Inspection on 01/07/08 for St Raphael`s Christian Care Home

This inspection was carried out on 1st July 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Raphael`s Christian Care Home 24/05/07

St Raphael`s Christian Care Home 25/07/06

St Raphael`s Christian Care Home 27/09/05

St Raphael`s Christian Care Home 07/03/05

St Raphael`s Christian Care Home 22/06/04

St Raphael`s Christian Care Home 06/11/03

St Raphael`s Christian Care Home 02/07/03

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE St Raphael`s Christian Care Home 32 Orchard Road Bromley Kent BR1 2PS Lead Inspector Wendy Owen Key Unannounced Inspection 10:00 1st July 2008 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 Raphael`s Christian Care Home DS0000010153.V365754.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 Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Raphael`s Christian Care Home Address 32 Orchard Road Bromley Kent BR1 2PS 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) 020 8313 1377 020 8460 1710 straphaels@schealthcare.co.uk Trinity Care Ltd Manager post vacant Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (58) of places St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 58 24th May 2007 Date of last inspection Brief Description of the Service: St Raphael’s is a large extended building situated in its own grounds with off road parking to the front of the building and within easy reach of local shops. The own is also on a bus route giving access to Bromley shopping centre and leisure facilities. St Raphael’s is part of the Southern Cross Healthcare Group, established in 1996, the company provides long term care for vulnerable people throughout the United Kingdom. The home is divided into three units, one on two levels and the other on four levels, with passenger lifts for accessibility. The home offers good communal areas accessible to all its residents. The home is dual registered with an attached purpose built nursing wing on the ground floor. All of the bedrooms in the Mellifont unit have en suite facilities as do the majority of bedrooms in the nursing unit. The older part of the building, the Orchard unit, bedrooms are provided with a wash hand basin, and toilet and bathroom facilities are within easy reach. All the bedrooms are designed for single occupancy. The home has the benefit of central heating; radiators in the resident’s bedrooms are covered in line with health and safety requirements. There are grab-rails on the stairs and in the corridors, toilets, showers and bathrooms. Specialist bathing, toilet and lifting aids are available for residents use. All bedrooms, toilets, shower rooms and bathrooms are fitted with a lock, to ensure privacy, these locks can be accessed from outside in the event of an emergency. St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 5 Information on fees has shown they range from £378.51-£987.50. F3es for Local Authority funded people are different to those for private. Fees also differ for residential and nursing units. The Statement of Purpose states that a copy of the latest inspection report is available on request from the home. There is also a copy available in the reception area. Information is also provided to prospective residents in the form of a Service Users Guide. St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 2 star. This means the people who use this service experience good outcomes. This inspection took place over one day with two inspectors. We also visited a few days later to provide feedback. This inspection included a tour of the home, speaking to four residents, three relatives and four members of staff during the visit together with the manager. We observed practice, viewed records and received comment cards from two health professionals; eight from staff; eight from relatives and nine from people who use the service. We also considered the Annual Quality Assurance Assessment (AQAA) which Providers have to send us and tells us about how they are delivering the service. This was received on time and fully completed with comprehensive information. This report also includes the outcome from an unannounced visit made in January 2008. What the service does well: St Raphael’s provides a good standard of care to people living there. One relative wrote “excellent caring staff” whilst another wrote “The home has a very warm and friendly feel.” Health care needs are generally met by experienced staff. One health professional wrote “I think all of the staff at the home care greatly for the resident. Any suggestions I make regarding dietary always gets done.” This shows staff take on board professional advice to ensure individual needs are met. St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 7 Staff are trained, competent and receive the support to provide the care people want and to ensure they are kept safe and well. They also provide a warm and friendly atmosphere where people feel valued. The food provided is of a good standard with variety and choice that ensures nutritional needs are met. There is a range of activities that are improving gradually with more staff involved in this. The impact the manager has had on the home since she arrived and been very positive. People are able to approach her, she is supportive and deals with any issues well. She encourages people to be more involved in decisions about their care so that the home is run according to their needs. St Raphaels has “an excellent manager who cares about charges” wrote one relative whilst another felt the home provided “A caring environment with a happy atmosphere. Well run.” The home is run effectively and efficiently with systems in place to ensure the safety and well-being of those living there. Complaints or concerns, including adult protection issues are managed effectively and involves the necessary agencies to ensure openness and transparency. What has improved since the last inspection? There has been more progress since the last key inspection with an unannounced inspection in January showing good progress to meeting the requirements. There has also been improvements in the way staff plan peoples’ care trying to ensure they have information about all aspects of care and they are more person-centred. The way in which prescribed medication is recorded has also been improved with more robust recording in place to ensure the well-being of the individual. Mealtimes on the nursing unit have also been reviewed to ensure staff have the time to support people to eat their meals. St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 8 The manager has improved the system for recording complaints with an audit trail of the investigation and any actions taken to resolve the issue. There has been work completed in the home, particularly in the residential unit to improve the environment for those living there. We noted that the formal supervision of staff and training provided has been more organised and provide regularly. Recruitment practices have also been more organised and robust ensuring vulnerable people living in the home are protected. A new alarm call has also been fitted to ensure people living there have access to staff in an emergency. