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Inspection on 04/06/07 for St Quentin Nursing Home

Also see our care home review for St Quentin Nursing Home for more information

This inspection was carried out on 4th June 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

We found that people felt that they had been provided with the right information for them to make a decision that the service would meet their needs. The service had a good Service User guide that included pictures and comments from people that used the service. People that moved to the service had an assessment before they were offered a place to make sure that the service could meet their needs. The overall view of relatives and people that lived at the service was that it was providing a good service. Comments received from a relative included `Care is excellent` and `staff are caring`. People were having their health care needs met. They saw the GP, dentist, chiropodist and the optician. People were provided with care to prevent pressure sores for example having pressure-relieving equipment. The service was able to provide good treatment to any one that had a pressure sore. We found that the service was making sure that people had their dietary needs assessed and had plans in place to address any dietary issues and was monitoring people`s weight. We saw that staff were promoting people`s privacy and were dealing with personal care issues in a sensitive way. Staff we spoke to were aware of people`s personal and health care needs. We found that the service supported people to make choices about their lifestyle. The service provided activities both in groups and individually although a few people that we surveyed felt there could be more activities. Everyone we spoke to or surveyed was aware of the service`s complaints procedure. People told us and we saw from records that when issues were raised they were addressed. We found that the staff had knowledge about adult protection to safeguard people. The service provided suitable staffing levels to meet the needs of the people that lived there. We saw that the service had a good procedure for recruiting staff making sure that all the necessary checks were undertaken. The service had a training programme to make sure that staff received the training they needed. The manager of the service was supporting staff through individual supervision sessions and through having occasional staff meetings.

What has improved since the last inspection?

Since we visited last the service has in place individual supervision to provide support to staff and to aid them to further develop. The service has also introduced a comprehensive induction programme for all new staff. The service has continued to make progress on decorating and upgrading the accommodation.

What the care home could do better:

The service provided some good outcomes for the people that lived there however we did make a number of requirements that the service needed to address. We saw that some elements of the care plans needed to be further developed to make them really good working documents for the staff to use. There were some issues about the medication arrangements that must be looked at to make sure that the service can show that people are getting the right medication.We found that wheelchairs were not always well maintained and were sometimes being used without the footplates. This could be a hazard to people using them. The service had not yet been able to sort out the problems it had with its hot water supply meaning that some areas were not always having hot water. We also found that the service did not have an evacuation plan in place that took account of the help each person would need to be able to be evacuated. We also saw that a number of ire doors were being propped open, which would mean that they did not create a barrier in the event of fire. We made a number of recommendations that the service relating to the service provided that if acted upon would improve the service.

CARE HOMES FOR OLDER PEOPLE St Quentin Nursing Home Sandy Lane Newcastle Staffordshire ST5 0LZ Lead Inspector Jane Capron Key Unannounced Inspection 4 June 2007 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 Quentin Nursing Home DS0000026964.V339663.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 Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Quentin Nursing Home Address Sandy Lane Newcastle Staffordshire ST5 0LZ 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 Services Limited Angela Harrison Care Service 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.V339663.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 2 DE(E) 33 PD over 60 years Date of last inspection 4th January 2007 Brief Description of the Service: St Quentin Nursing Service is registered for 33 people who require twenty-four hour nursing attention. The service 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 Service is to provide a high standard of nursing care provided by an experienced and competent team of staff. The service 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. The weekly fees are £410 per week plus the amount paid for nursing care by the Health Authority. St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. When we visited the service they did not know we were coming. We stayed at the service for over seven hours. When we were there we talked to some people that lived there, some visitors, staff and the manager. We also used information that the service had given us Before we went that told us about the service they provided to the people that lived there. We looked at the information the service provided to people that might want to move there and whether the service was making sure that they only admitted people whose needs they could meet. We also looked at whether the service was providing people with the health and personal care they needed and whether the way they were administering medication was making sure that people’s medication needs were being met. Whilst we were there we also looked at how the service was meeting people’s social needs including what activities they offered and whether