Care Home: Nazareth House

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What the care home does well The home has an admission process in place for new people and this includes an assessment of their needs and a visit to the home by the person and their family/representatives. The long term assessments of peoples` needs are very detailed and person centred and provide staff with holistic information. The upkeep of the home and cleanliness is very good and no unpleasant odours were detected during our tour of the environment, which is excellent. We found in the recruitment records for a new member of staff that they did not start working at the home until after their CRB had been returned and this is good practice. The feedback we received from the surveys and from people we spoke with during the inspection all indicated that they were very happy with the standard of care they receive. What the care home could do better: Once the home has introduced the new care planning system they need to make sure that people have care plans in place for all assessed needs, they are person centred andrisk assessments are also in place. A system needs to be devised by the home for management of people who use bed rails. This must include a risk assessment, consent form and ongoing safety checks on the bed rails. The home needs to continue with their plans to change the controlled medication storage cupboards and look at devising a frequent audit of this medication. The home needs to review the system they have in place for delivering peoples` clothing as it does not respect their privacy and dignity. An urgent review of their moving and handing equipment is needed to make sure people are not being placed at unnecessary risk. Random inspection report Care homes for older people Name: Address: Nazareth House London Road Charlton Kings Cheltenham Gloucestershire GL52 6YJ three star excellent service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sharon Hayward-Wright Date: 0 4 0 6 2 0 1 0 Information about the care home Name of care home: Address: Nazareth House London Road Charlton Kings Cheltenham Gloucestershire GL52 6YJ 01242516361 01242547696 manager.nazhsechelt@btinternet.com www.sistersofnazareth.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) The Congregation of the Sisters of Nazareth Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 63 Number of places (if applicable): Under 65 Over 65 63 old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 0 Nazareth House, a purpose built care home, is situated on the outskirts of Charlton Kings, within walking distance of the local shops and public transport. It is registered to provide accommodation for sixty-three older people who require personal care. All the bedrooms offer single accommodation; many have en suite facilities. A shaft lift and stair lift provide assisted access to the upper floors. The communal areas consist of five lounges/quiet areas, three dining rooms plus a large function room and sun lounge. There is also a Chapel attached to the Home where daily services take place. Care Homes for Older People Page 2 of 11 Brief description of the care home People living at the home have the benefit of a large attractive garden with summerhouse, which is easily accessible and well maintained for use in all weathers. The fees for personal care at Nazareth House are dependent on individuals assessed needs, and the fee is determined by whether the needs for care are high, medium or low, and whether the accommodation has en-suite facilities. The fees do not include the cost of items such as newspapers, toiletries, magazines, chiropody and sundry items, and there may be charges for some outings and trips. The excellent rating for this service was made on the 12th June 2007. Care Homes for Older People Page 3 of 11 What we found: This unannounced inspection took place on day in June 2010. Prior to the visit to the home we sent them an Annual Quality Assurance Assessment (AQAA). This was returned to us on time and contained information about what the service feels they do well and any areas they are looking to improve on. The AQAA also contained numerical data called Dataset. We also sent to the home some questionnaires for people who use the service and staff. We received 9 from people who use the service and 6 from staff. Some of the results from these have been used in this report. At this inspection we focused on pre admission assessments of people recently admitted to the home, some peoples care plans, arrangements in place for the management of controlled medication, a tour of some of the environment and recruitment records of recently appointed staff. We also followed up on some of the requirements issued at the last key inspection which took place in June 2007. Since the last key inspection the Registered Manager has retired and a new manager is now in place. We examined the pre admission assessments of two people who have recently moved into the home. Both people were living in their own homes prior to moving in and were assessed by a previous manager. Both people had detailed pre admission assessments that listed their care needs. Additional information had been obtained from health care professionals for one person. We spoke to one of the new people who explained they had visited the home prior to moving in and a member of their family had found the home on the internet. They said they were more that satisfied with this home. We also spoke to one of their family members who explained that they know about the home as they live in the local community and they also know some of the people who live there. They also said they feel the home is looking after their relative exceptionally well and their general condition has improved allowing them to be more independent and enjoy life again. The other person who was recently admitted to the home was displaying some challenging behaviour whilst living at their own home that was causing concern amongst social and health care professionals involved in their care. This has continued, however the home have involved external health care professionals and a system put in place to manage this. A member of staff we spoke with said this is now improving. One relative had commented on behalf of person who uses the service in their survey I was particularly impressed with the pre admission assessment of my relative which emphasised meeting their needs. We examined the care records of three people. Two people were recently admitted to the home and the other person had lived at the home for a period of time. We found that each person had a very detailed long term assessment of needs and these had been updated when required and reviewed on a frequent basis. However we found that care plans were not always in place for each assessed need and they were not person centred. We also found that not all people had risk assessments in place for the following; moving and handling, nutrition, falls and pressure area care. The AQAA told us that the home has plans in place to introduce a new computerised care planning system very shortly. The new manager also confirmed this and said that all care staff will receive training in care planning and risk assessments. We found that one person had bed rails in use but no Care Homes for Older People Page 4 of 11 consent or risk assessment was in place. There also needs to be frequent checking of the bed rails to make sure people are not being placed at risk of entrapment. Bumpers or padded covers must also be placed over the bed rails for safety. We asked people in the surveys we sent to the home for them to complete, do you receive the care and support you need? 7 people said always and 2 people said usually. We also asked are the staff available when you need them?, 6 people said always and 3 people said usually. We examined the system the home has in place for the management of controlled medication. The new manager informed us that the store cupboards for this medication do not comply with current legislation, however new cupboards are on order and they will be