Inspection on 01/03/06 for St Peter`s House

This inspection was carried out on 1st March 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 Peter`s House 18/12/08

St Peter`s House 06/02/07

St Peter`s House 05/09/05

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

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

CARE HOMES FOR OLDER PEOPLE St Peter`s Cottage Nursing Home 29 Out Risbygate Bury St Edmunds Suffolk IP33 3RJ Lead Inspector Kevin Dally Unannounced Inspection 1st March 2006 02:30 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 Peter`s Cottage Nursing Home DS0000064425.V285420.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 Peter`s Cottage Nursing Home DS0000064425.V285420.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Peter`s Cottage Nursing Home Address 29 Out Risbygate Bury St Edmunds Suffolk IP33 3RJ 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) 01284 706603 01284 706811 County Care Homes Limited Post Vacant Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places St Peter`s Cottage Nursing Home DS0000064425.V285420.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th September 2005 Brief Description of the Service: St Peters Cottage is a privately owned care home with nursing, and is registered to accommodate up to 15 Older People. The home is situated on a main road out of Bury St Edmunds, opposite the West Suffolk College. It is within a residential area close to facilities, such as shops and churches. The building, which is set in its own grounds with ample car parking, has an enclosed garden and patio area at the rear. The accommodation is partly in a converted domestic dwelling and partly in a purpose built extension. All rooms are on the ground floor and are single, five with en-suite facilities. St Peters recently changed ownership, and the new owners, County Care Homes Ltd, plan to extend the premises. There are two lounges and a dining room. There is access to the garden from all bedrooms and communal rooms St Peter`s Cottage Nursing Home DS0000064425.V285420.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report follows a routine unannounced inspection of St Peters Cottage Nursing Home, which was carried out over a 4.5 hour weekday period between 2.35 pm and 7.10 pm. Mrs Pam Noble-Partridge, the proposed manager, was present throughout the afternoon and was available to answer any questions. Residents, relatives and staff members were spoken with about the service, and some administration records were checked. A brief tour of the premises was completed. This inspection revealed that of the 30 standards inspected, 24 were assessed as “fully met”, and 6 standards as “almost met”. Standard 15, meals and mealtimes, was assessed as “exceeding the standard”. What the service does well: What has improved since the last inspection? Service and care improvements continue to be developed including the implementation of new detailed care plans, close monitoring of falls and accidents, and the appropriate storage of medication. Previous concerns around markings on some hallway carpets, and recruitment procedures have been addressed, and staff supervision was being undertaken. Staff training and development continued to be developed for staff. St Peter`s Cottage Nursing Home DS0000064425.V285420.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 Peter`s Cottage Nursing Home DS0000064425.V285420.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 Peter`s Cottage Nursing Home DS0000064425.V285420.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): 3,4,5 People can expect to have their care needs assessed prior to admission and will know whether or not the home is able to meet their needs. EVIDENCE: Residents and relatives were spoken with about the care offered by the home. One resident stated that they were personally happy with the home, and that they usually saw the manager during the week. Two relatives spoken with stated they visited twice a week and their impressions of the home were excellent. Prior to their relative’s admission they had been shown around the home by the staff who were courteous and helpful. Further, the home was without odour, and their initial impression of what they saw was very good. The relatives thought that first impressions were important, and these had not changed since their first visit, some months ago. One resident’s records were checked and were found to contain a detailed assessment of this resident’s care needs. St Peter`s Cottage Nursing Home DS0000064425.V285420.