Inspection on 09/01/06 for St Raphaels Nursing Home

This inspection was carried out on 9th January 2006.

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 05/07/05

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 Raphael`s Danehurst Danehill East Sussex RH17 7EZ Lead Inspector Unannounced Inspection 9th January 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Raphael`s DS0000014049.V276653.R01.S.doc Version 5.1 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 DS0000014049.V276653.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Raphael`s Address Danehurst Danehill East Sussex RH17 7EZ 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) 01825-790485 01825-790715 The Trustees of the Order of St Augustine of the Mercy of Jesus Sister Mary Basil (aka Catherine Rath) Care Home 58 Category(ies) of Dementia - over 65 years of age (58) registration, with number of places St Raphael`s DS0000014049.V276653.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. The maximum number of service users to be accommodated is fifty eight (58). That only adults with a dementia type illness are to be accommodated. That service users must be sixty five (65) years or over on admission. That a maximum of eight (8) service users with a learning disability can be accommodated, who can be aged below sixty five (65) years. That service users between the age of fifty five (55) and sixty four (64) years with a dementia type illness can be accommodated. 5th July 2005 Date of last inspection Brief Description of the Service: St Raphaels is a care home providing nursing and social care for up to fiftyeight 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 Raphaels 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 Raphael`s DS0000014049.V276653.R01.S.doc Version 5.1 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 report should be read in conjunction with the report of the inspection that took place on 5 July 2005 for an overview of the core standards inspected over the year. This was an unannounced inspection carried out by two inspectors between the hours of 10.00 and 16.45 on a day in January 2006. This inspection focussed on the experience for residents living in the home and the inspectors spent most of their time with residents in the communal areas of the home and in individual rooms, two visitors were also spoken to. The inspectors observed staff working and spoke informally and formally to staff members and discussed the management of the home with the registered manager and her deputy. The care documentation pertaining to 6 residents were reviewed in depth along with 4 staff recruitment files. What the service does well: What has improved since the last inspection? The home has met the requirements made at the last inspection. Record keeping in respect of medicine administration has improved since the last inspection. A new adult protection policy and procedure has been implemented since the last inspection and all the homes policies and procedures have been reviewed. St Raphael`s DS0000014049.V276653.R01.S.doc Version 5.1 Page 6 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 Raphael`s DS0000014049.V276653.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection St Raphael`s DS0000014049.V276653.R01.S.doc Version 5.1 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 the following standard(s): 3 and 5 The admission procedures ensure residents are suitably assessed prior to admission, residents and their representatives are involved in this process and are provided with relevant information on the services, facilities and suitability of the home. EVIDENCE: During the inspection the inspectors were able to access the quality of the preadmission assessment documentation. This was found to be full and to take into account residents and relatives views. This assessment is used to inform the care of residents and is incorporated into the care documentation, however it was noted that the date of completion is not always recorded. Discussions with visitors confirmed that they were involved in the admission procedure both visiting the home prior to an agreement for any admission to take place. Both confirmed that they felt consulted and that a positive choice was made by residents and their relatives to move into St Raphael’s. The home manager also confirmed that a 6-week trial period is operated. St Raphael`s DS0000014049.V276653.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 and 9 The home was found to be meeting the health, personal and social care needs of the residents with the support and advice of community health care professionals as necessary. Procedures in the home allow for the safe administration of medicines to be recorded. EVIDENCE: Six individual plans of care were inspected and these were found to be individual and full, giving good guidance to care staff on how to care for residents. Currently a monthly evaluation is completed on the computer system. The care documentation is kept in 2 separate offices and the inspectors found different systems in place for record keeping. One office did not appear to keep any hard copies of the plans of care and all records had to be accessed from the computer. This access is limited as there are only 2 computer terminals available to care staff. Staff interviewed confirmed that they would access the up to date plans of care from either the computer or the folder containing the care documentation and St Raphael`s DS0000014049.V276653.R01.S.doc Version 5.1 Page 10 that they were given clear information from the registered nurses at hand over. Discussion took place with the management around the need to ensure that the plans of care are readily available to staff and that there is a clear system to identify evaluation and up dating of these. 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, staff and health care professionals. Staff were also seen to respond to residents sometimes challenging behaviour in an understanding and professional manner. An examination of the medicine records confirmed that the completion of medicine administration charts had improved since the last inspection. St Raphael`s DS0000014049.V276653.