Inspection on 28/06/06 for St Paul`s Care Home

This inspection was carried out on 28th June 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 Paul`s Care Home 20/11/08

St Paul`s Care Home 23/11/07

St Paul`s Care Home 27/10/05

St Paul`s Care Home 19/07/05

St Paul`s Care Home 12/10/04

St Paul`s Care Home 13/05/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

Thorndene

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE St Paul`s 65 Albany Road St Leonards On Sea East Sussex TN38 0LJ Lead Inspector Liz Daniels Key Unannounced Inspection 28th June 2006 12:00 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 Paul`s DS0000014047.V290418.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 Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Paul`s Address 65 Albany Road St Leonards On Sea East Sussex TN38 0LJ 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) 01424-425798 StPauls@New-Meronden.co.uk www.newcenturycare.co.uk New Century Care (Hastings) Limited Margaret Law Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25), Physical disability (25) of places St Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is twenty-five (25) Service users must be aged sixty-five (65) years or over on admission Service users with a physical disability can also be accommodated Date of last inspection 27th October 2005 Brief Description of the Service: St. Paul’s is a detached property that has been converted and adapted as a care home. It is owned by New Century Care Ltd and provides nursing and personal care for up to 25 residents of an older age, including those with physical disabilities. The accommodation is arranged over three floors, with a shaft lift providing access to all floors. There are three double bedrooms, two of which have en-suite facilities and nineteen single rooms, seven with ensuites. The home has hoists, bath hoists and an assisted shower room, for those who are less mobile. There are also grab rails and disability aids in the bathrooms and toilets. A large spacious lounge/dining room, with access to a patio area outside, provides communal space and at the front of the home, there is a parking area for several cars. The home is situated in a residential area of St. Leonards on Sea and is on the bus route for the shops at Silverhill or for the town of Hastings. The home welcomes prospective residents or their representatives to view the premises, discuss their needs with the Registered Manager and spend time with the staff and residents. Weekly fees, as at 3/5/06, range from £450 - £625. The fees do not include hairdressing, chiropody, residents’ telephone calls and any sundries, such as newspapers: these are charged as extras. Information about the service is available on the organisation’s website (New Century Care) and from the home’s Manager. St Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced. It included a visit to the home by an Inspector, which began at 12midday and lasted for nine hours. The Manager facilitated the visit and the Area Manager also attended for part of the time. It provided the opportunity to talk with them, the Deputy Manager, two care staff and one of the catering staff, before spending time with several residents sitting in the lounge and meeting one of them in the privacy of their own room. Many of the residents are frail and it was therefore not possible for the Inspector to seek their views: no visitors were available to meet with the Inspector during the site visit. The Inspector also toured the premises and examined records that included resident’s files, medication records, staff files, training records, the accident log and the complaints log. Evidence contributing to this inspection has also been gathered from previous inspections, surveys circulated to residents and their relatives (eight of which had been returned to the Inspector) and from data provided by the Registered Manager of St. Paul’s. All of the key standards, together with those where concerns had been raised at the last inspection, were inspected. There were 24 residents on the day of the site visit. What the service does well: What has improved since the last inspection? Six Requirements from the last inspection have been met, whereby information about the service is now readily available and the privacy for one particular occupant has been improved. The risk from a hazard in the home has been reduced, the home is now fresher and monitoring of the hot water and testing of the fire alarms protects the safety of the residents. In addition the home has developed models of care that improve continuity for the residents and they are publicising the staff team to help residents and their relatives recognise staff, know them by name and therefore feel more confident about who they are talking to. St Paul`s DS0000014047.V290418.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. St Paul`s DS0000014047.V290418.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 Paul`s DS0000014047.V290418.