Random inspection report
Care homes for older people
Name: Address: St Quentin Nursing Home Sandy Lane Newcastle Staffordshire ST5 0LZ one star adequate service 21/04/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Yvonne Allen Date: 1 1 0 8 2 0 0 9 Information about the care home
Name of care home: Address: St Quentin Nursing Home Sandy Lane Newcastle Staffordshire ST5 0LZ 01782662911 01782620255 st.q@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : St. Quentin Residential Homes Limited care home 31 Number of places (if applicable): Under 65 Over 65 31 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is: 31 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 31 Date of last inspection Brief description of the care home St Quentin Nursing Home provides accommodation for up to 33 older people who may require 24 hour nursing care. The home is a large detached property that has been extended to provide comfortable accommodation on two floors. A passenger lift provides access between the floors. There are two lounges and a dining room situated on the ground floor. The home is set in approximately one acre of very pleasant
Care Homes for Older People Page 2 of 12 1 1 0 2 2 0 0 9 Brief description of the care home gardens, a mile or so from the wide range of community facilities provided in the town of Newcastle-under-Lyme. There are adequate parking facilities. As no information is included in this report in relation to fees charged by the home, readers of this report are advised to contact the service directly for this information. Care Homes for Older People Page 3 of 12 What we found:
We carried out this unannounced Random Inspection as part of our regulatory process to assess whether the requirements of the previous Key Inspection have been met. The inspection visit was carried out by two inspectors and took just over five hours to complete. We spoke to some of the people who live in the home and some visitors. We also spoke to some of the staff who work at the home. We held discussions with the prospective registered manager Mr Nick Frain and the Provider Mrs Emma Averil. Mr Frain has worked in managerial posts previously, is a Registered General Nurse (RGN) and has completed a First Line management course. Mr Frain confirmed that staff team is getting better now and that he is in the process of recruiting more care staff as the occupancy number rises. He told us that there is usually himself, a nurse, 5 carers and an administrator on duty but that today a carer had rang in sick. Mr Frain told us that Relatives meetings are now held regularly and we saw a meeting advertised in the home. We also looked at relevant records and documentation. These included care plans, Medication Administration Record (MAR) charts and records of daily care. We observed staff interaction with people including watching how people are moved and handled. We found that the service has addressed the legal requirement fom the last Key Inspection report. This requirement was for an application for Registered Manager for the service. Both Mr Frain and Mrs Averil confirmed that the manager application process has now commenced. Mr Frain also confirmed that he has improved the management of complaints and that he actively encourages people to raise any concerns they might have. We noticed the complaints procedure displayed within the home and people we spoke with told us that they know how to raise concerns. It was concerning, however, to note that one person who had raised a concern about having to have her bedroom door closed had not been listened to and nothing had been done about this. On discussion with the manager the problem could easily be rectified by providing a door guard unit which would enable the door to be safely kept open. This could have been addressed much sooner. Care Homes for Older People Page 4 of 12 Also, a person who was lying in bed and shouting, as we have described in more detail later in the report, wanted to sit out in his chair in his bedroom. When we asked about this the manager told us that the special gel cushions ordered for this person and others in the home had only just arrived. On further investigation it was identified that these cushions had arrived ten days previously. This means that this person could have been sat out of bed ten days prior to the inspection visit. The service will need to demonstrate more clearly that people are listened to and that people who live in the home have a voice. We were told that there are 5 people nursed in bed. We met these people and saw that care charts had been completed. These consisted of nutritional and fluid intake and positional turning charts. We were told that there are currently no people in the home with any pressure sores. The service has