Inspection on 19/11/07 for St Peter`s Nursing Home

This inspection was carried out on 19th November 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Peter`s Nursing Home 04/01/07

St Peter`s Nursing Home 05/01/06

St Peter`s Nursing Home 20/06/05

St Peter`s Nursing Home 08/12/04

St Peter`s Nursing Home 21/06/04

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

CARE HOMES FOR OLDER PEOPLE St Peter`s Nursing Home Council Avenue Northfleet Gravesend Kent DA11 9HN Lead Inspector Lisbeth Scoones Key Unannounced Inspection 19 November 2007 09:55 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 Nursing Home DS0000026205.V350807.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 Peter`s Nursing Home DS0000026205.V350807.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Peter`s Nursing Home Address Council Avenue Northfleet Gravesend Kent DA11 9HN 01474 335241 01474 537242 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) Ranc Care Homes Limited Mrs Carol Ann Merry Care Home 56 Category(ies) of Dementia - over 65 years of age (56) registration, with number of places St Peter`s Nursing Home DS0000026205.V350807.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th January 2007 Brief Description of the Service: St Peter’s Nursing home is a large detached listed building with a purpose built extension. The home provides care and accommodation for 56 older people with dementia and nursing needs. The accommodation is in three units. Acorns provides accommodation for 8 people in 2 single and 3 double rooms. Vines provides accommodation for 22 people in 6 single rooms and 8 double rooms and Shamrock provides accommodation for 26 people in 14 single rooms and 6 shared rooms. The home is situated about three miles from Gravesend and a main line station. Fees range from £591.61 to £795. St Peter`s Nursing Home DS0000026205.V350807.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on 19th November 2007 and comprised discussions with the registered and clinical managers, two unit sisters, two staff nurses and other care staff. A tour of the premises was undertaken and documentation perused in respect of care plans, medication records, complaints, menus, staff rotas, policies and procedures, financial records, risk assessments and audits. During the visit, many residents and two visiting relatives were spoken with. The inspection was further informed by an AQAA (annual quality and audit) completed by the manager prior to the inspection. Surveys were sent to the residents, relatives and staff and some of these were returned. Comments thus received are incorporated in the report. The CSCI has received no complaints since the previous inspection. What the service does well: There is a friendly and comfortable atmosphere in the home. The impression is given that people living at the home are happy and feel well cared for. The manager and her staff are approachable and the home is well managed. Staff say that they are well supported. The care planning process continues to develop focussing on person centred care. Good risk assessments inform the care plans which are regularly reviewed. The home promotes Equality and Diversity. The company has an Equality and Diversity monitoring group. Two full time activity co-ordinators provide a varied and stimulating programme of activities for the people living at the home. Staff are well trained and good training records maintained. Robust recruitment procedures are in place. Good monitoring and quality assurance systems are in place. St Peter`s Nursing Home DS0000026205.V350807.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. St Peter`s Nursing Home DS0000026205.V350807.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 Peter`s Nursing Home DS0000026205.V350807.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents and their relatives have access to detailed information to ensure that they make an informed choice about the home. All residents have a signed contract or terms and conditions. However for selffunding residents these need to be reviewed to comply with the regulation. A good pre-admission assessment ensures that only those residents are admitted whose needs can be met. St Peter`s Nursing Home DS0000026205.V350807.R01.S.doc Version 5.2 Page 9 EVIDENCE: A newly updated Statement of Purpose was seen on display. Residents and their families are supplied with a Service User Guide. All residents are issued with terms and conditions of their stay and a contract if they are placed there privately. A sample of contracts for self-funding residents was examined. These lack clarity in respect of the way the “free” nursing care contribution would be deducted form the weekly fee. It was agreed that such contracts would be reviewed. The Office of Fair Trading report “Fair Terms for Care” (2005), available at www.oft.gov.uk applies. The manager or her deputy carry out a detailed assessment of need prior to offering a place at the home. St Peter`s Nursing Home DS0000026205.V350807.