CARE HOMES FOR OLDER PEOPLE
St Quentin Nursing Home Sandy Lane Newcastle Staffordshire ST5 OLZ Lead Inspector
Mrs Sue Mullin Unannounced Inspection 14th December 2005 11:00 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 Quentin Nursing Home DS0000026964.V272796.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 Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St Quentin Nursing Home Address Sandy Lane Newcastle Staffordshire ST5 OLZ 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) 01782 662911 01782 620255 St. Quentin Residential Homes Limited Angela Harrison Care Home 33 Category(ies) of Dementia (2), Old age, not falling within any registration, with number other category (33), Physical disability (4) of places St Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 2 DE(E) 33 PD over 60 years Date of last inspection 22nd June 2005 Brief Description of the Service: St Quentin Nursing Home is registered for 33 residents who require twentyfour hour nursing attention. 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 aim of St Quentin Nursing Home is to provide a high standard of nursing care provided by an experienced and competent team of staff. The home is set in approximately one acre of very pleasant 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. St Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection focused on 27 care standards indicated throughout the report. Those not covered at this inspection were addressed at the previous inspection. On the day of the inspection the home had 30 residents receiving general nursing care including one resident receiving general residential care. The home chooses to use two double rooms as singles and consider themselves full at 31 beds. There was one vacancy. The inspector toured the ground floor of the home and made a visual check of the environment from the exterior. A number of care plans were inspected and found to be very comprehensive. The care manager Ms Angela Harrison gave valued assistance thought the whole inspection, as did all members of staff encountered. Several residents were consulted throughout the day and all made positive comments on the high standards of care delivered in the home. The environment of St Quentin creates a homely atmosphere. Communal areas are spacious and comfortable. Staffing levels provided at the home were found to be satisfactory. The registered manager has been in post now for some years and it was noted that morale within the staff team was high. Effective and productive teamwork was evident throughout the inspection. Staff were sure of their roles and duties and carried them out with minimum direction. All routines and regimes were well understood by all staff working in the home. Residents were the primary focus of the 24-hour period and staff were seen to administer care with diplomacy, empathy and professionalism. Staff engaged in conversation stated ‘ the atmosphere in the home is really good, we all get on well together’ another said ‘ residents are happy we all have a laugh together and we enjoy coming into work’ ‘ The care managers door is always open if we have any problems, we feel valued and well supported’. Mrs Moorhouse and Mrs E Averill, both directors attended the home later in the afternoon and were present during verbal feedback. St Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection?
Ongoing, significant training and updating of staff competencies continues throughout the home. This forms the basis and infrastructure of delivering excellent standards of care. The dedication and determination of the care manager, ensures that she maximises the quality of life for all residents when in the care of St Quentin nursing home. St Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 Page 7 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. St Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 Page 8 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 Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 Page 9 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): 1,2,3,4 Information was available to perspective residents and representatives, ensuring that residents seeking nursing care will have all the information that they need to make an informed choice about residing in the home. The home confirms that it is able to meet residents assessed needs prior to admission. EVIDENCE: During the course of the inspection a relative of a resident confirmed that the family had been provided with verbal information, and a copy of the statement of purpose, and service users guides for the home. The staff confirmed that they were able to meet resident’s needs, and this was supported when talking with residents about their life in the home. The care manager and her staff had a good sound knowledge about the needs of their residents, their lifestyle, and the things each individual liked and disliked.
St Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 Page 10 Reference to the care plan of the most recently admitted resident demonstrated that as well as implementation of long and short term problems, organised reviews had taken place with the social worker, the resident, and relatives, in order to establish how best identified needs could be met, and whether St Quentin was a home suitable to provide care for those needs. In discussion with the care manager, it was established that a full assessment of their physical, mental and social needs, prior to their admission was undertaken for all prospective residents. Trial visits are encouraged where residents can met other residents, staff and become more acquainted with the surroundings and facilities. St Quentin does not provide intermediate care. St Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 Page 11 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): 7,8,9,10,11 Records examined, practices observed, and the comments of residents and staff, confirm that health and personal care needs are being well met. All residents receive full NHS entitlements. EVIDENCE: The inspector looked at care plans of residents, which all included a complete overview of the health and personal care needs of individuals. There was also a comprehensive record of how these needs were being met on a daily basis. All long-term problems are reviewed monthly, with short-term problems being reviewed weekly or more frequently if required. All residents have a named nurse and support key workers linked to their care. Information contained in the body of the care plans included reference to residents personal preferences. Residents stated that they could choose their daily routines and had the flexibility to take a rest or simply spend private time in their room during the course of the day. Two GP surgeries offer services to the home and all resident have the full benefits of NHS entitlements.
St Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 Page 12 An examination was made of the storage facilities for medication on the nursing floor. Qualified staff administers medication all administration is handled with both competency and safe practice. Photographs of residents were on all medication sheets and a specimen signature was in the front of the drug sheets. The care manager was able to assure the inspector that they received a good service from their dispensing pharmacy. The pharmacy would deliver twice a day to the home if required. At all times during the inspection staff were seen to be treating residents with respect and dignity, and this was confirmed by those residents who were engaged in conversation. Care staff were engaged in conversation regarding the management of dying residents and coping with death. It transpired that bereavement training is undertaking thought the NVQ training syllabus and by the homes policies and procedures. One member of staff stated that ‘we are very respectful and offer the families hospitality during these sad occasions’. Another said ‘ someone always go to the funeral, as this is the last thing we can do for them’. A recent death was discussed and it was clear that the staff handled the whole event with professionalism and dignity. St Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 Page 13 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): 13,14,15 Residents informed the inspector that they were extremely satisfied with the way the home met their social needs, encouraged their family and friends to visit, allowed them to take decisions affecting their lives, and maintained a good choice and provision of food. EVIDENCE: From conversations with residents and details taken from their care plans, there was evidence that they were able to carry out activities in their life that they had become used to. Residents have to live their lives according to their wishes. All residents who spoke to the inspector were encouraged to maintain contact with their family and their friends. Additionally, residents were complimentary about the fact they were encouraged to fulfil the choices and desires that they had expressed. There was a very pleasant dining room. The meals served were both wholesome and appealing, and observing remaining residents, they all appeared to be enjoying their food and the social event and pleasant occasion the staff strived to maintain. There was a selection of choices available.
St Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 Page 14 The kitchen was inspected and was found to be spotlessly clean. The kitchen staff know the residents very well including their culinary preferences. All diets are catered for and the kitchen staff continues to provide good quality meals with the emphasis on presentation and taste. Residents stated that they were ‘ spoilt for choice, it is a social occasion and we get very good food all the time’. Two members of staff told the inspector that ‘ the food is gorgeous and there is plenty of it’ another stated ‘when we work a long day we have the same food as the residents and we really enjoy it’. St Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 Page 15 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 The evidence gathered supported the statement that residents and their representatives felt confident that their complaints would be listened to, taken seriously and acted upon, and that all steps possible were being taken to prevent them from all aspects of abuse. EVIDENCE: A relative’s son confirmed that he indeed knew whom in the home to complain to if he was concerned about anything, and who to take the matter up with further if he was not satisfied. There were no complaints made to the Commission since the last inspection. St Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,24,25,26 Observation, discussion, and the examination of records, confirmed that residents are living in a safe and well-maintained environment. This included easy access both internally and externally. The home had adequate washing and toilet facilities, including comfortable and personalised bedrooms, all well maintained, clean, and free from odours. EVIDENCE: Communal spaces were all found to be very clean, tidy and very much in keeping with the resident’s preferences. A visual examination was conducted on the grounds and exterior condition of the building. All areas seen were in line with Health and Safety Executive’s regulations. Residents were encouraged to bring into the home on their admission items of personal choice such as photographs, ornaments and small pieces of furniture.
St Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 Page 17 The home was clean, fresh, neat and tidy throughout. All radiators and pipe works guarded against the incident of accidental burning. Hot water outlets are regularly tested in line with the Health and Safety Executive’s regulations. All furnishings provided by the home were of a good standard with good carpeting and comfortable seating in the communal areas. St Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Residents could expect continuity of care provided by sufficient levels of welltrained and motivated staff. Discussion with management and staff, confirmed that al mandatory training with the exception of manual handling for some staff had been undertaken in line with national minimum standards. EVIDENCE: A team of experienced trained nurses supports the care manager who controls St Quentin’s overall management. At the present time there is between one and two qualified nurses on duty on the early shift. There are usually two trained nurses on duty on the early shift for 5 shifts a week. The care manager has supernumerary time as required to undertake management duties. For the rest of the 24 hours a day there is one qualified nurse on duty and additionally, on the: • • • Early shift (8.00 – 2.00) there are 6 care staff (two carers starts work at 7.00am) Late shift (2.00 – 8.00) there are 4 care staff Night shift (8.00 – 8.00) there are two care staff Two domestics/laundry staff per day a day for 5 days a week and one at the weekends. The level of cleanliness seen in the home was very good and a credit to the team. Catering staff were sufficient to meet the needs of the residents and staff on a daily basis.
St Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 Page 19 Handymen/gardeners are used where needed and are on call. The home does not employ an in house administrator; the owners are responsible for this area. On the day of the inspection it was determined that there were appropriate staffing levels and skill mix on duty. The staff complement and their deployment were discussed with some of the residents, and each said that they considered that there were generally sufficient staff available to meet their needs. Evidence of staff training was examined and the staff files provided evidence that mandatory training is up to date with the exception of moving and handling for some members of staff. This is outlined further in the report. Recruitment procedures were checked and all found to be in order. In fact the owners liaise carefully with the Commission to ensure that all areas of protection for residents in their care are explored. Staff have been supplied with a job description and a statement of their terms and conditions of employment. The inspector spoke at length to several disciplines of staff, which lead the inspector to conclude that they had a sufficient level of knowledge and skills to carry out their duties under the supervision of the care manager and her deputy. St Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,38 A very competent caring experienced nurse manager directs the care delivered in the home. The home is run entirely on the best interests of the residents. The health, safety and welfare of residents and staff were promoted by extensive policies and procedures and implemented safe working practices. EVIDENCE: Effective and productive teamwork was evident throughout the inspection. Staff were sure of their roles and duties and carried them out with minimum direction. All routines and regimes were well understood by all staff working in the home. Residents were the primary focus of the 24-hour period and staff were seen to administer care with diplomacy, empathy and professionalism. All care staff continues to improve the standards of care delivered in the home. St Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 Page 21 Comments from a relative as well as the outcomes of discussions with residents reflected an overall opinion that the home was devoted to meeting their individual needs and choices. From scrutiny of individual care plans it was evident that all issues of behaviour were well managed to maximise the dignity of individual residents. Residents pocket and personal monies was discussed and records evidenced these were being handled in line with National Minimum Standards. Observations throughout the day confirmed that safe working practices were in operation. Fire tests and maintenance of fire equipment was seen and up to date. Fire drills were undertaken in line with Fire Authorities requirements. Records were inspected regarding emergency lighting, hot water testing servicing of gas and electrical appliances (PAT) and no anomalies were found. Hoist and the passenger lifts are serviced regularly. The home has robust procedures in place for fire safety training and completing accident and incident records. Not all staff members have received mandatory manual handling training. This was very disappointing for the managers in the home in that they have trained trainers on site and have continually undertake training sessions in the home. These sessions are well organised and advertised and all staff are requested to attend. However, several members of staff have not attended the sessions and this has resulted in the home receiving a requirement. Manual handling training must be delivered to all disciplines of staff once a year. This will be checked on the next inspection. St Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 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 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 3 X X X 3 3 3 STAFFING Standard No Score 27 4 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 X 3 X X 2 St Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 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 Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP38 Regulation 18 (1)(c) (i) Requirement Manual handling training must be delivered to all disciplines of staff once a year Timescale for action 14/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Quentin Nursing Home DS0000026964.V272796.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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