purchased some new nursing profiling beds (3 or 4). We observed these in use. We observed care staff using hoists on two different people and this procedure was carried out correctly and with dignity and respect. The care staff told us that they receive training in moving and handling and that this is regularly updated. We were informed that care plans are still in the process of transformation and are continuing to develop and improve. We noted that some identified goals had not been updated and did not reflect the current situation. We discussed this with the manager at the time. We looked at the care plans of 4 people accommodated in the home. We saw that assessments and reviews had been carried out by the service and by funding bodies. We saw how one person had suffered with a pressure sore and the service had accessed the involvement of Tissue Viability Nurse specialist. This sore is now healed. The identified goal to sit this person out under a phased process had, in fact been achieved but this was not updated in her care plan. We did meet this lady sitting in an easy chair in the lounge. One visitor told us that her relative was admitted to the home in November and said that she has settled although it took her a good while. She does not like her bedroom door closed and both she and her relative asked for it to be propped open. She said that she has spoken to the manager but been told that it is a fire risk. We discussed the need to fit a door release mechanism linked with the fire alarm system and Mr Frain agreed to organize this for this lady. We were informed that one person has been nursed in bed for the past week and is poorly. We observed the GP visiting this lady and other people at the time of the inspection. The necessary health tests were being carried out for this lady. We looked at this ladys care plan. There was a record of professional visits including the Optician, GP, and Chiropodist. There are risk assessments in place for the activities of
Care Homes for Older People Page 5 of 12 daily living. The mobility risk assessment shows a high risk of falls. There is a monthly Accident, Incident and Vulnerable Adult Referrals form in place to record any of these events. There were no recorded events for this lady. A Mental Capacity Assessment was completed by the manager Nick Frain. He told us that he had received training from a solicitor to do these assessments. We discussed the good practice of having two nurse signatures for these assessments and Mr Frain agreed. This ladys care plan also contained information about her skin integrity and pressure area care including Body Mapping. Mr Frain told us that this person has positional changes very regularly whilst she is in bed, usually hourly. There is a Clinical Measurement Record in place. This shows Blood Pressure and Pulse were checked only in March and July 2009. We discussed this with Mr Frain who agreed that these should have been carried out monthly. We noted that the GP visit form shows a review by the doctor of a skin problem who advised review in 6 weeks. There was no record of a follow up of this and this was discussed with Mr Frain who did not recall whether this has been followed up. We looked at the MAR chart and discovered that this person was prescribed Paracetamol as required (PRN) but that there was no record of this being administered or being offered. We discussed this with Mr Frain as there is a recommendation for people to be offered pain relief regularly as prescribed. This person was prescribed Conotrane cream and there was no record of this being administered. We discussed with the Senior nurse and the manager. There is a recommendation for a record to be kept of administration of prescribed creams and ointments. This should include the date, times and signature of the staff member administering the cream. We visited this person in her room. She was unwell and said she that she ached all over. Mr Frain gave her a drink. She said she was comfortable and that she had eaten lunch. A written record was seen on her bedside table to confirm this. This person appeared clean, well cared for and dressed appropriately. Whilst we were there a domestic assistant came into the room to change the bedding. We case tracked another person and looked at his care plan. The Relative Communication Record shows contact was made on many occasions and there is a record of Professional visits. There are records of skin integrity assessments and he is nursed on a special mattress. Documentation in the Care Plan on 30/6/09 states needs to get out of bed to relieve his pressure areas. The record does not show when this person did get out of bed. We looked at the daily record for August and identified that he was only got out of bed on 09/08/09.
