Inspection on 05/09/07 for The Georgians Nursing Home

This inspection was carried out on 5th September 2007.

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

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

Other inspections for this house

The Georgians Nursing Home 14/06/06

The Georgians Nursing Home 01/11/05

The Georgians Nursing Home 06/05/05

The Georgians Nursing Home 24/01/05

The Georgians Nursing Home 26/05/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE The Georgians Nursing Home 50 Wide Bargate Boston Lincs PE21 6RY Lead Inspector Toby Payne Unannounced Inspection 5th September 2007 08:15 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.V341163.R01.S.doc Version 5.2 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.V341163.R01.S.doc Version 5.2 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 richard@thegeorgians.co.uk 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.V341163.R01.S.doc Version 5.2 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 categories: 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 14th June 2006 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 fees at the inspection visit on the ranged from £348 to £533 each week. Additional charges were Hairdressing Chiropody Personal newspapers, magazines and personal toiletries. The statement of purpose, service user’s guide and information about the home could be obtained from the manager of the home. £4.50 to £19 £8 The Georgians Nursing Home DS0000002556.V341163.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection visit was unannounced and started at 8.30 am. It was undertaken using a review of all the information available to us about The Georgians Nursing Home. We spoke with 12 residents, 2 visitors, 5 staff and the manager and a representative of the owners of the home. The main method of inspection was called “case tracking”. This involved selecting 2 residents and tracking the care they received through the checking of records, discussion with them, the care staff and observation of their care. We also examined an Annual Quality Assurance Assessment, which had been completed by the manager. Comment cards were received from 12 residents. What the service does well: What has improved since the last inspection? What they could do better: There were no requirements or recommendations from this inspection visit. Where improvements are required these have or are taking place. The home continues to meet the national minimum standards. The Georgians Nursing Home DS0000002556.V341163.R01.S.doc Version 5.2 Page 6 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 summary of this inspection report can be made available in other formats on request. The Georgians Nursing Home DS0000002556.V341163.R01.S.doc Version 5.2 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.V341163.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3, 4, 5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is clear detailed information about the home to enable residents to make a decision whether or not to come to this home. Each resident receives an assessment by the manager to ensure the home can meet their needs. EVIDENCE: There was a detailed statement of purpose and service user’s guide, a copy of which is given to each new resident. A copy of both documents was also available at the entrance to the home. Each new resident received an assessment by the manager before admission. Wherever possible residents were offered an overnight stay at the homes’ expense. There was an admission sheet, letter confirming the home could meet the person’s needs, assessment for daily living, moving and handling assessment and transfer information. Both residents spoke about their satisfaction with the care. One commented, “They came to see me before I came here. I received information about the home. They then arranged for me to come here. The Georgians Nursing Home DS0000002556.V341163.R01.S.doc Version 5.2 Page 9 Everyone was very welcoming and I have settled in”. Both residents told us they had settled in the home and found the staff welcoming and friendly. The home does not provide intermediate care. The Georgians Nursing Home DS0000002556.V341163.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are comprehensive and up to date care plans, which ensure that residents’ health, personal and social care, are met. There are systems in place to ensure that medication is given safely by staff who know what they are doing. EVIDENCE: All residents had care plans outlining their needs. These were in each bedroom to enable staff to record day to day issues. We saw residents reading their care notes and aware of the information in the care plans. Information about their contracts and other confidential information was stored in the manager’s office. We could see staff looking at care plans and using them to provide to care to the residents. All residents we spoke with were satisfied with the care and approach of the staff. The care records included, a residents profile including how they wished to be addressed, photograph, social interests, individual care plan, activities care plan with needs, objectives and activities, folder of contents, Waterlow assessment, risk, nutrition, moving and handling risk assessments, weight chart, bed rail assessment, care plan review and daily record. Care plans showed evidence of The Georgians Nursing Home