Inspection on 16/03/09 for St Vincents House

This inspection was carried out on 16th March 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Vincents House 22/09/08

St Vincents House 30/06/08

St Vincents House 21/01/08

St Vincents House 16/07/07

St Vincents House 05/02/07

St Vincents House 25/07/06

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 20/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Vincents House Queen Caroline Street Hammersmith London W6 9QH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ann Gavin     Date: 1 7 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: St Vincents House Queen Caroline Street Hammersmith London W6 9QH 02086000510 02087485912 admin.st.vincent@careuk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Care UK Community Partnerships Ltd care home 92 Number of places (if applicable): Under 65 Over 65 48 44 dementia old age, not falling within any other category Additional conditions: 0 0 On the Ground Floor Unit up to 10 people may be aged between 50 and 65. Date of last inspection Brief description of the care home St Vincents House is a purpose built registered care home providing nursing care for elderly frail people and people with dementia. There is also a separate unit on the ground floor which is also a Palliactive Care Unit for ten people aged 50-65. The home opened on 3rd April 2006 and is situated in Hammersmith, West London. It is well located, close to public transport links, shops and services. The weekly fees for the service range from #795-#908. 2 2 0 9 2 0 0 8 Care Homes for Older People Page 4 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection carried out by Ann Gavin and Sheila Lycholit over two days the 16th and 17th March 2009. The Manager and staff were very welcoming and eager to present the work they had done to improve the services. This report is based on speaking with residents and relatives, the Managers, Unit Managers and staff. The care of ten residents was tracked meaning both they and staff working with them were spoken with, their personal care plans and documentation linked to them was reviewed. A selection of the homes documents and records were looked at, a tour of the home undertaken and the information received from the Manager in his annual AQAA ,Annual Quality Assurance Assessment, was read and used to inform the inspection. Care Homes for Older People Page 5 of 32 Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? All the requirements set at the last inspection have been met. Care planning has been improved, with more individualised and detailed plans, which are regularly discussed with families and carers. Care plans better reflect residentscultural and religious needs, which staff have taken steps to meet. The quality of care provided in the Palliative Care Unit has been improved, in part as a result of staff training which has included placements at Trinity Hospice in Clapham. The home is working towards achieving the Gold Standard in end of life care for all units. The home has received good support from the PCT Commissioning Manager who has contributed to the development of the service through encouraging multi professional working, identifying training resources and improving practice, including care planning. A decision has been taken to care for residents in four smaller groups on the 2nd and 3rd floors in the two 24 place dementia care units. This will allow staff to provide more individualised care. Planning for these changes, including consultation with families, is underway. As part of the planning and development of smaller units, an assessment of current practice, which has included the use of dementia care mapping has taken place. Further training for staff in dementia care and in managing challenging behaviour is planned to support the proposed changes. Care Homes for Older People Page 7 of 32 A high priority has been given to residents nutrition. Monitoring sheets are much improved, with action taken promptly where intake is of concern. Mealtimes are calm and quiet and generally staff take care to ensure that all residents have time to eat their meal in a relaxed manner. Unit Managers have direct access to professional advice from Dieticians and from the Speech and Language Therapy team. Steps have been taken to improve the handling of medication, including ensuring that the Registered Nurse is not disturbed when administering medication, staff training and daily monitoring of medication records. This action has been successful in reducing errors and medication incidents. Improved standards and a system of regular contact with relatives and carers have resulted in fewer concerns and complaints being raised. Very positive comments, in particular regarding the care provided by staff, were received from relatives spoken with during the inspection. There has been a complete redecoration of whole home, including new flooring. This has given a fresh, bright look to the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. St Vincents now has a timescale for the admission of residents which allows prospective residents and their families, the opportunity to visit the home and to have their care and social needs assessed. Evidence: The Manager has negotiated a longer timescale with Hammersmith and Fulham and the PCT Primary Care trust for the admission of residents to allow the homes staff to undertake a fuller assessment and to give the prospective resident, their family and carers time to visit. Two pre assessments were looked at on the dementia care units. Both were