Inspection on 04/01/07 for St Peter`s Nursing Home

This inspection was carried out on 4th January 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 19/11/07

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 Sally Hall Unannounced Inspection 11th December 2006 09:30 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 Nursing Home DS0000026205.V321146.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.V321146.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 Home’s 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.V321146.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Patients detained under Sections of the Mental Health Act may not be admitted to the home Care of one service user is restricted to one person whose date of birth is 25/05/1945. Care of one service user who has a dianosis of dementia whose date of birth is 18/09/41. Care for one service user who has a diagnosis of dementia under the age of 65 whose date of birth is 25.11.1948. 5th January 2006 Date of last inspection 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 service users in 2 single and 3 double rooms. Vines provides accommodation for 22 service users in 6 single rooms and 8 double rooms and Shamrock provides accommodation for 26 service users 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.V321146.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 at St Peter’s Nursing Home took place on 5th January 2007 between 11.30 and 16.30. The link inspector was Sally Hall On the day of the inspection the Inspector agreed and explained the inspection process with the Registered Manager. Time was spent reading a sample of care plans, written policies and procedures and records kept within the home. Staff were spoken to and a tour of premises was undertaken. The focus of the inspection was to assess St Peter’s Nursing Home in accordance with the National Minimum Standards for Older People. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. The home was ask to complete a pre–inspection questionnaire, and to send out surveys to service users, friends/families and other professionals that are involved with the service users at the home. Evidence from these documents is also included in this report. What the service does well: The feedback from the service users families was very good. It was very apparent that their relatives are very happy at the home. The manager and her staff are approachable and the home is well managed. Staff said that they are well supported and the whole home has a family feel about it. The home has a very comprehensive assessment process from which care plans are written and indicate in detail the care required to meet the individual needs of the service user. It was noted that staff regularly review all aspects of the care plans and make changes as required. Daily logs were also informative and comprehensive. There are two activity co-ordinators at the home and between them they have a wealth of experience which they use affectively to ensure all service users have some sort of stimulation during the week. When caring for people with dementia it is often the case that group activities other than sing-a-longs are not always successful, so most activities by the home are one-to-one to suit the service users’’ wishes and needs. St Peter`s Nursing Home DS0000026205.V321146.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.V321146.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.V321146.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, 6 not applicable Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Prospective service users and their relatives have access to the information they require to make an informed choice about the home. There is a system of pre assessment at the home that enables staff to assess the needs of service users prior to and following admission to ensure that service users’ needs are met. EVIDENCE: Service users and their families are given the information they need to make an informed choice about the home prior to trial stay. Service users are issued with terms and conditions of their stay and a contract if they are placed there privately. St Peter`s Nursing Home DS0000026205.V321146.R01.S.doc Version 5.2 Page 9 The home completes a detailed assessment of need prior to offering a place at the home. The manager or her deputy normally undertakes the assessments and they are both trained nurses. As well as the needs of the new service users being considered, so are the needs of the service users with whom the new service users will share. The home receives a referral from the local authority if the service users have a Care Manager. They also send a copy of their assessment and care plan prior to the service user’s admission. The home does not offer an intermediate care service. St Peter`s Nursing Home DS0000026205.V321146.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, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from a high standard of care planning and their health care needs are fully met. The safety of service users may be compromised because the home’s administration and recording of medication is unsafe. The service users benefit from staff who respect their privacy and dignity. EVIDENCE: The care plans and nursing plans seen by the inspector in the files sampled indicates the care and nursing in put required by each individual Service users. These plans are reviewed monthly by staff and before if there is a change in the Service users’ conditions or needs. The daily records seen by the inspector did cover the care provided as detailed in the care and nursing plans. It was evident from the observations of the inspector that Service users are receiving St Peter`s Nursing Home DS0000026205.V321146.R01.S.doc Version 5.2 Page 11 good care and special needs are also being provided as documented in the individual records. In files sampled all accidents reported featured in the accident book. The inspector found that the use of bed rails had been risk assessed and permission had been sought to install these. Health monitoring was evident in the daily records. These also indicated when the GP had been called into give treatment or advice. The care plans detailed the care required