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 15 Contact with visitors and the community is given a high priority and promoted. 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: Through contact with residents, visitors and staff it was confirmed that Christmas was well celebrated with everyone enjoying the activities entertainment and decorations. On speaking to residents and visitors it was clear that visiting is very positively encouraged with no restrictions being imposed. Many visitors spend a great deal of time in the home and staff make them feel welcome and involve them in the activities whenever possible. The 2 visitors spoken to said that they were kept fully informed of resident’s condition and the care that they needed. The organisation provides residents and visitors with a bi-monthly newsletter, which was found to contain useful information. 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 and encouraging them to eat and St Raphael`s DS0000014049.V276653.R01.S.doc Version 5.1 Page 12 maintaining their independence whenever possible. Resident’s dignity was maintained with the use of napkins as opposed to bibs to protect clothing. St Raphael`s DS0000014049.V276653.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Procedures and training in the home ensure that adult protection issues are managed appropriately. EVIDENCE: The home has a detailed adult protection procedure that has been up dated since the last inspection. This has been implemented with further staff training. The local Adult Protection guidelines were available in the office area. Staff spoken to had a good understanding of what constitutes abuse. St Raphael`s DS0000014049.V276653.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,23,25 and 26 St Raphael’s nursing home has been well adapted and the 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. During the inspection staff were also seen to be using hoists appropriately. Residents are provided with environmental adaptations and disability equipment that meets their individually assessed St Raphael`s DS0000014049.V276653.R01.S.doc Version 5.1 Page 15 needs. The toilets and bathing facilities provide good assisted facilities, and the corridors are wide and accommodate any equipment needed. A new fully assisted shower has been provided on the ground floor since the last inspection and staff confirmed that this facility is well used. Resident’s rooms are very attractive and personalised with safe heating and water supply. St Raphael’s was found to be very clean on the day of this inspection although one area on the ground floor was found to be malodorous. This was identified to the home manager who confirmed that this would be addressed. The two visitors spoken to were complimentary of the physical environment saying how pleasant it was. St Raphael`s DS0000014049.V276653.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 The homes recruitment procedures were on the whole good. Further attention is needed to ensure all required documentation is available in the home. EVIDENCE: At the time of this inspection the home was full with 58 residents living in the home. The recruitment records for 4 staff members were reviewed in depth and on the whole these were found to be full and contain the required information. However one file did not contain evidence of identity and a recent photograph and another file did not contain a health questionnaire and a reference from this carers other current employer. The home manager advised the inspectors that any documents that were not available in the home would be available at the main office based at St Georges. St Raphael`s DS0000014049.V276653.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,36 and 37 The management of the home encourages an open, relaxed, homely and caring atmosphere where care staff are suitably supported and guided EVIDENCE: Feedback from visitors, residents and staff confirmed that the home manager and her deputy are approachable and respond to any contact positively. Staff spoken to said that they thought that they were listened to and that their points of view were respected. The home has developed a quality assurance system that uses questionnaires and takes into account the views of residents, relatives and their representatives. These questionnaires are audited and now need to be reported on and circulated to interested parties and the CSCI. Staff supervision is provided and documented along with supervision agreements. St Raphael`s DS0000014049.V276653.R01.S.doc Version 5.1 Page 18 The homes policies and procedures have been reviewed since the last inspection. St Raphael`s DS0000014049.V276653.R01.S.doc Version 5.1 Page 19 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 X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X 3 3 3 X 3 3 STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 X X 3 X X St Raphael`s DS0000014049.V276653.R01.S.doc Version 5.1 Page 20 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 OP7 Regulation 15 Requirement That accurate up to date plans of care are available to all care staff. That these plans demonstrate regular review and includes further information on activities undertaken and available. That the personnel files retained in the home contain all the required documentation. That prospective staff have references from their current or last employer. Timescale for action 01/02/06 2. OP29 19 01/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP1 OP3 OP28 Good Practice Recommendations That the service users guide includes the number and size of rooms in the home. That the pre-admission assessment is dated and signed on completion. That a minimum ratio of 50 care staff have obtained DS0000014049.V276653.R01.S.doc Version 5.1 Page 21 St Raphael`s 4 5 OP30 OP32 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 bi-monthly newsletter. St Raphael`s DS0000014049.V276653.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex 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 Raphael`s DS0000014049.V276653.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!