completed more fully than at previous visits. A needs assessment from the Care Manager was also available on one of the files seen. No information was available regarding one residents background and social history, for example whether she had children or Care Homes for Older People Page 10 of 32 Evidence: other family or her occupation. The Unit Manager said that she had asked the residents Social Worker for more information. The homes getting to know you form had not been completed on either file. Some of the assessments seen on the ground and first floor were very comprehensive and informative. Others although much improved still lacked sufficient information on peoples social history. It is recommended that this aspect of the assessment continues to be developed. The manager now reviews each assessment to confirm the home s capacity to meet the prospective residents needs. Everyone who is admitted to St Vincents has their care and social needs assessed by a senior member of staff who is always a qualified nurse. The majority of people are admitted from hospital. All prospective residents are offered an opportunity to visit the home. The manager says that there has been an increase in pre admission visits though these still are normally from the relatives. It would be good to see more prospective residents visiting prior to admission. Care Homes for Older People Page 11 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. St Vincents has developed their planning of residents care, increasing the involvement of residents and their families. There is ongoing training for staff in care planning. The administration of medication has greatly improved. Evidence: The care of ten people was case tracked as part of the inspection. This involves talking with the person, reviewing their care plan and documentation linked to them and talking with staff. One aspect of the homes improvement strategy has been to develop better care planning. All staff have received training in care planning and more training is planned for the future. The care plans looked at contained more information about residents social history and their religious and cultural needs. Care Homes for Older People Page 12 of 32 Evidence: This has been greatly helped by the introduction of the Getting To Know you, questionnaire which covers a number of areas to seek peoples likes, dislikes, fears, preferred times of getting up and going to bed of their preferred foods. This complements the care planning and enables staff to have a greater sense of each resident so as to provide more individual care to each person. Talking with staff, Unit Managers and the Manager they are all aware that these care plans need to be continued to be developed so as to have a consistent person centred care plan for each resident. Staff were seen to respect reisidents privacy and dignity. Though some residents would benefit from further attention being paid to their appearance. The five care plans looked at on the dementia care units were more detailed than at previous inspections and more fully reflected residents needs. Each eating and drinking plan described how the person should be supported, including positioning, consistency of food and drink and the use of specialised equipment. Residents weight is monitored by monthly checks, which are more frequent where a residents weight is of concern. Food and fluid intake is monitored daily for all residents whose nutritional assessment indicates they are at risk. Monitoring sheets seen were fully completed, with notes made to explain any gaps, for example where a resident had gone to a hospital appointment. Records show that referrals are made promptly to the Dietician and Speech and Language Therapist. The Unit Manager said that she can phone the Speech and Language Therapy team for advice, which she finds helpful. In discussion one resident indicated that he would like to move to more independent accommodation in view of the recovery he has made since moving to St Vincents. The Manager undertook to contact the Care Manager for a review of the placement. More attention is paid to residents religious and cultural needs, which are recorded in the care plan. The Manager gave examples where food that was not available from the homes suppliers, has been obtained from others sources, including a local Polish delicatessen. The Manager confirmed in the AQAA that visits to the home from local clergy are now taking place. Care plans are reviewed at least monthly, with the on line system alerting managers to any overdue reviews. Risks assessments seen were up to date and gave details of action to be taken to reduce risks. Care plans looked at described how each resident was to be cared for at night, including the use of a crash mattress and lowering the bed. The Manager Care Homes for Older People Page 13 of 32 Evidence: confirmed that bedside rails are seldom used in view of the risk of injury. On the ground and first floor the level of detail in the health and personal support plans has also increased given a greater sense of the type of support each person prefers. The home has built up good contacts with local health professionals. The monitoring of wound care has greatly improved with good outcomes for residents and a level of documentation which enables the progress to be seen. Each resident had all the assessment of moving and handling and other risk assessments in place. These were generally good though whilst some contained good detail of the type of moving and handling support, the type of hoist, some care plans were