Care Homes for Older People Page 6 of 12 The Clinical Measurement Record documented nothing recorded for him in June 2009. In his Clinical Risk Management done on 16/04/09 it documented that He has sensory needs. Has been seen by advocate. On 25/05/09 sensory lighting was installed in this gentlemans room and he did not like this. The daily records seen for these people did not show that actions and activities are focused on goals and outcomes outlined in care plans. We discussed with Mr Frain the need to focus care and daily records to show that care being delivered is person centered and reflects individual needs. We visited this gentleman and spoke to him. He was able to respond. He told us that he kept saying Help Me through habit. We asked him what he wanted help with and he said that he didnt know. He said that he was comfortable but that he was existing. When we asked him whether he would like to go downstairs he said no. He did, however, say that he would like to sit out of bed in his room. We spoke about this to Mr Frain who was present and he said he had a special gel cushion available that would be suitable for this gentleman. He told us that he would make arrangements for him to sit out of bed. When we asked Mr Frain how long he had had the gel cushions for he told us that it was about 10 days. Care plans contain some documentation of social and therapeutic activities but these are haphazard with gaps in between, and, on some occasions, up to a month with no record of activity taking place for the person. For one person who stays in his room it was documented - Activities 25/04/09 nails cut; 26/05/09 played music to him. Then Tried to have a chat but wasnt interested then on 01/07/9 Summer Slide Show. It was documented for another person that on 28/03/09 - feet massaged then 11/04/09 - hands massaged then 05/06/09 - manicure then 26/06/09 - massaged legs and feet then 20/7/09 - manicure and chat then 28/07/09 - Nails. It is also documented that this person is at risk of social isolation . For another person, records of activities were documented as - nails cut on 9/7/09 then nothing until 24/7/09 - craft then nothing further to date. This same person suggested It would be nice to have some trips out. It was documented in this persons care plan that she could be at risk of social isolation due to immobility. We met with a visitor who told us - its alright here - my relative seems quite happy although she would not wish to say anything to rock the boat! There is not a lot of social stimulation here. We looked at how the service adheres to the Safeguarding Policy and looked at records pertaining to a person living in the home. One incident the service had raised their concerns as a Safeguarding referral. For this person all relevant documentation had been completed including referrals to relevant bodies. We noted that there had been other incidents where this person had sustained bruises to her arms but the staff had documented explanations recording direct causes for these.
Care Homes for Older People Page 7 of 12 We saw where the GP had been called out by the service to assess this person as to the cause of the bruises sustained as they were concerned about her. We also saw that there was a notice displayed in the home inviting staff to attend training in Safeguarding Adults. On arrival at the home we found it difficult to identify which is the front entrance to the home as there are no signs directing the way. Also, once we found the front entrance we could not find the bell, we could only see the staff identification unit. A person who had come for an interview let us in where we found the signing in register. We were later shown the front door bell which is a small bell located half way down the front door on the left hand side. It is recommended that the service review the provision for entry to the home and make the direction clearer. This is so that people who have come to visit their relatives or friends in the home, especially for the first time, know where to go and how to attract attention. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 12 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 7 The service should identify, by way of documentation, whether goals laid down in peoples care plans have been achieved. This should also link in with daily records of care. In this way the service will be able to demonstrate whether or not progress is being made and individual goals achieved. The service should review and assess people who are nursed in bed for long periods of time with a view to enabling and encouraging people to sit out of bed and, wherever possible, come down to the communal areas. This is to promote individual health and wellbeing and to help avoid social isolation. Staff who administer medication should ask people if they require as and when required prescribed medication(PRN), such as pain relieving drugs. This should then be documented on the MAR chart. This is to ensure that people are given the opportunity of accepting or declining PRN medication. The service should provide a record of administration of prescribed creams and ointments. This should document
Page 10 of 12 2 8 3 9 4 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations the date and time given and signature of the person administering the cream. This will help ensure that people receive the creams and ointments prescribed for them. 5 12 The provision of activities should be improved and made more person centred, especially for those people at risk of social isolation. This is to ensure that peoples social and therapeutic needs are fully met. The service will need to demonstrate that people are listened to and that any concerns they might have are taken seriously and acted upon. This is so that people who live at the home are not afraid to raise concerns and have a voice. It is recommended that the service review the provision for entry to the home and make the direction clearer. This is so that people who have come to visit their relatives or friends in the home, especially for the first time, know where to go and how to attract attention. 6 16 7 19 Care Homes for Older People Page 11 of 12 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 12 of 12 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