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 9 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 Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 10 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): 2,3,5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have information about the service to decide whether it is able to meet their needs. Staff have information about the individual prior to admission to ensure they can provide the care and support to individuals admitted into the home. EVIDENCE: The random inspection visit in January 2008 found the pre-admission procedures to be generally good with assessments taking place and residents and family involved in the provision of information as well as health professionals. Some gaps. St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 11 The home encourages people to view the home before making any decisions. Encourage people to view the home. One person spoken to at this inspection who arrived very recently said their son settled them in and that his room is personalised. They also told us that they were very happy with the accommodation. “Its really nice here” they said. One other person told us that the social worker found the home for them and they (resident) visited the home prior to being admitted. Individual files viewed contained pre-admission assessments by the home and assessments provided by the Local Authority, when the arrangements are made by them. We noted that the person and family members were involved in this process ensuring staff have the information they need about the how they can best meet needs, how their family member wished to be cared for and how they are in certain situations. The assessment should be followed by a pre-admission care plan detailing how staff are to meet core needs. The development of the were mixed which leaves some aspects of care, when first admitted, to word of mouth. There was evidence of the home writing to individuals stating that after assessment, they are able to meet their needs. Contracts were found to be in place with the majority of surveys from people using the service stating they had received a contract and information about the home. Standard 6 is not applicable. St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 12 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 good. This judgement has been made using available evidence including a visit to this service. People living in the home have a care plan developed to ensure staff have the information to meet their needs. Health care needs are met through accessing appropriate healthcare and ensuring medication practices are safe. EVIDENCE: The random inspection in January 2008 found care plans had been developed and were comprehensive and personalised although there were some gaps in recording needs including social care needs. St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 13 During this inspection we found that progress has been made in respect of care planning information and the records about how the home meets individual needs. There was some detailed information including care plans developed from risk assessments, also their needs regarding personal care, mobility etc. Some of the issues raised at the last inspection have been addressed for example detailing the pressure relieving equipment and hoists used and specific slings and mattresses. There were still some gaps in the information eg: for one person the risk of epileptic fits had not been identified on a risk assessment/care plan. There is also a need to ensure communication, confusion/emotional needs are detailed and more specific information on how their personal care needs are to be met such as number of staff to undertake personal care and what form this takes ie bath or shower. Some aspects of the care plans are person centred whilst others do not give enough information about specific needs or patterns of routines of the day. The manager acknowledges the need for improvement in the way care plans are developed and be made more person-centred and continues to develop these and provide staff with training in this area. Relatives spoken to were generally happy with the care provided to their family member. There were some areas that could be improved such as ensuring male resides are shaved daily where they wish this to happen. One relative said “X… generally looks tidy but hasn’t been shaved very well. looks a little stubbly.” This is sometimes restricted because male staff are not always on duty to do this. One relative felt that they often do this better than female carers. One person said “I feel happy and at home there.” Another relative was very happy with the care and they visit each day. They said, “Staff do try”. “ I am very pleased the way X is looked after. The staff are always very nice. He is always kept nice and clean.” Most people felt that staff were kind and sensitive to their needs and when meeting personal care needs they (staff) did so in the privacy of their rooms or bathrooms/WCs. We noticed that people living there were generally groomed and wellpresented, although for one relative the were issues about ensuring they were St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 14 dressed in the way they felt they would wish to be. This is where improvements can be made to ensure the specific needs are met. It was clear from the surveys returned by people living in the home and their family members that they believe their needs to be met. There were some issues about staffing levels raised by people using the service and staff. When asked are staff available three said staff are always available, five usually and one sometimes. So whilst some comments reflected people having to wait for staff the overall experiences were positive. We received written feedback from two health professionals, nine service users and eight