DS0000002556.V341163.R01.S.doc Version 5.2 Page 11 reviews every month with the involvement of the resident and their relatives. Entries were signed and dated. Staff were seen to have evident pride in their work and attended to people promptly and with little fuss. The last pharmacy visit was on 19/6/2007. The report considered the service was in “good order”. The deputy manager was responsible for medication and records were well maintained for receipt, administration and disposal. A medication round was observed. The medication was dispensed from a trolley, checked against the chart, given to the resident and signed for after this. Nurses and senior care assistants gave medication. Each person was assessed before they could practice and the manager observed their practice. We had no concerns about the medication arrangements. There was one resident self medicating. This was indicated on their medication sheet, the person had a locked drawer and received a week’s supply of the medication, which was monitored by the staff. Every resident we spoke with felt that staff always treated them with respect in a dignified manager. Comments were, “staff always explain about they are going to do, I can’t fault them” and “they have just put nail varnish on my nails and I have had my haircut. The staff are so kind and polite”. The Georgians Nursing Home DS0000002556.V341163.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by staff to take part in a range of activities, maintain control over their lives and receives a balanced, nutritious and varied diet to suit their needs. Visitors are welcomed to the home. EVIDENCE: Activities in the home were provided by 3 occupational staff. There was a written activities programme and monthly newsletter. The activities programme was displayed in each lounge and on notice boards throughout the home. Activities included trips out into Boston, beetle drives, musical activities, craft sessions, gardening and general games. There was a range of books, music playing in communal areas and various sitting areas throughout the home. The home had a separate hairdressing room on the ground floor with charges clearly displayed on the door. The manager had regular meetings with residents. We spoke with 2 visitors who told us they could visit whenever they wished to do so and always received a warm and friendly welcome and were offered refreshments. They were very satisfied with the home. Comments were, “it is the finest home in Boston. Nothing is too much. It is clean, with excellent food, cheerful, kind, considerate and caring staff. I am very satisfied”. The Georgians Nursing Home DS0000002556.V341163.R01.S.doc Version 5.2 Page 13 The last Environmental Health Officer’s inspection by Boston Borough Council was on the 10/1/2007 and as a result the home was awarded a silver award for its catering service. The award was displayed one the wall in the corridor outside the kitchen. There was a menu with 2 alternatives and the menu was displayed in each dining area. Lunch was observed in the dining rooms on the ground and first floors, which was nicely decorated with residents having lunch attended by care staff who wore plastic aprons and served food in a discreet manner. Catering staff served lunch from hot trolleys. We saw staff sitting by the side of residents who could not feel themselves helping them in a calm and unhurried manner. No resident had any complaints about the food and it was well served and residents were not hurried. Comments were, “the food is lovely, well cooked, the way I like it” and “the food here is excellent”. The Georgians Nursing Home DS0000002556.V341163.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents know how to make a complaint and feel that staff will listen to their views. Staff are aware of how to respond to a complaint or an adult protection allegation. EVIDENCE: There was a complaints procedure displayed at the entrance to the home and each person received a copy of the complaints procedure in the service user’s guide. The home and the commission had received no complaints since the last inspection. No one had any complaints about the home during the inspection. However we were made aware of an adult protection issue in May 2007. This issue was thoroughly investigated by Lincolnshire County Council’ Social Services Dept. and the Police. There was full co-operation by the home and the correct procedures for reporting the incident were carried out. As a result of this an ex member of staff had been placed on the Protection of Vulnerable Adults temporary register. Staff were correctly recruited with application form, references obtained, and induction. A member of staff confirmed she had been recruited with a criminal records bureau check and a well supported induction. Staff knew about abuse and their role and training had been provided for all staff on abuse prevention in 2006 and further updates planned for 2007. In addition the home had a copy of the new Lincolnshire Adult Protection policy. The Georgians Nursing Home DS0000002556.V341163.