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10,11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a good standard of care planning and their health care needs are fully met. Residents benefit from policies and procedures in respect of the safe administration of their medication. Residents benefit from staff who respect their privacy and dignity. EVIDENCE: A sample of care plans was examined and discussed with senior staff. In general these demonstrate that staff are provided with comprehensive information to enable them to care for the residents. Care plans are personcentred, informed by a range of risk assessments and regularly reviewed. There was evidence that relatives are aware of the content of the care plan. St Peter`s Nursing Home DS0000026205.V350807.R01.S.doc Version 5.2 Page 11 Biographical details are included. The format is to be further enhanced and a “map of life” introduced. Staff would benefit from such information as it gives them a better insight in the residents’ life and experiences, likes and dislikes. A new care planning tool is to be introduced. The benefits of the new approach (which incorporates Equality and Diversity) to residents and staff were discussed. Good daily records are maintained. Minor recommendations were made in respect of wound care evaluation and elimination recording. Residents are regularly seen by their GP and other health professionals such as continence advisor, tissue viability nurse, chiropodists, opticians, dentists and community psychiatric nurses. It was recommended that all visits by professional be recorded on the designated page in the care plan. Since the previous inspection, medication administration procedures have been strengthened. Medication charts were checked and found to be correct. Good auditing systems have been introduced and regular staff training updates provided. Both clinical rooms are in need of decorating in respect of new floor covering and wall damage. The need for a work surface and a hand wash facility in one of the rooms was discussed. Medical examinations and consultations take place in residents’ own rooms. In shared rooms adequate curtains have been provided to ensure privacy. The home has a visitors’ room. Staff interact with the residents in a respectful manner. All staff knocked on bedroom doors before entering and responded quickly when help was called for. Residents’ relatives spoken with confirmed that staff respect their relatives’ privacy and dignity. Care plans contain an End of Life plan and a section “In the event when someone passes away”. This is good practice. St Peter`s Nursing Home DS0000026205.V350807.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from maintaining contact with family/friends and the local community as they wish. Residents, including those who remain in their bedrooms, benefit from a programme of activities, which ensures stimulation and enjoyment. Residents are enabled and encouraged to stay in control of their lives by the choices they are offered though the day. The home provides a choice of nutritious well-balanced meals that take into account special diets or other nutritional needs St Peter`s Nursing Home DS0000026205.V350807.R01.S.doc Version 5.2 Page 13 EVIDENCE: The home has two activity co-ordinators who encourage residents to participate in individualised activities. These may be arranged in the lounge, snoezelen room or in a room, which has been made to look like a 1950’s living room. Activities are extended to those residents who are confined to bed. An activities programme was seen on display and records of activities taken part in are contained in residents’ care plan. Visits to local amenities are undertaken. The sensory garden has improved and provides a tranquil environment with lavender and rosemary. The manager said that more rose gardens are to be created at the back of the home. It was evident that visitors arrive any time of the day. Several visitors spoke about their experience of visiting the home on a daily basis and had nothing but praise for the staff at the home. Recently, following consultation with the residents, the menus have been revised affording choices and alternatives. Wholesome meals are provided. Laminated menus are to be provided for ease of residents’ use. St Peter`s Nursing Home DS0000026205.V350807.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives know that the home takes all complaints seriously and use the outcomes to improve the quality of service offered. Residents are protected from abuse. EVIDENCE: The home has a clear complaints procedure, referred to in the statement of purpose and service user guide. Those complaints received have been investigated and acted upon. “A visitor said I have no complaints”. Another, “They are very good.” The home ensures the residents are safeguarded from any abuse, neglect or harm by robust policies and procedures. Staff receive regular training. Staff spoken with demonstrated a good awareness of what constitutes abuse and the steps to take to report to the appropriate authorities. St Peter`s Nursing Home DS0000026205.V350807.