relatives with verbal feedback from a health professional, three relatives and four people living in the home. Once again the overall feedback was positive. Health professionals stated that staff follow their directions, most people felt their medical needs were always or usually met and relatives stated that they were informed about their health needs of their family member. It was clear from the individual records and from observations that people are provided with pressure relieving equipment, aids and adaptations and other equipment to ensure their health needs are met. Records also showed people accessing health professionals to receive appropriate treatment, including specialist treatment such as dietician. The exception to this is access to appropriate dental care. One relative felt that their family member had not received the continued specialist support from as they had done at home. The manager dealt with this immediately. We noted individual weights were being monitored as required by risk assessments and appropriate action taken eg referring to GP or dietician. It is also positive that the manager is sending two staff from each unit to attend foot care training to ensure people receive regular foot-care treatment rather than rely on the NHS specialist. Feedback from the health professionals also confirmed staff approached people living there with kindness and a caring attitude. Discussions with the manager and information provided, demonstrates the manager’s aim to ensure care planning extends to meeting their needs at the end of their lives. They have chosen to implement the Gold Standards Framework under the guidance of and support from St Christopher’s Hospice. St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 15 We also inspected the medication practices and records to ensure people’s healthcare needs are being addressed in relation to prescribed medication. When we inspected the medication during the inspection in January we found that improvements had been made with a number of requirement met although further requirements were made in respect of “as directed” mediation, ensuring records of medication are carried forward and ensuring creams were stored safely. During this inspection we audited the medication on two units. These were generally in good order. Records were complete with photographs and allergies recorded. The number of medications remaining each month had been carried forward as required at the last inspection, although this needs to be more consistent. This was also true of the “as directed” where not had the guidance as to how the creams are to be administered. In most cases, where there were variable doses, the number administered had been recorded. Once again consistency is an issue and may lead to misinformation about the persons healthcare. Over both units there were minor gaps and one medication handwritten with one signature. The Registered General Nurse administers medication on the nursing unit and care staff are responsible on the residential unit. The controlled drugs were stored and recorded accurately and medication in generally was stored securely in medical rooms and trolleys. We noted that temperatures were recorded for the fridges and rooms, although the temperature in the medical room on the residential unit was running high. Medication must be stored below 29 degrees to ensure the affect is not altered. We noted that one person has insulin administered by the care staff, although this is not identified in a risk assessment or care plan nor is there a record of training by the District Nurse (DN). Discussions with the DN confirmed that they had trained the senior staff but had not recorded this. In these cases it is the responsibility of the DN delegating responsibility for administering the insulin to record the training and action and monitor the healthcare of the person. We discussed the options with the DN and Commission Pharmacy Inspector with changes made to existing arrangements to make these more robust without negatively affecting the healthcare of the person. We also recommended that the system for administering warfarin be reviewed as it is not clear. Some individuals self-medicate and this is good practice. Risk assessments are in place although the system would benefit from improvement also. For St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 16 example showing there is a record of medication handed over, record of monitoring and compliance. St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 17 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 enjoy a good standard of food with choices and variety to meet nutritional needs. There is a range of activities on offer with some progress being made to ensure staff understand their role in interacting with people to ensure they are stimulated and engaged in what is going on around them. EVIDENCE: St Raphaels has one activity co-ordinator who works to provide a range of activities and entertainment for the people living in St Raphaels. The manager has also made arrangements for three care staff to attend Age Exchange training to ensure staff understanding their role in the stimulation and engagement of residents. This is good practice and shows the manager is aware of the importance of this in residents’ everyday lives. St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 18 The co-ordinator has developed a schedule of activities and spends time between the residential and nursing units although it still appears that the people living on the residential units benefit more. One resident onth4e nursing unit said that they send all day in their bed and whilst staff visit them this is only to undertake tasks rather than provide any engagement or stimulation. This may be improved once staff have attended their training. Entertainment is arranged and there is the expectation that more trips are to be organised for example a trip to Eastbourne. The manager is also looking to improving involvement with the community, including schools, churches and day centres or clubs. The recently held garden fete was deemed a success with a number of residents and relatives involved making it a very enjoyable day. We noted that while inspecting the nursing unit during the afternoon the staff were involved in a quiz with some of the people on the unit. It was clear that all those involved, however minimal, enjoyed the stimulation and engagement. People also benefit from a pleasant garden and once again we noticed the activity co-ordinator spending