Inspection on 02/02/06 for St Oswalds Nursing & Residential Home

This inspection was carried out on 2nd February 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Oswalds Nursing & Residential... 23/04/09

St Oswalds Nursing & Residential... 18/08/08

St Oswalds Nursing & Residential... 19/12/07

St Oswalds Nursing & Residential... 17/07/07

St Oswalds Nursing & Residential... 29/06/06

St Oswalds Nursing & Residential... 02/09/05

St Oswalds Nursing & Residential... 04/01/05

St Oswalds Nursing & Residential... 27/05/04

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

CARE HOMES FOR OLDER PEOPLE St Oswalds Nursing & Residential Home 2 Crowhall Lane Felling Gateshead Tyne & Wear NE10 9PX Lead Inspector Mr Tom Moody Unannounced Inspection 2nd February 2006 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 Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 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 Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Oswalds Nursing & Residential Home Address 2 Crowhall Lane Felling Gateshead Tyne & Wear NE10 9PX 0191 495 0585 0191 438 1722 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) None Four Seasons Healthcare (England) Limited (Wholly owned subsidiary of Four Seasons Health Care Ltd) Care Home 70 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (64), of places Physical disability over 65 years of age (52), Sensory Impairment over 65 years of age (9) St Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. One person under the age of 65 who also has a physical disability. Date of last inspection 2nd September 2005 Brief Description of the Service: The home is in an urban setting close to local facilities. The home extends to four stories. It is contains 70 registered beds. Social care is provided on the ground floor and social care for service users with dementia is provided on the top floor. The middle two floors provide nursing care. The home is of traditional appearance with a tiled roof. It has one passenger lift and because it is built on rising ground there is access to the outside from the two lower floors. For the same reason views from some of the lower floor windows are restricted. There is a lounge and dining room on each floor with additional lounge space close to the first floor entrance. The home has a patio area and a large care park. The grounds are landscaped. St Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day in February commencing at 10am. One inspector was present throughout the day. The manager and staff were spoken to as well as service users and relatives. Care plans and other documentation were examined and a tour of the premises took place. Verbal feedback was given to the manager, on the day, on the main findings of the inspection. The home is reasonably well equipped with appropriate aids and adaptations in bathrooms and toilets. The decor is suited to the client group’s age and lifestyle preferences. The home has plenty of space in all areas. It is popular with service users and their families. What the service does well: What has improved since the last inspection? A permanent manager has been appointed. Staff morale has improved and staff are volunteering ideas to improve the quality of service user’s lives. Qualified nurses feel they are supported by the manager. The quality of care plans has improved in most of the examples seen. The grounds have been tidied and there is a lot less litter outside the home. Some decoration has been carried out to improve the appearance of the home. St Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 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 Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 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 Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 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): 3, 4 Although most service users have a comprehensive assessment of need this is not so in all cases. EVIDENCE: Most service users have an assessment carried out by the referring agencies as well as senior staff at the home. There has been an improvement in care planning and most examples seen were comprehensive. One example of a care plan was seen where no assessment of needs, or plan of care, had been made out by home staff. Staff are aware of service user’s needs when they are asked about this, however this needs to be formalised into a written care plan. St Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 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, 8, 9, 10 Although one care plan indicated that needs are not assessed in every case the majority of needs were accurately assessed and this would contribute to health care needs being met. Medication policies are robust and the home is operating these to ensure service users receive appropriate medication. The care practice that was observed would promote service users privacy and afford them respect. EVIDENCE: Most service users have a comprehensive care plan that addresses all aspects of their care, including healthcare. Documents contain references to service users being referred to healthcare professionals and clinical specialist. Care plans also record GP visits. Staff are aware of services such as chiropody and other services offered by primary healthcare teams. It was observed that one service user was attending a hospital out patients appointment and had been provided with an escorting staff member. GP’s were seen carrying out visits during the inspection. St Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 Page 10 Medication storage was appropriate although one clinical area was left unlocked with medication and other substances unsecured. Recording of medication is carried out thoroughly. The home has appropriate policies and procedures. Staff were observed to knock at doors before entering. Service users were addressed respectfully using appropriate terms of address. Bedroom doors were locked if this was the service user’s choice. Service users who needed support were assisted in a way that preserved their dignity. St Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 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, 14, 15 Most service users have had accurate assessments of there needs and preferences including accurate assessment of social care needs. There is a variety of social events organised that includes the opportunity to go into the local community or have contact with family friends and others from outside the home. Service users are offered a varied diet that is wholesome and appealing, however, as noted in the last inspection, the dining environment is deteriorating and does not enhance mealtimes. EVIDENCE: The kitchen staff are committed to providing meals that meet service user’s expectations and preference. Thee is a good variety of meals listed on the menus. Service users confirmed this and spoke highly of the quality of meals. Unfortunately the dining rooms, and the attached kitchenettes, were not well cleaned and maintained. There were food splashes on walls, skirting and radiators. Tables and chairs were scuffed and there was food debris left on the floor from the previous meals. Although cleaning staff are working hard there St Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 Page 12 does not appear to be enough domestic hours to ensure the home is kept clean. Most care plans now contain detailed social assessment and list service users preferences and dislikes. Care plans also note the service user’s preferred term of address. There is a programme of activities displayed on the notice board and the manager spoke of small scale activities being organised in addition to these. This included a visit to the local social club. Several service users confirmed this had taken place. The service users also spoke positively about the introduction of the managers dog and stated they appreciated it’s presence. h St Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 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, 18 Service users and relatives told inspectors they would be happy to bring problems to the attention of staff or the manager. Although the homes whistle blowing policy has some deficiencies the staff feel more supported in raising issues of practice with the new manager. This will improve protection for service users. EVIDENCE: Service users said that they were happy to raise issues with the manager or the staff in the home. Relatives also confirmed this. The new manager of the home is aware of the homes history and past events. The manager spoke of starting regular staff meetings. Staff confirmed these took place regularly. Qualified staff felt they were more supported in challenging poor practice and felt more secure in their role. However, the company’s whistle blowing policy still encourages written disclosure. This may discourage whistle-blowing by concerned staff. St Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 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): 19, 20, 21, 23, 24, 25, 26 The main systems in the home are maintained in a safe condition however fire precautions and drug storage arrangements should be observed to ensure that service users are safeguarded. Service users have access to communal facilities that meet their needs. Service users bathroom and lavatory facilities are sufficient to ensure service user’s safety. Most service users have bedrooms that are furnished to their own taste and meet their needs, however, one bedroom was not adequately heated. The home is not well cleaned in many areas and odour was noticeable in some bedrooms. This poses a potential hazard to the safety of service users in relation to hygiene and infection control. St Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 Page 15 EVIDENCE: The handyman in the home has improved the paintwork in many areas although some refurbishment still needs to be carried out. There is a wide variety of communal space and the patio area at the back of the home has been developed. The procurement of a canopy and garden furnishing has transformed this area to a useful amenity space. The home was not well cleaned in many areas. Although cleaning staff were busy, vertical surfaces were stained in many areas with food or other organic matter. Many surfaces were scored and damaged and this would not allow proper cleaning to take place. There is still bad impact damage around doors. The small kitchens on each floor were in need of refurbishment. Sealant around sinks was discoloured or badly damaged. The floors in these areas are badly discoloured and need to be thoroughly cleaned. Paintwork in these areas, as well as in parts of the dining rooms, is stained and worn. Some toilets were not cleaned promptly, this and soiled paintwork would discourage service users from using these facilities. A number of carpets were worn and stained. Although some corridor carpet has been replaced this has been done with a uniform black colour that gives a drab and “industrial” effect. It is far from “homely”. Some fire doors were being held open and others were obstructed by trolleys. This was brought to the managers attention during the inspection. Service user’s bedrooms were well furnished and contained personal items. They reflected the taste of the occupants. One bedroom was particularly cold and the radiator was not producing an adequate amount of heat. In addition the windows in this room had been taped to reduce drafts. It has been noted in earlier reports that the type of lock in use did not ensure privacy for service users St Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 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, 28, 30, There were sufficient care staff on duty, however the home may have a shortfall in domestic hours and, therefore, may not meet all the needs of service users. Training takes palace and staff are competent enough to ensure the safety of service users. EVIDENCE: The registration of this home as a Care Home Providing Nursing does not seem to reflect the way the home operates, in that there are separate floors providing only social care. It was suggested in the last inspection report, staffing levels and the current registration of the home should be reviewed in light of this. There have been no changes in this. There were sufficient nursing and care staff on duty to meet service user’s care needs. The manger also confirmed that there had been an increase in domestic hours allocated to the home. This may still be not adequate for the size and complexity of the home and the type of service user cared for. There was still a lack of cleanliness in some parts of the home. A number of staff spoke of having received training in the Protection of Vulnerable Adults (POVA) procedures and prevention of elder abuse. The manager spoke of some staff that have received training in dementia care and this is being extended to all staff. Training materials were seen. St Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 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, 32 33, 38 The home is managed by an experienced and conscientious manager who has a good approach to running the home. The homes philosophy and statement of purpose is appropriate and staff act in service user’s best interests. Although most aspects of heath and safety are adequate there are some potential hazards that could put service users at risk. EVIDENCE: The manager of the home is not yet registered with the regulating authority although she has been a registered manager in other homes. She is an experienced registered nurse. The manager said that she had started regular staff meetings and had carried out an audit of staff perceptions of the home. St Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 Page 18 Staff confirm this and expressed positive views about this. Survey documents were seen. Qualified nurses stated that they now felt well supported by their manager. Most aspects of health and safety were addressed and most staff had a good awareness of risk. There were some exceptions. Some fire doors were held open or potentially obstructed by trolleys. The lack of hygiene in some areas was potentially problematic. The failure to secure a clinical area is also a potential hazard. St Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 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 2 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 x 3 2 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x x x x 2 St Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? yes 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 OP8OP7 Regulation 14 Requirement Timescale for action 31/03/06 2 3 OP9 OP38OP19 4 5 OP25 OP26 Assessments must be thorough to ensure that all aspects of the service users’ care needs have been identified and care plans formulated to address those needs. 13(2)(4a) Service users medication must be stored safely in accordance with professional guidelines. 16, 23 The home should be maintained in a safe condition suitable for it’s stated purpose and all precautions taken to prevent accidents or hazards to occupants. 23(2p) The home should be adequately heated in all areas. 13, 16, 18 The home must be kept clean and sufficient staff employed to maintain it in a hygeinic condition. 28/02/06 15/03/06 15/03/06 15/03/06 St Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 Page 21 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 OP14 Good Practice Recommendations It is recommended that the type of locks be replaced to ensure service users can control entry to their rooms. St Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Oswalds Nursing & Residential Home DS0000018178.V268213.R01.S.doc Version 5.1 Page 23 - 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. 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