Inspection on 01/06/05 for St Peter`s Court Nursing Home

This inspection was carried out on 1st June 2005.

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 Court Nursing Home 07/08/07

St Peter`s Court Nursing Home 04/09/06

St Peter`s Court Nursing Home 18/01/06

St Peter`s Court Nursing Home 16/11/04

St Peter`s Court Nursing Home 05/05/04

St Peter`s Court Nursing Home 26/01/04

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

CARE HOMES FOR OLDER PEOPLE St Peters Court Nursing Home Spital Road Maldon Essex CM9 6LF Lead Inspector Lysette Butler Unannounced Wednesday 1st June 2005 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 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 Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service St Peters Court Nursing Home Address Spital Road Maldon Essex CM9 6LF 01621 840466 01621 840801 admin.stpetersscourt@careuk.com Care UK Community Partnerships Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Penelope Irene Heap Care Home 24 Category(ies) of Dementia (24), Dementia - over 65 years of age registration, with number (24) of places St Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 Persons of either sex, aged 60 years and over, who require nursing care by reason of dementia (not to exceed 24 persons). 2 Persons of either sex, aged 65 years and over, who require nursing care by reason of dementia (not to exceed 24 persons). 3 The total number of service users accommodated must not exceed 24 persons. Date of last inspection 16 November 2004 Brief Description of the Service: St Peters Court is a care home with nursing for 24 Older People with Dementia. A multidisciplinary team that includes Registered Mental Nurses, Care Assistants, and other professionals allied to medicine, deliver care that enables the service users to live safely and securely. The care environment consists of a purpose built bungalow style accommodation, situated in the grounds of St Peters Hospital in Maldon, Essex. There are eight single and eight double rooms. All service user rooms are on the ground floor, with staff areas only on the upper floor. St Peters Court is part of Care UK Community Partnerships Limited. St Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took seven hours on Wednesday 1st June 2005. Twenty-two of the thirty-eight National Minimum Standards were inspected during this visit. It was found that many of the standards had been met or partially met. The overall care and well being of the residents was very good; staff and visitors were welcoming and happy to speak to the inspector. During this visit the inspector spoke to four relatives/significant others; eight staff members including the administrator; the maintenance person; one of the housekeeping staff; the laundry person; one Registered Nurse and three care assistants. The inspector also spent time with the acting manager and relatives of the residents who expressed satisfaction with the care offered and with the quality of the food. What the service does well: What has improved since the last inspection? What they could do better: An occupational therapy assessment should be carried out in the home to assess if the environmental needs of the residents are being met to the fullest extent. Water temperatures at the point of delivery do not comply with current legislation. The number of domestic hours allocated is not sufficient to keep the mal odours in the home to a minimum. St Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 Page 6 Induction programmes were not being correctly completed and did not protect the safety of the residents. 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 Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection St Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 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 standard(s) 3, 4 & 5. Standard 6 is not applicable at this home. The choice of home is based on clinical need and multidisciplinary assessment, ensuring that the residents are in the right home environment. EVIDENCE: All service users at this home are admitted from the Drake House assessment centre, which is a National Health Service centre. All beds are block purchased by the National Health Service. However the manager has the final say on who is appropriate for the home and the current service users. The acting manager using Care UK paperwork carried out initial assessments at Drake House. A number of other assessments are used to assess the needs of the residents. Reassessments were carried out regularly to make sure that the needs of the residents were being met. The inspector reviewed the assessments of the last two admissions to the home. The paperwork was good, but had not been signed or dated by the assessor. The residents’ family and friends mainly supplied the information for the life histories, with clinical input from the staff of Drake House. St Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 Page 9 Staff training is linked to the needs of the residents with specific reference to dementia care. The registered nurses in the home are mostly mental health trained. Trial visits are not normally offered as residents find a visit too confusing. Relatives are asked to visit the home if they wish to. However a number of the residents regularly attend the home for respite care, which means that the residents and relatives get to know the home and the staff before they are admitted on a permanent basis. There had been a recent change in protocol concerning admission from Drake House, so that residents are admitted on a trial basis and can be readmitted if found to be unsuitable for St Peters Court. Intermediate care is not offered at this home. St Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9, 10 & 11. Health & personal care procedures, privacy & dignity issues and medication procedures at this home were good and protected the safety of the residents. EVIDENCE: All indicators examined during