people were provided with good meals. We looked at the training the staff received and whether the service was making sure that they only recruited staff that were suitable to do the work. During the time we were there we looked round the service to see what the accommodation was like. We also looked at whether the service was safe for the people that lived there. What the service does well: We found that people felt that they had been provided with the right information for them to make a decision that the service would meet their needs. The service had a good Service User guide that included pictures and comments from people that used the service. People that moved to the service had an assessment before they were offered a place to make sure that the service could meet their needs. The overall view of relatives and people that lived at the service was that it was providing a good service. Comments received from a relative included ‘Care is excellent’ and ‘staff are caring’. People were having their health care needs met. They saw the GP, dentist, chiropodist and the optician. People St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 6 were provided with care to prevent pressure sores for example having pressure-relieving equipment. The service was able to provide good treatment to any one that had a pressure sore. We found that the service was making sure that people had their dietary needs assessed and had plans in place to address any dietary issues and was monitoring people’s weight. We saw that staff were promoting people’s privacy and were dealing with personal care issues in a sensitive way. Staff we spoke to were aware of people’s personal and health care needs. We found that the service supported people to make choices about their lifestyle. The service provided activities both in groups and individually although a few people that we surveyed felt there could be more activities. Everyone we spoke to or surveyed was aware of the service’s complaints procedure. People told us and we saw from records that when issues were raised they were addressed. We found that the staff had knowledge about adult protection to safeguard people. The service provided suitable staffing levels to meet the needs of the people that lived there. We saw that the service had a good procedure for recruiting staff making sure that all the necessary checks were undertaken. The service had a training programme to make sure that staff received the training they needed. The manager of the service was supporting staff through individual supervision sessions and through having occasional staff meetings. What has improved since the last inspection? What they could do better: The service provided some good outcomes for the people that lived there however we did make a number of requirements that the service needed to address. We saw that some elements of the care plans needed to be further developed to make them really good working documents for the staff to use. There were some issues about the medication arrangements that must be looked at to make sure that the service can show that people are getting the right medication. St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 7 We found that wheelchairs were not always well maintained and were sometimes being used without the footplates. This could be a hazard to people using them. The service had not yet been able to sort out the problems it had with its hot water supply meaning that some areas were not always having hot water. We also found that the service did not have an evacuation plan in place that took account of the help each person would need to be able to be evacuated. We also saw that a number of ire doors were being propped open, which would mean that they did not create a barrier in the event of fire. We made a number of recommendations that the service relating to the service provided that if acted upon would improve the service. 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 Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 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.V339663.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service provides people with information so that they know what the service offered and always completed an assessment in order to make sure that only people whose needs they could meet lived there. The service provided staff with the necessary training and knowledge to make sure that people’s needs were met. EVIDENCE: The Statement of Purpose and service user guide provided the information to identify what the service provided. This was provided to all relatives and people that lived at the service. All people surveyed said that they had enough information about the service to make a decision that the service could meet their needs. A relative spoken to confirmed that they had been given the St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 10 service user guide and had been able to visit unannounced before making a decision for their relative to move to the service. The information could be improved through the documentation being available in alternative formats. Records and discussions with a relative confirmed that prior to anyone moving to the service an assessment was completed. Where people were paying for themselves this was completed by the managers of the service. When people were partly funded by the local authority assessments was completed by the local authority and by the service. These assessments covered the necessary areas of health and personal care, social needs and family involvement. The service was able to meet the needs of the people that lived there. Staff had received a range of training relating to relevant conditions and care practices. The nursing staff received training to keep up to date with current practices including in tissue viability and continence and the deputy had completed a diploma in gerontology. Most staff had received training in caring for people with dementia. St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 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. 