more basic in their information. These need to be developed to the standard of the good detailed ones. The delegating of tasks to the senior carers and care staff has also had an impact on the level and consistency of the support and care residents receive. Residents named key worker is written beside their own names on their bedroom doors so that both they and their relatives know who the key person is involved in their care. The Manager spoke of how they try to link residents with key workers taking into account also the residents and key workers first language. This is reflected in the food and fluid charts seen on the first floor were clear, up to date and well completed. None of residents whose charts were seen had less that 1,000 mls of fluid and it was noted by both inspectors throughout the home that everyone had a drink to hand at most times during the day. The medication was checked on two units and all was found to be better managed. Each unit is now doing their own audits. These were seen on one unit. They were all up to date and very clear leaving no room for error. The two Unit Managers spoken with regarding medication said how the training received from Boots on medication adminisrtation record,MAR sheets was really helpful. The Manager has introduced a system where the nurse administering medication wears a tabard to highlight that they must not be disturbed by persons or the phone. There have been three audits of medication since the last inspection. These were carried out by Care UK, Boots and one by the PCT Pharmacy dept who will be sending the report of their findings in April. Care Homes for Older People Page 14 of 32 Evidence: All the nursing staff spoken with said that the strategy adopted by the Manager to improve the handling of medication by specific training, on going audits, of protecting the nurse administering medication from being disturbed by people or phones including wearing a tabard has really been effective. The Palliative Care Unit is on the ground floor and there has been close working and training a training programme put in place with Trinity Hospice. The Unit Manager and nursing staff are currently all rotating in completing a two week placement at the hospice. The Unit Manager had just returned and found the experience excellent consolidating much of the training they have been completing. Each staff member has returned with new ideas for the unit. All units in the home are participating in the Gold Standard Framework GSF in end of life care and are working towards completion and accreditation by June 2009. Every resident now has an end of life care plan. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. St Vincents has a programme of individual and group activities which they review constantly. There is now greater contact with the community and a planned volunteer programme which will hopefully increase residents ability to be supported to go outside the home and visit the local area Evidence: St Vincents now have three activity coordinators since the addition of an extra coordinator last August. There is an activity schedule which is updated weekly. This includes sensory stimulation, film afternoon and board games. A person from Mobility London does an exercise class one a week which has proved very popular. The coordinators also help complete the Getting To Know you questionnaire and they build up peoples individual sessions from the information gained. The activities ,work and play, sections of care plans were more detailed than at previous visits. Activity programmes and the monthly newsletter show that staff have developed a varied programme, which reflects residents interests and their cultural background. Care Homes for Older People Page 16 of 32 Evidence: In discussion one relative who visits regularly commented on how much he and his wife had enjoyed the various days where staff have celebrated their culture with residents. A party was organised to celebrate Diwali and Christmas was celebrated with a church service and carols. A gospel choir attended the residents Christmas party. It is planned to increase both the one to one sessions and outings. This will be helped by the application recently submitted to be part of Hammersmith and Fulham volunteer programme. The newsletter continues to be published and it is hoped to start the outdoor activities now the weather is improving. Speaking with the senior activities coordinator they spoke of how they can now allocate the main activity amongst themselves allowing more time for the people who wish more individual support. One person stated that they did not want to record anything about their past but was happy to talk about and record what they liked doing now. This included information on their pastimes, the type of sport they liked to watch, the books they enjoyed being read from, the music they enjoyed and their preferred foods. On the two days of the inspection there was a film afternoon held and a St Patrick Day party. A small group of residents also had a sensory session. There is greater contact with the community and there is now a monthly Church of England service held in the home alongside a weekly Catholic Eucharistic Service. The coordinators say they try to see if people wish contacts with other faiths but this has not been the case as yet. Residents preferred routines regarding getting up and going to bed are noted in their care plans. One relative commented that she was unclear about her mothers routine especially regarding sleeping. The Manager confirmed that he was aware of her