Inspection on 18/10/06 for The St John Home

This inspection was carried out on 18th October 2006.

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

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

Other inspections for this house

The St John Home 29/08/08

The St John Home 30/08/05

The St John Home 10/05/05

The St John Home 22/11/04

The St John Home 19/07/04

The St John Home 09/01/03

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE The St John Home 1 Gloucester Road Whitstable Kent CT5 2DS Lead Inspector Mrs Susan Hall Unannounced Inspection 18th October 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The St John Home DS0000035046.V302045.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 St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The St John Home Address 1 Gloucester Road Whitstable Kent CT5 2DS 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) 01227 273043 The Priory of England & the Islands of the Order of St John Mrs Joyce Mitchell Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th August 2005 Brief Description of the Service: The St. John Home is a detached building, situated in a quiet residential area of Whitstable, near to the town facilities and the sea. It is owned by The Priory of England and the Order of St. John, and was initially set up in 1947 by five members of the local St. John Ambulance division. It is a Royal Charter Home, with charitable status, and is therefore a non-profit making business. It is run by a management committee, who meet quarterly. Accommodation is provided on two floors, with a stair lift to the first floor. There are lounges on both floors, and the one on the first floor has a view across the harbour and the sea. There are sixteen single bedrooms, and one shared. Many of the rooms are quite small, but they have been carefully furnished, allowing space for necessary nursing equipment. All bedrooms are fitted with telephone points and a call bell system. The home has gardens to the front and the side of the property, which have been paved for easy wheelchair access. They are enhanced by flower beds and tubs, and provide an attractive area to sit in good weather. The home can easily be accessed by public transport, and by road. On road car parking is available. The fees are set at £469.98 per week. This information was provided by the manager on pre-inspection documentation in October 2006. The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a well run home, very pleasant to visit, and with a homely and friendly atmosphere. It has a very well established staff team, which contributes to a sense of stability and confidence in the care given in the home. The manager has been in post for over 20 years, and is therefore thoroughly acquainted with all aspects of the life of the home, and the local area. This was a Key Inspection, which includes information gained since the previous inspection. The Inspector received a good response to survey forms, which included 6 replies from GPs, 2 from service users and their relatives, and 3 from care managers. All the replies were positive in their contents and GP replies included comments such as “ an excellent home” and “ the staff are always on hand to accompany me when I visit”. Care managers reported that they are “ very satisfied with the overall care provided”. A specialist support nurse – who was visiting to assess nursing contributions – agreed with this viewpoint. A Lay Preacher was visiting service users individually, and said he is welcomed into the home to help to meet spiritual needs, and he also offers friendship to the service users. The Inspector talked with 4 service users on the day of the inspection visit, and met others briefly. They stated that they find the manager and staff to be very good, caring and friendly, and that they are settled and happy living in the home. One service user expressed her pleasure at the improvement in her condition since her admission. Service users were also unanimous in their praise of the quality and quantity of the food, and said that they enjoyed the range of activities provided. The home currently had all female service users in residence. There is no bar to male service users, and this situation has happened by available placements, and not by design. The Inspector talked with 7 staff, including a nurse, a carer, domestic staff, a cook, a kitchen assistant and the administrator. The inspection included assessing most of the national minimum standards, and reading documentation such as care plans, medication charts, menus, accident records, maintenance records and some policies and procedures. What the service does well: The Inspector has assessed every outcome group in this report as “good”, showing that the home provides good quality in every area. The most notable of these is the staffing, which has been stable for many years, and means that The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 6 there is continuity for service users. Staff relate well to each other, and treat service users with respect and an awareness of their individual concerns. The home is kept very clean, and although rooms are quite small, they are homely and welcoming, and include personal items which are special to service users. Most had items of their own furniture, as well as books, ornaments, photos and pictures. Staff have completed mandatory training, and the manager ensures that they have relevant updates for safe working practices. A high percentage of care staff (77 ) have completed NVQ 2 and/or 3 training. Service users were high in their praise for the quality of the food, and said their only problem was having to take care not to put on too much weight. What has improved since the last inspection? What they could do better: Care plans are satisfactory, but could include more information for each plan. There are no property lists for service users, and there is a requirement to include these (i.e. for furniture items). The home could provide clearer written evidence for ongoing staff training for