replaced as a matter of urgency. We undertook with a member of staff an audit check of the controlled medication and this included counting the medication and checking them against the records. We found that the medication issued by the staff in the home to be correct. We did find that the controlled medication administered by Community Nurses not to be correct on the stock check, however this has now been addressed. The home must demonstrate that they are undertaking frequent stock checks on this medication and maintain records of this. The AQAA describes the home as having extensive well maintained grounds that have won The Best Garden Award for Care Homes in the area for the second year running. There are many paths and benches to allow residents and visitors to enjoy the grounds. We toured parts of the environment and viewed some peoples rooms with their consent. We found the grounds surrounding the home are exceptionally well maintained and people we spoke with also agreed. One person told us they have their own section of garden and how much they enjoy tending to their plants. The standard of cleanliness is very good and we did not find any unpleasant odours. We saw that people had their own belongings on display in their rooms. We were concerned to find in one of the communal corridors that none of the windows have restrictors on them. We spoke to the new manager who said she was aware of this and showed us the restrictors they are purchasing for all windows in the home. This needs to addressed as soon as possible for the safety of people who use the service and any visitors to the home. We also found that at times the cupboard on the upstairs floor used to store chemicals for cleaning is not always locked, this also needs to be addressed. In one of the corridors on the upstairs floor, we found peoples clothing hanging up and their underwear was placed on seats. We asked the care staff about this and they said the laundry staff leave it there for them to put away. This practice does not respect peoples privacy and dignity and needs to stop. We informed the new manager who said she would address this immediately. As part of the tour we observed the homes hoists on the upper floor, we found that the Velcro on several of the slings had a build up of fluff that could reduce their effectiveness and possibly place people and staff at risk. We spoke to some members of staff about one hoist as it appears to be very old. One member of staff when asked by us showed us how they use this hoist and it appears they have to do a lot of pushing and pulling movements which could place them at risk of injury. We strongly recommend that the home looks to replace this hoist. The home needs to urgently review all their hoists and slings to make sure they are not placing people who use the service or staff at risk. We examined the recruitment records of two members of staff who have recently started at the home. One of these was the new manager and she said that not all her information is stored at the home but is at the head office. The other member of staff did not have a Care Homes for Older People Page 5 of 11 full employment history and the gaps had not been explored. They were also using years and not more specific dates. The home must demonstrate that they have received references prior to any new member of staff starting work. A photograph is also required. This member of staff did not start working at the home until the full Criminal Records Bureau Disclosure (CRB) was obtained and this is good practice. We also found that on the homes application form it only mentions convictions, however a new application form has been devised and this now also asks for details about any cautions. We asked people in the surveys we sent them what does the home do well and we received the following comments; I am very happy and satisfied, staff are friendly and receptive. Premises are pleasant with a range of communal areas. Visiting is possible at all times and visitors are always welcome, I can do what I like and staff cannot do enough for me and Spiritual provision as well as lots of activities. We also asked what could the home do better and we received the following comments; nothing it is excellent in every respect, look after the laundry more carefully, food is rather samey and there is a lot of waste, it would be nice to see more mixing encouraged between the upper and lower floor and communication with residents could be better when services i.e bath times have to be cancelled and towels not changes as frequently. Staff shortages have meant that services have not been as good recently. People and visitors to the home we spoke with on the day of the inspection were very happy with the standard of care provided by the home. We spoke to a number of staff during the inspection and the feedback we received was they all enjoy working at the home but feel that not all the staff pull their weight which means their workload is harder. The feedback we received in the staff surveys indicated that they also enjoy working at the home but felt more staff are needed especially in the afternoons. Several staff in the surveys also commented that senior staff spend all their time in the office and need to be out on the floor more often. What the care home does well: What they could do better: Once the home has introduced the new care planning system they need to make sure that people have care plans in place for all assessed needs, they are person centred and Care Homes for Older People Page 6 of 11 risk assessments are also in place. A system needs to be devised by the home for management of people who use bed rails. This must include a risk assessment, consent form and ongoing safety checks on the bed rails. The home needs to continue with their plans to change the controlled medication storage cupboards and look at devising a frequent audit of this medication. The home needs to review the system they have in place for delivering peoples clothing as it does not respect their privacy and dignity. An urgent review of their moving and handing equipment is needed to make sure people are not being placed at unnecessary risk. 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 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 18 13(6) Mental Capacity Act training for all staff. This requirement was not followed up at this inspection. 30/12/2007 2 33 24(2) The Registered person must 31/01/2008 produce an annual quality assurance report to evidence the review of the quality systems in the home. This must include stakeholders views and future developments in the home This requirement was not followed up at this inspection. Care Homes for Older People Page 8 of 11 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, 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 1 22 13 The Registered Person must 30/07/2010 make sure that a review is undertaken of the homes moving and handling equipment to make sure it is safe. This will help to make sure that people who use the service and staff are not placed at unnecessary risk 2 29 19 The Registered Person must 30/07/2010 make sure that all the required recruitment checks are undertaken prior to the new member of staff starting work at the home. This includes a full employment history with any gaps explored and written verification of their reasons. This will help to make sure that people who use the service are safeguarded. Care Homes for Older People Page 9 of 11 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 1 2 3 4 5 8 9 22 22 29 A system for the management of bed rails needs to be devised and implemented. The home needs to look at devising and implementing an auditing system of their controlled medication. The home should replace all the old hoists. A system needs to be devised for the ongoing monitoring of the homes moving and handling equipment. The home needs to demonstrate that all references for new staff are received prior to them starting work at the home. Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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