Care Home: St Catherine`s House Nursing Home

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What the care home does well St Catherine`s House supports frail older Sisters of the Order to continue to take part in the religious community life that they have chosen. Staff work closely with the multi-professional health care team, to ensure that residents, the majority of whom are physically very frail, receive a high standard of health care. The professional development of staff is encouraged and staff have access to regular training and workshops, as well as accredited external training. Recording is of a high standard. The Board of Trustees plays an active part in the overall management and development of the service and provides support to the Manager. The building, which is in a quiet square, just of High Street Kensington, is well adapted and is set in very attractive gardens. What has improved since the last inspection? The Manager has established more individualised care, with the particular needs of each individual carefully assessed and reviewed. Care planning continues to be developed and health care assistants are being encouraged to take responsibility for some aspects of care planning as part of their professional learning. Two health care assistants are undertaking nursing training and changes to their hours have been made to accommodate their training commitments. Communication between staff has improved, with people working together as a more cohesive team. The Manager has been provided with the information she required regarding contracts and records relating to maintenance and health and safety. CARE HOMES FOR OLDER PEOPLE St Catherine`s House Nursing Home 23a Kensington Square London W8 5HN Lead Inspector lSheila Lycholit Key Unannounced Inspection 24th September 2007 11:00a X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Catherine`s House Nursing Home Address 23a Kensington Square London W8 5HN Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 7937 9688 020 7361 4757 The Trustees of the Congregation of the Religious of the Assumption Care Home 14 Category(ies) of Physical disability (14) registration, with number of places St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th July 2006 Brief Description of the Service: St Catherines House is a 14 place Care Home with Nursing, which provides care and support for older Sisters of the Order of the Religious Assumption in a setting where they can continue to be part of the religious community. On occasions lay people needing care may be admitted. The accommodation is in a modern, well-adapted building over 3 floors. It overlooks a large garden square shared with other services on the Maria Assumpta site. The home also has its own private garden. All bedrooms are single rooms with en suite facilities. The building has a lift and is accessible for wheel chair use. St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit took place on Monday 24th September 2007 from 11AM until 3PM. The Manager, who had completed a pre inspection quality assurance assessment, was on duty with one RGN and one agency care assistant and made herself available throughout the visit. The Community Superior was on retreat. Other Sisters of the Order were in the building to assist with administration, receiving visitors and answering the phone. The Chef and a domestic assistant were also on duty. There were 7 Sisters resident in the registered care home at the time of inspection. The Inspector made a tour of the building with the Manager and spoke with the RGN on duty. What the service does well: What has improved since the last inspection? The Manager has established more individualised care, with the particular needs of each individual carefully assessed and reviewed. Care planning continues to be developed and health care assistants are being encouraged to take responsibility for some aspects of care planning as part of their professional learning. Two health care assistants are undertaking nursing training and changes to their hours have been made to accommodate their training commitments. Communication between staff has improved, with people working together as a more cohesive team. St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 6 The Manager has been provided with the information she required regarding contracts and records relating to maintenance and health and safety. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Clear information about the service is available, though Sisters who are considering entering St Catherine’s already know the service well. Staff are experienced in undertaking assessments. EVIDENCE: A Statement of Purpose and Service User’s Guide are available, which provide essential information. The Service User’s Guide would benefit from some updating regarding staffing and the management structure. As members of the Order, residents who are Sisters do not have a contract. There were 7 residents at the time of the inspection, all of whom are Sisters of the Order. There have been no admissions since the last inspection in July 2006. Individual records and care plans show that staff regularly re-assess residents’ needs using a number of standard formats and would undertake similar assessments for new residents. St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 9 Prospective residents have normally been living in the adjacent convent and therefore know St Catherine’s well before deciding to move to the home. Nevertheless a trial period is negotiated to ensure that St Catherine’s meets their needs. St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9,10 and 11 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The Manager has continued to develop the standard of care planning and has established more individualised support. Care plans are regularly reviewed and audited. The health care needs of residents are a high priority and staff work closely with the multi-professional team. The administration of medication is closely monitored and all aspects of handling medication are regularly checked. An atmosphere of respect and concern for residents has been established. EVIDENCE: The care plans, daily notes and health care notes of three residents were looked at. Care planning is of a high standard, with residents’ needs regularly reviewed and re-assessed. Risk assessments are detailed and set out action to be taken. Discussion with the Manager, observation and care plans show that residents are receiving more individualised support, for example with