Inspection on 13/03/08 for St Nicholas Nursing Home

This inspection was carried out on 13th March 2008.

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 Nursing Home 20/01/09

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 Nursing Home 1-3 St Nicholas Place Sheringham Norfolk NR26 8LE Lead Inspector Mrs Marilyn Fellingham Unannounced Inspection 13th March 2008 10:00 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 Nursing Home DS0000070891.V360917.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. 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 Nursing Home DS0000070891.V360917.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Nicholas Nursing Home Address 1-3 St Nicholas Place Sheringham Norfolk NR26 8LE 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) 01263 823764 01263 821941 ADR Care Homes Ltd Position Vacant Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places St Nicholas Nursing Home DS0000070891.V360917.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered persons may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission are within the following category: Old age, not falling within any other category - code OP. The maximum number of service users who can be accommodated is 30. 11/04/07 2. Date of last inspection Brief Description of the Service: The home is situated in a pleasant area of Sheringham near the town centre, shops, beach and promenade. It is a detached property comprising of two floors dating from the nineteenth century. Sheringham has regular bus and train services providing access to the wider community and to Norwich. The home has adequate parking and access for wheelchair users. The front entrance opens into a reception area with a conservatory and dining room leading off. There is an attractive garden area with a patio for service users to use. The home has recently undergone a change of ownership and manager. The current range of weekly fees is £462-£550. St Nicholas Nursing Home DS0000070891.V360917.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate outcomes. This was an unannounced inspection that took place over eight hours. The focus of the inspection was to assess all the key standards for care homes for older people and also to follow up requirements that resulted from the home’s previous inspection in April 2007. Care services are judged against outcome groups that assess how well a service delivers outcomes for people using the service. The key inspection for this service has been carried out using information from previous inspections, information from the Annual Quality Assurance Assessment (AQAA), some service users, their relatives and people who work in the home and other visitors. A tour of the premises was undertaken and service user records and staff files examined. What the service does well: What has improved since the last inspection? Many areas both internally and externally have been improved. New profile beds have been obtained. Steps have been taken to monitor the care and service user satisfaction. The home is now free from unpleasant odours. St Nicholas Nursing Home DS0000070891.V360917.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. St Nicholas Nursing Home DS0000070891.V360917.R01.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 Nursing Home DS0000070891.V360917.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have good information before making a decision whether the home is suitable for them. The personalised needs assessment means that people’s needs are identified and planned for before they move to the home. EVIDENCE: The service users guide has been updated and reflects the services that the home can offer. Examination of admission records confirmed that service users are appropriately assessed before admission to the home. Prospective service users are given the opportunity to visit the home before they decide if the home can meet their needs. St Nicholas Nursing Home DS0000070891.V360917.R01.S.doc Version 5.2 Page 9 Discussion with a recently admitted service user confirmed that they had been given sufficient information in order for them to make an informed decision prior to their admission. St Nicholas Nursing Home DS0000070891.V360917.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The variable practice in relation to care planning and delivery of care means that all service users cannot be sure that their health and personal needs will be fully met. Poorly completed medication records means that service users may not be given their medicine or may be given the wrong medicines: this has the potential of putting service users at risk. EVIDENCE: We examined six care plans and it was evident from these that the assessment process was not linked to the formulation of planning care. The care plans overall lacked detail in relation to specific needs of the residents. It was noted that some of the residents had problems that were identified in the daily notes but no care plans were in place to meet the changing needs of these individuals: this could lead to shortfalls in care and mistakes being made. For example one resident was identified as being at risk of choking but no plan of care was in place to direct the care staff as how to deal with this and what care St Nicholas Nursing Home DS0000070891.V360917.R01.S.doc Version 5.2 Page 11 needed to be in place. The care plans in many cases also lacked any evidence of continued evaluation of care. Discussion with the service users led us to believe that they did make decisions about their daily lives, however these decisions were not reflected in the care plans. One visitor we spoke to said that “that they felt the care was not as good as it had been in the past”, they also commented that a lot of staff had left since the new owners had taken over and that it was difficult to get to know the staff now. A number of residents felt that the standard of care depended on who was on duty at any given time. One resident felt that the care was very inconsistent. The staff that we spoke with had a good understanding of the care needs but felt that they “were stretched” in relation to the levels