Inspection on 05/07/05 for St Raphaels Nursing Home

This inspection was carried out on 5th July 2005.

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 Raphaels Nursing Home 06/09/07

St Raphaels Nursing Home 09/08/06

St Raphaels Nursing Home 09/01/06

St Raphaels Nursing Home 01/02/05

St Raphaels Nursing Home 15/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St Raphaels Danehurst Danehill East Sussex RH17 7EZ Lead Inspector Melanie Freeman Announced 5 July 2005 10:00 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 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 Raphaels H59-H10 S14049 St Raphaels V227255 050705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service St Raphaels Address Danehurst Danehill East Sussex RH17 7EZ 01825 790485 01825 790715 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Trustees of the Order of St Augustine of the Mercy of Jesus Sister Mary Basil Care Home wih Nursing (CRH) 58 Category(ies) of Dementia - over 65 years of age (DE(E)), 58 registration, with number of places St Raphaels H59-H10 S14049 St Raphaels V227255 050705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users to be accommodated is fifty eight (58). 2. That only adults with a dementia type illness are to be accommodated. 3. That service users must be sixty five (65) years or over on admission. 4. That a maximum of eight (8) service users with a learning disability can be accommodated, who can be aged below sixty five (65) years. 5. That service users between the age of fifty five (55) and sixty four (64) years with a dementia type illness can be accommodated. Date of last inspection 1 February 2005 Brief Description of the Service: St Raphael’s is a care home providing nursing and social care for up to sixty people suffering with dementia. The Trustees of the Order of St Augustine of the Mercy of Jesus are the owners. The organisation has other homes in East Sussex. St Raphael’s is situated in extensive grounds near to the hamlet of Danehill. The nearest towns are Haywards Heath and Burgess Hill. The home provides twenty-eight single rooms and fifteen shared rooms. There are several lounges and dining areas. The chapel attached to the home is open to local residents. Set in landscaped grounds, there are attractive enclosed gardens as well as lakes and woodlands. Service users can access these safely. St Raphaels H59-H10 S14049 St Raphaels V227255 050705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at St Raphael’s Nursing Home will be referred to as ‘residents’. This was an announced inspection carried out by two inspectors between the hours of 10.00 and 16.15 on a day in July 2005. As part of the inspection process the inspector made comment cards available to residents, visitors and health care professionals. Comment cards were received from 24 visitors/relatives. This inspection focussed on the experience for residents living in the home. The inspectors spent most of their time with residents in the communal areas of the home and in individual rooms. The inspectors observed staff working and spoke informally to staff members and to the home’s management team. The care documentation pertaining to 6 residents were reviewed in depth along with staff training records. The inspectors toured the home and were able to review the environment and facilities. What the service does well: Residents spoken to praised the home and staff and feedback from the comment cards was very positive. Comments included ‘my husband receives wonderful care from thoughtful well trained staff’ ‘I am extremely satisfied with all aspects of my fathers care’ ‘the standard of care is excellent’ ‘St Raphael’s is just wonderful’. Interaction observed between staff and residents was positive and appropriate. Care documentation confirmed that the medical and health care needs of residents are fully assessed and responded to. Residents and visitors felt that the care needs of the residents are fully met within a caring environment. Care and practice observed by the inspectors confirmed a high standard of care is provided. The quality and standard of the food and entertainment was found to be good. The comment cards also confirmed a high regard for the food provided ‘I am also impressed with the quality of the meals provided’. The home has a huge commitment to maintaining links with the community and particularly with visitors. Staff provision is well maintained with an appropriate number of staff suitably qualified working in the home. The home has been upgraded and adapted to provide high physical and environmental standards throughout. St Raphaels H59-H10 S14049 St Raphaels V227255 050705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Raphaels H59-H10 S14049 St Raphaels V227255 050705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection St Raphaels H59-H10 S14049 St Raphaels V227255 050705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 and 6. St Raphael’s Nursing Home provides appropriate information about the home and the services it offers. The home ensures they can meet resident’s needs prior to them being admitted. EVIDENCE: St Raphael’s has a full and comprehensive statement of purpose and service users guide that is provided to residents or their representatives prior to admission. This should provide clearer information on room numbers and sizes. The homes terms and conditions of residency are included within the service users guide and provided to all new residents. During the inspection it was confirmed that either the home manager or one of the senior registered nurses, complete a comprehensive needs assessment prior to the admission of a resident. Assessment documents are used and these are used to inform