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in very well decorated, comfortable, clean, safe and well maintained accommodation. EVIDENCE: The home was very clean, tidy, well decorated and odour free throughout. There was a decoration programme. Since the last inspection there had been extensive refurbishment and replacement of 17 windows with a redecoration of the large ground floor lounge/dining room. New equipment had also been purchased. We spoke to 3 housekeeping staff who showed evident pride in what they were doing. They said they enjoyed their work and felt valued and supported. All the residents spoke highly of the accommodation and how much they liked their bedrooms. There was a shaft lift installed. There was one case of MRSA and there was an infection policy, gloves and aprons and alcohol rubs. The Georgians Nursing Home DS0000002556.V341163.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sufficient levels of staff at the home with appropriate training and skills to meet the needs of the residents. EVIDENCE: Many staff had worked in the home for many years. All staff spoke of working as a team. Staff, residents and visitors felt there were sufficient staff in the home. The manager monitored dependency and was able to employ more staff where required. There were separate staff for catering, laundry, housekeeping, maintenance and administration. Staff meetings were held every 3 months and the minutes for the meetings for the 16/8/2007 and for night staff for the 30/8/2007 were displayed. Training since the last inspection had included, tissue viability, diabetes management, health and safety, pain control, skills for care, wound management, infection control, basic food hygiene, fire prevention, duty of care, privacy and dignity, catheterisation, skin care and adult protection. In addition, there were 20 full time staff and out of these 8 staff who had obtained a care qualification (National Vocational Qualifications) level 2 and 8 staff studying for this. In addition, 3 care staff had obtained NVQ level 3 and 3 studying for this. One member of staff was training to be an assessor. There were 50 of staff who had or were studying for NVQ. New staff received a comprehensive and supported induction programme in line with skills for Care The Georgians Nursing Home DS0000002556.V341163.R01.S.doc Version 5.2 Page 17 which if successful lead to the offer of NVQ training. Staff were correctly recruited. Staff commented, “we work really well together, there is a good team” and “when I came here I received a warm welcome and was supported throughout my induction. I am pleased I came here”. The Georgians Nursing Home DS0000002556.V341163.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the best interests of the residents. Quality assurance systems are well established. Residents’ views are obtained in order to ensure the home is meeting their needs. Residents’ health and safety needs are protected by staff and management systems. EVIDENCE: The manager was a very experienced nurse and had a management qualification and was an assessor. Staff, visitors and residents had confidence in the manager. There is active participation in the management of the home by the provider. Staff received supervision regularly and spoke of the support received from the manager and deputy manager. Practice observation had also been introduced. The Georgians Nursing Home DS0000002556.V341163.R01.S.doc Version 5.2 Page 19 There was an annual internal audit, which was carried out by the manager in April 2007 in line with the Registered Nursing Home Association Quality Management System. This was comprehensive and covered all aspects of the home. In addition, the manager carried out monthly audits of infection, accidents and pressure ulcers and report was made available to staff. She also carried out random audits of care records. Surveys were carried out to obtain the views of residents and visitors. Eight comments were examined for April 2007. All were very positive. Specific comments were, “all staff treat my father with love and respect which we are grateful for”. The home had policies and procedures including clinical procedures. Records were well maintained, up to date and accessible. There was a detailed equal opportunities policy, which referred to discrimination, disability and victimisation. There were no communication issues. There were no concerns about equality and diversity. The manager had information about the Mental Capacity Act 2005. Residents commented, “I feel the staff can adequately meet my needs”, “I like it here” and “this is an excellent home” and “I can’t fault anything”. The home had detailed health and safety procedures. There were also infection control policies. Where required risk assessments had been carried out and documented. There were a range of policies and procedures available in the home relating to fire safety and fire risk assessments. There was also evidence that the fire alarm, fire drills and emergency lighting checks and testing of hot water have been undertaken. Care staff also received fire training as part of the homes initial training and as a regular training event. There was a health and safety audit. The Georgians Nursing Home DS0000002556.V341163.R01.S.doc Version 5.2 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 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 The Georgians Nursing Home DS0000002556.V341163.R01.S.doc Version 5.2 Page 21 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. Refer to Standard Good Practice Recommendations The Georgians Nursing Home DS0000002556.V341163.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V341163.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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