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Inspection on 01/11/05 for The Georgians Nursing Home

Also see our care home review for The Georgians Nursing Home for more information

This inspection was carried out on 1st November 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is well run, and staff are supported by a range of policies and procedures, which are followed. Staff receive regular training and supervision, which supports the team in offering sensitive and caring support to residents. The home continues to offer a positive environment and the social and individual needs of residents are seen as important, with a range of activities, both individual and group provided on a regular basis.

What has improved since the last inspection?

Care plans continue to be reviewed on a regular basis. Carpets in the main communal first floor area have been replaced, Fire bells are now tested on a weekly basis as recommended by the fire authority and regular checks are made on the nurse call bell system which ensures that residents calling for assistance receive a response from staff on duty.

CARE HOMES FOR OLDER PEOPLE The Georgians Nursing Home 50 Wide Bargate Boston Lincs PE21 6RY Lead Inspector Roger Harrison Unannounced Inspection 09:30 1 November 2005 st 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 The Georgians Nursing Home DS0000002556.V252247.R01.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. The Georgians Nursing Home DS0000002556.V252247.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Georgians Nursing Home Address 50 Wide Bargate Boston Lincs PE21 6RY 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) 01205 364111 01205 311417 The Georgians (Boston) Limited Mrs Patricia Cope Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48), Physical disability (1) of places The Georgians Nursing Home DS0000002556.V252247.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide nursing and personal care for service users of both sexes whose primary needs fall within the following cat egories:Old age, not falling within any other category (OP) (48) Physical Disability - under the age of 65 years (PD) (1) for one named service user. The maximum number of people to be accommodated is 48. 2. Date of last inspection 06/05/2005. Brief Description of the Service: The Georgians Care Home is a listed building situated in the centre of the market town of Boston and a short walk from the shops and local facilities. There is a small car park to the side of the home and a patio area to the rear. There is ample public parking to the front of the building. The home provides both personal and nursing care. Accommodation for residents is available on both the ground and first floor. Rooms on the first floor are served by a shaft lift and stair lift. The home has twenty-four single rooms and twelve double rooms. There is a regular bus and train service in Boston. The Georgians Nursing Home DS0000002556.V252247.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken over a four-hour period, with the inspector using a method of inspection called “case tracking”. This involved selecting four residents who currently live at the home and tracking their experience of the care and support they have received during the time they have lived at the home. This was achieved by the inspector talking to the manager, touring the home, looking at information on care plans and files, talking to residents and care staff, and observing day-to-day care practice within the home. What the service does well: What has improved since the last inspection? Care plans continue to be reviewed on a regular basis. Carpets in the main communal first floor area have been replaced, Fire bells are now tested on a weekly basis as recommended by the fire authority and regular checks are made on the nurse call bell system which ensures that residents calling for assistance receive a response from staff on duty. The Georgians Nursing Home DS0000002556.V252247.R01.S.doc Version 5.0 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. The Georgians Nursing Home DS0000002556.V252247.R01.S.doc Version 5.0 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 The Georgians Nursing Home DS0000002556.V252247.R01.S.doc Version 5.0 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): 1,2,3 and 5. Written information is available for new residents and their relatives to advise them what services and facilities are available in the home with residents being clear about what services they are paying for. Residents’ are only admitted if the manager and senior staff are sure that their needs can be met. EVIDENCE: The home has a statement of purpose and a service users’ guide, which is provided the reception area and as appropriate in resident’s rooms. Terms and conditions are provided for residents on admission to the home The Manager confirmed that pre-admission assessments are undertaken to ensure any new need matches that of existing residents. New residents and their relatives are encouraged to look around the home before deciding to move into the home. Regular reviews are used by the care team to ensure that any changes in need can be met in the way residents wish them to be. The home does not offer an intermediate care service. The Georgians Nursing Home DS0000002556.V252247.R01.S.doc Version 5.0 Page 9 The Georgians Nursing Home DS0000002556.V252247.R01.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): 7,9,10 and 11. The staff team have a caring and gentle attitude towards residents and their privacy and dignity is respected in a variety of ways especially at the end of their lives. Comprehensive care and nursing plans are provided for residents ensuring that residents’ health, personal and social care needs are attended to. Systems are in place to ensure the safe storage, recording and administration of medications. EVIDENCE: Each resident has a care plan which is regularly reviewed. Care plans were found to be accurate and included the health, social and personal preferences of individuals. Staff were observed talking to residents in a gentle and caring way and took action to ensure that the resident’s privacy was respected during the inspection. One resident told the inspector that, “I have my care plan in my room and I know when staff are coming to see me, there are no surprises here. The care I receive is just the job for me”. The Georgians Nursing Home DS0000002556.V252247.R01.S.doc Version 5.0 Page 11 All residents are encouraged to self-medicate. When this is not possible medicines are kept on behalf of residents in a separate, locked room. Responsibility for supporting residents with medication is given only to senior team members who have received training. Records were found to be maintained appropriately and all medicines administered using records for reference by senior staff on duty. Two residents told the Inspector. “The staff look after our medication and make sure we get it when we need to”. The Manager has recently produced a “Bereavement Information” leaflet for residents and their carers to inform them about local services, contacts and to offer support direct. The manager described the positive support given to residents and relatives during the process of bereavement and information provided on care plans confirmed that the care team consults with residents about their needs in an appropriate way. The Georgians Nursing Home DS0000002556.V252247.R01.