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): 7,8,9,10,11, People can expect to receive good quality planned nursing care with adequate risk assessment of residents needs. Based on service users comments, people can expect to be treated with respect and be encouraged to maintain their independence. EVIDENCE: The home had introduced a new care plan format, which provided a sequence of assessment of a resident’s care needs. This included various risk assessments and outcomes, from which a detailed care plan could be developed. At the previous inspection some care plans were noted as not having been fully developed. One resident with high care needs was selected and their care plan checked. The resident’s care plan was found to provide a very detailed and holistic plan of care and the records had been reviewed and updated on a regular basis. St Peter`s Cottage Nursing Home DS0000064425.V285420.R01.S.doc Version 5.1 Page 10 Assessments included a “Health and Social Assessment” form, which incorporated 19 areas of basic assessed personal needs. Further, the plan included a manual handling assessment, a Waterlow pressure area risk assessment, a nutritional screening assessment and a falls risk assessment. The resident’s weight had been monitored on a monthly basis. Residents, relatives and staff members spoken with confirmed that the home met the resident’s healthcare needs. The records of one resident who had experienced a high number of falls confirmed they had been carefully monitored by the home. This included the use of a body chart, falls assessment, the use of protection aids, accident reporting and monitoring. This enabled the home to assess why the falls had occurred, and how to reduce these. The resident had only experienced 1 fall since a new strategy had been implemented a month ago. Residents confirmed that they had access to their own Doctor, the Dentist, the Chiropodist and the Optician, when required. The new care plans included a separate record of any Doctors, Dentists or Chiropody visits. The home’s medication system was checked and this revealed that medication was now stored in a locked metal medication trolley. The home used the Medication Dispensing System (MDS) with prepared blister packs, and Medication Administration Record (MAR) sheets. Registered Nurses would check a resident’s records and administer medication directly to them. One nurse maintained overall responsibility for the ordering of medication each 28 days and had a system in place to ensure that ordering and sufficient stock was maintained. At the previous inspection the home was required to provide a more suitable medication cabinet and this has been provided. Further, the home was required to produce more detailed guidance on the administration of Controlled Drugs, (CD’s) and which was still required, including the process required for the storage, administration and disposal of CD’s. The medication policy should also be further developed to include who is responsible for the medication ordering procedures, and the systems currently used including the system for record keeping. The medication policy should also include whether there are any special requirements around the administration of specialised medication, for example insulin. Residents and relatives spoken with confirmed that staff respected residents privacy, and provided care in a supportive and dignified manner. Records checked revealed that the home maintained records of a resident’s wishes in the event of the death of the resident. St Peter`s Cottage Nursing Home DS0000064425.V285420.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, People can expect a positive lifestyle that enabled residents to participate in personal, social and leisure activities within the home or community. Relatives and friends can expect to be made welcome when visiting the home. Residents can expect to receive very good meals that are nutritious, balanced which meets their needs. EVIDENCE: Discussion with residents, relatives and staff members confirmed that residents are able to follow their own routines and a variety of leisure and personal pursuits. One resident confirmed they were able to choose when to rise in the morning, and staff would respect their requests to remain in bed should they so choose. Residents and staff spoken with confirmed that the home had different activities that residents could pursue including visiting the hairdresser, exercises to music, scrabble, card games, reading, and a prayer meeting to attend. The local Chaplin held regular communion for those interested residents. One resident stated they spent two mornings a week attending a day centre and two mornings with their relative within the community. Meal times also provided a good social time to gather with other residents and discuss the day’s events. Residents are able to choose where they eat their meals, including their own room or in the dining room. St Peter`s Cottage Nursing Home DS0000064425.V285420.R01.S.doc Version 5.1 Page 12 One resident’s records checked revealed that individual interests, likes, dislikes and preferences are recorded within their care plan. Families, friends and representatives are welcomed at the home and relatives and friends were seen visiting on the day of the inspection. Residents and relatives spoken with confirmed that friends and family were able to visit the home with out restriction. The home had worked very hard to further develop their rolling menu, which offered residents a well balanced, varied and nutritious diet. The evening meal was said to be a lighter meal but also offered a hot food option. The meal on the evening of the inspection looked and smelt very appetising and was very well presented. Alternatives were either Tuna Bake Pie or a salad sandwich, and dessert was Bakewell tart or milk jelly. Residents confirmed that this was a very good meal. The menu plan for the remainder of the week revealed a good variety of very well considered meal choices. Blended meals were offered to those requiring