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Good information about the service provided at St. Paul’s has been produced, and a thorough assessment of prospective residents takes place, ensuring a resident’s individual needs can be met. EVIDENCE: The Resident’s Guide for St. Paul’s is included in a ‘Welcome Folder’, which is available in the main entrance hallway of the Home. It is up to date and comprehensive: the Manager confirmed that New Century Care could provide a copy in varying formats to suit individual need, on request. A copy of the guide is given to prospective residents and a copy has been put in each room for current residents. Also included in the folder is the analysis of the last survey conducted amongst residents and their relatives, as well as the most recent inspection reports from the Commission. The organisation’s website also has a link that enables access to view the Commission’s inspection reports for the home. ‘Thank you’ cards and tributes are also publicised in the folder and a copy of the home’s complaints procedure is available in the guide as well as being displayed in the front entrance of the Home. A ‘photo board’ which St Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 9 includes all the staff, is on display in the main hall to enable residents and their relatives to be familiar with the staff team. As has been found at previous inspections, it is usual practice that, following an enquiry, prospective residents or their relatives are invited to visit St. Paul’s and spend time with the Manager and staff, view the available rooms and discuss the home’s suitability. If they then wish to pursue an admission, the Registered Manager or her deputy undertakes an assessment in their own home or if they are in hospital, they visit them there. A comprehensive proforma is completed. The Manager confirmed that she also asks for information from the prospective resident’s Care Manager, or from nursing and medical staff if the person is in hospital. However, their written assessment is rarely available before the home’s assessment is undertaken. If the home is suitable, a letter is sent to the person, or their relatives, to confirm that the home can meet their assessed needs. Once funding has been agreed, if it is needed, they are then admitted for a trial period. One resident who met with the Inspector, had been admitted four weeks previously. She could recall the deputy manager coming to see her and chatting about her needs. She had been unable to view the Home but her son had been on her behalf. Three rooms were available and he was therefore able to choose her room. She felt she had had ‘good information about the home.’ Four resident’s files were viewed during the inspection. All had comprehensive pre-admission assessments in place and the information gathered had been used to underpin a plan of care for each resident. Each of the four residents had also had nursing assessments on the day of admission. St. Paul’s does not provide Intermediate Care, although residents are admitted for planned respite care. Very occasionally, emergency respite care is also provided. St. Paul’s also offers a ‘Step Up/Step Down’ provision, which is funded by the Primary Care Trust (PCT). For this, residents are admitted to St. Paul’s for a definitive period of time. There are a set number of therapy hours provided and the aim of the programme is to provide a rehabilitation period (usually following discharge from hospital) prior to a resident being transferred home. There is no dedicated accommodation provided: residents admitted for the ‘Step Up/Step Down’ programme are integrated with the long-term residents in the home. St Paul`s DS0000014047.V290418.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The comprehensive care plans promote individualised health and personal care for the residents and the practises in place encourage residents to be cared for with respect and dignity. EVIDENCE: The care files for four residents were reviewed. All had care plans and risk assessments to reflect the individual needs of the resident. All had been reviewed monthly and there was evidence that they had been updated. A ‘Daily Record Sheet’ is completed for each resident, recording any significant events: any changes in care are also passed on verbally in the handover between each shift. The care plan is shared with the residents, or if more appropriate a relative, and they sign it to demonstrate this. The condition of residents’ skin is assessed and monitored: any pressure areas are recorded and if a sore develops the treatment and outcome is documented. The Manager confirmed that advice is sought from a private company specialising in tissue viability. However there is no protocol in place to meet the National Institute for Clinical Excellence (NICE) guidelines for pressure area care: these recommend that any person who develops a Stage 2 pressure sore is referred to a nurse specialist, enabling the resident to have expert advice and an St Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 11 individualised plan of treatment. The home undertakes trials with different dressings, as appropriate, with the signed consent of the resident or their relative. Alternatively the home refers residents back to the GP and a district nurse is asked to visit. There are various types of pressure relieving mattresses and cushions, including air overlay mattresses, to support the management of pressure areas at St. Paul’s. Resident’s dependency is also assessed and the risk of falling is identified. The home has electric hoists, (last serviced in February 06) and there is a wheel-in shower and hoist-assisted baths for those with reduced mobility. Grab rails are fitted in the toilets and raised seats are available; there are also adjustable beds. Each resident has a continence assessment as part of their admission and if necessary they are seen by the continence nurse specialist. All the carers have been trained in incontinence care and catheter care. Nutritional screening is also undertaken and resident’s weights are monitored. The chiropodist visits the home every 6 weeks or more frequently if needed and arrangements are made for