time with a small group chatting and enjoying the sunshine. Of the surveys returned one said activities were always arranged that they can take part in; four said usually and three sometimes. People also benefit from the regular visits by a hairdresser and various multidenominational church services. The feedback received on the quality of food ranged from “generally good” to “bland” although it was clear from the feedback that people generally liked the food provided. One person told us that there was no choice of meals and they ”had what they were given.” Whilst others told us of the choices on offer. This as supported by the menus in place. Some people told us of things they would like to see on the offer such as “I would like more fruit to be made available.” “I would like herbal tea to be available occasionally.” The manager should try and obtain this sort of information from people to ensure they are offered a variety of foodstuffs. The support people need is mixed with some very dependent on staff assistance and support. The last inspection required the manager to review the mealtimes on the nursing unit as the staffing levels did not meet the needs St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 19 of the people there. This has now been done with meals staggered and support provided where necessary to ensure people benefit from adequate nutrition. Some people prefer to eat their meals in their rooms whilst others enjoy meals in the dining room. This is entirely their choice. We noted that there were drinks provided throughout the day with one relative, who visits daily, confirming this. They told us also about the choices of food available to meet individual diets. One relative told us that their family member had difficulty eating their meals and we noticed this had been made easier by the use of a special plate. Other specially adapted crockery and cutlery is available, if required. We noted that the choices on offer are based on the Nutmeg menu (to enhance healthy eating and to ensure people are getting all nutrients they need for a balanced diet.) The home encourages relatives to visit their family members. A number of residents and relatives told us they received regular visits from family members and are made very welcome. One person we spoke to had their family member there each day. Another relative said they visited almost everyday. It is clear from observations that some people prefer to spend their days in the rooms or even in bed whilst other prefer the company of others and enjoy different routines. Looking at care plans and other information we suggest that there should be more information about people’s preferred routines of the day or their daily pattern. This would give staff more guidance and show that routines are flexible to meet people’s individual needs. St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are systems in place to ensure people are listened to and any concerns or allegations listened and responded to appropriately. Staff are aware of their role in ensuring people are protected and the quality of care improved. EVIDENCE: A complaints procedure has been developed and provided to all in the form of a Service Users’ Guide. The manager and Providers were strongly advised to ensure the complaints procedures are made available in other formats to ensure those who may have visual or communication difficulties are able to understand the procedures. It is positive that at the last inspection that the manager’s approach to complaints is to record all verbal or written and ensure they are investigated in an open and transparent way. One improvement required was to ensure there is a clear and transparent audit trail in place. The AQAA showed there to have been four complaints over the last year with one adult protection investigation. Two of the complaints had been upheld and St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 21 the adult protection allegation had been investigated fully and in line with guidance and good practice. The records viewed in the home showed there to have been eight complaints since 30/06/07. These had been recorded and investigated with records of the investigation, letters to complainants and outcome of the investigation. On viewing the surveys from people using the service and relatives we found that they knew who to speak to if they were unhappy, knew how to make complaint and felt that they were responded to appropriately. We also spoke to three relatives who stated that they knew how to raise any concerns and felt the manager open and approachable. We received very favourable comments from a number of people regarding the manager’s approach to ensuring people receive the care they need or want. “Senior members of staff are very approachable and very caring and always ready to listen and any constructive criticism and act upon it.” One person wrote “Comments taken seriously, always logged and acted on.” Staff who provided written feedback also understood their role in ensuring complaints are dealt with if they are able or referred on senior staff. Adult protection and whistle-blowing procedures have also been developed and are comprehensive. Staff are provide with guidance in these procedures during the induction and re-enforced with adult protection training at a later date. The manager has obtained copies of the various Local Authority “Inter-agency Guidelines on abuse.” We spoke to staff about their understanding of abuse and how they would deal with suspicions or allegations of abuse. Both staff had a good understanding of abuse, their role in protecting people and the role of other agencies such as Social Services, police and the Commission. The AQAA also states that staff have been provided with guidance on the Mental Capacity Act. St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 22 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, 21,22,23,24,26,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home are provided with a mixed standard of accommodation, although there has been some improvement in the residential unit over recent months to make the home more comfortable and homely for them. The home is generally clean and fresh and people are able to make their rooms homely with personal possessions brought in. EVIDENCE: St Raphaels Care Home is located over two floors with a nursing and residential unit. St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 23 The nursing unit provides more up to date accommodation being the more recent build. The residential