CARE HOMES FOR OLDER PEOPLE
St Peter`s Nursing Home Council Avenue Northfleet Gravesend Kent DA11 9HN Lead Inspector
Wendy Jones Announced Inspection 5th January 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.V266131.R01.S.doc Version 5.0 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.V266131.R01.S.doc Version 5.0 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.V266131.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 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. 20th June 2005 Date of last inspection Brief Description of the Service: St Peters Nursing home is a large detached listed building with a purpose built extension. It is situated about 3 miles from Gravesend and a mainline railway station. The home provides care and accommodation for 56 older people with dementia and nursing needs. It is comprised of three units: Acorns provides accommodation for 8 residents in 2 single and 3 double rooms; Vines provides accommodation for 22 residents in 6 single rooms and 8 double rooms and Shamrock provides accommodation for 26 service users in 14 single rooms and 6 shared rooms. St Peter`s Nursing Home DS0000026205.V266131.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection carried out by Wendy Jones, Regulatory Inspector between 9:30am and 3:15pm. Judgements are based on conversations with management, staff, residents and their relatives, reading of care plans and other documentation and records, comments received prior to the inspection from residents’ relatives/visitors and a tour of parts of the home. What the service does well: What has improved since the last inspection? What they could do better:
Copies of the signatures/initials of staff trained and designated to administer medication should be kept with the medication administration records for each unit so that they can be easily audited. The planned replacement of windows on the first floor, which includes two broken panes in the dining room, must be completed and the broken pane of
St Peter`s Nursing Home DS0000026205.V266131.R01.S.doc Version 5.0 Page 6 glass in the hobby room must be replaced. Suitable adaptations must be made available for residents in the Acorns unit to have access to other communal and private areas in the home. At least a further 8 care staff should undertake NVQ 2 in Care this year in order for the home to be on course to reach fifty per cent trained. Plans should also be put in place to continue to increase this number to ensure that a minimum of fifty percent trained staff can be maintained in the future. A recent fire officer’s visit highlighted a number of areas that needed attention and the manager confirmed that most of these had been completed. However, she stated that there was some confusion about whether the need for fire approved closers for bedroom doors refers to all bedroom doors, or just those designated as fire doors. This point must be clarified with the fire officer and actioned as necessary. 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 Nursing Home DS0000026205.V266131.R01.S.doc Version 5.0 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.V266131.R01.S.doc Version 5.0 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): These standards were not assessed on this occasion. EVIDENCE: Standards 1 and 3 to 5 in this section were met when assessed at the previous unannounced inspection on 20 June 2005. St Peter`s Nursing Home DS0000026205.V266131.R01.S.doc Version 5.0 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 and 10 Residents’ health, personal and social care needs are fully met and they are treated with respect. Medication procedures and storage arrangements protect the residents. However, residents would be further protected if the initials/signatures of staff authorised to administer medication were available for checking against medication administration records. EVIDENCE: A new care planning system has been introduced since the last inspection. Care plans seen contained detailed information about residents’ personal and health care needs. They met relevant clinical guidelines and evidenced that doctors and other healthcare professionals such as the continence nurse and dementia liaison nurse visit when needed. Appropriate risk assessments for the residents, including risk of falls and wandering have been carried out and added to the care plans. Medication records and storage in the Shamrock unit was looked at on this occasion. Medication was stored securely in a locked trolley in the office on and records accurately reflected what residents had taken and confirmed that medication was being administered safely. Although the Manager keeps
St Peter`s Nursing Home DS0000026205.V266131.R01.S.doc Version 5.0 Page 10 examples of the signatures/initials of the staff trained and designated to administer medication, examples were not available for comparison with the records seen. It was recommended that copies be kept with the medication administration records for each unit so that they can be easily audited. A relative of a resident said that all their relative’s needs are being met and they are very happy and grateful for the help and support they get. They also said that their relative is always treated well by the staff and felt that they had all the privacy they needed. All relatives who completed comment cards indicated that they are satisfied with the overall care provided by the home. Staff on duty were clear about the help and support residents need, treated them with respect and clearly had a good relationship with them. A number of residents’ bedroom doors continued to be propped open. The Manager and Deputy Manager explained that this is in some cases because of the nature of the resident’s dementia,. They feel ‘shut in’ which can make them anxious and as such has identified a risk to their safety. In some cases it is what the resident prefers. They confirmed that the new care plans now contain details of any risk assessment, or request made, for bedroom doors to be propped open. The Manager advised that the ceiling tracking has been moved in the shared room where the curtains were very close to the side of the bed. This has now given more space around the bed should a resident want to sit in a chair, or use a bedside table, when the curtains are pulled. St Peter`s Nursing Home DS0000026205.V266131.R01.S.doc Version 5.0 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 - 15 Residents enjoy a wide range of activities and have regular contact with their family and friends. Residents have a choice of wholesome and appealing meals, which are taken in pleasant surroundings. EVIDENCE: Residents are able to use all communal areas in the home. Some were sitting in the lounges and others were in their rooms. During the inspection the activities co-ordinator and staff were taking time to carry out various activities with the residents on a one-to-one basis. One resident was clearly enjoying painting, others were arranging flowers and some were listening to music. The activities co-ordinator explained that she organised activities for residents depended upon what they have enjoyed doing in the past and their current needs. Residents’ care plans contained details of the types of activities that residents enjoyed and when these had been provided. There is a ‘snoozlem’ room on the first floor with sensory equipment etc., which is a peaceful area for residents to relax in. Alongside this room is the ‘hobby’ room, which has been set up as a 1950’s room. The Manager and Deputy Manager explained how residents enjoy using this room and how it helps with reminiscence activities.