this inspection suggested that the staff looked after the resident’s health and personal care needs. Three care files were reviewed during this visit. There had been a general improvement in the quality and content of the care plans in use at the time of this inspection. Regular reviews had been undertaken and separate falls documentation was completed as necessary. One file showed changes had been made to the care plan when new problems arose or incidents/accidents happened. Another of the files reviewed was of a resident who had been going to the home regularly for respite but had been permanently admitted to the home on the day of this visit. The care plan had been reviewed at each visit to the home. Residents were given access to all medical professionals needed, or requested. Nutritional assessment was undertaken on admission and regularly there after. The retained GP attended the home on a Wednesday and at other times as requested on a form put together for that reason. The forms were then kept as a record of the request. The GP was at the home at the beginning of this visit seeing a resident who was unwell. Regular healthcare appointments took place St Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 Page 11 in the home due to the residents’ level of dementia. If hospital appointments were necessary a member of care staff went with them in booked hospital transport. Pressure relieving equipment was in use throughout the home and at the time of this inspection there was one resident with a pressure sore. Medication procedures were good. Registered Nurses administer all medications. Due to the mental capacity of the service users in this home, written permission had been sought from their relatives to disguise medications, if needed. The Royal College of Nursing had developed the forms signed by the relatives.. There were no controlled drugs in the home at the time of this inspection. The manager has improved communications between the home and the dispensing pharmacist, which has lead to a better service to the home. The retained GP reviews all medications on a regular basis. Personal care in the home was good; residents were dressed in age appropriate cleanly laundered clothing. Staff ensure that the privacy and dignity of the residents is protected. Visitors to the home spoken to were complimentary about the home and felt that the residents were well looked after. Induction policies & procedures included information on privacy & dignity issues, with the companies’ expectations of conduct by the staff. The resident’s preferred name was highlighted in the care plan and used by the staff. Individual care plans contained funeral and resuscitation instructions signed by the resident’s family. The home often accepted residents back from hospital for terminal care so that the resident was in familiar surroundings. Accommodation for families at the end of their relative’s lives is difficult but can be arranged if required. All staff attend bereavement training. St Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12. The activities in the home are varied and concentrate on the individual needs of the residents. EVIDENCE: The activities coordinator works in the home full time, but the hours are divided between care hours and activities. The hours are flexible and the coordinator frequently works with the residents on a one-to-one basis. Activities are often arranged on the day with very few planned ahead. The relaxation room had recently been dismantled following a Health & Safety Executive visit. The room was now being used as an activities room where the coordinator can work with a few residents at a time. The coordinator also arranged activities in the lounges and limited trips outside of the home. The manager and inspector discussed specialised training for the activities coordinator. There was no hairdresser visiting the home at the time of this inspection, but the care staff and coordinator do hairdressing and beauty therapy as part of the home’s activities. St Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 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 standard(s) EVIDENCE: These three standards were not looked at during this visit. St Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 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 standard(s) 19, 20, 21, 22, 23, 24, 25 & 26. The general environment of this home was good. The housekeeping staff and maintenance person keep the home clean, light and airy. EVIDENCE: There had been no change to the fabric of the building since the last inspection. All areas of the home were toured during this visit. Redecoration of the home was ongoing, but the home is in need of a more major ‘face lift’, with consideration of replacing carpets and curtains. More pastel colours were being used in the redecoration. The maintenance person works three days per week. The atmosphere was homely, with pictures and personal furnishings throughout. There was a new canvas ‘pagoda’ in the patio area of the home that produced a shaded sitting area. There is a small fishpond in the garden area that residents only go out to with care staff. There were no issues with fire protection in the home following a fire officer’s last visit. There are four lounge areas in the home, one of which is used as the activities room. The other three lounges had various uses. Only one resident was a smoker at the time of this inspection and they sat outside to smoke with a St Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 Page 15 member of care staff. The communal dining area was bright and inviting. Residents mainly had the meals in the dining area but some were fed in their rooms. Bathrooms and toilets were all marked with appropriate pictures to aid the resident’s recognition of the rooms. The double rooms in this home are the only ones with ensuite facilities. The local continence nurses worked in conjunction with the home’s staff to improve the