Care Home: St Alban's Nursing Home

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What the care home does well St Albans provides a homely, relaxed and comfortable environment with a welcoming and friendly atmosphere. The home and grounds are also well maintained. Pre-admission assessments are good and provide enough evidence that each persons` needs are understood and can be met by the home. All people have a plan of care which sets out in detail the actions that must be taken by staff to ensure that all aspects of their health, personal and social care needs are met and these are regularly reviewed. Medication administration, recording and storage is safe and accurate, minimising any risks to people. People living there say that staff are kind and caring and that their privacy and dignity is respected at all times. People are encouraged to make choices about how they live their lives and the home assists in providing access to social, cultural and recreational activities. People are encouraged to maintain their links with family and friends and visitors to St Albans are made welcome. People are positive about the food at St Albans. Food is well presented and staff are available to assist residents if help is required. The complaints and adult protection procedures ensure that people living there and their representatives` well-being and comfort, is important to the home and that any concerns raised will be properly investigated and resolved. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the care needs of people. The home is meeting the Department of Health target of having 50% of their care staff with National Vocational Qualifications in care at level 2 or equivalent. Recruitment procedures are robust ensuring that only suitable people are employed to work in the home. Induction and staff training are good which means that staff are better equipped to meet peoples` needs. The home is well managed. Financial procedures within the home also ensure that peoples` interests are protected. Regular staff supervision takes place ensuring that staff needs are met and people can be cared for by well supported staff. What has improved since the last inspection? This is the first inspection for this service since BML became the Registered Provider for St Albans. What the care home could do better: Handwritten care documentation should be legible and consideration given to electronically recording care plans. Soiled and foul smelling carpet should be replaced with a suitable alternative which can be kept hygienically clean and improve the comfort of people living at St Albans. Annual surveys should also be considered for healthcare professionals who visit the home, to include their feedback on the running of St Albans. (On 10 February 2010, the registered manager informed us that she had taken some actions to address these recommendations and these are reflected in the main body of this report). Key inspection report Care homes for older people Name: Address: St Albans Nursing Home 8 Avenue Road Christchurch Dorset BH23 2BY     The quality rating for this care home is:   two star good 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: Joanne Pasker     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 25 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 25 Information about the care home Name of care home: Address: St Albans Nursing Home 8 Avenue Road Christchurch Dorset BH23 2BY Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Julia Hutton Type of registration: Number of places registered: care home 21 Mr Barry Lambert Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 21. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home St Albans is a large detached property, situated in a residential area of Christchurch. The home is not far from local shops and amenities. There is some limited car parking for visitors at the side of the home, with additional parking on surrounding roads. Care Homes for Older People Page 4 of 25 Over 65 0 0 21 0 0 0 Brief description of the care home The home provides nursing and personal care for up to 21 people over the age of 65 years of age. Accomodation is provided on ground and first floor levels with bedrooms, a lounge, kitchen, managers office and laundry on the ground floor and further bedrooms on the first floor. Communal areas include the lounge and conservatory, part of which is also used as a dining room and there is a small garden to the rear of the home. Care Homes for Older People Page 5 of 25 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: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced key inspection was carried out over approximately 5 hours on the 25 November 2009. This was a statutory inspection and was carried out to assess all of the key standards and ensure that the people living at St Albans are safe and properly cared for. The inspection was carried out by one inspector, however the term we is used throughout the report to reflect the findings of the Care Quality Commission (CQC). We sent surveys to the home for both staff and people living there and their comments are used throughout the report. We spoke to residents, families and staff about life in the home and we also observed practice. We spoke to the manager and provider. We looked at the individual records of both staff and people living there and we looked at Care Homes for Older People Page 6 of 25 training, health and safety records and also toured the building. Care Homes for Older People Page 7 of 25 What the care home does well: St Albans provides a homely, relaxed and comfortable environment with a welcoming and friendly atmosphere. The home and grounds are also well maintained. Pre-admission assessments are good and provide enough evidence that each persons needs are understood and can be met by the home. All people have a plan of care which sets out in detail the actions that must be taken by staff to ensure that all aspects of their health, personal and social care needs are met and these are regularly reviewed. Medication administration, recording and storage is safe and accurate, minimising any risks to people. People living there say that staff are kind and caring and that their privacy and dignity is respected at all times. People are encouraged to make choices about how they live their lives and the home assists in providing access to social, cultural and recreational activities. People are encouraged to maintain their links with family and friends and visitors to St Albans are made welcome. People are positive about the food at St Albans. Food is well presented and staff are available to assist residents if help is required. The complaints and adult protection procedures ensure that people living there and their representatives well-being and comfort, is important to the home and that any concerns raised will be properly investigated and resolved. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the care needs of people. The home is meeting the Department of Health target of having 50 of their care staff with National Vocational Qualifications in care at level 2 or equivalent. Recruitment procedures are robust ensuring that only suitable people are employed to work in the home. Induction and staff training are good which means that staff are better equipped to meet peoples needs. The home is well managed. Financial procedures within the home also ensure that peoples interests are protected. Regular staff supervision takes place ensuring that staff needs are met and people can be cared for by well supported staff. Care Homes for Older People Page 8 of 25 What has improved since the last inspection? What they could do better: 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 25 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 25 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. New residents move into the home having had their needs assessed and been assured that these needs will be met fully. Evidence: The care files of 2 people who had recently moved into the home were seen. They contained comprehensive pre admission assessments which had been documented by the registered manager and discussed with the nearest relative, both of whom had signed the forms. The forms showed enough information about an individuals needs and copies of letters were seen from the home, confirming that they could meet each persons needs. Two surveys were received from people living at the home and they both confirmed that they had received enough information about St Albans, prior to moving in, to decide whether it was the right place for them. Care Homes for Older People Page 11 of 25 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. Systems are in place to provide staff with the information they need to meet the health and personal care needs of residents. Medicines are safely managed and the principles of respect, dignity and privacy are put into practice. Evidence: The care documentation for three residents was reviewed and it contained the relevant assessments and care plans needed so that staff had the information to be able to give a good standard of care. The care plans were evaluated on a monthly basis and two of them had been discussed and agreed with the nearest relative, who had signed them. It was discussed with the registered manager that some of the handwriting was very difficult to read and that consideration might be given to typing the care plans in future. (On 10 February 2010 the registered manager informed us that she had started the process of typing up all existing care plan documentation and soon all care plans would be typed and not handwritten. This will be checked at the next inspection). There was evidence to show that residents get support from General Practitioners, Care Homes for Older People Page 12 of 25 Evidence: specialist nurses and chiropodists. Surveys that were returned by people living at the home indicated that they received the medical care they needed. The medications policies and procedures were reviewed and found to be very comprehensive, with arrangements for ordering, storage, administration and disposal. Examination of records and observation of medication administration showed us that medicines were being safely administered and in the prescribed way. It was not identified in one persons records when and why a medicine, prescribed as when needed, should be be given though. This was discussed with the registered manager who immediately started to address the issue. Staff were seen treating people with dignity and respect throughout the day and observed assisting them with care and thoughtfulness. Comments received from staff, relatives and people living at the home included The staff are dedicated and generally have empathy.....they also take time to talk..., St Albans makes sure that all clients needs are met and that there is a very friendly atmosphere with clients and staff and I think all residents feel valued, individual, cared for etc. Staff (incl. Matron) are friendly, caring to residents, families, visitors. Care Homes for Older People Page 13 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported to maintain their interests, independence, contact with important others and lifestyle, which enhances their quality of life. Evidence: Life diaries were seen in each persons care records which reflected individuals lifestyles before coming into the home and their interests and preferences. These had been put together by the activities organiser who had spoken to each person living at the home and their closest family and friends. Activities were seen displayed on a board in the main hallway and also in each persons room and events included Pat dog visits, visiting entertainment, games, hand massage and exercises. On the day of the visit a singer was entertaining several people in the lounge. Trips out are also arranged in the warmer months of the year. Regular church attendance is possible and visitors are welcomed warmly into the home. Surveys indicated that people felt differently about the activities at the home, with one person saying there was always something they could join in with and another saying sometimes. Care Homes for Older People Page 14 of 25 Evidence: Menus displayed in the home showed that there is a good choice and variety of food available for all main meals of the day. The chef is aware of peoples preferences and dietary needs and staff assist people appropriately as needed. Lunch on the day of the visit was sausage and onion platt or omlette, with vegetables and raspberry pavlova or semolina for dessert. Comments received from people living at the home and staff included The food is delicious-so much choice and variety. My relatives have peace of mind knowing I am looked after here, Choice and quality of food/meals is good and residents enjoy their meals. One person commented that the tea time menu could improve slightly and that a grilled kipper wouldnt go amiss!. Care Homes for Older People Page 15 of 25 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 who use the service are able to express their concerns and have access to an effective complaints procedure. Protection from abuse is promoted. Evidence: The home has a robust complaints policy in place and this is made available to residents and their representatives. Any concerns received were clearly documented in the complaints book and well investigated and the manager audits these monthly. Adult