Inspection on 15/12/05 for St Ronans Nursing and Residential Care Home

This inspection was carried out on 15th December 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Ronans Nursing and... 12/11/08

St Ronans Nursing and... 13/11/06

St Ronans Nursing and... 07/06/05

St Ronans Nursing and... 05/01/05

St Ronans Nursing and... 13/07/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE St Ronan`s Nursing and Residential Care Home 23 - 27 St Ronan`s Road Southsea Portsmouth Hants PO4 OPP Lead Inspector Jan Everitt Unannounced Inspection 15th December 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Ronan`s Nursing and Residential Care Home Address 23 - 27 St Ronan`s Road Southsea Portsmouth Hants PO4 OPP (023) 92 733359 (023) 92 817738 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) Mr John Pattison Ms Jane Helliwell Ms Amanda Jayne Brett Care Home 33 Category(ies) of Dementia - over 65 years of age (33), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (33), Old age, not falling within any other category (33), Terminally ill (33), Terminally ill over 65 years of age (33) St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the TI category can not be admitted under the age of 55 years. 7th June 2005 Date of last inspection Brief Description of the Service: St Ronans is a care home providing nursing and personal care for 33 older people in the categories of terminally ill, mental disorder, excluding learning disabilities and those with mental frailty associated with old age. There is a condition of registration that no person under the age of 55 years can be admitted with terminal illness. The home is owned by a partnership of two people and is the only home owned by them in the area. The home is three large, four-story Victorian houses that were converted to a care home a number of years ago. The home is located in a residential area of Southsea in close proximity to the seafront and local shops and is in easy access to Portsmouth city and the local hospitals. The current providers are in the process of negotiating and planning extensive alterations to the home, over the next two years, to provide level access to all parts of the home and general refurbishment of the home. The first phase of this work has been completed and it is anticipated that the next phase will commence in the spring of 2006. St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on the 15 December 2005 and was an unannounced inspection and the second inspection for this 2005/6-inspection year. The inspector who attended the home was assisted throughout the inspection process by the registered manager, Ms A Brett. At the time of the inspection 31 service users were in residence. During this inspection eleven standards were assessed of which ten were core standards. Of the eleven standards assessed, nine met the minimum standards and two standards had minor shortfalls, which have been discussed in the main body of this report and requirements made. All the core standards to be assessed over the 2005/6-inspection year have now been assessed. The overall standard of care in this nursing home is good. The inspector toured the building and spoke with a number of service users and staff. The mental frailty of a number of the service users prevented the inspector from gaining their views and opinions but all service users looked well presented. The general comments from those service users spoken with were ‘I am well looked after’, ‘the staff are wonderful’ ‘I feel happy here but there is no place like home’. None of the service users commented on the works that had been going on in the home and therefore the inspector concluded that their lives had not been unduly disrupted during this time. There were no visiting relatives at the time of this inspection. From conversations with service users and staff, the home provides a homely environment that is conducive to the service users’ well being. A visiting district nurse was also spoken with and she reported that the primary care team considered this nursing home to have good practices and that they only visited the home to give advice or in exceptional circumstances for a particularly difficult dressing. A pre-inspection questionnaire was completed by the manager and returned to the CSCI prior to the inspection. What the service does well: The home is friendly and welcoming and the staff were observed to interact well with the service users and demonstrated that they work well as a team. The home provides a good standard of care and encourages the service users to be as independent as possible. This was confirmed by observing that some St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 Page 6 of the service users were able to mobilise around the home freely and independently. Staff were observed to be treating the service users with respect and were sensitive and tolerant to the service users physical and mental frailty and strived to give them choices throughout their day. The proprietors are working hard to improve the environment and extensive alterations have been made since the last inspection. Service users have a social history recorded in their care plans and from this the home try to provided appropriate activities throughout the week to meet specific needs and preferences. A service user reported to the inspector that she enjoys having her nails manicured and painted each week and was obviously delighted with this being available to her from the hand therapist. . What has improved since the last inspection? What they could do better: St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 Page 7 A new computerised care planning system has been installed and must be developed further to enable all levels of staff to use the system as a working document to inform their practice and to be able to assess the outcome of the planned care. Medicine charts must be documented with identifiable codes to indicate why medication has not been administered or if medication has been refused or not needed. Recruitment practices must be more robust. Written references must be received, one being from the most recent employer, to ensure that all the necessary documentation is in place before employment commences. Application forms must be scrutinised more closely and working histories explored at interview. Interview notes need to be more detailed and demonstrate that the interviewee has screened the candidate appropriately. This was a requirement from the previous report. Reports of the regulation 26 visits by the responsible individual, or their representative, have not been received by the CSCI. The system of supervision of all levels of staff must be organised so that staff receive formal supervision six times a year and this is recorded appropriately. 