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, 13,14 and 15. The importance of providing activities for residents in the home is taken seriously and residents are able to make a choice about activities they become involved in. Residents are supported by staff to maintain control over their lives. EVIDENCE: The home has an “Open door policy” which encourages family carers, relatives and friends to visit. On the day of inspection the home received a number of visitors. Two people visiting the home told the inspector that they were made to feel welcome and well informed about the needs of their relative . An activities co-ordinator is employed to work with residents on a daily basis to assist them with their social activities. A record is kept as part of the whole care plan, which is based on social needs and on individual choices regarding how they like to spend their time and what they prefer to do. A monthly magazine is produced by the manager, which residents contribute to. The latest edition provided evidence of a wide range of activities and included The Georgians Nursing Home DS0000002556.V252247.R01.S.doc Version 5.0 Page 13 positive articles, which residents had fully contributed to. Meals at the home are planned using feedback from residents. On the day of inspection the menu boards located in first a second floor communal areas highlighted a wholesome lunch was being offered. Alternative choices are available by request. There are regular religious services held at the home and opportunities for residents to be supported with other religious needs wherever appropriate as part of their individual care plan The Georgians Nursing Home DS0000002556.V252247.R01.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): 16 and 18. Complaints are recorded and responded to appropriately and residents are supported by staff, who are able to respond if they believe that residents may be put at risk of abuse or harm. EVIDENCE: The home has received no complaints since the last inspection. The manager provided a record of informal concerns raised by residents, which the manager had responded to as they had been raised to ensure they were resolved quickly. Residents and carers meetings are held regularly to provide a forum for discussion regarding concerns, and also to enable individuals and their families to contribute to the development of practice at the home. During the inspection the inspector spoke to three staff members about their understanding of Safeguarding residents from abuse. The group confirmed they had received training on how to recognise when residents need support, and how to follow up concerns raised appropriately. The Georgians Nursing Home DS0000002556.V252247.R01.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): 19,22,24, 25 and 26. Resident’s needs are met within a clean, hygienic, well-maintained enviroment. EVIDENCE: The home was cleaned to a high standard throughout and was odour free. It is well maintained with an on going programme of decorating and refurbishing. On the day of inspection it was confirmed that all carpets in communal corridor and stair areas had been replaced. Residents and staff told the inspector that the home is always well maintained and cleaned regularly. During the inspection the inspector spoke to several residents in their own rooms Residents confirmed that they are able to bring their own personal belongings into the home including small items of furniture. Whilst talking to residents the Inspector carried out a test of the call-bell system, this was responded to by staff appropriately. The Georgians Nursing Home DS0000002556.V252247.R01.S.doc Version 5.0 Page 16 Rooms were personalised to a high standard and one resident told the inspector “They couldn’t look after me better than they do” and “My room is my home” The home also provides a range of well maintained aids to assist more dependent residents when necessary; these include specialist beds, hoists and specialist baths. The Georgians Nursing Home DS0000002556.V252247.R01.S.doc Version 5.0 Page 17 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 and 30. The manager ensures that staff are recruited safely and that all staff have been checked by the Criminal Records Bureau in order to protect residents. Residents feel that competent, caring and considerate and well-trained staff are meeting their needs. EVIDENCE: A trained nurse is always on duty in home on a 24-hour basis. There are usually two trained nurses on duty in the morning assisted by eight carers, which reduces to one trained nurse and six carers in the afternoon and evening. On the day of inspection staff and senior team members were observed providing a range of personal and social care support sensitively. Residents told the inspector that they receive care in the way they wanted it to be. Staff are recruited appropriately and are provided with induction training. This was confirmed by staff records and a new member of staff who told the inspector about the induction process and that it was of benefit to her. Team meetings are used to provide staff with an opportunity to discuss issues. These meetings were discussed with team members and the manager. As a result of this discussion the manager is considering ways of changing the current meeting structure in order to encourage staff members to put forward ideas for practice and service development. The Georgians Nursing Home DS0000002556.V252247.R01.S.doc Version 5.0 Page 18 Training courses are organised for staff to meet needs identified in their appraisal, and thorough supervision, which is provided individually and through the use of six practice observations during each year by the manage and senior staff. Opportunities are offered, when available, for care staff to enrol on a National Vocational Courses and at present nine team members are undertaking a range of NVQ qualification courses, including assessor training. The Georgians Nursing Home DS0000002556.V252247.R01.S.doc Version 5.0 Page 19 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 and 38. The home is well managed and run in the best interests of residents living in the home. Their health and safety needs are promoted and protected by the manager and staff team. EVIDENCE: The home has a well-established, registered manager who continues to update her skills and knowledge in relation to caring for older people. Staff receive supervision, which the manager uses creatively to assess practice and performance. An internationally accepted quality assurance method has been adopted by the manager, which is reviewed annually. The manager has a person centred “hands on” approach to managing staff and is available to discuss issues with individual team members, as they need. The Georgians Nursing Home DS0000002556.V252247.R01.S.doc Version 5.0 Page 20 Staff told the Inspector that they respected the manager and that she provided fairness and a supportive approach. The manger utilises a range of policies and procedures for staff to follow, which are kept in the manager and nurse’s offices as appropriate. These procedures help to support and maintain the safety of residents. During the last inspection a concern was raised regarding the testing of fire bells and servicing of fire equipment. The manager has taken appropriate action to address these issues, which have been fully resolved. The Georgians Nursing Home DS0000002556.V252247.R01.S.doc Version 5.0 Page 21 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 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X 3 3 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 3 The Georgians Nursing Home DS0000002556.V252247.R01.S.doc Version 5.0 Page 22 NO. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP36.3 Good Practice Recommendations It is recommended that the manager gives further thought to developing supervision using team meetings to incorporate group supervision. With the aim, to provide staff with the opportunity to contribute fully to all aspects of practice, philosophy of care in the home, and career development needs. The Georgians Nursing Home DS0000002556.V252247.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 The Georgians Nursing Home DS0000002556.V252247.R01.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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