prevention of adult abuse. There has been so little recruitment needed over the last few years, that the home has lapsed with some requirements in regards to staff recruitment procedures. A hazard warning sign is needed to indicate where oxygen is in use/stored. The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 7 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 St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 The quality for this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home provides clear information to enable service users to make a choice about living in the home. EVIDENCE: The home’s statement of purpose includes all the details required by the standard, and schedule 1 of the Care Home’s Regulations. It provides clear information stating that the home has a charitable status, and explaining the aims and objectives of the home. The schedule of accommodation is included. This is important, as some rooms are quite small, and they are clearly identified. Concerns or complaints can be raised directly with the management committee, or with the “Friends of St. John Home” – an identified group of associated people who are actively involved in the life of the home. The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 10 The service users’ guide is set out in large print, with a colour photograph of the property on the front. It includes information such as visiting arrangements, hairdressing, laundry, telephone availability and bringing in one’s own furniture. The guide includes an outline of a typical day, which is a helpful way of showing prospective service users what to expect. All service users are given a copy of this guide before they move into the home. The manager carries out a pre-admission assessment prior to agreeing the placement, and service users are invited to visit the home before admission. The Inspector viewed three pre-admission assessments, and these contained detailed information about the service users’ medical needs and medication, and the help needed with managing personal hygiene, skin care, nutrition, communication, social needs, and all activities of daily living. The Inspector noted that these included specific personal details, such as if the service user needed a hearing aid, help with feeding, or mobility equipment. If any specialist equipment is required, the manager ensures that this is present in the home prior to admission. This may include items such as a nursing bed or a pressure-relieving mattress. There is a trial period of four weeks, after which the placement is reviewed to check the suitability. Each service user is provided with a contract agreeing the terms and conditions of the home, and the payment of fees. The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 11 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): 7-11 The quality for this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users health needs are fully met; and care needs are met with respect and attention to individual requirements. EVIDENCE: The Inspector viewed four care plans. These are set out in individual folders with colour coded sheets for easy access of information. Care plans are identified from the pre-admission assessment, and further assessments are carried out on admission. Assessments include moving and handling information, nutrition screening, risk assessments and skin care. The care plans do not contain lengthy details, but seemed to include the most important aspects of care for each section. The Inspector stated that it would be good practice to include more details for each care plan, and this view was shared by care managers and specialist support nurses in their feedback. The care plans are evaluated every month, and re-written every three months – or more frequently if indicated. They cover all activities of daily living, such as personal care, dental care, mobility, pressure area care, and social needs. The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 12 Daily records are completed for each service user, and identify the care plans which have been met on that day, and add extra comments in regards to physical health and mental state. These were suitably detailed, such as showing the action taken to alleviate pain, or comments regarding mental state such as “she said she is pleased with the progress she is making”. The inspector noted that care plans were completed with attention to details, including “likes to be known as”, religion, family data, bath temperatures, and monthly blood pressure and weight. Assessments for moving and handling, nutrition screening, and risk of developing pressure sores are completed monthly. Any wounds or bruises are recorded on body maps. The Inspector was unable to see completed wound care assessment forms, as no service users had any wounds or sores. The manager explained how these records would be completed if needed – ensuring that the progress of each wound could be clearly followed. She said that the home aim to heal any wounds present on admission, and then keep the service user free from them. Good records were included for visits from other health professionals such as GP, community physiotherapist, dentist, and care manager. Medication is appropriately stored in a locked area and administered by trained nurses. Controlled drugs are stored and documented correctly. The room and drugs fridge temperatures are recorded daily. The medication cupboard was in good order, with no out of stock medication, and with good evidence of stock rotation. One service user was self-medicating for nebulisers and inhalers, and her ability to manage this had been checked. The manager and the Inspector discussed the possibility of setting out a clear format for checking the competency for anyone who wants to self-medicate in the future. Medication Administration Records (MAR charts) are printed out by the home, and were seen to be well completed. There were clear details for any drugs which had been discontinued or had an altered dosage, and handwritten entries are double