residents to see a dentist or optician as needed. A key-worker system is just being introduced, to improve continuity of care for the residents. The plan is that there will be a photo of the key worker for each resident in their room with their name, to help them identify who to link with if they have any concerns or worries. Where possible residents remain registered with their own GP or they register with a GP of their choice. No current residents wish to self-medicate. A resident’s medication is discussed at their pre-admission assessment and the Manager assesses whether it is appropriate for them to self medicate if they wish to do so, recording it as a Risk Assessment. If they are assessed as safe, the resident, their GP and the Registered Manager, signs a consent form which is then kept in the resident’s file. All rooms have a lockable space where the resident can keep a month’s supply of medication and the staff then monitor the Medication Administration Record (MAR chart) and check that the medication is being taken. The medications for the remainder of the residents are stored in a clinical room, with some stock in a wall cupboard, but most in a medicine trolley. Residents have an individual space or tray where their ‘as required’ (PRN) medications are kept. The majority of medication is dispensed in blister packs. The ‘Controlled Drugs’ (CDs) are stored appropriately and an accurate correct record kept of their administration. There is a drug fridge and the temperatures are recorded daily. The MAR charts for all the residents had all been correctly completed on the day of the visit. The name of residents with their photo, accompanies their MAR chart. The trained nurses at the home administer medications; they have all had in-house training with the Boots pharmacist and then have an annual update. Carers assist in the administration of medication if it is at mealtimes and it is easier for a resident to take it with their meal. They are not involved in the administration of CDs. Medication ready for disposal is then recorded and signed for by a trained nurse: the value of two nurses checking this medication and signing for it was St Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 12 discussed and agreed. Medications in the home are audited twice yearly by a Boots pharmacist. Staff who met with the Inspector confirmed that they aim to support residents by providing personal and nursing care where needed, but at the same time they endeavour to maintain privacy and dignity, showing respect when residents are undergoing examinations or personal care. Resident’s telephones were seen in some of the rooms and all residents seen were appropriately dressed for where they were. Screens are provided for those residents in double rooms and during the visit, staff were observed to be attentive and courteous. At the last inspection it was highlighted that a communal bathroom with a door that led into a bedroom did not protect the privacy of the resident occupying that room. This has now been addressed and the door has been locked ensuring no resident can walk from the bathroom into another resident’s room: this meets the Requirement from the last inspection. St Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 13 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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The choices of food and recreational pursuits that are available, must be circulated to all residents in the home, to ensure that their social, cultural, religious and recreational interests and needs are met. EVIDENCE: There is a large lounge/dining room at St. Paul’s, enabling the residents to sit together and watch television, read or meet with their visitors. Videos and various games are available, as well as a selection of books. There are now two ‘Activity Co-ordinators’ in post, who job-share and organise an activities programme. A notice board in the main hall of the home has a plan of the activities available over the next month. There is one event planned per week and the Manager explained that other ‘ad-hoc’ events are arranged dependant on the weather and staff availability. The co-ordinators also spend time with each resident, supporting them individually by shopping for them, chatting with them, writing and posting letters for them if they wish or providing activities such as foot spas and hand massages. A newsletter has just been introduced highlighting any special events and any resident’s birthdays that will be celebrated. This is also available in the main hallway. One resident attends a social club in Rye each week, a manicurist St Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 14 visits the home each month and a hairdresser each week. Resident’s meetings are held within the home every 3 months, although the Manager explained that they are not well attended. Arrangements are made if residents wish to receive communion or attend church services and the home currently celebrates the Christian festivals. There are several nurses and carers employed from overseas and although there have not been celebrations for other festivals the Manager explained that the nurses and residents chat about their different cultural backgrounds. The Manager is therefore confident that the home could meet the needs of residents with varying social and cultural needs. Social and emotional needs are identified in the care plans and the staff who spoke with the Inspector felt the residents are encouraged to maintain any hobbies they may have, if possible. One resident who spends most of her time in her room said