet in each bedroom for a quick reference for each staff member and reviews take place with records seen of these events by the circling of the appropriate month the review took place. St Nicholas House DS0000034973.V272082.R01.S.doc Version 5.0 Page 10 Two residents of the three care plans seen were spoken to. Both felt their care needs were being met. One lady had improved since her move recently to St Nicholas and this was seen in the daily records. “We did the right thing moving here. I feel so much better” was one response noted. Two Care Co-ordinators were both checking and ordering the medication supplies during the inspection and showed the MAR charts that were noted as being completed appropriately. The trays of medication were stored appropriately in a lockable cupboard with creams in date order in another cupboard. The controlled drugs were in a double locked wall cabinet. The MST tablets were counted and corresponded with the records. (The administration of this controlled medication had been signed for by two people as required by the medication procedure). A discussion was held over the way insulin is now administered and the training that staff received on the use of insulin pens. Not all residents are happy with this method and prefer the needle and syringe. The pharmacist inspector is to be asked for his advice as there is some confusion on what is now seen as the correct method of insulin dependent people. Although there is some uncertainty about this, the methods used at present are seen as safe by the Homes staff and Inspector with insulin stored in the fridge in the medication room, which is kept locked. Throughout the visit, conversations heard between staff and residents were appropriate. Doors were knocked on before entering and personal care tasks were carried out in a dignified manner. When a gentleman was returning from a bath with a staff member a comfortable and pleasant conversation with plenty of laughter was noted. On talking to this gentleman at a later stage he was full of praise for the staff and had thoroughly enjoyed his bath. St Nicholas House DS0000034973.V272082.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 15 Residents are encouraged and can lead a lifestyle that they wish. The Home welcomes and encourages contact with families and friends. The residents enjoy and are offered a wholesome, balanced diet with choice. EVIDENCE: During the walk around the building it was noted how individuals were filling in their time and how each one was different. One person had a pile of paperwork on the table in a small lounge for action. Another has a personal computer with Sky about to be installed in a bedroom. Another was busy with a word search and one person was sitting with his radio in the main entrance listening to music. During the inspection a residents meeting took place where residents were putting their ideas and points of view across. Plans for the Christmas period were discussed and the activities were posted on the ground and first floor for residents to read. Throughout the visit many visitors were seen. In the dining room two tables were being used by residents and visitors, the small sitting room was in use St Nicholas House DS0000034973.V272082.R01.S.doc Version 5.0 Page 12 and at least three residents were receiving visitors in their bedrooms. People were stopping to talk to staff and one resident spoke of her friend coming to visit on Christmas day and staying for the Christmas dinner. The atmosphere was relaxed and people were coming and going in an easy manner. The way people are informed about the meals available has improved. All meals are now posted on the notice board and this was seen in the dinning room corridor. Residents can see at a glance the meals for the week so they can plan when and if they would like to go out or discuss with the kitchen an alternative meal if the choices available are not suitable. On the day of the inspection the residents spoke of a very good steak and kidney pie with rhubarb tart and custard to follow they had received for lunch. Throughout the inspection three residents were spoken to and all said the meals were good. “I won’t give it ten out of ten but at least eight” was one comment. There were cold drinks available throughout the home on various coffee tables and a trolley of hot drinks was taken to everyone in the middle of the afternoon. St Nicholas House DS0000034973.V272082.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Residents, relatives and friends can be confident that their complaint/concern will be listened to and acted upon. EVIDENCE: The Home is very active in recording and dealing with any comment or complaint that is presented. The complaints folder was seen and it was noted that residents,’ or family members, who had been unhappy with any part of the service, had been seen by the Manager and action had been taken to rectify any issues. Clear documentation was evident and outcomes recorded. St Nicholas House DS0000034973.V272082.R01.S.doc Version 5.0 Page 14 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): 21 and 25 There are insufficient bathing facilities for residents with too greater distance to travel to use the two available. The residents’ safety is at risk with water temperatures too high in bedroom sinks. EVIDENCE: This Home has long corridors and with only two assisted bathrooms, makes the offer of a bath very difficult for some residents who may be unfortunate to have a bedroom at the far end of the building. The Home does have a room