signed. The Inspector noted that there was no hazard warning sign on the door of a bedroom where oxygen was in use, and this is a fire safety requirement for anywhere that oxygen is stored or in use. (See “The Administration of Medicines in Care Homes”, section 8.1). Disposal of unused medication was still via the home’s pharmacy, and the manager needs to be sure of the amended legislation regarding the disposal of medication from nursing homes, in case the pharmacy does not continue to hold a licence for this. The Inspector had no doubts that service users are treated with respect and dignity, as there was clear evidence from the service users themselves, from feedback from others, and from personal observation. Service users said “the care here is wonderful, I couldn’t be anywhere better”; and “this is the best place in the world to be looked after”. All bedroom doors are fitted with locks, so that anyone who wishes to have their door locked can do so. Most service users choose to leave their doors The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 13 unlocked. Bathrooms and toilets have indicators on the doors to show if they are in use, so that privacy is maintained. The home has one shared room, and the screening is just adequate. The home states in the statement of purpose that “they provide terminal care and support the right of each service user to die with dignity.” Visitors are welcome at any time for someone who is dying, and staff will take time to sit with the service user if wanted. Service users are able to stay in their own rooms, and be cared for by staff who know them. Any religious preferences are taken into account, and visits will be arranged from church ministers or friends if requested. The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 14 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): 12-15 The quality for this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Social activities are provided to fit in with service users’ preferences, and provide sufficient variety and stimulation. The home provides nutritious food which is suited to individual requirements. EVIDENCE: The home holds a specific activities afternoon every Monday, when there is a planned programme of exercises, general knowledge quizzes, reminiscence etc. These are run by an activities co-ordinator. Recent craft activities included a wall display based on Vivaldi’s “Four Seasons”, depicting Spring, Summer, Autumn and Winter, and service users said they had enjoyed working together on this. The co-ordinator completes an activities folder, which contains details of different events held in the home, and who has taken part in these. Events included a variety of talks, including one from a local historian, one from a staff member about Romania, and one from a staff member about Indian dress The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 15 and customs. One of the service users is very active in helping to organise these, and in thinking up new ideas. Each event is advertised with a separate leaflet, and given out to each service user. The home also holds buffet parties, singing entertainment and musical afternoons. The “Friends of St. John Home” arrange outings, using a St. John’s minibus. Outings may include shopping in Canterbury, seaside visits, parks, gardens, theatre etc. Outings to the Old Time Music Hall at Whitstable Playhouse are popular. The Friends also organise cream teas, coffee mornings and other events to raise funds. Many service users like to read, and there were bookcases in nearly every bedroom, as well as in lounge areas. The home owns a large number of large print books for service users to enjoy. A small shop is available in the home on request, and service users can buy stamps, writing paper, sweets, toiletries etc. A portable payphone is available for anyone to use. Service users can have their own private line fitted if they want to. Service users are enabled to attend the church of their choice, or to join in with services held in the home. A Free Church service is held monthly. A Lay Preacher visits monthly as well, to give Holy Communion, and also visits service users individually to chat, read or pray with them. A Roman Catholic priest will visit if requested to do so. Visitors are welcomed between 9 a.m. and 9 p.m., or at other times for anyone who is ill. There is a “quiet hour” each day from 1-2 pm, enabling service users to rest quietly after lunch if they wish to do so. Service users are encouraged to bring in personal items of furniture, ornaments etc., and most service users had taken up this offer. The Inspector noted that property lists had not been completed, and this is a requirement. Service users are also encouraged to maintain their own finances, or will be assisted with advocacy if needed. The kitchen had been re-fitted during the past few years, and contained all the necessary equipment. The cook is on duty each morning to prepare lunches and afternoon cakes, and is helped by a kitchen assistant. The kitchen was clean and in good order. Service users said that “the food in the home is excellent”, and that the whole day seems to be punctuated with food. Early morning tea is followed by breakfast, which is prepared by care staff. Then there is mid-morning coffee and biscuits, a main meal at lunch, afternoon tea and cakes, tea, and milky drinks at bedtime. Menus are on a 6 week rolling programme, and are prepared by the cook in discussion with the manager and service users. Meat is delivered from a high quality local butcher’s and fresh fruit and vegetables are delivered several times per week. The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 16 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): 16,18. The quality for this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users know that any concerns or complaints will be listened to and acted on appropriately. Service uses are protected from abuse. EVIDENCE: The home has a complaints procedure on display, and a summary is included in the service users’ guide. The procedure encourages service users or relatives to speak with the manager or nurse on duty in the first instance, but they can also speak with one of the “Friends of St. John”, or the management committee, if preferred. The manager has a visible presence in the home, and talks with most service users every day. She is used to dealing with any concerns immediately, and this works effectively, as there have been no official complaints since 2003. Complaints records showed that any complaints are taken seriously, and are acted on appropriately. Verbal training in the prevention of adult abuse is included with the induction, which is the “Learn to Care” training. A high number of care staff have completed NVQ 2 and/or 3 training, and this includes recognition and prevention of different types of abuse. The home has a low staff turnover, and The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 17 it was clear that staff know how to treat people correctly, and how to avoid potentially abusive situations. Staff recruitment procedures include POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) checks. The home has a copy of the Kent & Medway protocol for Adult Protection, and this is kept in the staff room for easy reference by staff. The Inspector assessed this standard as being met, but recommended that there is written evidence to show that staff receive regular updates with this training. The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 18 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): 19-26 The quality for this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home is suitable for it’s purpose and is well maintained. It provides a welcoming and homely environment. EVIDENCE: The home is situated in a residential area, and has paved areas at the front and side of the property where service users can sit in good weather. The property is generally well maintained. The manager has arrangements with a local painter/decorator, an electrician, plumber and carpet fitter to carry out maintenance as needed. There is a large lounge/dining room on the ground floor, and a smaller lounge on the first floor. This has sea views across the harbour and the bay, and provides an interesting viewpoint for service users. The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 19 Most bedrooms (16) are for single use, and most are fairly small (9-10 sq.m), but are very thoughtfully arranged and decorated. Each room has a vanity unit and washbasin, and most contained items of service user’s own furniture. Bedrooms are usually redecorated and re-carpeted when vacant, and colours are according to the service user’s choice if the room has already been allocated. All bedroom doors are fitted with locks, and each service user has a lockable facility for any specific personal items. The shared room has satisfactory screening between the beds, and the manager stated that there were plans to improve this still further. Furnishings and fittings throughout the home were satisfactory. The management committee enable the manager to replace any items of damaged furniture immediately if necessary. The home has 2 bathrooms – one on each floor. These are large rooms with disabled toilets and assisted baths. Both baths have a shower attachment. There are a sufficient number of toilets, and these are sited near to service users’ rooms, and communal areas. Most service users have a commode in their rooms. There are no en-suite facilities. The home has suitable nursing equipment in place, including nursing beds, pressure-relieving mattresses, grab rails and raised toilet seats. There is a stair lift to the first floor. Since the last inspection, all bedrooms, bathrooms and communal areas have been fitted with overheads tracking for hoisting. This is an excellent decision as it prevents mobile hoists from blocking corridors and becoming a hazard. Tracking has been fitted so that transfers can be made between bed/armchair, commode/wheelchair/ bath etc. All hot water outlets in bedrooms and bathrooms have been fitted with thermostatic valves, and the water temperature is recorded for each bath. Laundry machines are situated in the same area as the sluice. This has been checked by the infection control team, who were satisfied that there are effective infection control measures in place. There are 2 washing machines with sluice facilities; and a red alginate bag system is used for soiled items of clothing. The room also has a tumble dryer, and clean clothes are transferred directly between washing machines and the dryer, and are then removed to a clean linen room for sorting and ironing. The home employs a laundry assistant in the mornings, and care staff continue with laundry at other times. There are 2 domestic staff for cleaning each day, and one usually works on the ground floor and one on the first floor, so that they become familiar with how service users like their ornaments and personal items placed in the rooms. One day per week is set aside for additional cleaning duties such as windows and skirting boards. The home was seen to be clean in all areas, and there were no offensive smells. The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 20 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): 27-30 The quality for this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home has a very stable staff team, and there are suitable numbers of staff on duty at all times. Recruitment practices require some updating. EVIDENCE: Shift patterns have remained unchanged since the last inspection, and changeovers for day and night staff are at 09.00 and 21.00. Day shifts are for 8 or 4 hour shifts, from 9-1, 9-5, 1-9 or 5-9. There are 3 care staff and 1 nurse in the mornings, 2 care staff and 1 nurse in the afternoons/evenings, and 1 carer and 1 nurse at nights. The manager’s hours are mostly supernumerary. These numbers of staff allow for sufficient time to be given to service users to meet all their personal hygiene and toileting needs, and help with meals, activities etc. There are suitable numbers of ancillary staff to assist with the running of the home. Many of the staff have worked in the home for several years, and no new care staff had been recruited since 2001. 