the care documentation. During the inspection it was noted that the needs of residents were being responded to effectively by staff, who have received training on the specialist care needs of the residents. This view was supported by the 23 comment cards received from visitors. Specialist staff training provided includes training on dementia, stroke and depression in older people. St Raphaels H59-H10 S14049 St Raphaels V227255 050705 Stage 4.doc Version 1.40 Page 9 A staff handover attended by an inspector confirmed that the specialist care needs of residents are fully discussed and recorded in the care documentation. Intermediate or rehabilitative care is not provided at St Raphael’s Nursing Home. St Raphaels H59-H10 S14049 St Raphaels V227255 050705 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10. The home was found to be meeting the health personal and health care needs of the residents with the support and advise of community health care professionals as necessary. Procedures for the safe administration of medicines are not being fully adhered to. The privacy and dignity of residents is respected. EVIDENCE: Six individual plans of care were inspected and were found to be full and up to date. The plans of care are extensive and detailed and provided guidance to all care staff on the individual needs of residents. The documentation indicated that regular reviews are undertaken and that residents or their representatives are involved in the planning of care. The documentation also indicated that the home has created multi-disciplinary networks that allow open communication with external health care agencies. These agencies are contacted for support and advise as necessary and this contact is then recorded. The inspectors noted that residents who have varying needs and dependencies were receiving appropriate nursing and personal care tailored to meet their care needs, with the support of appropriate equipment and staff. A recognised pressure sore assessment tool is used to identify residents at risk of pressure sore development. St Raphaels H59-H10 S14049 St Raphaels V227255 050705 Stage 4.doc Version 1.40 Page 11 Visitors and relatives comments on the care provided were all positive and included ‘my husband receives wonderful care from thoughtful well trained staff’ ‘I am extremely satisfied with all aspects of my fathers care’ ‘the standard of care is excellent’ ‘St Raphael’s is just wonderful’ ‘this is a particularly caring home, we feel that our mother is made as comfortable and happy as possible’. An examination of the medicine records confirmed that medicine administration charts were not always accurate. This was identified to the home manager. Resident’s rooms were found to be very individual and an area that was respected as the resident’s own private space. St Raphaels H59-H10 S14049 St Raphaels V227255 050705 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,14 and 15. Resident’s opportunities for stimulation through leisure and recreational activities are good and meet individual needs. The provision of meals is well managed and provides choice of meals to a good standard. Meals are well supervised and monitored to ensure residents receive an adequate diet. EVIDENCE: The provision of meaningful activities and entertainment is central to the care provided at St Raphael’s and well developed. Information on this programme is available throughout the home. The home employs two activities co-ordinator and staffing numbers allow for individual time for residents. During the inspection it was noted that care staff had time to provide hand massage with aromatherapy oils. On the afternoon of this inspection an art club was provided. This is a regular class and the inspector who attended this class found it much enjoyed by the residents. Shopping trips are arranged regularly and the home has access to a mini bus. The gardens and grounds at St Raphael’s are a particular feature, and the residents are encouraged to enjoy them with events like tea parties and walks. There is also an attractive patio area with an aviary. Resident’s wishes are respected and during the inspection it was noted that residents were encouraged to make choices whenever possible and to be independent with supervision being provided. St Raphaels H59-H10 S14049 St Raphaels V227255 050705 Stage 4.doc Version 1.40 Page 13 The inspectors ate a midday meal with the residents in separate dining rooms. The meal provided was found to be well presented and to have a good taste. Staff were seen to be supporting residents as necessary and encouraging them to eat in a patient way. One resident was reluctant to eat and the staff member caring for him notified the registered nurse, and the other care staff so that this could be monitored and responded to. St Raphaels H59-H10 S14049 St Raphaels V227255 050705 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. Procedures and practices in the home ensure that complaints made are managed appropriately. Clear guidance on the protection of vulnerable adults is lacking and does not effectively demonstrate that the well being of residents is fully protected. EVIDENCE: The home has a clear complaints procedure and records seen confirmed that complaints are dealt with appropriately. The comment cards received confirmed that the complaints procedure had been made available to interested parties and that none of the respondents had wanted to make a complaint. The adult protection procedure did not provide clear guidance in accordance with local guidelines and confirming that the home must not undertake an investigation without prior consultation with social services. This procedure is being updated. Although staff training