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a clean, pleasant, safe, comfortable and wellmaintained environment. EVIDENCE: A tour of the building was undertaken. The home was clean, free from offensive odours and in good decorative order. The home was pleasantly warm except in two areas on the top floor used for activities. At the time of the visit these were not in use and it was said that portable heating would ensure a comfortable temperature. In discussion with the manager it was agreed that the heating supply to this area would be looked into. St Peter`s Nursing Home DS0000026205.V350807.R01.S.doc Version 5.2 Page 16 The old features in some of the old part of the building have been preserved and generally the home has a homely feel. Since the previous inspection, a new platform lift now links the stairs at the end of the corridor to the Acorns Unit. This provides easier access to residents with a mobility problem. Good safety measures are in place and risk assessments carried out. Accidents are well recorded and audited. Residents’ bedrooms are fitted with devices that hold the doors open but automatically close when the fire alarms go off. Due to uneven flooring in some parts of the building, it was said that such devices do not always function well. It was recommended that suitable and safe alternatives be found. The home has carried out a fire risk assessment and staff receive regular fire training. Next session is due on 22 November. St Peter`s Nursing Home DS0000026205.V350807.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are met by sufficient numbers of motivated and well-trained staff. Residents are protected by the home’s recruitment procedures. EVIDENCE: The rotas seen demonstrated that staffing levels are good and ensure that residents’ needs could be met. Each unit is staffed individually with two trained staff and 10 carers on duty during the day. The manager confirmed that staffing would be increased if there were a special need. The home also employs catering, domestic and maintenance staff. Staff spoken with confirm that they work as a team. “This is a good place to work with on the whole a stable staff”. “Very pleasant”. “A family atmosphere.” Relative spoken with praised the staff. “They manage my husband very well”, “They keep me informed”. “They know my relative well.” St Peter`s Nursing Home DS0000026205.V350807.R01.S.doc Version 5.2 Page 18 A sample of staff files evidences that good recruitment procedures are in place. The staff working in the home are encouraged to undertake an NVQ. Currently 6 members of staff have a level 2 qualification with 9 working towards it. Ten staff have an NVQ in Dementia care. All trained staff are doing a distance learning course in medication. A training matrix demonstrates that all staff are provided with statutory and specialist training such as dementia care, Equality and Diversity and the Mental Capacity Act. Staff files contain individual training assessments and profiles. The home has a multi- cultural work force. Staff receive continual training in the enhancement of communication skills. “Conflict and resolution” training is also provided. All new staff have induction training in accordance with the Skills for Care standard. St Peter`s Nursing Home DS0000026205.V350807.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a well managed home which is run in their best interests. Residents are protected by the home’s financial procedures. Staff are well supervised and supported. Residents’ and staff’ health and safety are promoted and protected. St Peter`s Nursing Home DS0000026205.V350807.R01.S.doc Version 5.2 Page 20 EVIDENCE: The management approach of the home has resulted in an open and inclusive atmosphere. The manager and her deputy work and communicate well together and show a dedication to providing high standards. Good quality assurance systems are in place. These include audits and regular monitoring, policies and procedures review, residents’ and stake holder surveys and formal detailed Regulation 26 visits. The devising of an annual development plan could enhance the system further. The home has suitable accounting and financial procedures in place for the protection of residents’ monies. The manager continues to be an appointee for a few service users but systems are in place to ensure all monies are accounted for. Staff confirmed that they receive regular supervision from the manager and her deputy. Good records are maintained and staff said that they feel the benefit. The AQAA received confirmed that all maintenance contracts and checks have been carried out resulting in a safe and well maintained home. Staff have received training in fire safety, health and safety, food hygiene, and infection control. St Peter`s Nursing Home DS0000026205.V350807.R01.S.doc Version 5.2 Page 21 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 2 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 x 3 St Peter`s Nursing Home DS0000026205.V350807.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP2 Regulation 5 (1) (bb) (4) Requirement That contracts for self-funding residents contain a statement as to how the free nursing component is to be deducted from the weekly fee Timescale for action 31/12/07 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 Refer to Standard OP9 OP33 Good Practice Recommendations That the clinical rooms be upgraded and a hand wash facility provided That an annual development plan be devised St Peter`s Nursing Home DS0000026205.V350807.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Peter`s Nursing Home DS0000026205.V350807.R01.S.doc Version 5.2 Page 24 - 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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