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. The service’s care plans provided most of the necessary information but there was scope for further development to ensure that staff had the full information needed to ensure that all needs were fully met. The service was meeting the healthcare needs of the people that lived there in a manner that promoted their rights to privacy and dignity. Effective medication procedures and practices need to be implemented in order for the service to be able to confirm that medication is always administered correctly. EVIDENCE: St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 12 A sample of care plans was looked at. They covered a range of areas but did need to be expanded to include all areas of need for each person including the areas of social and spiritual needs where these were required. Where people had mental health needs that could result in challenging behaviour a care plan should be in place to ensure that all staff knew who to respond. Plans contained a fall risk assessment. There was evidence of some people being involved in the care planning process and one relative reported that the staff kept her well informed and involved in any changes in her relative’s needs. Plans were evaluated monthly and where necessary updated. The local authority undertook yearly reviews where they sponsored a person. Relatives were invited to take part in these. The service was promoting people’s health care needs. Assessments were completed in respect of their nutritional needs, over tissue viability and mobility and moving and handling needs. The service was effective in responding to pressure sores with good documentation in place and clear information over how to deal with any pressure sores. The service was also promoting tissue viability through the use of pressure relieving equipment such as mattresses and cushions and through regular turning of people and ensuring a good fluid and diet. The service was identifying people’s nutritional needs and was monitoring their weight every month. In specific cases they were completing fluid and food intake monitoring. One relative said the staff had asked her to keep a note of how much their relative drank so their fluid intake could be monitored. Examination of the records and discussions with people that lived there confirmed that the dentist, optician and chiropodist visited the service. The arrangement for the administration of medication was looked at. The service stored medication in locked cabinets and a locked trolley. The service had a medication fridge and the records of temperatures showed that it was within the accepted temperatures. This fridge should be kept solely for medication. The service was not recording the quantity of medication in the service and therefore could not demonstrate that their administration records were accurate. The service was producing its own computer generated Medicine Administration Records (MAR) charts and there was no system in place to check that these records were accurately transcribed from the pharmacy labels. Examination showed that with a few exceptions the Medication Administration Records were properly completed. There were a small number of gaps in the records and due to the absence of a proper auditing system it could not be ascertained whether medication had been given and not recorded or whether medication had not been given. Staff were using the symbol ‘O’ to record when medication was not given and in most instances there was an explanation for this recorded. Examination of the medication stocks showed that in respect of certain medication i.e. Movicol and Lactulose there was medication sharing. Due to this it was impossible to do an St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 13 audit to ascertain whether the medication records were an accurate reflection of the medication administered to individual people living at the service. The service had some controlled medication in stock although this was waiting to be returned to the pharmacist. Controlled medication was being stored, recorded and administered correctly. Discussions with staff did confirm that they were aware of each person’s medication and the reasons for it. The medication was administered by nursing staff and they had received recent medication training. Discussions with staff confirmed that they were aware of good practices issues relating to ensuring that people were treated with respect and that their rights to privacy and dignity were promoted. Staff were able to describe how they bathed and undertook personal care tasks in a discreet manner and how they promoted independence with people that needed a lot of support. Staff were observed providing support in a way that showed people respect and dignity. One relative spoken to said that ‘the care was excellent’ and that staff provided ‘the personal touch’ and were ‘caring’. St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 14 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. People that live at the service are supported to make choices about their lifestyle. They can choose to take part in the activities on offer and join in with other people or to enjoy the privacy of their own room. The service encourages and supports people to maintain relationships with friends and relatives. The service provides people with a varied menu and with choice of meals. EVIDENCE: The service’s assessment had identified people’s previous lifestyle and the activities they liked however this had not been developed into a care plan to demonstrate how these needs were to be met. However when discussions were held with two staff members there were aware of the preferences of people and the activities that they would take part in. One staff member who had worked there for some time knew people’s previous occupation, their families and felt that this information helped her to have a better St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 15 understanding of the person. The service had started to develop life storybooks with the relatives of the people that lived there but the completing of these had been delayed. Life storybooks are a good way of getting to know people as individuals with individual lifestyle and