of staff on duty and attending to the residents increasing needs. Another service user commented that they felt that the care had gone “from bad to worse”. One service user was quite distressed over the care that they were now receiving and felt that it was not good and that their needs were not being met. Examination of the medication records showed some shortfalls in the documenting of medicines that had been administered or not administered; inaccurate records means that it is not possible to know whether residents have received their medication or not. One resident’s Christian name differed in two different places, one on the medication bottle and the other on the medication record chart. Those people who were prescribed prn medication (as required) had no care plan in place to justify continued use. There were no records in place for random auditing of medication. The ‘homely remedies’ in use did not correspond with those identified in the policy. St Nicholas Nursing Home DS0000070891.V360917.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A limited range of activities within the home and community means that the service users do not have a range of opportunities to participate in stimulating and motivating activities. Although the meals and choices of available food is good mealtimes could be better managed. EVIDENCE: Throughout the day of this visit we did not notice any form of activities taking place whatsoever and there was no written evidence to support that the service users were encouraged to take part in an activity programme. The service users we spoke with were unable to confirm that they had taken part in any form of social or recreational activity. The acting manager and those members of staff we spoke with recognise the shortfalls in this area but acknowledges that the staffing levels and the increasing needs of the service users restricts the promotion of an activity programme. The menus were varied and nutritionally well balanced. We observed the service users being given choices in relation to what food that they would like St Nicholas Nursing Home DS0000070891.V360917.R01.S.doc Version 5.2 Page 13 and the dessert trolley had a selection of food to choose from including fresh fruit. The general consensus from the service users was that they thought the food was good. We did notice that about 50 of the service users required assistance with feeding. The service users choose where they would like to eat their meals and we noted some were having lunch served in their rooms, whilst others chose to eat in the dining room or conservatory. The lunchtime appeared to be relaxed although the staff were having a problem making sure that all the service users were being assisted as required due to a lack of numbers of staff on duty for this purpose. St Nicholas Nursing Home DS0000070891.V360917.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for dealing with complaints are satisfactory. Service users feel safe and their concerns are listened to. Staff are aware of issues relating to safeguarding adults. EVIDENCE: A complaints procedure is available for all service users and their relatives. Those service users and a relative that we spoke with knew how to air their concerns and who to go to. They felt safe and listened to. They also felt that their concerns were addressed, one service user said that the Matron was very good and they go to her when concerned. We have received one complaint from a Social Worker in relation to a service users and the outcome of the homes investigation was satisfactory. The records for complaints were seen and had been dealt with appropriately. There were no records in place for small concerns voiced by the residents and their relatives and these were only recorded in the daily notes, it is recommended that these also be recorded on a formal basis so that an audit trail can be kept. St Nicholas Nursing Home DS0000070891.V360917.R01.S.doc Version 5.2 Page 15 Most of the staff have had training in relation to safeguarding adults and some were attending a session for this on the day of inspection. Those staff we spoke with confirmed that they had received updates in safeguarding adults and had a good basic understanding of the subject. St Nicholas Nursing Home DS0000070891.V360917.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The new provider has showed a good understanding of what needs to be carried out in order for the residents to live in a safe and comfortable environment, however there is still a good capacity for the service to improve. EVIDENCE: A tour of the premises took place and it was evident that the necessary refurbishment of the home had started. New dining room furniture had been obtained, the reception area and conservatory had been re carpeted and bedrooms had been re carpeted as they had been vacated. New profile beds were gradually replacing the old ones and two new hoists had been obtained with another one on order. A new call bell system is being organised and door guards fitted on all the doors to comply with fire regulations. A new laundry St Nicholas Nursing Home DS0000070891.V360917.R01.S.doc Version 5.2 Page 17 and sluice has been accommodated in the home and plans are in place for refurbishment of a shower room. There are still areas within the building that need further attention. The area outside has had little attention since the last inspection and it is hoped that the clearing up of this area will take place soon. The home appeared clean with no offensive odours detected. St Nicholas Nursing Home DS0000070891.V360917.