concerns. Residents are supported to take part in residents meetings, which take place every three months. The notes of recent meetings show that issues concerning the catering dominate the agenda but as well, residents who generally were positive about the range of activities available, said that they would welcome the opportunity to go out of the building for example for a walk or to the local shops. Staff also said that they would like the opportunity to take residents out even for a short period, as they feel that some people would benefit from a change of environment and undertaking a Care Homes for Older People Page 17 of 32 Evidence: familiar activity. Relatives spoken with expressed a high degree of satisfaction with the care provided and spoke warmly of the staff. Records show that Unit Managers contact families and carers regularly to discuss their relatives condition. Each of the relatives spoken with confirmed that they had received a copy of the care plan, including revisions. The Manager said that attendance at his regular surgeries for families and carers is minimal, which he believes reflects the increased communication made by Unit Managers, as well as the overall improvements in the standards of care at St Vincents. Lunchtime was observed on all floors during the course of the two days. On the ground floor and first floor carers were observed being attentive and sensitive to peoples needs and were clearly aware of the food people enjoyed and the best position for them to maximise their enjoyment. The dining rooms were attractively decorated and looked homely and welcoming. The pace of serving food was unhurried and relaxed. Those people who required assistance were given it in a discrete and positive manner. Mealtimes in the dementia care units continue to improve, with a calmer and more relaxed atmosphere created by staff. Tables look attractive with clean cloths and illustrated menu cards, which had just been introduced. Staff who were supporting residents with eating were generally doing so in an unhurried manner, sitting beside the person and conversing with them. The majority of residents on the dementia care units need some support with eating varying from prompting to eat to one to one assistance resulting in a very busy period for staff. The Clinical Nurse Manager was observing lunch on one unit as part of a focus on nutrition and to evaluate the changes that are being introduced. One member of staff, out of sight of the Clinical Nurse Manager, was seen to start feeding two people at once while standing between them, indicating that good practice has not yet been fully integrated. The Manager is continuing negotiations to bring all the catering on site, rather than the cook chill system currently operating. The cook chill system does have some cultural dishes but staff need to access local delicatessen for some foods. Introduction of in house catering would allow the home to better meet the nutritional needs of very frail residents and to ensure that recommendations of the Dietician can be implemented. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. St Vincents has a complaints procedure which is made available to all residents, their relatives and any visitors. There are policies and procedures for safeguarding people who use the service Evidence: St Vincents complaints procedure is available in residents welcome pack as well as in the reception area. It is also on display on the units. The home uses a computerised system to log all concerns and complaints. The homes complaints are monitored by Care UK head office weekly to ensure that no complaints are left unattended to. The home Manager offers monthly open surgery for relatives to address their concerns and complaints. Service users are encouraged to use the complaints procedure. One of the relatives commented that they had no complaints,that things were not perfect but the staff did their best. St Vincents has started a system which holds both complaints and safeguards. These were all well documented and all had good outcomes. One of the complaints was about the laundry and missing clothing. In response the Manager has initiated a new tracking system for peoples laundry.The Manager continues to monitor all complaints, concerns Care Homes for Older People Page 19 of 32 Evidence: and any safeguarding issues. Each unit was seen to have a quick reference guide as to what to do in the case of any safeguarding issue. All staff have now received training in safeguarding. Staff spoken with were more confident in understanding and following safeguarding guidelines. There have been four safeguarding referrals since the last inspection. Two were not upheld , one had no further action as there was no evidence and no sign of any untoward reaction of the residentthough staff will monitor them.The most recent alert concerned one of one resident hitting another. This alert had just been reported at the time of this report. All of the referrals were made to Social Services who responded promptly. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. St Vincents House is a purpose built home providing single rooms with en suite facilities. Residents in each unit have the use of a range of sitting areas, and a dining room. There is a garden with tables and chairs to the rear and side of the building. The whole home has recently had a complete redecoration and new flooring which has made the home fresh, bright and clean Evidence: The Manager quoted in his Annual Quality Assurance Assessment that security of the building is paramount. All fire exits are alarmed and CCTV is in operation externally and in the reception area. A fire risk assessment for the building is in place and all staff have recently undertaken more fire awareness training through a external provider. A discussion was held with the Manager about the use of keypads,without any visible codes,on all exits. This is a Care Uk policy for security. This needs to be reviewed in the light of the deprivation of liberty safeguards. St Vincents had just completed a three month redecoration programme which included replacing the carpets in the communal areas with cushioned wooden effect flooring. The home looks bright and the new flooring has eliminated some of the odours that Care Homes for Older People Page 21 of 32 Evidence: had lingered on the carpets despite constant cleaning. The home have an ongoing maintenance programme. Talking with the maintenance Manager he was able to show the records of the ongoing regular checks on equipment. The home is fully wheelchair accessible with a lift to all floors and a range of aids and equipment. There are a good number of bathrooms and toilets. The home employs domestic staff to do all the cleaning. The home was clean throughout. The home has an infection control policy in place, and is working in conjunction with the local NHS trust on implementing further training. There were hand cleaning dispensers in place around the home. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. St Vincents has managed to establish a more stable staff team. There has been a marked increase in staff training which was evidenced in the greater interaction with residents. An ongoing consideration of staffing levels in the light of increasing residents needs and move to smaller units will be important to enhance peoples experience of care. Evidence: We have received excellent training and we continue to receive training every month. It has really helped. Quote from staff There has been amazing support with the introduction of the clinical nurse manager. They have brought us lots of ideas research and training opportunities. Quote from Nursing staff I understand what I need to, do my areas of responsibility and I am happy to do it we help each other out. We work now as a team. Quote from staff Staffing levels remain the same as at the previous inspection but staff interaction with residents was observed in all units to have markedly increased. Better management of Care Homes for Older People Page 23 of 32 Evidence: staffing on the units has led to fewer residents calling out for assistance or wandering unattended. There are now two nurses on each morning shift and one nurse on duty for the afternoon, evening and night shift. They work alongside five carers. Staffing levels should be consistently monitored to meet the complex needs of residents. The staff spoken with were clear on their roles and responsibilities and felt happier in their jobs following the increase in training and greater sense of leadership. The recruitment records of the four most recently appointed staff were looked at. Files were in good order, with all recruitment checks completed. The newly appointed Business Manager confirmed that he checks PIN numbers and visas monthly to highlight any that need to be renewed. A comprehensive training programme has been implemented based on the needs of the service and assessments of the competencies of staff. Discussion with the Deputy Manager who has responsibility for training and records show that staff have attended a range of training since the last inspection, some of which has been provided by external trainers and some in-house by senior staff. Recent training has included handling medication, safeguarding adults, The Mental Capacity Act, nutrition, dementia care and record keeping. Registered Nurses have also attended training in nursing practice including wound management and catheter care. Registered Nurses in the Palliative Care Unit have had two week placements at Trinity Hospice. The amount of training provided is commendable, for example in January this year 98 staff attended training and in February 68 staff. In discussion staff commented on how helpful they have found the training programme in giving them the confidence to carry out their work. The home has received good support from the PCT Commissioning Manager who has contributed to the development of the service through encouraging multi professional working, identifying training resources and improving practice, including care planning. There was an opportunity to speak with him during the inspection. He said that the PCT are reviewing the services provision and will seek solutions to any gaps in the service that are identified. There are also plans to link a Consultant Geriatrican to the home offering three Care Homes for Older People Page 24 of 32 Evidence: sessions a week across three of Hammersmith and Fulham homes. A decision has been taken to care for residents in four smaller groups on the 2nd and 3rd floors in the two 24 place dementia care units. This will allow staff to provide more individualised care. Planning for these changes, including consultation with families, is underway. As part of the planning and development of smaller units, an assessment of current practice, which has included the use of dementia care mapping has taken place. Further training for staff in dementia care and in managing challenging behaviour is planned to support the proposed changes. As part of the homes strategy for improvement, Unit Managers have been given the opportunity to enroll on NVQ4 in Leadership and Management, with the aim of achieving the award in September this year. The percentage of Care Assistants achieving NVQ2 remains low, with 22 out of 72 staffing having NVQ2 or above. Three more staff are awaiting confirmation of the award. In view of the increased responsibility given to senior carers their professional development needs to be kept under review. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager has continued to implement a number of changes to improve the service.Record keeping is of a good standard. The daily notes have improved, with more detailed entries, providing a better record of care provided and of the residents well being. Evidence: Great improvement since this manager took ove. Comment from a relative St Vincents has clear leadership from an experienced manager who has put in place effective strategies to effect a real change and improvement in the home. Progress observed at the previous inspection in September 2008 has been maintained, with improved standards of care evident in all of the units. The Manager has been in post, since the December 2007. He has extensive experience Care Homes for Older People Page 26 of 32 Evidence: of working in elderly care. He has a qualification in Mental Health Nursing and has completed the Registered Managers Award. He has recently undertaken two short courses on good practice and dementia care needs. Since the last inspection a Clinical Nurse Manager has been appointed and has been working closely with the nursing and care staff developing training and clinical practice. Records of supervision show that all staff are provided with one to one sessions at least every two months and often more frequently. All staff carrying out supervision have received training, which has resulted in supervision becoming more focused. The Deputy Manager, who monitors the frequency of supervision, confirmed that staff receive a copy of supervision notes. Record keeping is of a good standard. The daily notes have improved, with more detailed entries, providing a better record of care provided and of the residents well being. There is a system in place for checking the quality of the care in the home, which includes seeking the views of the residents. Residents are given the opportunity to comment on aspects of the service through completing a satisfaction questionnaire. The last questionnaire was completed in September and October 2008 and a copy of the outcome was received. People felt their views were listened to, that staff were approachable and polite. One person commented that staff are al work hard and are busy but always find time to speak. In answering question about the staff knowing residents as individuals people commented that with the staff numbers it is not possible to have enough one to one time with residents. The administrator remains the person who manages the records of those residents who require assistance with managing their money. A safe is available in the home for safekeeping and records of all transactions maintained. The four records seen were clear and well kept. A selection of health and safety records were checked during the inspection. All the record keeping was clear They were up-to-date, showing that equipment is regulaly serviced and checked. The fire equipment was due to be tested this month. The maintence manager showed the records and explained the weekly maintenance checks they undetake. Care Homes for Older People Page 27 of 32 Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 28 18 Although the overall 31/07/2009 standard of training is excellent attention needs to be paid to the level of NVQ2 qualifications obtained. This needs to be at least 50 percent amongst the carers to achieve the minimum standard and to ensure that staff have the necessary skills to care for the people who live in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 Steps should be taken to further increase the information available regarding residents social history, family network and cultural background as part of the assessment process so as to be sure to be able to fully relate to people and to meet their personal aspirations. The development of person centred care plans should continue so as to have a whole picture of each person, their Page 30 of 32 2 7 Care Homes for Older People needs and preferences in all aspects of their lives. 3 8 Whilst risk assessments seen were generally good with details of the type of moving and handling support, the type of hoist, some were more basic in their information. All risk assessments need to contain detailed information of the support and action required for every resident in each area of risk identified. Consideration should be given to supporting residents on trips out in the local area, for example by the river or to local shops and cafes. To continue to negotiate for the introduction of in house catering which would allow the home to better meet the nutritional needs of very frail residents and to ensure that recommendations of the Dietician can be implemented. A review of the use of keypads without visible codes on all exits of the home need to be reviewed in the light of the Safeguarding of Liberty Safeguards. Staffing levels should be consistently monitored to meet the complex needs of residents. In view of the increased responsibility given to senior carers their professional development needs to be kept under review. 4 12 5 15 6 19 7 8 27 30 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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