St Peter`s Nursing Home DS0000026205.V266131.R01.S.doc Version 5.0 Page 12 The head cook prepares menus in advance and residents have a choice of meat and fish dishes and a range of desserts. A number of different choices are also available for tea. The part-time cook said that she very much enjoyed working in the home. She has worked as cook there for almost two years and has completed the foundation certificate in food hygiene in addition to other health and safety courses. St Peter`s Nursing Home DS0000026205.V266131.R01.S.doc Version 5.0 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 and 18 Residents are protected from abuse and they and their relatives and friends are confident that any complaints are taken seriously and acted upon. EVIDENCE: One complaint has been received during the last twelve months. A log is kept of all complaints received. Records were seen of the investigations that had been carried out and of feedback given. These showed that complainants are being kept informed and responded to within 28 days. The most up to date Kent and Medway Multi Agency Adult Protection Policy is available in the home. Adult protection training is provided to all staff and records were seen of who had attended this training and when. St Peter`s Nursing Home DS0000026205.V266131.R01.S.doc Version 5.0 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, 24 and 26 Residents live in a clean, pleasant, safe, comfortable and reasonably wellmaintained environment. EVIDENCE: There is a main entrance hall with corridors leading to the Vines and Acorns units on the ground floor and staircases and a lift to the Shamrock unit on the first floor. There are grab rails and other aids provided for residents around the home. Residents in the Vines unit on the ground floor live in 8 double rooms and 6 single rooms. One of the double rooms and two of the single rooms have en suite facilities. Residents in the Acorns unit on the ground floor live in 3 double rooms and 2 single rooms. None of these have en suite facilities. Residents in the Shamrock unit on the first floor live in 6 double rooms and 14 single rooms. One of the double rooms and three of the single rooms have en suite facilities. St Peter`s Nursing Home DS0000026205.V266131.R01.S.doc Version 5.0 Page 15 All shared rooms have screens for privacy and there are communal toilets close to rooms that do not have en suite facilities. Bathrooms are fitted with standard baths and mobile hoists. The manager advised that a number of raised toilet seats have now been provided around the home as suggested at the previous inspection. There are a number of comfortably furnished and attractively decorated living rooms and a dining room in each unit. Some communal areas have recently been redecorated. However, the decoration and carpeting in the entrance area and corridor leading from it presented as a little ‘shabby’. The carpet is becoming thin in one particular area. The outline of the floorboards beneath is beginning to show through and fraying has started at the corners. Although these issues do not present a health and safety risk at this time it was noted that the condition of this carpet will continue to deteriorate due to its constant use and the regular cleaning that is required. The manager advised that she is hopeful that redecoration and a replacement carpet for this area will be included in the redecoration programme for the home. All windows have been replaced on the ground floor and the manager advised that the first floor windows are due to be replaced within the next two months. This will include the dining room, which at present has two cracked panes of glass. It was noted that there is now also a crack in a pane of glass in the window of the hobby room. The manager advised that this window is not due to be replaced and agreed that the pane must be replaced. The manager and director of nursing and operations explained 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 in the next two months. There is a car parking area to the front and side of the house. It was a very cold day but the home was warm and residents were clearly comfortable. Everywhere was clean and there were no offensive odours at this time. St Peter`s Nursing Home DS0000026205.V266131.R01.S.doc Version 5.0 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 - 30 Residents are protected buy a robust recruitment process and an appropriate number of skilled and competent staff on duty at all times. However, residents would be further protected if more of its care staff (at least 50 per cent) were trained to at least NVQ level 2 in care or equivalent. EVIDENCE: There were 54 residents living in the home at this time. Staff were able to carry out their duties unhurriedly and efficiently and had time to speak with residents. Registered Nurses, care staff a cook, kitchen, laundry and domestic staff were working at this time. In addition the manager and assistant manager were on duty. A staff list and duty rosters seen showed that there were enough trained and competent nurses and care staff to ensure that an appropriate number of staff are on duty and residents needs are met at all times. The home has still not reached fifty per cent of the care staff having achieved at least NVQ 2 in care. Currently six care staff have completed an NVQ 2 or higher with three more currently undertaking an NVQ. The assistant manager advised that as soon as funding has been confirmed further staff will be registered. It is recommended that at least a further 8 care staff undertake NVQ 2 in Care this year in order for the home to be on course to reach fifty per cent trained, based on the current numbers of care staff. Plans should also be put in place to continue to increase this number to ensure that a minimum of fifty percent trained staff can be maintained in the future.