she ‘can’t go downstairs much, so I don’t really know what goes on’. However she enjoys watching television. Of the service user surveys returned to the Inspector prior to the visit, 62.5 of the respondents said there are ‘always’ activities for them to take part in, 15 said ‘usually’ and 15 said ‘never’. One resident commented that they had ‘never been a partaker of group activities’ and another that they are ‘quite happy to sit in my room’. The value of providing more structured activities and circulating the plan and the newsletter to those residents, who spend more time in their room, was discussed and agreed. Some of the residents manage their own financial affairs but in general relatives or solicitors act on their behalf. Some residents choose to keep money in their room in a lockable cupboard or drawer, whilst others prefer that their money is held in the home’s safe. It is kept in separate wallets and accounted for individually. If staff are asked to shop for a resident, receipts are obtained. The home does not act as the appointee for any resident. Previous inspections have found the food provided at St. Paul’s is varied and enjoyed by the residents. Meals can be eaten in the lounge / dining room where there is a dining table at one end or individual tables. Alternatively some residents prefer to eat in their own rooms. The menu seen by the Inspector was nutritious and varied. Two choices of meal were available for lunch, except on a Wednesday and a Sunday when a roast lunch is prepared. There is a light tea of soup, sandwiches and a dessert. The menu is displayed on the hall table and on the dining table. The Manager explained that residents are asked their choice for lunch and that there are also standard alternatives available if residents prefer. It was agreed these should be publicised on the menu and that those residents who cannot access the menus currently displayed, may benefit by it being circulated throughout the Home each week. One resident who met with the Inspector described the food as ‘mostly good’, whilst in the surveys returned, 75 responded that they always like the food, 12.5 said ‘usually’ and 12.5 said ‘sometimes’. The Inspector was able to see supper being served and enjoyed by residents in the lounge / St Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 15 dining room: all ate from individual tables on that occasion. The kitchen and storage areas were viewed. Fresh fruit and vegetables were evident and food was appropriately stored in the fridges and freezers. Some residents also have small fridges in their rooms to enable them to keep cold drinks or particular choices of fresh food. St Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 16 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a satisfactory complaints procedure and residents are confident that their views are listened to and acted upon. Safe measures are being put in place to ensure residents are protected from abuse. EVIDENCE: As stated earlier in this report, the home’s complaints procedure is displayed in the main hall and in the Resident’s Guide. There is a policy within the home that clearly identifies timescales for any concerns or complaints to be investigated and a response to be given. The outcome of any investigation would be fed back to the complainant. The resident who spoke with the Inspector during the site visit and the service user surveys received, all expressed confidence in the Management Team; 75 of them responded that they ‘always’ know who to speak to if not happy. The Commission has not received any complaints about the service since the last inspection and the last entry in the home’s complaints log was in September 04. This was discussed and the Manager explained that it has not been the home’s practice to document concerns that are managed informally, if it seems the issue has been ‘dealt with’ and the person concerned appears happy with the outcome that has been reached. It was agreed that there was value in recording any concerns raised and the action taken, as the severity of the query is not always initially identifiable. The home introduced a ‘Comments and Suggestions’ Book during the site visit, in line with the organisation’s current policy. The Manager confirmed that all staff will be made aware of the need to record any concerns or suggestions for improvement, that are raised with them. St Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 17 Adult Protection policies and procedures continue to be in place and Criminal Record Bureau (CRB) Disclosures are now applied for as part of the recruitment process. All staff have now been trained or updated in ‘Adult Abuse’ within the last two months. A copy of the East Sussex multi agency guidelines is available in the home and the home works to the organisations policies for the management of adult abuse and for whistle blowing. The Area Manager described a recent situation and the action taken, which clearly demonstrated that the home knew the appropriate action to be taken to protect an individual’s interests. St Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 18 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, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. St. Paul’s provides a safe, place for residents to live although the general décor now needs improving to ensure it is a pleasing and homely environment for residents. EVIDENCE: St. Paul’s is a detached property that has level access to the front entrance, suitable for wheelchairs. It is situated in a residential part of St. Leonards on Sea, and with easy access to