77 of care staff have achieved NVQ level The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 21 2 and/or 3, and this is exemplary. Staff were clearly motivated, and very caring towards the service users. The Inspector examined 4 staff files, including some for nurses and some for care staff, and one for someone from abroad. No recruitment had taken place for some time, and the home had not kept fully up to date with changing requirements for staff applications. The Inspector pointed out that a full employment history is now required (not 10 years). Staff files should also contain proof of identity (e.g. photocopy of birth certificate, passport). Proof of identity had been seen, as all staff had completed Criminal Record Bureau (CRB) checks, and these documents are needed for CRB applications. However, copies of the documents had not been held on file. One file only had 1 written reference and 1 verbal reference. Files had a basic statement in regards to staff’s mental and physical health, and the Inspector and the manager discussed the possible use of a health questionnaire in future, which would show up more clearly any previous history of serious illness or injury which may need to be taken into account. Files contained staff training records, and there is a staff training matrix for trained and untrained staff. This showed that mandatory training for safe working practices is suitably updated. Some evidence was seen for trained staff being able to carry out courses to update their skills and competencies. There is a recommendation to ensure that all nursing staff are actively encouraged to do this. The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 22 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): 31-38 The quality for this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The manager provides a strong leadership to staff, and is very competent in running the home. Safe working practices are maintained in the home. EVIDENCE: The manager is a level 1 nurse who has worked in the home as matron/ manager for 22 years, and is committed to ensuring that good nursing care is carried out. Staff and service users spoke highly of her leadership to staff, and her caring attitude. She is proactive in ensuring that service users and staff are appropriately cared for, and has provided a settled management of the home for many years. The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 23 The home is run by a management committee, and three people from the committee take it in turns to carry out monthly Regulation 26 visits for the home. They meet the service users, and monitor the progress of the home. The “Friends of St. John” also meet service users at other times, and this provides another source for ensuring there is an effective quality assurance process. Business accounts are audited every year, and the report for May 2006 stated that the home has suitable accounting and finance procedures, and could demonstrate financial viability. Some service users are unable to maintain their own personal finances. The manager oversees individual accounts for day to day “pocket monies”, and all transactions are recorded and double signed. All receipts are retained, and storage is in a safer place. Service users’ general finances are not managed by the home, but either by themselves, an appointee or an advocate. Formal staff supervision has been implemented for all staff. There is also informal day to day supervision at handover times and throughout the day. Policies and procedures are kept available in the staff room, and are amended as the need arises. These had all been reviewed in 2003. The Inspector recommended that it is good practice to review these on a yearly basis, to ensure that any ongoing changes have been made, and any new legislation has been taken into account. Records were generally well maintained, and safely stored. Staff keep up to date with safe working practices, and all care staff had been trained to use the new overhead tracking system for hoisting. COSHH sheets are in place for all chemicals used in the home, and staff knew where to access these. Accident records are properly maintained, and do not compromise the Data Protection Act. The Inspector viewed maintenance certificates for the fire alarm system, gas, hoist servicing, and PAT testing, and these were all up to date. The manager was aware of new fire safety regulations, and was checking that the home is compliant with these. The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 24 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 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 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 4 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 (2) Requirement All rooms or areas where oxygen is stored or in use must display a statutory warning notice. Staff recruitment procedures must be amended to include a full employment history, 2 written references, and proof of identity kept on file. Current staff files should be updated to include proof of identity. Timescale for action 18/11/06 2 OP29 19 and Schedule 2 18/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP8 OP18 Good Practice Recommendations To review the format for care planning, with the possibility of including more information on individual care plans. To provide written evidence to show that staff receive regular updates for training in prevention of adult abuse. DS0000035046.V302045.R01.S.doc Version 5.2 Page 26 The St John Home 3 4 OP30 To actively encourage trained staff to develop their skills and competencies. To review policies and procedures for the home on a yearly basis. OP37 The St John Home DS0000035046.V302045.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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. 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