continence of the residents. The home has two sluices. At the time of this inspection one was clean and tidy, the other was untidy, dirty and unlocked. However the manager was informed, the room was locked immediately and was clean before I left the home. The home had very little storage space but what there is was used well. The home’s hoists and therapeutic baths were all serviced during this visit. An occupational therapy assessment needs to be undertaken in the home. Rooms had minimal freestanding furniture because of the levels of dementia in the home. One resident was holding his own room key at the time of this inspection. The hot water sink tap in one of the rooms was continuously registering temperatures above 50oC. A new part had been on order for two months. Other maintenance records were all up-to-date and correct. All windows had restrictors fitted. At the time of this inspection there was one domestic staff member who came on duty at about 10.00. The staff stated that only one was on each day and they did not start until 10.00 so that they can clean the dining area after lunch before finishing their shift. On arrival at the home there were mal odours throughout the home, although this had improved before I left, mid afternoon. The laundry room was neat and tidy with a one-way ‘in/out’ system of work. The room was small and was in need of better ventilation. Both washing machines had sluicing facilities. St Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 & 30. Staffing numbers are generally good and their training was up-to-date ensuring the staff had the appropriate skills to care for the residents. . EVIDENCE: There is a good multidisciplinary staff team in this home that work together for the benefit of the residents. Care staff hours were slightly in excess of those required, because of the levels of dementia experienced by the residents. There was still a high level of agency staff in the home, but there was an active recruitment process ongoing at the time of this inspection. The administrator operates a Commission for Social Care Inspection folder that allows the inspector to access all paperwork needed for an inspection. When checked at this inspection folder was up-to-date and it contained copies of current/past two weeks, staff rotas. I was therefore able to check staffing numbers quickly and accurately. However housekeeping staff numbers were not adequate for the number and type of resident at this home. Training offered to staff was varied and complied with all statutory requirements for this home. At the time of this inspection nine care staff had achieved National Vocational Qualifications at level 2 or above and five were undertaking courses. Three staff training files were reviewed during this visit. Staff spoken to stated that training offered by Care UK was very good, varied and related to residents with dementia. A training matrix for all the staff was maintained and there were also individual training plans for staff in their personnel files. One of the care staff spoken to had recently returned to St Peters and she said that the training offered was one of the reasons for her return. Care UK operates a comprehensive induction programme for new staff. St Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 Page 17 However there was evidence that one of the programmes had been inappropriately completed. The manager was aware of the problem and the member of staff involved was due to be interviewed by the manager. St Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 & 32. The management and administration of this home was very good and ensured a good working environment. EVIDENCE: The acting manager was welcoming and helpful throughout the inspection. She is on a six-month secondment to the post that is up for review in the next couple of months. She has applied to start the Registered Managers Award and is awaiting a start date. If her post is confirmed as permanent a Commission for Social Care Inspection registration application will be forwarded to the local office of the Commission. The manager is a Registered Mental Nurse with a lot of experience with dementia. She demonstrated good leadership skills and staff liked her management style. They felt respected and included in the running of the home. Her communication skills were good and the ethos in the home was very good at the time of this inspection. There was a strong team spirit in the St Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 Page 19 home and morale was good, which benefited the residents and their care. Staff and visitors said that there was a family atmosphere in the home. St Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x COMPLAINTS AND PROTECTION 3 3 3 2 3 3 2 2 STAFFING Standard No Score 27 2 28 3 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 3 x x x x x x St Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 25 Regulation 13 (34a/b) Requirement Water temperatures must not exceed 43degrees centigrade at the point of delivery. (Thermostat fitted before publication of report. Temperatures within required limits.) Induction programmes must be completed correctly to ensure the safety of the residents. Timescale for action 31st July 2005 2. 30 18 (1a-c) 31st July 2005 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 22 26 27 Good Practice Recommendations The proprietors should consider a full occupational therapy assessment of the home. The manager should ensure that the home remains odour free at all times. The proprietors should continue their recruitment drive for new housekeeping staff. St Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 1st Floor, Fairfax House Causton Road Colchester Essex, CO1 1RJ 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 Peters Court Nursing Home I05-I56 S15361 St Peters Court V228793 260505 Stage 4.doc Version 1.30 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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