shops, the sea front and the railway station. There is a large entrance area and a spacious lounge / dining room as communal space, where activities can be held and where residents can relax or chat together. Accommodation is arranged over 3 floors and each floor can be accessed by a shaft lift. There are also two half landings and the rooms on those are accessed by chair lifts. All radiators are guarded and emergency lighting is provided throughout the home. Thermostatic controls are fitted to the water outlets in bathrooms and en-suite facilities. At the last inspection the water temperature checks had not been recorded. The maintenance staff St Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 19 now check the outlets each month and record the temperature of the water. Magnetic door guards have been fitted to the fire doors throughout the building that need to be held open and to each bedroom door, enabling residents to choose to have their door open. The home is comfortably furnished and resident’s rooms are individualised with their personal possessions and in some cases small items of their own furniture. Each room is lockable and residents are offered their own key if appropriate. At the last inspection a door accessing steep steps leading down to the food storage area in the basement was left unlocked. This presented a hazard, as the door was not labelled. A sign has now been put in place to warn staff and residents of the steep stairs immediately inside the door. In general the home has been well maintained but as identified at the last inspection, it is due for refurbishment. Overall the general décor continues to show evidence of wear and tear; some of the stair carpeting is worn, wallpaper is scuffed and the paintwork is chipped, both in the communal areas and in resident’s rooms. The fire alarm is checked quarterly and last tested in May 06. Records show that alarms in different zones are activated each week on a rotational basis to ensure they sound and the fire doors close. Random fire drills also occur, during daytime and evenings whereby both groups of staff are involved. The Manager is confident that as most of the night staff work ‘set nights’ all staff attend sufficient drills. The value of developing a matrix was raised to enable monitoring that all staff attend the required number of fire drills. At the last inspection the home was found to have an odour in some areas although the general environment has always looked clean. At this visit the home smelt much fresher and 100 of the respondents in the service user survey answered that the Home is ‘always’ fresh and clean. The laundry room is situated whereby infected or soiled linen is not carried through areas where food is prepared or stored. The room has an impermeable floor and the wall finish allows easy cleaning. There is a washing machine with a 90°C wash and a sluice facility. Policies are in place for managing infected linen and it is washed separately to other laundry. There is also a sluice room, containing a disinfector. St Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 20 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, 29 and 30 Quality in this outcome area is good. This judgement has been made using evidence including a visit to the service. Residents are protected by the recruitment procedures in place, although there are insufficient staff that are appropriately qualified or receive the required training to ensure residents are in safe hands at all times. EVIDENCE: St. Paul’s has a registered nurse on duty for the full 24-hour period. Four carers support him or her during the morning, three in the afternoon and evening and two at night. The Manager works some shifts as the nurse in charge and some shifts as an extra, enabling her to provide staff support and to complete administrative work. These numbers appear adequate for the number of residents that the home is registered for. Agency staff are very rarely used as the organisation has its own ‘bank’ of staff to provide temporary cover. A cook and cleaning staff, maintenance and gardening staff are also employed. Of the fourteen care staff, six have or are currently studying for the National Vocational Qualification (NVQ) level 2. It is the home’s policy that any new care staff are recruited with a view to them undertaking the ‘Skills for Care’ Induction and Foundation, leading into the NVQ level 2 if they do not already have it. Four staff files were inspected during the site visit. All had CRB disclosures, two references and a completed application form containing all the appropriate St Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 21 information. One member of staff’s CRB had been received four months after her start of employment last year. The Manager explained that she had undertaken two supernumerary shifts and had a ‘Bank’ contract. She had never worked as the nurse in charge of the shift at the home. The Manager is responsible for organising all ‘Bank’ cover and new staff’s names are not put onto the ‘Bank staff’ list until their CRB has been received. A ‘Protection of Vulnerable Adults First’ (POVA First) check is applied for, for all new recruits, enabling staff to be employed to work under supervision until the full CRB disclosure is received. Copies of birth certificates and passports were held and each had a copy of the contract with terms and conditions of employment. An annual training programme is in place for both the trained nurses and the care staff. The mandatory training including fire training, ‘Moving and Handling’ and ‘First Aid’ are scheduled, but