Inspection on 29/08/08 for The St John Home

This inspection was carried out on 29th August 2008.

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

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 18/10/06

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 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The St John Home 1 Gloucester Road Whitstable Kent CT5 2DS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lisbeth Scoones     Date: 2 9 0 8 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: The St John Home 1 Gloucester Road Whitstable Kent CT5 2DS 01227273043 Telephone number: Fax number: Email address: Provider web address: stjohnhome@btopenworld.com Name of registered provider(s): Name of registered manager (if applicable) Mrs Joyce Mitchell Type of registration: Number of places registered: The Priory of England & the Islands of the Order of St John care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 27 0 Over 65 18 Brief description of the care home 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 preinspection documentation in October 2006. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection was carried out on 29th August 2008 and comprised in depth discussions with the registered manager, deputy manager and care staff on duty. An accompanied tour of the premises was made and 6 residents spoken with. Documentation was examined in respect of policies and procedures, medication records, menus, care plans and risk assessments, accident records, complaints, staff training and employment files. The inspection was further informed by an AQAA (annual quality and assessment) completed by the manager prior to the inspection. The last inspection was carried out on 29th August 2006. Care Homes for Older People Page 6 of 27 Residents said that they like living at the home and that the staff are excellent. Staff said that this is a good place to work with many training opportunities. What the care home does well: What has improved since the last inspection? What they could do better: Medication practices should be reviewed. and the medication policy updated. The home should have clear written evidence that staff are provided with ongoing training for prevention of adult abuse. Care Homes for Older People Page 8 of 27 A system is needed that ensures that all NMC PIN numbers are current. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with comprehensive information about the services and facilities the home provides. Pre-admission assessments are carried out to ensure that the home can meet residents needs. Evidence: All residents are given a copy of a well presented Service User Guide. It provides comprehensive information about the facilities and services St Johns offers. The manager carries out a pre-admission assessment before a decision is made to admit the resident. Residents are invited to visit the home before admission. A sample of pre-admission assessments was seen and this contained detailed information about residents medical and social needs. Care Homes for Older People Page 11 of 27 Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel confident that their assessed and changing needs are reflected in a regularly reviewed care plan. To fully protect the residents, the medication policy needs to be reviewed. Residents are treated with dignity, sensitivity and respect for their privacy. Evidence: A sample of care plans was viewed. These are set out in individual folders with colourcoded sheets for easy access of information. Care plans are identified from the preadmission assessment, and further assessments are carried out on admission. Care plans are informed by a range of risk assessments and cover all activities of daily living such as personal care, dental care, mobility, pressure area care, and social needs. Care plans are reviewed monthly and rewritten every three months. Care Homes for Older People Page 13 of 27 Evidence: In the previous report it was recorded that care plans do not contain lengthy details. There has been no change in this but the most important aspects of care for each section are recorded. Daily records are well maintained and provide detail of the care provided. As at the previous inspection, the manager reported that none of the residents have a pressure ulcer. Assessments for moving and handling, nutrition screening, and risk of developing pressure ulcers are completed monthly. Any wounds or bruises would be recorded on body maps. A GP visits weekly. Good records were included for visits from other health professionals such as GP, community physiotherapist, dentist, chiropodist, physiotherapist 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. Due to the absence of a shaft lift and limited storage space, the home does not use a medication trolley to take medication to the residents. The administration of medication was discussed both in respect of safety and as a person-centred task. The manager has taken this on board. The previous inspection recorded that the dispensing pharmacy disposed of unused medication. The manager reported that these are now disposed of at the Health Centre and appropriate records kept. It is evident that residents are treated with respect and dignity. Residents said, The care here is wonderful, I couldnt be anywhere better; and this is the best place in the world to be looked after. Staff are trained to care for residents who are nearing the end of their lives. Staff would support residents with dignity. Any religious preferences are taken into account and visits arranged from church ministers or friends if requested. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to make choices about their life styles and to develop their life skills. Residents benefit from a range of social, educational, cultural and recreational activities. Residents are provided with varied, wholesome meals. Evidence: An activities afternoon is held each week when there is a planned programme of exercises, general knowledge quizzes, reminiscence, art and crafts etc. The care plan contains an activities record. An activities folder contains details of different events held and who has taken part in these. Events include visiting speakers for special interests talks. Illustrated personal profiles were seen providing staff with background information allowing staff and other residents some insight and understanding of residents previous life style and interests. The Friends of St. John Home arrange outings, using Care Homes for Older People Page 15 of 27 Evidence: a St. Johns minibus. Outings may include trips to see spring blossom, gardens and the seaside. The Friends also organise cream teas, coffee mornings and other events to raise funds. Two residents visited enjoy knitting. Many residents 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 residents to enjoy. A small shop is available in the home on request, and service users can buy stamps, writing paper, sweets, toiletries etc. Residents may have their own private phone line fitted if they wish and many residents now have a mobile phone. Visitors are always welcome and are encouraged to sit with the residents on the benches outside or take the residents out for short walks and shopping trips. Visitors are welcomed between 00.09 and 21.00 or at other times for anyone who is ill. There is a quiet hour each day from 13.00-14.00 enabling residents to rest quietly after lunch if they wish to do so. Residents 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 Church of England lay reader visits monthly to give Holy Communion and also visits residents individually to chat, read or pray with them. A RC visitor comes weekly to give communion to one resident. A Roman Catholic priest will visit if requested to do so. Residents are encouraged to maintain their own finances and will be assisted with advocacy if needed. The kitchen is clean, bright and spacious with all the necessary equipment. The cook, helped by a kitchen assistant, is on duty each morning to prepare lunches and afternoon cakes. All residents spoken with said that the food in the home is excellent. Menus are on a 6 week rolling programme. These are prepared by the cook in discussion with the manager and residents. Meat is delivered from a high quality local butchers and fresh fruit and vegetables are delivered several times per week. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents know that any concerns or complaints will be listened to and acted on appropriately. Residents are protected from abuse. Evidence: The home has a complaints procedure on display and a summary is included in the Service User Guide. The procedure encourages residents 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 residents every day. She is used to dealing with any concerns immediately and there have been no official complaints since 2003. See also standard 33 in respect of official visits. The home has a low staff turnover and staff spoken with have a good understanding of Safeguarding vulnerable adults. Staff are trained in these issues at induction and NVQ level 2 and 3 training. 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. As recommended at the previous inspection, training files should evidence that staff receive regular updates with this training. Care Homes for Older People Page 17 of 27 Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is suitable for purpose, well maintained, welcoming and homely. Evidence: The home is situated in a residential area with paved areas at the front and sheltered area at the side of the property where residents 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. Since the previous inspection, in consultation with the residents, ready printed nameplates have been purchased for each bedroom door. Matching nameplates have been purchased for toilets and bathrooms. Two rooms have been repainted and both bathrooms re-tiled. 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 sea providing an interesting viewpoint for residents. Apart from one, all bedrooms (16) are for single use. Most are fairly small (9-10 sq.m), but are very thoughtfully arranged and decorated. Each room has a vanity unit and washbasin and contained items of residents own furniture. Bedrooms are usually redecorated and re-carpeted when vacant. All bedroom doors are fitted with locks and Care Homes for Older People Page 19 of 27 Evidence: each resident has a lockable facility for any specific personal items. The shared room has satisfactory screening between the beds. Furnishings and fittings throughout the home were satisfactory. The management committee enable the manager to replace any items of damaged furniture immediately if necessary. A resident said, I like it here and have a lovely view. 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 ensuite facilities. The home has suitable nursing equipment in place, including nursing beds, pressurerelieving mattresses, grab rails and raised toilet seats. The overhead tracking for hoisting in most bedrooms 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. Safe laundry and sluicing arrangements are in place. Laundry machines are situated in the same area as the sluice. The home employs a laundry assistant in the mornings and care staff continue with laundry at other times. Two domestic staff ensure that the home is clean and fresh. One day per week is set aside for additional cleaning duties such as windows and wheel chair cleaning. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are cared for by a very stable and well-trained staff team. There are suitable numbers of staff on duty at all times. Residents are protected by the homes recruitment procedures. Evidence: Staffing levels remain unchanged since the last inspection. During the morning shift there are 3 care staff and 1 nurse on duty, 2 care staff and 1 nurse in the afternoons/evenings and 1 carer and 1 nurse at night. The managers hours are mostly supernumerary. These numbers of staff allow for sufficient time to be given to residents to meet all their personal hygiene and toileting needs, 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. 79 of care staff have achieved NVQ level 2 and/or 3 and this is exemplary. Staff were clearly motivated and very caring towards the residents. I love working here. This is a good place to work. Care Homes for Older People Page 21 of 27 Evidence: A sample of staff files was examined. Since the previous inspection, these have been updated and now contain proof of identity (e.g. photocopy of birth certificate, passport). For al staff a Criminal Record Bureau (CRB) check is undertaken. For all new staff a full employment history is requested and a health questionnaire completed. Some dates on NMC PIN numbers documentation had expired. The manager said she would address this without delay. Files contained staff training records and there is a training matrix for trained and untrained staff. This evidenced that care staff receive all the mandatory training. In discussion with the manager it is evident that trained staff keep themselves updated. The home has an Infection Control link nurse who acts as a resource for other staff. Three trained members of staff have become mentors with Christchurch College. The home has been accredited to be a training centre for student nurses. Four trained staff have completed a two day course on continence training and assessment. Two trained staff have attended a Vulnerable Adult Protection Awareness course and two have attended a Mental Health Journey course. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager 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 24 years. She has the Registered Managers Award and is committed to ensuring that good nursing care is carried out. Staff and residents spoke highly of her leadership to staff and her caring attitude. She is proactive in ensuring that residents and staff are appropriately cared for, and has provided a settled management of the home for many years. She is supported by a deputy who is currently studying for the Registered Managers Award. The home is run by a management committee, and three people from the committee Care Homes for Older People Page 23 of 27 Evidence: take it in turns to carry out monthly Regulation 26 visits for the home. They meet with the residents and monitor the progress of the home. The Friends of St. John also meet residents at other times thus providing another source for quality assurance process. Some residents are unable to maintain their own personal finances and are assisted by staff. A small amount of pocket money is kept in the homes safe and all transactions are recorded and double signed. Formal staff supervision has been implemented for all staff. There is also informal dayto-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 2007. Accident records are properly maintained, and do not compromise the Data Protection Act. From information provided in the AQAA it is ascertained that all maintenance certificates and servicing records are up to date. A Fire Risk assessment has been produced and inspected by the fire officer in line with new fire safety regulations. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!