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 Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 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 the following standard(s): 7&9 The service users health, personal and social care needs are set out in individual plans of care, however, the computerised care planning system needs to be developed more to ensure all staff are more confident with the system. Service users are protected by the home’s policies and procedures for dealing with medication. EVIDENCE: A computerised care planning system has been installed. Staff have received training on how to use this system, but the manager reports, they are not yet used to using the system effectively. The staff use a hand-held computer and record the care delivered each day and the outcome, this is recorded on the daily report and not on the specific care plan and therefore it is difficult to track the effectiveness of the plan. The inspector viewed a sample of care plans. The information stated in Schedule 2 of the Care Home Regulations was recorded. The manager reported that paper copies of the care plans are continuing to be documented along side the computerised system. There are a number of risk assessments undertaken including falls. There was no evidence of nutritional risk assessment and the manager reported that the home has no St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 Page 11 appropriate scales for weighing the less able service users, but are to be purchased with the new equipment on order. The care plans are not signed by the service user/relative and the manager reported that they choose not to, therefore there was no evidence of their involvement and agreement. The manager agreed that the system has to contain information for staff to guide their practice and this needs to be developed more with the staff. The medicine policy was viewed. The home uses the monitored dose system (MDS) for medications. There were no service users choosing to self-medicate at the time of the inspection. The inspector viewed the MAR sheets which records what medication is prescribed and administered. The inspector observed that there were some gaps in the recording that did not identify if medicines had been administered or not given. The inspector observed that the code used for PRN medication that was not needed at specific times, could be mistaken for a signature and could cause confusion as to if the service user had taken medication or not. This was discussed with the manager and she was advised that a more identifiable code should be used if the medication is not needed. The controlled drug register was viewed. The manager highlighted an error in the register that had been made by the nurse who was no longer in their employ. This incident had been reported to the CSCI on a Reg 37 notice. The area in which the medicines are stored is appropriate but small, it is anticipated that a new medical room will be provided in the structural alterations to the home. St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 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 the following standard(s): 12 & 14 Service users are able to participate in activities and recreational interests that meet their needs. Service users are encouraged to make choices and maintain control over their daily lives. EVIDENCE: The home has a programme of social activities that take place throughout week. As the time of the inspection was around Christmas, school children were attending the home to sing carols. The inspector observed that this was very popular with the service users. A service user spoken with reported that she usually chooses to remain in her room but had come down to the lounge to hear the little children sing. There was an excellent response from the remainder of the service users who participated in the carols. The home has various visitors to the home to entertain the service users with music, theatre and PAT the dog. Service users have a social history recorded in care plans and a care plan setting out the service users preferences and past hobbies and what they like to do in the home. The dementia care group from the community visit the home twice weekly to undertake activities with those who are mentally frail. The vicar visits the home regularly. The inspector observed St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 Page 13 three service users reading the daily paper; one reported that she enjoys catching up with the news daily. Service users have choices and autonomy over their activities of daily living. A service user spoken with reported that he could get up whenever he chooses; he prefers to go to bed early. Service users do go out if they are able and a member of the sitting service attends the home weekly to take service users for trips in their wheelchairs, weather permitting. The manager reported that there are no service users choosing to manage their own financial affairs, relatives manage these, care managers of power of attorney appointees. St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 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 the following standard(s): These standards were not assessed at this inspection. EVIDENCE: St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 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 the following standard(s): 19 Service users live in a safe, well-maintained environment. EVIDENCE: The home has undergone some extensive alterations on the ground floor to allow level access to all areas of the ground floor accommodation. There are further alterations to commence in the spring, on the floors above with plans to extend the home when this has been completed. The manager reported that the service users and relatives have been informed of each stage of the alterations and refurbishment and consider it to be an improvement to the environment. The manager reported that whilst the alterations were taking place, the environment was risk assessed on a daily basis. The ground floor area that has undergone alterations has been completely redecorated with new carpets. The inspector observed that considering the vast alterations that have taken place, the home appeared settled with little disruption to the service users. On the day of the inspection two new sluice machines were delivered to be installed in the new sluice rooms. St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 