safeguarding training had been received by all staff within the last year and staff were aware of the local adult protection policy and procedure and the homes whistle blowing policy. Staff spoken with told us that they had also received training and guidance on how to recognise and report any allegations of abuse during their induction. Care Homes for Older People Page 16 of 25 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 environment is secure and well maintained, ensuring people are comfortable and safe. Evidence: A tour of the premises found most areas comfortable and clean, with an on going programme of maintenance in place. One bedroom smelt quite malodorous due to a repeatedly soiled carpet. This was discussed with the manager who said that alternative flooring options were being explored. We recommend that this is replaced with something more suitable, that is easily cleaned and does not present an infection control hazard. (On 10 February 2010 the registered manager informed us that this had now been actioned and the carpet replaced with a suitable vinyl flooring. This will be checked at the next inspection). Bedrooms were seen to be personalised with peoples belongings and furniture and all areas had a comfortable, homely feel. Bathrooms were seen to be uncluttered and well equipped, with one having an overhead hoist fitted. The laundry is sited down some steep steps in the cellar, however potential risks and hazards to residents and staff had been considered and appropriate actions taken as needed. One staff member is responsible for the laundry and it appeared to be well organised with adequate supplies of clean linen and hand washing facilities. Good Care Homes for Older People Page 17 of 25 Evidence: infection control procedures were observed around the home and adequate supplies of gloves, aprons and hand gel were available. Comments about the home from people living there and staff included The home has a very homely, dignified atmosphere and we are treated with respect and kindness and Provides a good atmosphere-friendly and kind. Care Homes for Older People Page 18 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient numbers of experienced staff are on duty to meet the needs of the people living at St Albans. A robust recruitment procedure ensures that the home only employs suitable staff to care for the people living there. Evidence: Staff rotas demonstrated that there were sufficient staff on duty to meet the needs of the residents and this was observed in practice, during the inspection. The home also employs staff to undertake the cooking, laundry and maintenance and is also recruiting for a cleaner. Residents spoken with confirmed that staff were available when they needed them and comments included I feel well looked after, which helps me to relax....., Nothing is too much trouble-all our needs are catered for and Everything is good. Staff are lovely-so kind and caring. The home has an ongoing training programme, which includes NVQ level 2 and 3 in care and at the time of inspection more than 50 of the care staff hold the minimum of a level 2 award in care. Three staff recruitment files were looked at and all contained the required documentation, including CRB and ISA checks. Care Homes for Older People Page 19 of 25 Evidence: Training files demonstrated that staff were receiving induction training and one member of staff is responsible for providing this. A clear training matrix showed that staff have received mandatory training required, including infection control, moving and handling and fire training. Staff also complete feedback sheets after each session and these, along with training certificates were seen in staff members files. Other supplementary training relevant to caring for the people living at St Albans, had also taken place and included palliative care, PEG feed management, Parkinsons care and continence management. Staff commented that There is always up to date training available. Care Homes for Older People Page 20 of 25 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 home is well organised and the daily management and running of the home centres round the care of residents. The management practice, systems in place, and records kept, confirm the health and safety of all in the home. Evidence: Mrs Julia Hutton continues to be the registered manager of the home and has the relevant qualifications and experience to manage St Albans. She demonstrated a good understanding of the needs of people living and working in the home and feedback from staff and residents indicated that they felt comfortable approaching her about any issues. Comments received from staff and residents included The management are always available when staff or clients wish to discuss any issuesand Matron shows interest and caring attitude to each resident, speaking to each of them and their families/friends and involving them in care planning and in day to day activities. The home has effective quality assurance and monitoring systems which are based upon the opinions of residents, families and staff. Annual questionnaires are given to Care Homes for Older People Page 21 of 25 Evidence: people living at the home and are planned for staff too, however it is recommended that this also includes GPs and other healthcare professionals. Required reporting by the home takes place, including regulation 26 visits and regulation 37 notifications, as needed. The home does hold some small sums of money for some people living there and a sample of these records showed that it was well managed. Records seen showed that staff were appropriately supervised and regular staff meetings and appraisals held, to monitor performance and support any learning needs identified. Health and safety records showed that staff had received fire training and that all fire checks were carried out as needed. Substances hazardous to health were seen to be stored securely and all accidents recorded and audited regularly. Care Homes for Older People Page 22 of 25 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 23 of 25 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 1 2 7 19 Handwritten care documentation should be legible and consideration given to electronically recording care plans. Soiled and foul smelling carpet should be replaced with a suitable alternative which can be kept hygienically clean and improve the comfort of people living at St Albans. Annual surveys should also be considered for healthcare professionals who visit the home, to include their feedback on the running of St Albans. 3 33 Care Homes for Older People Page 24 of 25 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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