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are at times unable to meet the service user’s needs and this puts the service users at risk. The staff-training plan needs to be activated so that more training takes place. The service users are protected by the home’s robust system for recruitment. EVIDENCE: The staff rotas indicated that there were sufficient staff on duty for some of the shifts; however when compared with the residents’ assessed needs this did not seem to be so. There were times when sickness and annual leave has caused staff shortages and necessitated those staff who were able to, to work longer shifts. Staff themselves felt that they were very busy, they also felt that they could not spend as much time with the service users as they wished; this was evident when it came to organising any activities for the residents and the lack of staff to carry them out. As previously mentioned we noted that a lot of assistance was required to ensure that the service users’ meals were carried out in a relaxed way. St Nicholas Nursing Home DS0000070891.V360917.R01.S.doc Version 5.2 Page 19 Although the service users’ basic needs were mostly being met, there are areas that can be improved to enable staff to respond to the individual needs of the service users. One service user felt that their care was not as good as it used to be and a number of service users commented that they had difficulty in understanding some of the new carers. Another service user said it took ages for their call bell to be answered and that the staff were always rushed off their feet. However, the providers feel that this situation is improving following the change of management of the service. Those staff we spoke with were clear about their roles and confirmed that they had received training in many of the areas applicable to the service users under their care: however a member of the care staff was observed hoisting a service user on her own, which is unsafe practice and it is recommended that they have an up date in manual handling. Staffing records were seen and discussion with the staff and the manager confirmed that training is adequate, but could be improved to cover such as aspects as manual handling. Risk assessments were in place for manual handling but it would appear that they are not always adhered to. The acting manager has devised an individual training plan for all staff but this has not yet been implemented. Recruitment records were examined and we found there to be a robust system in place for recruiting new staff. St Nicholas Nursing Home DS0000070891.V360917.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management arrangements do not appear to be meeting the needs of the service users. There is capacity for the management of the home to improve further. EVIDENCE: Those service users spoken with were aware that the home had changed ownership and that there had been a number of changes; they also felt it was too soon to make any other comments about the management. The service users, staff and visitors to the home felt that the acting manager was approachable. The acting manager has found it difficult over the past St Nicholas Nursing Home DS0000070891.V360917.R01.S.doc Version 5.2 Page 21 months waiting for the sale of the home and trying to put new systems into place. The system for formal supervision needs to be extended to include all the aspects of practice, philosophy of care in the home and career development needs. The acting manager seems committed to promoting equality and diversity in the home; she has started to instigate a service user survey and the results of these were seen however there was no formal system for monitoring the quality of its services. Discussions with staff led us to believe that there is a lack of overall management structure in place. St Nicholas Nursing Home DS0000070891.V360917.R01.S.doc Version 5.2 Page 22 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 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 15 2 2 2 x 2 2 2 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 2 2 x x 2 3 2 St Nicholas Nursing Home DS0000070891.V360917.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 14 15 Requirement Care plans for all residents must clearly set out a full range of needs in all areas of personal, health and social care. The content of the care plans must be reviewed at least on a monthly basis and more frequently when needs change. When medication is being administered to people who use the service it must be clearly recorded. This will ensure correct levels of medication are being given. People who use the service and are prescribed prn (as required) medication must have care plans in place to justify its continued use. The care home must be of sound construction and kept in a good state of repair externally and internally. All unusable equipment and rubbish must be removed from the rear garden to ensure safety for all people living and working in the home. All staff must receive regular DS0000070891.V360917.R01.S.doc Timescale for action 13/04/08 2. OP9 13 (2) 13/04/08 3. OP9 13 (2) 13/04/08 4. OP23 (2) (b) 13/08/08 5. OP19 23 (2) (o) 13/08/08 6. OP36 18 13/04/08 Page 24 St Nicholas Nursing Home Version 5.2 7. OP27 12, 18 8. OP27 18 © (i) 9. OP27 18 © (i) 10. OP33 24 (1) formal supervision. Staffing levels must be reviewed to ensure that they are adequate to meet the needs of the increasingly dependent residents and allow for an activity programme to be activated. A training programme must be instigated to ensure that persons working in the home have training appropriate to the work they are to perform. All staff using hoists must be appropriately trained in their use. This will ensure the safety of people using the service. The home must instigate a system for monitoring the quality of the services it provides to ensure that the home is run in the best interests of its residents. 13/04/08 13/04/08 13/04/08 13/08/08 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 OP9 Good Practice Recommendations It is recommended that regular auditing of medication takes place to ensure that correct levels of medication are attained all the time and MAR charts are accurately completed. All concerns expressed by service users should be recorded so that the home can demonstrate how they have been dealt with and will also allow underlying trends and patterns to be identified. 2. OP16 St Nicholas Nursing Home DS0000070891.V360917.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection 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 Nursing Home DS0000070891.V360917.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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