Care Home: Lourdes Nursing Home

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What the care home does well Many of the service users are nuns and their spiritual needs are met through the volunteer visiting nuns and the religious services conducted in the homes own chapel. The registered manager has also undertaken a course in spirituality. The assessment of prospective service users is detailed and includes personal preferences about individual daily routines. The care plans are well written and provide staff with instructions on how to meet the care needs of people. People stated they are well cared for, the staff are kind and listen to them and completed surveys confirmed this. Senior staff and care staff have undertaken training in `care of the dying` to enhance their understanding of peoples needs when coming to the end of their life. Medication is handled and administered safely ensuring people receive tablets appropriately. There is a variety of activities provided, supported by an activities person. The registered manager ensures that a thorough recruitment procedure is used, with all of the security checks being completed before new staff start work. New staff also complete a basic health & safety induction before working a shift and then proceed to the full induction programme. There is a full training programme that covers all of the mandatory subjects as well as additional specialist courses. The home is purpose built and there is a rolling programme of maintenance and refurbishment which results is the home being maintained to a good standard of repair and there is ongoing development of the home. The home is managed well by the registered manager who is supported by a deputy and two seniors; this enabled them to maintain her high standards during a period of compassionate leave. What has improved since the last inspection? Staff training continues to be ongoing. A rolling programme of maintenance and refurbishment maintains the home to a good standard of repair. What the care home could do better: Ensure that all components of the person centred care plans are accessible on the computer.Ensure that the staff training matrix is kept up to date Key inspection report Care homes for older people Name: Address: Lourdes Nursing Home Ursuline Convent 225 Canterbury Road Westgate-on-sea Kent CT8 8LX     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandra Crosby     Date: 2 6 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Lourdes Nursing Home Ursuline Convent 225 Canterbury Road Westgate-on-sea Kent CT8 8LX 01843836841 01843836841 lourdesosu@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Trustees for the Roman Union care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 15. The office previously registered as a bedroom and opposite bedrooms 7 and 8 can be used for Sister Vidler only. The community is to notify the commission of any changes to use of this room The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Lourdes Community is a building within the grounds of Ursuline Convent. There is accommodation on two floors and all rooms are registered as single. The building has been extended to provide additional communal space and so that all bedrooms meet the minimum size. There is a shaft lift and all rooms have a TV point and nurse call system. The Home has access to the extensive grounds of Ursuline Convent and is Care Homes for Older People Page 4 of 26 Over 65 15 0 Brief description of the care home within easy reach of the local shops, amenities and public transport. The aim of the Home is to provide a high standard of spiritual and emotional care in an environment in which the Sisters can continue to live their community life as well as providing nursing care. More recently the number of female service users from the general public community has increased. The Home provides nursing and personal care. The fees are: £597.00 to £680.00. Care Homes for Older People Page 5 of 26 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: three star excellent 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: The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This report contains the findings of the homes key inspection and takes account of information obtained from various sources since the last Key Inspection of the 12 December 2006, an Annual Service Review dated 13 May 2008 and a visit to the home. The key inspection visit was unannounced and carried out on Thursday 26th November 2009 between 10.00 and 15.00. The registered manager was not available during this visit and the inspector spoke with the nurse in charge, nurses, care staff, the cook, and people who use the service. Various records were seen during the visit, together with an accompanied tour of some areas of the premises. Information contained in the completed Annual Quality Assurance Assessment (AQAA), Care Homes for Older People Page 6 of 26 completed by the registered person was clear and informative. This information has been used together with information gained and observations made at the time of the inspection visit all of which has been used when completing this report. Eight service user surveys and eight staff surveys were sent to the home for completion. One service user survey and three staff surveys were returned at the time of writing this report. The aim of the visit was to carry out an inspection against the key standards of the National Minimum Standards for Older Persons in accordance with the Inspecting for Better Lives (IBL) process. Judgements have been made for each outcome area in this report and these have been made using the Key Lines of Regulatory Assessment (KLORA), which is guidance used to ensure that a fair and proportionate judgement is made in each outcome area. More information about KLORAs can be found on the Care Quality Commissions (CQC) website. The findings of this inspection were discussed with the nurse in charge at the end of the visit, and overall indicate that this home is providing sustained good quality outcomes provision for the residents and in line with CQC ratings agenda this service has achieved an excellent 3* rating. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: Ensure that all components of the person centred care plans are accessible on the computer. Care Homes for Older People Page 8 of 26 Ensure that the staff training matrix is kept up to date 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 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 26 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. People are provided with the information they need to make an informed choice about moving into the home. Pre-admission assessments ensure that the home can meet the persons needs. Intermediate care is not provided. Evidence: It was previously reported that the Statement of Purpose and Service User Guide met the standard required by regulation and provided people with the information they needed to make an informed choice about moving into the home. Prospective service users are encouraged to visit. The one survey returned at the time of writing the report by a person who lives at the home, confirms that they received enough information to help them decide if the home was the right place for them before they moved in. Detailed pre-admission assessments are conducted by the registered manager or one Care Homes for Older People Page 11 of 26 Evidence: of the senior nurses. KCC and/or PCT assessment documentation is also obtained as appropriate. The completed pre-assessment documentation is used to inform the setting up of the person centred plans of care. It was confirmed that the home does not provide intermediate care therefore standard 6 is not applicable. Care Homes for Older People Page 12 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from care planning that shows that person centred care is promoted. People can be confident that their health care needs are met and they are protected by the homes administration and recording of medication. People can feel confident that they will be treated with respect and their right to privacy is upheld. Evidence: The home maintains person centred care plans on a computer system. Parts of three service user care plans were case-tracked. Information seen was detailed and individual, with specific information on how to meet peoples care needs and personal preferences about daily routines, such as preferred bedtime routine and drinks. The person centred care plans are regularly reviewed and updated as appropriate. The care plans are also monitored by external professionals from the PCT. One of the completed staff surveys returned at the time of writing the report stated the care given is tailored to the needs of the individual. It was discussed that skin integrity and nutritional assessment were conducted and Care Homes for Older People Page 13 of 26 Evidence: linked to the care plan, although information in relation to skin integrity was not easy to find on the system at the time of the visit. There were nursing instructions in relation to the changing of wound dressings, however the nurse in charge was unable to locate the wound care plan on the computer system. Daily records were well recorded and informative. Overall the information evidenced was satisfactory. Medication records were viewed and indicated that these were mainly up to date and appropriately signed. Some gaps were seen, and the nurse in charge reported that this had been noted and a message for staff was seen on the medication trolley in relation to this. Changes in medication were recorded including the reasons for change. Medication audits are undertaken. Service users are treated with dignity and respect and observation of staff practice during the visit confirmed this. The one survey returned at the time of writing the report by a person who lives at the home, confirmed that staff listen and act on what they say, and a completed staff survey stated the residents are treated with dignity and respect at all times. People feel their rights as citizens are recognised and promoted, including fairness, equality, dignity, respect, and autonomy over their chosen way of life. This service is consistently providing good outcomes enabling this to be viewed as an excellent service in line with Inspecting for Better Lives. Care Homes for Older People Page 14 of 26 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. People are supported to participate in a variety of activities and maintain contact with family and friends. People have an active voice, expressing their personal preferences and this is respected and acted upon. People enjoy a good, balanced and wholesome diet with special diets being catered for. Evidence: The home has a Roman Catholic ethos, but people are free to partake as much or as little as they wish. The home looks after religious sisiters as well as lay people. The home is sensitive to their different needs. The person who arranges and provides a programme of activities at the home talked about a variety of activities that are undertaken for example bingo, aromatherapy, card games, glass painting and knitting. A session of beadcraft was being undertaken on the afternoon of the visit. The one survey returned at the time of writing the report by a person who lives at the home, commented that the home sometimes arranges activities that they can take part in. A variety of events have been arranged for the Christmas period. Care Homes for Older People Page 15 of 26 Evidence: The home benefits from beautiful gardens and also has two large communal rooms and a selection quiet rooms and a chapel. There are regular religious services provided in the chapel. Many of the service users are physically frail and require the support of care staff but have been supported to maintain their individual beliefs and personalities. Relatives and friends are able to visit when they wish. One completed staff survey stated residents are included totally in all aspects of care. The menu offers two choices of a hot main meal with other alternatives available. Fresh vegetables are used daily and fresh fruit is always available. The main meal on the day of the visit was beef and mushroom in a red wine sauce with mash potatoes, swede and carrots, with the alternative being sausages in an onion gravy. Special diets are catered for. The one survey returned at the time of writing the report by a person who lives at the home, commented that they usually liked the meals at the home and one completed staff survey stated dietary needs are met exceptionally well. The home has implemented the Safer food better business in the kitchen. It was observed and commented to the cook that the standard of cleanliness seen in the kitchen was excellent. Care Homes for Older People Page 16 of 26 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. People are confident that their opinions and concerns are taken seriously and responded to appropriately. People are protected from abuse and feel safe living in the home. Evidence: The home has policies and procedures in place in relation to the action to be taken if and when a complaint is made. The one survey returned at the time of writing the report by a person who lives at the home confirmed that they feel they are listened to, that they are able to express their concerns and that they are taken seriously. All returned staff surveys confirmed that they knew what to do if someone has concerns about the home. The Commission has not received any complaints