Inspection on 20/01/09 for St Nicholas Nursing Home

This inspection was carried out on 20th January 2009.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Nicholas Nursing Home 13/03/08

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Nicholas Nursing Home 1-3 St Nicholas Place Sheringham Norfolk NR26 8LE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marilyn Fellingham     Date: 2 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: St Nicholas Nursing Home 1-3 St Nicholas Place Sheringham Norfolk NR26 8LE 01263823764 01263821941 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): ADR Care Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 30 Number of places (if applicable): Under 65 Over 65 30 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is 30. 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. Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 25 Brief description of the care home 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. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection that took place over six hours. The key inspection for this service has been carried out using information from previous inspections, information from some residents, relatives, visitors to the home and people who work in the home. The main method of inspection was case tracking. This involved selecting individual care plans and information available about people who live in the home and tracking their experience as a result of the support provided. During our visit a tour of the premises was undertaken and residents records and staff Care Homes for Older People Page 6 of 25 files were looked at. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The detailed assessment of needs means that peoples needs are identified and planned for before they move into the home. Evidence: We looked at the assessment records for two new residents; a good format is used for the intial assessment of the prospective residents. These were very detailed for the two records we looked at; a further assessment is then carried out once the residents have settled and the service can continue to make sure that the residents needs can be met. This assessment is then used to formulate a plan of care associated with every need that has been identified. We spoke with one resident who had recently been admitted to the home who told us that she had been given sufficient information in order to make a decision about whether the home was suitable for them. Care Homes for Older People Page 10 of 25 Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The practice of planning and delivery of care in the home means that residents can be sure that their health and personal care needs will be met. Evidence: We looked at six care plans, two belonging to the most recently admitted residents to the home. All the care plans were good with evidence of resident involvement; they had detailed instructions for care needs and nutritional and skin integrity assessments had been carried out and regular weight monitoring had also been recorded. One resident had been identified as being at high risk of developing pressure sores and we noted that there was a care plan in place to provide preventative care in relation to this risk. The residents files had risk assessments for falls and these had been monitored on a monthly basis. The care plans had clear guidelines in place for care in relation to mobility needs and manual handling. We did note that the care plans did not record any information about the residents mental capacity. The manager told us that she and her deputy have done some Mental Capacity training and the carers have also been learning about this and that they are now hoping to develop their knowledge Care Homes for Older People Page 12 of 25 Evidence: and start carrying out assessments. The homes medication policies and procedures are being put into practice, we undertook a random check of medicines, the records were found to be in good order with clear indication for refusal or when medication had not been given. Case tracking two residents notes identified that medications for p.r.n. use, (to be given as required) did not have care plans in place to justify continued use or rationale. We spoke with three visitors on the day we were visiting the home, one remarked that their relative is very well looked after; another relative told us that there is a great atmosphere of happy care and understanding with good continuity in a relaxed manner. One other visitor told us that the staff and others look after my wife with care and compassion. A resident told us that they felt the home was wonderful, another said the carers are nice to me. One resident did say that they wished that the non English carers did not speak over them in their own language. Staff have an overall understanding of the care needs of the residents and this was demonstrated in discussion with them. The registered nurses felt that the care plans had improved greatly and they and the carers found it much easier to facilitate the care that had been prescribed. We felt that the care plans that we looked at showed a marked improvement since the last visit to the home. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are given a number of opportunities to participate in stimulating and motivating activities. Mealtimes are unrushed and appear to be a social occasion for many of the residents. Evidence: We were able to talk with a number of residents, staff and visitors about the activities within the home, we were also able to observe some activities taking place and social interactions among the residents and the staff. On the day of our visit three residents were painting in the lounge and being assisted by the activity coordinator; we noted that there was a lot of communication with the rest of the residents and that many of the residents were enjoying conversations with each other and the carers. One resident said there is always something going on now and another said I do not get so bored as I used to. We learnt from the manager that a sherry morning had been held to ascertain from residents and relatives what activities the residents would like to be involved with. We were informed by the staff and three of the residents that there had been quizzes to take part in, some had made peppermint creams for Valentines day and some had been doing some indoor gardening. We noted that there were a number of photos to Care Homes for Older People Page 14 of 25 Evidence: record some of the activities that had taken place. The residents are aware of what events are taking place and relative information is posted in the lounge where all can see it. There were good records in place for all activities, however the records did not reflect any reasons for not participating or the amount of participation that had taken place. The activity coordinator has completed a course in learning about activities for elderly people. We looked at a selection of menus, these were seen to offer a variety of well-balanced meals and one resident commented to us that the food was good. We observed the cook inviting those residents who were able, to choose from the days menus that included, turkey casserole, liver and bacon with fresh vegetables and a choice of sweets that included apples and custard and lemon curd tart. The residents are given a choice of hot lunch and supper always and the cook will provide other choices if a resident does not wish for something from the menu. We noted that those residents that needed assistance with their food were being helped in an acceptable manner and that the whole procedure did not appear rushed, in fact there was a lot of laughter and everyone seemed very relaxed. Each resident is given the choice of where they wish to have their meals and we noted three were having their lunch in the dining room, some in their rooms and some in the lounge. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. residents feel safe and listened to. Every effort is made to protect the residents. Evidence: A complaints procedure is in place and available to the residents and their families and friends, it is easy to read with clear instructions. We spoke with one resident who told us I know how to make a complaint and who to talk to if I have any concerns. Another resident when asked if they knew how to air their concerns said I know who to go to if I have any concerns. We looked at the records for complaints that the service had received, these were very comprehensive and the records indicated what action had been taken and if the complaints had been substantiated. The staff we spoke with were aware of the procdeure for making a complaint and they were also aware of issues relating to abuse, safeguarding adults and their responsiblity to raise any concerns that they may have with the management. We looked at the training records for staff and these indicated that staff have received training in issues relating to abuse. We noted that the service has meetings for residents that is used as another forum in place for allowing residents to express their views and concerns; we saw minutes of these meetings and how concerns are dealt with. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is still capacity for the service to offer a well maintained and safe environment. Evidence: The home was found to be clean and tidy and no offensive odors were detected. We noted that some improvements have taken place since our last visit, some rooms have been re carpeted, some have new furniture, a new call bell system has been installed and a new boiler. The service has continued to provide more profile beds, the manager explained to us that there were plans to re furbish the bathrooms and shower rooms. One residents room was in total need of re refurbishment, there were areas on the walls that had no paint on whatsoever, one wall was covered in empty raw plug holes and the chest of drawers was in need of mending. The area outside at the back of the house has been tidied up but there are still areas that are unsightly. Care Homes for Older People Page 17 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvement in training means that there are better outcomes for people using the service. Staffing levels could be improved which would result in better outcomes for the people using the service. Evidence: We looked at the duty rosters for the present week and the past two weeks, they showed adequate staffing levels although at times not sufficient to meet the assessed needs of the residents; however the manager did point out that there were fewer residents at the moment and as soon as the occupancy rode she would then increase the staffing levels. One member of staff commented that sometimes staffing levels are no too good as did one resident although we did note on the day of our visit call bells were being answered within a reasonable time span. The service has managed to not use agency staff and therefore there has been an effort to maintain continuity of care. The records show that 51 0f carers have a level 2 NVQ qualification and the rest are working towards this. Records for newly appointed staff were looked and these were seen to reflect a robust checking system before staff start; however we did note that one staff member had Care Homes for Older People Page 18 of 25 Evidence: been recruited without written references. Discussions with staff led us to believe that they have a good understanding of their roles, they told us that they felt supported by the management and that they had been doing more training sessions they also felt that they had been given sufficient knowledge to give the appropriate care to each resident. A recently employed registered nurse informed us that they had undergone an induction that was very thorough. We saw records for induction of new staff and also for training, we noted that the staff were going to partake in more training sessions particularly in relation to specific needs of some of the residents. Care Homes for Older People Page 19 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements are meeting the needs of the residents. Evidence: We looked at records for formal supervision these were with regard to all staff except the Registered Nurses and the manager. The manager is aware of this and is endeavoring to ensure that the Registered Nurses including herself receive formal supervision. When we spoke with staff members they confirmed that they had supervision sessions and found them useful especially in relation to their professional development. Those residents and relatives we spoke with were aware of the management arrangements for the home and felt that the home had been better managed recently and that the manager was easy to access. Whilst we were on our visit to the home a number of callers wished to speak with the manager, she made herself available to them some were professionals and some were relatives. The service has carried out an audit for monitoring the quality of the services it offers Care Homes for Older People Page 20 of 25 Evidence: and addressed some of the issues that it highlighted. The service also holds meetings for staff, residents and relatives, we saw minutes of these meetings and some of the issues discussed and how they had been actioned. We looked at records for servicing of appliances that are used in the home, these were good and up to date. We carried out a random check of residents monies that are held in the home for hairdressing, chiropody and small items of shopping; the receipts and balances all tallied. The home audits the monies monthly and the transactions are always carried out by two people. Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 (2) 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. 13/04/2008 2 9 13 (2) 13/04/2008 Care Homes for Older People Page 22 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 People who use the service 07/04/2009 and are prescribed p.r.n. (as required) medication must have care plans in place for this activity. This is to justify its continued use. 2 19 23 The care home must be kept 12/08/2010 in a good state of repair externally and internally. This means that the residents do not live in an adequate environment. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 It is recommended that all residents are assessed to establish their mental capacity and that this information is recorded on care plans and reviewed at apprpriate intervals. This will help to ensure the safety of the residents and their mental well being. It is recommended that the carers whose first language is Page 23 of 25 2 10 Care Homes for Older People not English refrain from talking in their first language to each other whilst giving care. 3 4 5 12 29 36 It is recommended that all activity participation be recorded and reasons for non participation. It is recommended that two written references are obtained for all new recruits. Ensure that all staff are appropriately supervised. Care Homes for Older People Page 24 of 25 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - 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!