unit has been in need of refurbishment over recent years with the last twelve months seeing some decoration work being undertaken. The inspection in January 2008 found some improvements to the home with “mellifont” dining room having been decorated. One of the bathrooms also had been decorated and more personal touches added. The progress had been restricted due to the lack of a maintenance man. This has now been resolved with a maintenance person employed since then. We have been provided with an action plan for further refurbishment and work to be completed. The number of metal frame beds had also been significantly reduced and further reductions since that inspection. There have been further improvements since the last inspection including vanity units for the rooms; carpets for communal areas; lighting and carpets in Orchard and the fitting of a new nurse call system. Fire doors have also been replaced and the reception area made more pleasant. Risks of falls have also been reduced with the fitting of keypads on three unit stairwells. There are further plans for the home. This includes making all “Orchard” bedrooms en-suite, relocation of the laundry from the basement to ground level and major redecoration. We had the opportunity to view the home’s refurbishment action plan with a number of areas already within the timescale. There are also plans to increase the number of rooms. The outside of the home has also seen some improvements with the building of a raised flower-bed and water feature. The manager is also looking to mark out car park to ensure disabled people have easier access. Some people who provided feedback felt that the signage could be improved around the home especially for people who are confused. We viewed some of the private accommodation and spoke to people about what they thought of their rooms. We found the rooms to be of a mixed standard but personalised with mementoes, photographs and TVs and telephones. The majority of people thought the home to be clean and fresh and this matched with our findings on the day of the visit. There were no strong or St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 24 offensive odours and it is only the “age” of some parts of the home that make it appear less than clean and fresh. One person mentioned the “toilet bowls” were in need of a more thorough leaning. St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 25 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. Recruitment procedures ensure that vulnerable people living in the home are protected from the employment of staff with poor practices. Staff are trained and competent to provide a good level of care and support to meet people’s needs. EVIDENCE: The nursing unit is staffed by a Registered General Nurse and care staff and the residential unit is the responsibility of senior care staff supported by care staff. We visited the home in January 2008 and this showed us that the overall staffing levels were satisfactory with the exception of mealtimes on the nursing unit. The routines have been reviewed and the support improved. Whilst this inspection shows that people are generally very pleased with the care there are still some concerns over the staffing levels. This means that St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 26 people may have to wait a while before they can be assisted to attend personal care needs or one person said they spent most of their day in their wheelchair. One person writing a form on relatives behalf wrote “ I’m always concerned that there never appears to be enough staff, especially around the lounge areas where majority of the residents sit.” We received some good comments about the manager and staff. “Excellent friendly staff/tenant relationship. I have never had any cause to doubt staff care/skills.” “The home has a very warm and friendly homely feel,” said one relative Staff gave positive answers to the support and training provided. “The manager has been supportive and she is approachable. She is always there for when you need help and my deputy manager.” Another said of the organisation that it “Gives the appropriate training to meet the needs of the users.” The improved training matrix, discussions with staff and viewing individual training needs analysis viewed confirmed that there is a range of core and specific training provided. It is positive that staff are provided with specific training such as foot care and activity support to meet identified needs. The deputy manager has attended dementia training “Yesterday, Today, Tomorrow and this is being cascaded down to staff. Staff spoken to said they enjoyed this training and the deputy manager said it is being well received. There was evidence of small amounts of training for the clinical staff. The manager may wish to review this to ensure nursing staff have the training to keep up their clinical practice. Common induction standards have been introduced for all new staff and this need to be recorded on the training matrix. Surveys from staff showed that staff are provided with information, training, support to do their job and that they believe they do it well and that people are well cared for. One staff member wrote “very good induction, it allowed me to do my job.” The AQAA shows there to be thirty-seven staff of which fifteen staff have NVQ 2 or above and seven working towards it. Staff stated that there are regular meetings and reports so staff have information about particular people and their care needs as well as meetings about more general care issues. St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 27 Recruitment practices were inspected through viewing of five staff files including an RGN; administrator; carer; domestic assistant. These were found to contain an application form; interview schedule and checks required. These checks included proof of identity; references; photograph and Criminal Records Bureau checks. In general the practice is satisfactory, although there were some gaps that need to addressed to make them more robust. This includes previous employment in care is verified as to the reasons why the person left the employment and that references are supported with compliment slip or company stamp to ensure the legitimacy of the reference. St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is experienced and professional and runs the home with an open and inclusive approach to ensure people have th3e care they want. The home is well run with effective systems in place to ensure the safety and