for service users with risk of pressure areas or nutritional problems for example. Evidence was seen that health professionals are arranged by the home. These include chiropodists, opticians, dentists and community psychiatric nurses. Medication was checked and audited and found not to be correct. The home is not using a recognised dosage system as recommended by The Royal Pharmaceutical Society Medication guide lines for care homes. The Medication storage room was clean and well organised. All medication was locked in cupboards and there was a facility for the storage of controlled medication. The Medication Record Sheets seen had not been completed fully in all cases. No gaps were seen in the signing of medication but the medication had not actually been given in all the examples audited. The manager was made aware of this and said she would be taking immediate action to ensure all staff followed the procedures for the giving of medication. The manager said she will be auditing the medication system regularly. Medication in stock at the end of the preceding month had not always brought forward. Controlled medication was also seen and recorded correctly. Only the qualified nurses in the home administer medication to Service users. There are no Service users able to administer their own medication at this time. The inspector saw evidence that all medication that is returned to the pharmacy is recorded and signed for. Medical examinations and consultations take place in Service Users’ own rooms. In bedrooms, which are shared, there are adequate curtains to ensure privacy. The home does have a Visitors Room so visits in private can take place. Staff were observed to treat the Service users with respect and took care when enquiring about personal issues. All staff were seen to knock on bedroom doors before entering and responded quickly when help was called for. The Service users’ families spoken to at the time of the inspection confirmed that the staff at the home respect their relatives’ privacy and dignity. St Peter`s Nursing Home DS0000026205.V321146.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. Service users benefit from activities and maintaing contact with family/friends and the local community as they wish. Service users, including those that remain in their bedrooms, benefit from a programme of activities which ensures that all service users have the opportunity of stimulation. Service users 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 any special diets service users may need. EVIDENCE: The home has two activity co-ordinators and most service users are encouraged to participate on mostly an individual basis. The Activity Coordinators arrange activities in the lounge, snoozlem room or in a room which has been made to look like a 1950’s living room. Service users who are St Peter`s Nursing Home DS0000026205.V321146.R01.S.doc Version 5.2 Page 13 confined to bed are offered activities as well. These may be more limited but the staff try to ensure all service users are included through the course of a week. Activities were observed by the inspector through the day and it was evident that they were arranged to suit the needs and aspirations of the service users. When interviewed, the activity co-ordinators staed they were very enthusiastic about what they do. They confirmed they had a budget with which to buy suitable materials and equipment. Both members of staff had worked at the home a long time and were very experienced, but it was also evident that they still look for new ideas to encourage the service users to become motivated. Photos around the home indicated a lot of the craftwork that service users have undertaken and evidenced the activities that took place during the Christmas period. Evidence was seen of visitors coming into the home during day with no restrictions being imposed on these visits. 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. Service users were seen to be offered choices during the inspection. The manager confirmed that service users are offered alternatives at meal times if they do not want the main meal offered at lunch time. The manager was asked to ensure that a real choice is offered everyday at lunchtime not just alternatives. The manager confirmed that the meals are all home cooked and fresh ingredients are used. Family members spoken to said that the meals provided always look appetising and plenty of food was made available. The home also caters for special diets. St Peter`s Nursing Home DS0000026205.V321146.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. The service users benefit from staff knowing how to report any possible abuse, and what immediate action needs to be taken to protect service users. The service users and their relatives benefit from knowing the home takes all complaints seriously, and use the outcomes of them to improve the quality of service offered. EVIDENCE: The home has a clear complaints procedure which was referred to in the statement of purpose and service user guide. The home has not received any complaints since the last inspection. The home ensures the service users are safeguarded from any abuse, neglect or harm by robust policies and procedures. The staff have attended courses in the Local Authorities protocols on Adult Protection, as well as having a copy of the updated policy on file. The manager was reminded that this training needs to be refreshed every three years. Staff, when questioned, were able to give comprehensive replies as to what they would do in case of suspected harm to a resident. The home has a whistle blowing policy which staff appeared to understand. Two cases of alleged abuse had been reported in the last year. St Peter`s Nursing Home DS0000026205.V321146.R01.S.doc Version 5.2 Page 15 On both occasions it was evidenced that the home had acted quickly and in the appropriate manner to protect its service users. St Peter`s Nursing Home DS0000026205.V321146.R01.S.doc Version 5.2 Page 16 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. Service users benefit from living in a clean, pleasant, safe, comfortable and well-maintained environment. EVIDENCE: Although an in depth tour of the building was not undertaken, the inspector