needs. The service provided activities both individually and in small groups. Responses to our survey gave mixed results with a number saying that they could join in with activities sometimes and one person said that there could be more activities and also trips out. Another person reported that they would like a quiet area with no TV on. However some people really enjoyed the activities enjoying doing craftwork, taking part in games and with a sing-along. One person told us that he enjoyed doing craft work and had made some cards. Currently most activities were provided by the care staff. If they had time in the morning they would organise a game for example ‘Play Your Cards Right’. Most activities took place in the afternoon when several staff worked additional hours specifically to do activities. Activities included board and card games, quizzes and bingo. In addition the service arranged for people to come in to provide gentle keep fit, a craft session and a sing along once a month. There were also occasional entertainers coming into the service for example ‘Music for Health’ and ‘Service Gardening’. For those people that did not take part in group activities staff provided some individual time for individual discussions and doing manicures and hand massages. The staff also took people out to the local park. The service intends to organise trips out and they reported they had in previous years. The service had a hairdressing visiting once or twice a week. The service was able to meet the spiritual needs of the main Christian denominations. A Church of England service was held in the care service next door and people could attend this. In addition a number of people had their spiritual needs met by visiting clergy. The service supported people to make choices about their own lifestyle. Several people chose to spend most of their time in the lounge whilst others preferred to remain in their bedrooms but come down for meals. People could choose whether to join in with activities or not. Discussions with people that lived there showed that they could choose when to go to bed and that staff would always ask them when they wanted to get up. Visitors were able to visit when it suited them and the service encouraged and supported relatives to take people out of the service. When we were there one relative took his mother out for a walk. Another relative said that she visited several times a week and was always made to feel welcomed. We felt that the service provided a menu that enabled people to have a varied diet that provided them with choice over what they had. However some of the surveys we received did feel that they did not always like the meals. There was a range of food for breakfast including a hot choice. The main meal was taken at lunchtime. There was always a choice offered and although the people chose St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 16 the day before there was scope for them to change their mind. The service provided for people with special dietary needs including food to suit people with diabetes and for those that needed a soft or pureed meal. The service reported that it could also provide peg feeding. We saw staff supporting people to have their meal and this was done in a relaxed and sensitive manner. The service provided a lighter tea that included sandwiches and cakes. Hot drinks were provided several times throughout the day and evening. St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 17 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): 16.17.18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service had a complaints procedure in place that could respond to issues of concern but the service needed to make sure that complaints were always properly recorded. The service had procedures and training in place to make sure that the people that lived at the service were having their rights protected and were safeguarded. EVIDENCE: The service had a complaints procedure in place. Everyone we surveyed reported that they knew the complaints procedure and those that had raised issues said they had been dealt with by the service. When we discussed this with a relative and with someone that lived at the service they told us that they knew the procedure and would feel able to complain. They both stated that they had not raised any concerns but felt that the manager would address any issues they raised. We looked at the service’s record of complaints and none had been recorded since the last inspection. However a copy of a meeting held between relatives and the service was seen and this showed there had been a complaint. When we looked at the details we found that although it had not been properly St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 18 recorded the complaint had been responded to. The service needs to ensure that all complaints are properly recorded including the nature of the complaint and the actions taken by the service to address the issues. We looked at the procedures and training the service had in place to make sure that people living there were safeguarded from abuse. All staff had been police checked and two references were always obtained. The service provided training in adult protection although not all staff had yet received this. However staff that had completed NVQ 2 would have had training in this area. We spoke to staff and they were aware of signs and symptoms of abuse and were clear over how they would respond if they had any concerns about abuse. We were also aware that the service had previously responded appropriately to incidents of potential abuse. The staff had several people that were using bedrails. The service was aware that these could be a means of restraint and had clear assessments in place and did not use rails without discussions with relatives. The service also had provided some staff with training in dealing with challenging behaviour. The service supported the people that lived there to have their legal rights protected. Evidence on records confirmed that they are supported to access health care services and are registered to vote at elections. St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 