that was originally a bathroom and needs to be brought back into use with the possibility of a flat floor shower. This will enable choice of bathing facilities for all residents and prevent the long distance some residents have to travel to have an assisted facility. (Repeat requirement). St Nicholas House DS0000034973.V272082.R01.S.doc Version 5.0 Page 15 Two bedrooms in different parts of the building had the water temperature probed (Room 16 and 58). The recordings were both over 60 degrees and way over the recommended 43 degrees. This problem has been identified by the Home and a risk assessment has been completed with hot water stickers placed by the taps. (Requirement) The two baths used also had the water probed with both recording just under 42 degrees so not causing any concern and the thermometer used to check this water was also checked to ensure it was working with no problems noted. St Nicholas House DS0000034973.V272082.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 The Home meets the needs of the residents by the numbers and skill mix of the staff team. The residents are protected by the Home following the correct procedures for recruiting new staff. EVIDENCE: The staff team are experienced and the majority of the workforce have been at the Home for a while. A new Care Co-ordinator and laundry assistant have joined the team. The one staff member was spoken to who has many years experience in care and can relate well with the rest of the staff team. The Home has no recruitment problems and there are no vacancies in the staff team. The personnel file of this latest recruit was seen and all paperwork was present to include CRB, POVA, two references, application form and two records of identification. (Marriage certificate and photo driving licence). On talking to this staff member she had been interviewed appropriately and has a contract and code of practice. St Nicholas House DS0000034973.V272082.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 36 and 38 The residents do live in a Home that is managed by a person who is able but who needs to have the management qualification to evidence this. Staff are beginning to receive supervision at timely intervals although it is not yet six times a year. The health, safety and welfare of all who are part of St Nicholas House are promoted and protected. EVIDENCE: The Manager has been registered for a number of years. Due to maternity leave the completion on the NVQ 4 has been delayed. The need to fast track this qualification has been identified by the authority and hopefully on the next inspection this certificate will be in place. (Requirement) St Nicholas House DS0000034973.V272082.R01.S.doc Version 5.0 Page 18 The supervision of staff has improved and although to date six times a year for all staff has not been achieved the dates are being planned and with the new Care Co-ordinator now in position this should be achieved in the near future (Recommendation). The Manager has just completed a fire risk assessment for the whole building, which has identified the difficulty in some exits from the building due to steps and no emergency lighting outside which could present a risk of falling on exiting in an emergency. As this has been recognised and acknowledge as an area that needs improvement this will not be a placed as a requirement on this report with the expectation that the work will be carried out before the next inspection. The data sheets and risk assessments are in place for cleaning materials used within the Home. Accident forms were seen and the documentation and recording was correct. One serious injury had been forwarded and received by CSCI the week prior to the inspection and this was discussed with the Manager. Records were seen of the first completed form for the monthly testing for Legionella, which had identified a concern of one reading not being completely correct. The Home is awaiting the outcome of a fax they have sent reporting the concern. (This test was carried out on the morning prior to the inspection visit). St Nicholas House DS0000034973.V272082.R01.S.doc Version 5.0 Page 19 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x x x 1 x x x 1 x STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x x x x 2 x 3 St Nicholas House DS0000034973.V272082.R01.S.doc Version 5.0 Page 20 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 OP21 Regulation 23(2)j j Requirement The registered person must put into place a plan to ensure there are enough bathrooms available for the number of residents accommodated. (Repeated requirement) The registered person must ensure all hot water supplies used by residents is thermostatically controlled at the point of delivery. (43degrees) The registered person must obtain the recognised management qualification as soon as possible. Timescale for action 31/03/06 2 OP25 13.4 31/03/06 3 OP31 9.2 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard 7 Good Practice Recommendations It is recommended that the Home continues to improve the care plans with what is relevant information to enable the home to develop the person centred approach for all DS0000034973.V272082.R01.S.doc Version 5.0 Page 21 St Nicholas House 2 36 residents It is recommended that staff have dates planned to ensure they receive supervision at least six times a year. St Nicholas House DS0000034973.V272082.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Norfolk Area Office 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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