was shown around and saw most of the areas. The home was clean, free of any offensive odours and in good decorative order. The old features in some of the old part of the building had been preserved and generally the home has a homely feel. In the last report it was advised that doors to service users’ rooms should be fitted with devices that would hold the doors open but automatically close when the fire alarms go off. These were seen to have been provided. St Peter`s Nursing Home DS0000026205.V321146.R01.S.doc Version 5.2 Page 17 During the last inspection it was commented that discussions were continuing with relevant companies with regard to the stairs at the end of the corridor to the Acorns Unit. Original plans for a chairlift and, more recently, a platform lift have proved not to be workable. A builder and fitter are to visit again on Monday 9 January 2006 when it is hoped that a solution can be agreed with a view to this work being completed within the next two months. The works however have not taken place but the manager confirmed that agreement had now been reached and work was due to start shortly. The manager agreed to inform the Commission for Social Care Inspection when the work was completed. Windows highlighted in the last report have been replaced and repaired. St Peter`s Nursing Home DS0000026205.V321146.R01.S.doc Version 5.2 Page 18 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. Service users’ needs are met by sufficient number of staff that are motivated and enthusiastic. Service users are care for by staff who are trained, however the home is yet to ensure that 50 of it care staff have an NVQ level 2 or another appropriate qualification. EVIDENCE: The rotas seen showed that there are good staffing levels being maintained to cover the needs of the service users. The manager confirmed that staffing is increased if there is a special need. Normally there is a minimum of two qualified nurses in the at all times. Each unit is staffed individually with care staff in sufficient numbers to meet the needs of the service users. The home also employs cooks and ancillary staff that keep the home clean and well maintained. The staff working in the home are encouraged to undertake an NVQ but at this time they had not achieved the 50 of staff that is required. At the time of St Peter`s Nursing Home DS0000026205.V321146.R01.S.doc Version 5.2 Page 19 the inspection there were ix care staff who had NVQ Level 2 or 3 and five staff who were due to start soon. The records of the required training for staff, such as moving and handling for example, showed that not all courses had been undertaken or were out of date. However, it was clear that these records were not up to date and were therefore not accurate. It was suggested that the manager should produce a matrix of staff training that she can use to monitor that all staff training is undertaken and kept up to date. St Peter`s Nursing Home DS0000026205.V321146.R01.S.doc Version 5.2 Page 20 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, 35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users benefit from having a well supported and well led staff team who are appropriately supervised. Service users are protected by the home’s financial procedures. EVIDENCE: The management approach of the home has resulted in an open and inclusive atmosphere. The processes of managing and running the home are open and transparent. It is apparent the manager and her deputy work well together and communicate well. They both show a dedication to providing high standards. St Peter`s Nursing Home DS0000026205.V321146.R01.S.doc Version 5.2 Page 21 The home has suitable accounting and financial procedures in place for the protection of service users’ 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 supervision is happening on a regular basis and the manager and her deputy carry this out. The quality of the staff supervision looks high and staff said that they feel they benefit from this. All staff can access the policies and procedures. The manager confirmed that all policies and procedures are reviewed at least annually. On this occasion the policies and procedures were not sampled by the inspector. Pre-inspection information received and records sampled showed that all maintenance contracts and checks had been carried out and that residents lived 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.V321146.R01.S.doc Version 5.2 Page 22 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 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 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 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X 3 X 3 St Peter`s Nursing Home DS0000026205.V321146.R01.S.doc Version 5.2 Page 23 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 Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP22 Regulation 23(2)(n) Requirement Suitable adaptations must be made available for residents in the Acorns unit to access other communal and private areas in the home. The manager will inform the inspector when this work has been completed. Timescale for action 31/03/07 2 OP9 13,17 28/02/07 The registered person ensures that there is a policy and staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines, in that a full audit of medication will undertaken straight away, that administration and recording will be regularly monitored, staff not following the guidelines will be retrained or disciplined, that a recognised system of medication is introduced to the home, St Peter`s Nursing Home DS0000026205.V321146.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 2. Refer to Standard OP28 Good Practice Recommendations An appropriate number of care staff should undertake an NVQ 2 in care course in 2006 to ensure 50 per cent achieve this qualification. Future planning to continue to increase this number to ensure a minimum of 50 per cent trained staff can be maintained should also be put in place. St Peter`s Nursing Home DS0000026205.V321146.R01.S.doc Version 5.2 Page 25 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.V321146.R01.S.doc Version 5.2 Page 26 - 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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