there is also specialist training specific for the needs of the residents currently at St. Paul’s. All training is held in work time whereby staff have a minimum of three paid training years per year. St Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 22 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, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using evidence including a visit to the service. St. Paul’s is well managed and there are good quality assurance processes in place to ensure that the home is run in the best interests of residents, ensuring the residents are kept safe. EVIDENCE: The Manager at St. Paul’s is a registered nurse with considerable experience in caring for the elderly and she has attained her Registered Manager’s Award (RMA). A deputy manager supports her in leading a team of carers and ancillary staff and it is anticipated she will be undertaking her RMA in September this year. An Area Manager for the organisation visits the home at least once a week. One member of staff commented that ‘the Management Team are very supportive’ and another that ‘the residents are well cared for’. St Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 23 The home undertakes annual service user surveys as part of its quality assurance. These are analysed and the results publicised within the home. A copy of the feedback and an analysis of the results are included within the ‘Welcome Folder’ in the main hallway. The analysis is also fed-back to staff at staff meetings and any areas for improvement are discussed. A questionnaire has just been devised to send out to stakeholders: a copy was shown to the Inspector and it is anticipated it will be sent out in July or August. The plan is that it will be analysed in the same way as the service user surveys and similarly publicised and discussed. The organisation has an Annual Development Plan for the home and it has been found at past inspections that this is moulded and changed, dependant on current issues and the needs of the residents. The Area Manager confirmed that this ethos continues. As stated earlier in the report, some of the residents manage their own financial affairs but in general relatives or solicitors act on their behalf. The Head Office for the organisation holds individual accounts for some residents and their personal allowance is then sent out from that account, to the home. A balance of their account is held on computer. The resident then has a choice how their money is spent. Some residents have money brought into the home by relatives: residents can then either keep it in their room or it is held in the office safe, in individual wallets. Individual records of expenditure are maintained and receipts are kept for any items purchased. The Inspector viewed the receipts, money and records that were being held for residents at the time of the visit and all were found to be accurate. Prior to the site visit the Manager returned data to be considered as part of the inspection. The training matrix included within that, shows that some staff had not had their mandatory annual training in fire procedures or ‘Moving and Handling’. However there are training sessions for these scheduled within the next few months and the Manager is confident that all staff will therefore have their mandatory updates this year. Similarly many of the staff have not been trained in ‘First Aid’ and ‘Food Hygiene’: these sessions are not currently scheduled on the home’s training plan for the year. Maintenance records were not explored in full at this inspection as the data previously provided by the Manager suggests that all checks are maintained. The Accident Log for the home was viewed: slips, trips and falls have been recorded and appropriate action taken. The Manager explained that she monitors all the accidents and therefore identifies if there are any trends and the action needed to reduce that trend. St Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 24 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 St Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 25 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 OP8 Regulation Schedule 3 (3)(n) 12 (1) 13 (1) 2. OP19 23(2)(b)( d) Requirement A protocol, that meets the NICE guidelines by ensuring residents are referred to a tissue viability nurse specialist if they develop a Stage 2 pressure sore, must be in place. Parts of the Home are showing signs of wear & tear and should be considered for re-decoration. This is an outstanding Recommendation from the last inspection. At least 50 of care staff must be qualified to NVQ level 2 or above. Staff must have their mandatory training updates in Fire and First Aid. Staff must be trained in Food Hygiene. This is an outstanding Requirement from the last inspection. Timescale for action 31/08/06 31/12/06 3. 4. OP28 OP38 18 (1)(ac) 18(c)(i) 31/12/06 30/09/06 St Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP9 OP12 OP15 Good Practice Recommendations Medication for disposal should be checked and signed for by two nurses. Residents should be made aware in advance, of the facilities and activities available to them, enabling them time to make a choice about their involvement. Residents should be made aware in advance, of the menu and any alternatives that are available should be included on it, enabling them to have time to make a choice. St Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Paul`s DS0000014047.V290418.R01.S.doc Version 5.2 Page 28 - 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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