soft diets and components would be liquidised and served separately on the plate to maintain a variety of textures, flavours and colours. Most residents chose to eat in the dining room, although meals could be taken in the privacy of residents’ rooms. Drinks were available throughout the evening and the evening meal was unhurried with sufficient time given to residents to eat in comfort. A large selection of fresh fruit was available for residents in the dining room. One resident revealed that the meals were “very nice, with two options”. Further, that they had ordered and received a cooked breakfast that morning. Two relatives spoken with stated that their relative “eats extremely well, that the meals were home cooked, and that the staff will make anything for you”. Due to the quality of the meals provided by the home, this standard was assessed as “standard exceeded”. St Peter`s Cottage Nursing Home DS0000064425.V285420.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 People can expect to have their complaints taken seriously and acted upon. Resident’s safety, including by appropriate training and recruitment checking, can be expected. EVIDENCE: The home had a complaints policy, which included appropriate details about how a complaint can be made to the home. The home had a complaints book in operation, which showed that three complaints had received since the last inspection. These complaints had been investigated and responded to by the home. On the day of inspection residents spoken with said that they felt safe at the home and felt confident that they could talk to staff, if they had any concerns. One staff member’s records checked revealed that the home had undertaken a Criminal Bureau Record check (CRB), a Protection of Vulnerable Adults (POVA) check, two reference checks, and proof of identity checks. St Peter`s Cottage Nursing Home DS0000064425.V285420.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): 19,20,21,22,23,24,25,26 People can expect a safe well maintained environment, which would be clean, hygienic, and odour free. They can also expect to have the aids and equipment to meet their individual needs. EVIDENCE: St Peter’s Cottage is a privately owned care home with nursing, and is currently registered to accommodate up to 15 Older People. The building, which is set in its own grounds has an enclosed garden and patio area at the rear. The accommodation is partly in a converted domestic dwelling and partly in a purpose built extension. All rooms are on the ground floor and are single, five with en-suite facilities. St Peters Cottage changed ownership in 2005, and the new owners, County Care Homes Ltd, plan to extend the premises, and upgrade the existing building. There are two lounges and a dining room. There is access to the rear garden from all bedrooms and one of the communal rooms. St Peter`s Cottage Nursing Home DS0000064425.V285420.R01.S.doc Version 5.1 Page 15 A brief environmental tour of the premises was undertaken which included checking two lounges, two bathrooms, the hallway areas, the dining room, the staff room, and several residents’ rooms. These were found appropriately decorated with fixtures, fittings, and carpet to most areas. Some of these areas were showing signs of ageing, but positively the owners were addressing this by a redecoration programme. Residents’ personal rooms were found adequately decorated, comfortable, and maintained. Since the last inspection the hallway carpets had been thoroughly cleaned. At the previous inspection the owners confirmed that some carpets will be replaced after completion of the new building programme. This inspection required one resident’s torn bed base to be replaced. Some residents’ wheelchairs were left outside their rooms in the hallway, and which may pose an obstruction to these areas. These were required to be moved and appropriately stored. The home had a variety of aids, adaptations and a call bell system. On the day of the inspection the home was found to be clean, hygienic and odour free. The bathrooms, toilets and bedrooms seen were provided with liquid hand wash and paper hand towels. Residents, relatives and staff spoken with confirmed that the home was always maintained in a clean and hygienic state, and that there were never any unpleasant odours. A sample of hot water tap temperatures revealed that these were maintained around the recommended guideline of 43 degrees Celsius. Further, radiators had been provided with protectors for residents’ safety. The laundry was checked and found that there were appropriate washing machines with foul linen cycle washes. St Peter`s Cottage Nursing Home DS0000064425.V285420.