since the last inspection. The staff training matrix indicates that staff undertake training in Safeguarding of Vulnerable People, Mental Capacity Act and Deprivation of Liberty. Care Homes for Older People Page 17 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a pleasant, homely environment that is well maintained. People are encouraged to maximise their independence by having access to the range of specialist equipment supplied by the home. People live in a clean and hygienic environment. Evidence: The building is a purpose built home, with its accommodation provided on the ground and first floor, there is a shaft lift to access the first floor. All of the bedrooms are single and have en-suite facilities. People are actively encouraged to bring in pieces of furniture and personal possessions, making the bedrooms both intimate and individual. The home has a selection of communal rooms including a chapel in which service are conducted. The home provides assisted bathrooms and toilets. Infection control procedures are fully implemented and the appropriate equipment provided. Specialist equipment/adaptations are provided when needed to meet the needs of the service users. The home was seen to be clean and free from offensive odours and this was supported by the comments in the surveys completed by people who use the service and staff, one commenting it is very clean. A team of ancillary staff and maintenance staff are employed and the home has an Care Homes for Older People Page 18 of 26 Evidence: ongoing maintenance programme. There is regular investment in the home. Care Homes for Older People Page 19 of 26 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. People benefit from a well-trained, enthusiastic and supportive staff team. People are protected by the homes recruitment procedures. Evidence: The home employs a team of both registered nurses and care staff. There is also a team of ancillary staff and a person designated to provide activities. There is usually a minimum of one registered nurse on duty excluding the registered manager, until 3.00pm and then the registered manager is the nurse in charge until 4.30pm. There are also between 4 and 5 care staff on duty during the day and one registered nurse and one waking carer at night. It was indicated during discussion with staff that the home has a stable staff group with many of the staff having worked at the home for many years. The staff team are currently pulling together at a time when the registered manager is not available. Recruitment files were not seen at this visit, information from staff confirmed that a thorough recruitment procedure is in place at the home. It was previously reported that two of the most recently employed staff files were assessed, these contained application forms, interview records, references, proof of identity and all relevant documentation as required by regulation. The files provided evidence that staff do not start work until receipt of both the CRB and POVA check. The three staff surveys completed and returned at the time of writing this report all confirmed that the Care Homes for Older People Page 20 of 26 Evidence: employer carried out checks such as CRB and references before they started work at the home. Equality and Diversity are promoted through staff training and evidenced in personcentred care plans. Staff training is ongoing at the home. In discussion with the nurse in charge it was indicated that the staff training matrix is currently being updated. Staff undertake all mandatory training and this is updated as required. In reply to the survey question of are you given training that, is relevant to your role, helps you understand and meet the individual needs of people, keeps you up to date with new ways of working and gives you enough knowledge about health care and medication all replied yes to all components of this question. The AQAA documentation reports that 50 of care staff have completed the NVQ level 2 or above in care. It was previously reported that all new staff work induction shifts to start with, where they are fully supervised by staff and complete health and safety induction. All staff complete the full induction programme, and the three returned staff surveys in reply to did your induction cover everything you needed to know to do the job when you started, one stated very well, and two stated mostly. People are well supported by a staff team that recognises and responds appropriately to their diverse needs and human rights. This service is consistently providing good outcomes enabling this to be viewed as an excellent service in line with Inspecting for Better Lives. Care Homes for Older People Page 21 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home provides leadership, guidance and direction to staff to ensure that people receive consistent quality care. Sound financial procedures protect people. Peoples health, safety and welfare are promoted. Evidence: The home is managed in a way that shows it has the best interests of the people living there at heart and puts them at the centre of what they do. The registered manager is well qualified for the position and has the registered managers award and has also undertaken training in spirituality. The home has been well managed with the homes ethos being maintained. The completed Annual Service Review dated 15 May 2008 stated that the completed AQAA evidenced that the recommendations made in the last key inspection report have been acted upon. The home contacts the Commission if there are any significant events that affect the Care Homes for Older People Page 22 of 26 Evidence: well being of the residents. One such event was reported and the home dealt with the issues quickly and took appropriate action. There are quality assurance systems in place, a full report is produced each year and a plan of action implemented. Regular residents and staff meetings are held together with regular audits being undertaken for example medication. Service users financial records were not seen at this visit, but it was reported at the last inspection visit that these were seen and included receipts and cash and the records corresponded. The AQAA documentation confirms that the environmental health and safety certificates are maintained and updated as appropriate. Policies and procedures are regularly reviewed. This service is consistently providing good outcomes enabling this to be viewed as an excellent service in line with Inspecting for Better Lives. Care Homes for Older People Page 23 of 26 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 24 of 26 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 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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