has been provided this was in accordance with the policy and procedure that needs to be updated. St Raphaels H59-H10 S14049 St Raphaels V227255 050705 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23,24 and 26. St Raphael’s nursing home has been well adapted and physical standards throughout are very high ensuring that residents live in a spacious, comfortable and safe environment. EVIDENCE: St Raphael’s is an attractive country house that has been extensively upgraded and adapted for its present use. The home is well maintained and provides facilities and living space sufficient for the residents accommodated. Level access is made available by a passenger lift and the grounds are accessible to wheelchair users. All external doors are accessed via number lock to ensure safety. The home is well equipped with mobility aids and provides room for the movement of residents safely. Residents are provided with environmental adaptations and disability equipment that meets their individually assessed needs. The toilets and bathing facilities provide good assisted facilities, and the corridors are wide and accommodate any equipment needed. Resident’s rooms are personalised and individualised with safe heating and water supply. St Raphael’s was found to be very clean on the day of this inspection. St Raphaels H59-H10 S14049 St Raphaels V227255 050705 Stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28 and 30 Staffing numbers and skill mix provided were found to be good and suitable to meet the needs of the residents living in the home. EVIDENCE: At the time of this inspection the home was full with 58 residents living in the home. Staffing levels seen confirmed that they are good and appropriate to meet the specialist care and social needs of residents. Although the home uses agency staff on a regular basis, staff rotas and discussion with agency staff confirmed that they receive training from the home, and are asked to work in the home on an ongoing basis to provide continuity. During the inspection residents spoken to were complimentary about the staff and the comment cards confirmed a high satisfaction with the care and the staff in the home. Many of the comment cards recorded very positive comments including ‘the sisters and all the staff are excellent, friendly and helpful’ ‘staff are excellent, a truly caring and professional environment’ ‘my husband receives wonderful care from thoughtful well trained staff’. Staff training is ongoing and the home is working towards having 50 of the carers qualified at NVQ level 2. A well developed training programme is in place and this includes mandatory training such as first aid, manual handling and infection control, and training based on meeting the specialist needs of the residents. This includes dementia, depression in the elderly and stroke. Although induction training is provided there was no record of staff receiving an induction to the home and safety matters that is provided over the first couple of shifts. St Raphaels H59-H10 S14049 St Raphaels V227255 050705 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,34,35 and 38. The home manager has the skills and commitment to mange the home well. The financial procedures safeguard resident’s personal money and the financial viability of the home. Health and safety procedures are good and ensure staff and resident’s safety. EVIDENCE: The home manager is a registered nurse with extensive experience in caring for residents with a dementia-type illness. She has registered to start an NVQ in management at level 4 starting in September 2005. The home manager was seen to work closely with the staff in the home and to know all the residents well. The home has a business plan and accounts that take in to account proposed spending. There is a system in place to allow for residents to buy and spend money as they wish, receipts are then kept and are added to the individual monthly accounts. All records relating to health and safety matters were found to be full and thorough. It was however noted that the home’s policies and procedures need to be reviewed to demonstrate regular updating. St Raphaels H59-H10 S14049 St Raphaels V227255 050705 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 x 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 4 13 x 14 3 15 3 COMPLAINTS AND PROTECTION 3 x 3 x 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x x 3 3 x x 2 St Raphaels H59-H10 S14049 St Raphaels V227255 050705 Stage 4.doc Version 1.40 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 9 18 Regulation 13(2) 13(6) Requirement That medicine records are all maintained accurately. That an adult protection procedure providing clear guidiance to staff on what to do following an allegation or suspicion of abuse is provided. That all policies in the home are reviewed and updated as necessary Timescale for action 1.7.05 1.8.05 3. 38 13 1.10.05 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. Refer to Standard 28 30 32 Good Practice Recommendations That a minimum ratio of 50 care staff have obtained NVQ level 2 in care by 2005 That initial induction training is recorded for all staff including agency staff. That relatives/representatives be informed of the inspection process through the homes quaterly newsletter. St Raphaels H59-H10 S14049 St Raphaels V227255 050705 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Ivy House 3 Ivy Terrace Eastbourne East Susssex BN21 4QT National Enquiry Line: 0845 015 0120 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 Raphaels H59-H10 S14049 St Raphaels V227255 050705 Stage 4.doc Version 1.40 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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