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): 27,29,30 People can expect that the home will be appropriately staffed. People can expect effective staff recruitment, training and supervision procedures. EVIDENCE: The home ensured that there is a registered nurse on duty each shift, and in addition to the nurse, 3 care staff on an early, 2 on a late, and 1 at night. On the afternoon of the inspection, 1 registered nurse and 2 care staff were on duty in addition to the manager. Further, two kitchen assistants provided cover during the teatime period until 6.30 pm. Comments received from residents, relatives and staff members confirmed that sufficient staff numbers were maintained to meet resident’s care needs. One resident stated that staff were “pretty good, with good levels of staff on duty, and that they were courteous and polite”. One staff member confirmed that consistent numbers of staff were maintained. One new nurse’s employment records were checked, and these included a Criminal Record Bureau check (CRB), Protection of Vulnerable Adult (POVA) check, two written references, their personal details, proof of identity, their Professional Identity Number (PIN), and an application form. Staff members spoken with confirmed they received training and updates relevant to their job. One nurse confirmed that they had received induction training and this was recorded within their records. St Peter`s Cottage Nursing Home DS0000064425.V285420.R01.S.doc Version 5.1 Page 17 This included moving and handling training, infection control, emergency first aid, health and safety training, food hygiene and fire prevention training. The manager provided a staff training and development programme, which recorded when the training had been delivered. However, there were a number of gaps within the training records, were required to be updated, to evidence all completed training. St Peter`s Cottage Nursing Home DS0000064425.V285420.R01.S.doc Version 5.1 Page 18 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, 35,36,38 People can expect the home to be properly managed and which has an open atmosphere. They can also expect a safe environment. EVIDENCE: Residents, relatives, and staff spoken with confirmed that the management were approachable, and were making all efforts to improve the service. This included upgrading the environment, maintaining the cleanliness of the home and improving the meals. There is still a plan to extend the home and further upgrade the existing premises. The manager continues to focus on improvements around the nursing care provided, and care records have been significantly improved. Staff confirmed that the manager was available most days for advice and support. The manager has now been in post 9 months, but the Commission has not yet received her application for registration. St Peter`s Cottage Nursing Home DS0000064425.V285420.R01.S.doc Version 5.1 Page 19 This was discussed with the manager and it was agreed that this must be forwarded to the CSCI without delay. This is an outstanding requirement from the previous inspection. Two residents’ personal finance records were checked and the cash held balanced with the cash recorded. Each transaction record had been appropriately checked by two staff members and signed. Staff spoken with and records checked revealed that supervision was undertaken on a regular basis. Staff had received relevant health and safety training appropriate to their job roles. The home was being properly maintained and relevant maintenance records maintained. Fire records checked revealed that these were up to date, and that regular fire alarm checks were completed. It was noted that there was no fire risk assessment in place, and which was immediately required. The home provided Control Of Substances Hazardous to Health (COSHH) sheets for staff information, but a locked COSHH cupboard had not been provided for the safe storage of any harmful substances. This was required to be immediately addressed by the home. St Peter`s Cottage Nursing Home DS0000064425.V285420.R01.S.doc Version 5.1 Page 20 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 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 x x 3 3 x 2 St Peter`s Cottage Nursing Home DS0000064425.V285420.R01.S.doc Version 5.1 Page 21 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 OP9 Timescale for action 13(2) The Controlled Drugs policy must 31/03/06 be further developed to be clear about the process required for the storage, administration and disposal of Controlled medication. This is an outstanding requirement from the previous inspection. 13(4)(a)(c Wheelchairs must be 31/03/06 ) appropriately stored to avoid hallway obstruction. This is an outstanding requirement from the previous inspection 16(2)(c) A torn bed base must be 30/04/06 replaced. 17(2) Staff training records must be 30/04/06 Sch updated to evidence when staff 4(6)(f) have received training sessions. 8(1)(a) The proposed manager must 31/03/06 forward an application for registration to the CSCI without delay. This is an outstanding requirement from the previous inspection. 13(4)(a) A lockable COSHH cupboard 31/03/06 (c) must be provided for the safe 23(2)(l) storage of dangerous substances. Regulation Requirement 2 OP19 3 4 5 OP24 OP30 OP31 6 OP38 St Peter`s Cottage Nursing Home DS0000064425.V285420.R01.S.doc Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Medication policy should be further developed to include who is responsible for the medication ordering procedures, and the systems currently used including the system for record keeping. Medication policy should include whether there are any special requirements around the administration of specialised medication, for example insulin. 2 OP9 St Peter`s Cottage Nursing Home DS0000064425.V285420.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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