19 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): 19,20,21,22,24,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service provides suitable communal and private accommodation for the people that live there, however there are areas that need to be addressed including some decorating, the provision of locks on bedrooms and toilets and the absence of hot water in some bedrooms. Dealing with these matters would significantly improve the accommodation. The service provides people with equipment to aid their independence but needs to ensure that all wheelchairs are well maintained and do not present a hazard. The service is clean throughout and has practices in place to minimise the spread of infections. EVIDENCE: St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 20 The service provides accommodation in a large extended detached property. The service is set back from the road having a large garden at the front. Although the service has decorated and upgraded quite a lot of the property there were some areas that needed attention and there is a long-term plan in place to achieve this. When we visited there was paintwork in the corridors and doors on the ground floor that were badly marked and needed painting. The hallway was in the process of being decorated and refurbished. The service provided people with large communal rooms including two large lounges and a separate dining room. These were suitably furnished and decorated. There were bedrooms on the ground and first floor, the service having vertical lifts to access the upper floor. The service provided two double rooms with all others being for single occupancy. None of the bedrooms had ensuite facilities. The double bedrooms had privacy screen provided. A sample of bedrooms was looked at and these were of varying size and decoration. Most seen provided good accommodation with good quality furniture and soft furnishings although one double would benefit from redecoration and upgrading. There was evidence of rooms being personalised with the ornaments, small items of furniture and family photographs. None of the bedrooms were lockable. We saw that the service provided suitable bathing and toilet facilities, having both toilets and baths upstairs and downstairs. We did notice that some of the toilets downstairs did not lock and were not clearly marked. The service provided people with a range of equipment to support them to be as independent as possible. The baths were fitted with hoists and there were a range of grab and hand rails around the building. The service had hoists for moving people safely. The service had a number of wheelchairs and we noticed that some of these were not well maintained, being used without footplates. This could place people at risk. Bedrooms were fitted with call systems. As on our last visit the service was having some problems making sure that each bedroom always had hot water. The owners had written to us to explain that the arrangements for ensuring hot water at all times was not adequate for the building and to correct it would mean having a complete new hot water system and this was not able to be done at the current time. The current arrangements meant that there were times when staff had to take bowls of hot water to people’s room in order for them to have a wash. This does need to be addressed, as the current arrangements are a risk to staff and the people that live there. We saw that the service was clean throughout. The service had domestic staff on duty five days a week. The standard could be improved if domestic staff were on duty every day. A relative said that the service was always clean and tidy. The service had a laundry and we saw that this well organised and had St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 21 washing machines that could wash at a temperature to disinfect laundry. The service had procedures in place to prevent the spread of infections. St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 22 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. The people that lived at the service were safeguarded by the service’s recruitment and selection process. The service supports staff to gain the knowledge and skill to effectively support people but needs to make sure that all staff have the training to work effectively with people with dementia care needs. EVIDENCE: We looked at how the service recruited its staff by looking at a sample of staff files. We found that there was a robust system in place. All staff had a police check and two references had been obtained before a staff member started work. The service was also checking that staff were fit enough to do the work and made sure that they confirmed staff’s identity. We looked at the rosters and saw that the service provided suitable staffing levels to meet the needs of the people that lived there. There was always a qualified nurse on duty and during the day there were usually two on duty, one of which was the manager. Throughout the day there were adequate care staff on duty to ensure that people’s health and personal care needs were met. St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 23 A number of care staff were employed for additional hours to provide people with support to take part in social activities. Overnight there was one qualified nurse and two care staff on duty. Due to recent staffing difficulties the service has needed to use more agency care staff during the night. The service has managed to get a small number of regular staff for agency. The service was in the process of recruiting staff to fill vacancies. We looked at the training that staff received to help them provide the support people needed. The service supported staff to get a qualification. At the time of this inspection 13 staff had obtained NVQ 2 and a further 9 were doing the qualification. The service had induction programmes in place and provided a range of ongoing training. This included training related to Health and Safety, medication, infection control and adult protection. The service did provide basic training in dementia care and as the service has some people with dementia care needs this is an area that all