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): 27, 29 & 30 The number and skill mix of staff meets Service users’ needs. The home’s recruitment policies and practices need to be more robust. Staff are trained to a level to enable them to do their jobs. EVIDENCE: Staff rotas were viewed and evidenced that the number of staff on duty were sufficient to meet the service users’ needs. On the day of inspection there were two trained nurses and eight support workers on duty, it was explained that because the carol singers were attending the home extra help was needed. On a usual morning there would be two trained nurses and five carers. These numbers are adjusted to the dependency of the service users. It has been identified by the number of reported deaths in the home over the last year, that the home admits highly dependant people who are in the terminal stages of their lives. The home has a separate domestic and kitchen staff on duty each day. The laundry is contracted out and personal laundry is undertaken in the basement laundry by night staff. The inspector viewed a sample of recruitment files. The recruitment practices need to be more robust. Of the two files viewed neither had received two written references. The referees written on the application form do not coordinate with the person sending the reference and was not from the most St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 Page 17 recent employer. Employment history is not followed up at interview and interview notes were poorly recorded. Poor recruitment practices were highlighted in the previous report of this year and requirements will be made around the findings of this inspection. A comprehensive induction programme is in the place for all new staff, which meets the requirements of the skills for care standards. Staff are supported to undertake the NVQ level 2 training and a further five care staff are undertaking the NVQ level 3. A number of staff were spoken with in a group. All had achieved or were undertaking their NVQ level2 training and reported that the home supports them to undertake training appertaining to the client groups that the home is registered to admit and that they enjoyed working at the home. A training matrix is maintained to enable the manager to identify who and what training has been undertaken. St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 36 The home is run and managed by a person who is fit to be in charge, of good character and is able to discharge her responsibilities fully. The home is run in the best interests of service users. Staff supervision does not consistently take place formally. EVIDENCE: St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 Page 19 The registered manager, Ms. Brett, is a trained nurse and has many years experience in working with the elderly. She has gained the National Vocational Qualification level 4 in management and care and continues to update her clinical skills by attending relevant training events. There are clear lines of accountability within the management structure, and Ms Brett reports that she is supported in her duties by the staff and the providers, to fulfil her job description. The home has a quality assurance system in place. The manager audits the MAR sheets monthly to ensure they are being completed correctly. The home has an annual audit of all systems. A service user survey to service users and relatives is distributed and the results of this have been analysed. The inspector viewed the results of the survey, which in the main were very positive. The inspector spoke to a visiting district nurse who reported that she and her team considered the home to be professional and to deliver a good standard of care in general. The home subscribes to various organisations that aid their auditing procedures. Organisations include a Quality Management System, a financial business-planning package, IRPC that audit the building and health and safety issues. These systems together with the monitoring undertaken by the manager on documentation, supervision of staff and general feedback from service users, demonstrated that the home is quality assuring the services delivered in the home. The CSCI has not received copies of Regulation 26 visits from the proprietor in the last six months. The manager reported that staff supervision does take place by her solely, which is proving to consume a large part of her time, she has therefore, put in a system where once the staff nurses are trained to do so, they will be key workers and supervise the care staff and she will just supervise the staff nurses. Supervision does take place on a day-to-day basis and the manager reports that she undertakes formal supervision whenever she is able, but she anticipates that this will be done more systematically once all the staff have been trained to appraise and supervise. St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 Page 20 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X X STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X X St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation Reg 17(1)(a) Requirement Timescale for action 28/02/06 2. OP29 4. OP33 Clear codes must be recorded on MAR sheets of service users who have refused or not taken prescribed medication at a specific time. A clear code must also identify PRN medicines that are not needed. 28/02/06 Reg The recruitment practices of the 19(1)(b)(c home must be made more ) Reg 19 robust. Two written references (4)(c) must be received, one being from the most recent employer. Employment history must be explored at interview. Interview notes must be more detailed and contain relevant information with reference to the information on the application form. This was a requirement of the previous inspection report with a timescale given of 31/08/05. Reg 26 A copy of the monthly reports 28/02/06 made by the responsible individual must be submitted to the CSCI. St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 Page 22 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 OP36 Good Practice Recommendations It is strongly recommended that the system for formal supervision of all levels of staff be organised so that the identified supervisors undertake it, 6 times a year and that records are maintained appropriately. St Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Ronan`s Nursing and Residential Care Home DS0000011505.V254746.R02.S.doc Version 5.0 Page 24 - 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. 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