St Peter`s Nursing Home DS0000026205.V266131.R01.S.doc Version 5.0 Page 17 Staff files and recruitment records seen contained all relevant information, documentation and checks needed to ensure that residents are protected. Details of the induction programme new staff undertake was seen. This followed the Skills for Care (formerly TOPSS) programme. Training records are kept in separate files. They contained a list of the training undertaken and copies of certificates for each member of staff. Training courses provided in 2005 included first aid, care of medicines, moving and handling, challenging behaviour, health and safety, COSHH, adult abuse and dementia. The manager explained that courses are set up by the organisation each year based on both core training needs and personal training needs identified through appraisal and audits of training records. St Peter`s Nursing Home DS0000026205.V266131.R01.S.doc Version 5.0 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, 33, 35, 36, 37 and 38 Residents benefit from living in a home which is well managed, safeguards their best interests and promotes and protects their health, safety and welfare. However, residents safety could be at risk as fire approved closers for bedroom doors are not used when bedroom doors are ‘propped’ open. EVIDENCE: The registered manager is very experienced and runs the home competently and in the best interests of the residents. She has achieved the Registered Managers Award and is a registered nurse. There was a calm atmosphere in the home at this time. Comment cards from seven relatives or visitors of residents were received prior to the inspection. They stated that they can visit the home at any time and in private, are kept informed of important matters, are consulted and all were satisfied with the overall care provided. Relatives spoken with said staff are always welcoming
St Peter`s Nursing Home DS0000026205.V266131.R01.S.doc Version 5.0 Page 19 and say hello. They “feel part of the home” and “couldn’t wish for nicer people”. Although financial records and accounts for the home were not seen on this occasion there was evidence that the home was financially viable. Resources were available for staff to meet the needs of the residents and the structure and contents of the home were in good condition. Appropriate insurance cover is provided for the home and a current insurance certificate is displayed. Small amounts of cash are kept for residents in safes located in the staff offices in each of the three areas of the home. Any balance of residents’ monies is kept in the manager’s office. Records seen clearly showed the money that is kept in the safes for each resident, what has been spent and what this leaves. Regular audits are also carried out. Records for a number of residents were sampled. These tallied with receipts and monies held in the safe for each. The manager is appointee for three residents. Records of finances and accounts for these were also maintained appropriately and each have their own personal bank accounts. The manager and assistant manager are responsible for carrying out appraisals and supervising staff. Records seen showed that appraisals are carried out yearly and supervision is carried out at least every two months. Staff seen and spoken with were clearly competent and aware of the help and support the residents needed. All records seen were stored securely and confidentially in locked cabinets in offices. Training records showed that staff receive regular updates on manual handling to avoid injury to residents or themselves. Regular fire training is provided and regular fire drills are carried out. A recent fire officer’s visit had highlighted a number of areas that needed attention and the manager confirmed that most of these had been completed. She stated that there was some confusion about whether the need for fire approved closers for bedroom doors refers to all bedroom doors or just those designated as fire doors. This point must be clarified with the fire officer and fire approved closers provided as agreed with him. The kitchen was clean and hygienic. The manager advised that Environmental Health had recently carried out an inspection. The only action resulting from this inspection was to redecorate the kitchen ceiling and this has now been done. St Peter`s Nursing Home DS0000026205.V266131.R01.S.doc Version 5.0 Page 20 Accident records were seen. These did not raise any concerns and evidenced that the manager carries out regular audits to identify any risks or patterns. Pre-inspection information received and records sampled showed that all maintenance contracts and checks had been carried out and residents live in a safe and well maintained home. St Peter`s Nursing Home DS0000026205.V266131.R01.S.doc Version 5.0 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x 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 2 3 3 2 x 3 x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 3 2 St Peter`s Nursing Home DS0000026205.V266131.R01.S.doc Version 5.0 Page 22 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 OP19.2 Regulation 23(2)(b) Requirement Timescale for action 05/03/06 2 OP22.2 23(2)(n) 3. OP38.2 23(4)(c) (i) The premises must be kept in a good state of repair in that the: • planned replacement of windows on the first floor, which includes two broken panes in the dining room, is completed and, • broken pane of glass in the hobby room is replaced Suitable adaptations must be 05/03/06 made available for residents in the Acorns unit to access other communal and private areas in the home. Action must be taken to comply 05/03/06 with the Workplace Fire Precautions Legislation as listed in the Fire Officer’s letter dated 6 December 2005. In that, after clarification as to whether all bedroom doors should be fitted with fire approved closers, the required action is taken to be compliant with this legislation. St Peter`s Nursing Home DS0000026205.V266131.R01.S.doc Version 5.0 Page 23 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 OP9.7 Good Practice Recommendations Copies of the signatures/initials of staff trained and designated to administer medication should be kept with the medication administration records for each unit so that they can be easily audited. 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. 2. OP28 St Peter`s Nursing Home DS0000026205.V266131.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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