staff should have a good knowledge of. St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 24 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): 31,33,35,36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service is well led with the Care Manager providing good leadership and support to staff. However there are areas that need to be addressed to ensure that the service is continually improving and is providing the people that live there with a completely safe environment. EVIDENCE: The Care Manager has been managing the service for four years. She is a qualified nurse and has undertaken training to ensure her nursing knowledge and skills are kept up to date. She was fully aware of the needs of the people St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 25 that lived there and provided good support to the staff. To date she has not completed a management qualification. The service had systems in place to support the staff. The service had staff meetings and had started to provide staff with individual supervision. We looked at the system the service had to monitor the quality and to improve the service provided to the people that live there. The service undertook quarterly surveys of the people that live there and their relatives. These looked at their views of the accommodation, the care provided, medication, cleanliness and the information provided prior to moving to the service. The results of these were used to review the service. There was scope for this system to be further developed to include the views of significant others such as health and social care professional, and to include internal managements reviews of for example care plans and medication. These could lead to a plan for improvement. The service looked after some money of people that lived there. After checking a sample of finances we saw that the service kept people’s money safely locked away and kept good records of any expenditure. The service had Health and Safety procedures in place and had developed a number of risk assessments relating to care practices and environmental issues. Staff had received training in Health and Safety issues including first aid, food safety, moving and handling and infection control. The service reported that it had completed the required servicing of equipment. We looked at the service’s arrangements for fire safety. Staff had been trained in fire safety and there were regular fire drills. The fire alarm and emergency lighting checks were being done. However we saw that a number of fire doors were being propped open and this would negate the effects of fire doors in the event of a fire and could therefore place people at risk. The service had an evacuation plan but this did not take account of the individual needs of the people that lived there. The service was keeping a record of accidents. St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 26 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 SERVICE Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 3 3 2 2 X 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? yes 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 Services Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Timescale for action 16/07/07 2. OP9 3. OP22 4. OP25 Care plans where necessary must provide staff with the information on how to respond to incidents of challenging behaviour thereby ensuring that people’s needs are met in an appropriate way and staff are protected. 13(2) The records of the receipt, administration and disposal of medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. 23(2)(c) & Wheelchairs must be properly 13(4)(c) maintained and used in an appropriate to ensure that they cannot be a hazard to people that use them. 13(4)(a)2 The registered person must 3(2)(j) ensure that hot water is available to all people rooms at all times, to meet their personal hygiene needs. Staff must not transport hot water around the building, as this is potentially dangerous. Hot water outlets must have hot water available as DS0000026964.V339663.R01.S.doc 16/07/07 02/07/07 01/08/07 St Quentin Nursing Home Version 5.2 Page 28 near to 43.C as possible. (Previous date of 04/02/07 not met) 5. OP38 23(4)(c) (iii) The service must develop an evacuation plan that takes account of the individual needs of the people that live there to make sure that all staff know the type of support each person would require in such circumstances. Fire doors must be kept closed or proper door closures fitted to ensure that they work as an effective barrier in the event of a fire. 09/07/07 6. OP38 23(4)(c) (i) 01/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 7. Refer to Standard OP1 OP7 OP16 OP10 OP12 OP19 Good Practice Recommendations The Statement of Purpose be available in alternative formats Care plans need to be developed in a person centred manner and to include all aspects of need including social and spiritual needs. The service needs to ensure that all complaints are properly recorded. All toilets and bathrooms should be identifiable and be lockable to aid people’s independence and to improve the level of privacy available. To undertake a review of activities to look at whether they are suitable to meet the needs of people. The environment would be improved through the decorating of doors that are badly marked and scratched, by replacing or making good the external windows that are showing signs of wood rot and replacing. The service should provide bedrooms that are lockable to increase people’s choices and to improve their privacy DS0000026964.V339663.R01.S.doc Version 5.2 Page 29 8. OP24 St Quentin Nursing Home 9. 10. OP27 OP30 It was recommended that domestic cover be provided at weekends. To further develop the system for the monitoring and improving of the service. St Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Stafford Local Office Dyson Court Staffordshire Technology Park Beaconside STAFFORD ST18 0ES 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 Quentin Nursing Home DS0000026964.V339663.R01.S.doc Version 5.2 Page 31 - 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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