well-being of the people living there. EVIDENCE: St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 29 The manager has been in post since October 2007. Our visit in January showed her to be making progress and improvements that were benefiting people with good feedback from relatives and residents. The manager has yet to be registered with the Commission, although registration has been applied for. This inspection found her to be continuing to build on the improvements made earlier on the year with good efficient systems in place. The feedback, both written and verbal, from residents, relatives and staff show that the manager continues to be making a positive impact. “I think in all aspects they perform to the highest level. The staff can only do well, if they have a good manager, and they have a great one, leading the way. Well done” wrote one relative. “Very friendly and supportive staff and an excellent about his charges” said another. “Manager and staff excellent” said one service user. One relative wrote “there has been a marked improvement in the care and attention in St Raphaels in the past year.” Staff also responded positively about the support provided by the manager who is “approachable.” Staff told us about regular staff meetings and handovers that are held to ensure staff involvement in determining the appropriate care and ensuring the quality of care is improved. Systems are also being implemented to ensure people are involved in decisions about the way the service is being run or wish it to be run. For example a relative/resident group that helps create a positive culture of determining the future. We asked the manager/Provider to ensure a review of the service is undertaken that includes consultation with people who use the service. The AQAA details difficulty in getting surveys back and therefore undertaking a full review of the service. A Registration certificate is in place and reflects the current position. The Employers Liability Insurance is also in date and for an appropriate amount ensuring adequate insurance in place in case of accidents or emergencies. St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 30 Formal supervision of staff is important to ensure staff are aware of what good care is, are provided with the resources and training to do so and are monitored in the practices. Evidence from staff and some documentary evidence confirms staff are receiving regular supervision from their line manager and that senior staff received supervision and appraisal training to ensure they could supervise staff appropriately. The manager maintains the health and safety of the home with checks undertaken on equipment and services used. We checked a sample of these, cross-referencing with the information held on the AQAA. Fire checks also completed including fire risk assessment; fire drills and servicing of the equipment used. There is a need to ensure they have a system in place for all care staff to benefit from participation in fire drills participation. The fire panel is awaiting replacement parts to ensure it works effectively throughout the home. We did not undertake an inspection of the kitchen as it achieved 5 stars from the Environmental Health Inspector showing it to be a excellent standard. The home has also progressed with the administration of the home with a new administrator recently recruited and having a positive impact including being more efficient and more organised. The training matrix shows core training is being provided for staff. Whilst it is clear that care staff receive moving and handling training the manager must ensure that all staff including laundry, domestic and the maintenance person are also provided with training that befits their role and tasks to be undertaken. The manager must risk assess the requirements each staff group and determine need for and the regularity of updates. First aid training is also provided, although the manager was made aware of the need, once again, to risk assess the requirements in relation to the type of training to be provided. Guidance on this was also provided. Monies well managed with receipts and records in place and regular audit to ensure the monies are protected. St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 2 3 2 2 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 X 3 St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 32 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 OP9 Regulation 13 Requirement Where staff administer insulin with residents’ consent, there must be a robust system in place for ensuring staff are trained and competent to protect people. The care plan must detail the action staff are taking to ensure the individuals needs are being met. People must have access to dental treatment, where these needs are identified to ensure healthcare needs are met. People must be protected by robust recruitment procedures. This must include verification of previous employment in care and checks to ensure the legitimacy of the references. Where there have been surveys completed on the quality of care provided a report must be produced detailing the outcome of the survey together with any action plan to improve the service. The report, once completed, must be sent to the Commission. A risk assessment on the DS0000010153.V365754.R01.S.doc Timescale for action 01/08/08 2 OP8 12 01/10/08 3 OP29 17 01/09/08 4 OP33 24 01/12/08 5 OP38 13 01/09/08 Page 33 St Raphael`s Christian Care Home Version 5.2 provision of first aid training for staff must be completed to determine the requirements of the home to meet the safety of people living there. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations Residents in the nursing unit should be provided with the opportunity to participate in activities and stimulation within the nursing unit. Risk assessment should be developed where keys cannot be held by residents. Care plans should be more person centred and include people’s preferred routines The complaints procedure should be made available in other formats to ensure those with communication difficulties are able to understand the procedures. Staffing routines and levels should be reviewed to ensure supervision and monitoring of people living there. Nursing staff should have access to more clinical training to ensure their clinical practice is up to date. 2. OP7 3. 4. OP3 OP16 5 6 OP27 OP30 St Raphael`s Christian Care Home DS0000010153.V365754.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. 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