regard to nutrition and support with eating. The Manager audits each care plan monthly. St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 11 The frailty of the current residents has increased considerably and staff are working closely with the local GP practice and other health care colleagues. All health care appointments are recorded on an annual plan, which ensures that routine checks and follow up appointments are not missed. Medication is stored in a locked room and dispensed to residents from a medication trolley. The Manager undertakes a monthly audit of all aspects of handling medication, including a sample of MAR sheets. The audits for the last 3 months were looked at. No concerns were highlighted. Incident reports show that a medication error took place earlier this year. An investigation was undertaken by the Manager and the staff spoken with. The staff, in addition to being RGNs, had received recent medication training. Residents were not adversely affected by the error. It is recommended that medication incident reports are stored with reports of other incidents for monitoring purposes, rather than on residents’ files. Two residents have died during the last year. St Catherine’s has a policy of caring for residents who are dying at the home, rather than in hospital, with the support of the local GPs. Spiritual care is provided by the Community Superior and other Sisters. A workshop for staff on Death, Dying and Bereavement was held in July this year. St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Sisters receive good support from staff and from the Religious Community to take part in the religious and social life of the house. Steps have been taken to improve the quality and flexibility of the catering so that the nutritional needs of the frailest residents are met. EVIDENCE: A schedule showing the Sister’s daily routine was seen on each of the 3 files looked at. Records and discussion with the Manager show that routines are changed in accordance with the Sisters’ wishes and to reflect any reduced mobility or independence. Sisters who are resident at St Catherine’s take part in the religious life of the community as far as possible, for example attending Mass in the chapel and taking part in prayer time. Where Sisters frailty means that they are largely confined to their rooms, steps are taken so that they can continue with their religious observance, for example by receiving Holy Communion in their rooms. Individual interests, such as music, are supported by the provision of CDs and audio equipment and there is a weekly art class, which is very popular. Each Sister has a daily diary in her room. Sisters are supported to take part in activities on the campus and to care for the pet rabbits and tortoise. St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 13 Discussion with the Manager and records show that good contact is maintained with families and friends, who can stay overnight if necessary. Residents have their main meals in the pleasant ground floor dining room with other Sisters who live in the house, or in their rooms if they are too frail to take part in communal meals. At the time of the inspection most of the residents were being served lunch in their rooms, so that they could be assisted and have time to eat at a slower pace, without distractions. A new contractor has been employed to provide the catering, which the Manager assesses is more flexible better meeting the needs of residents. All meals are cooked on site from fresh ingredients. The kitchenette on the first floor, from where meals are served to residents in their rooms, has been re-tiled and a new dishwasher and fridge installed. St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There is a clear complaints procedure, which is regularly revised. Steps are taken to protect residents and to promote their welfare. EVIDENCE: The complaints procedure is made available to residents and to visiting families and friends. Members of the Management Committee speak with residents during their monthly visits to ascertain if there are any concerns. No complaints have been received in the past 12 months. A safeguarding adults policy and procedure is available and all staff have received training. Records show that staff have also received training in managing aggression and in the implementation of the Mental Capacity Act. There have been no safeguarding adults referrals in the past 12 months. St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. St Catherine’s is an attractive and well adapted building, providing a pleasant and accessible environment for residents. EVIDENCE: St Catherine’s is located close to the services and public transport of High Street Kensington. All bedrooms are single rooms with en suite lavatories and washbasins. The windows have been designed so that residents can see out even when seated or in bed. The bedrooms overlook the home’s own gardens or the communal gardens and play area used by the local primary school. The home’s garden is accessible and is maintained by one of the Sisters who ensures that the planting looks just as attractive from the first floor bedrooms, as from the ground floor. The wildlife, in particular the birds, attracted to the garden, also provide enjoyment to the residents. The ground floor sitting area has been re-arranged and up to date newspapers and magazines are now made available. St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 16 Consideration has been given to replacing some of the hard flooring in residents’ bedrooms with carpeting. While it has been decided not to change the flooring for the current residents, providing carpeting for new residents should be considered. Residents have a range of possessions in their rooms, reflecting their wide interests. The building has a range of specialist equipment, including hoists and an accessible bath and shower. The ground floor laundry is well equipped and an auto-dosing system has recently been installed to improve hygiene and the efficiency of the machines. Some contractors has been changed to ensure a higher standard of maintenance. The Manager said that the employment of a part-time handyman has proved very helpful. The Manager and Community Superior carry out a regular review of the building, identifying issues that need to be addressed. Consideration is currently being given to the carpeting of bedrooms as discussed above, the creation of an additional sitting area for the frailer residents who are unable to use the ground floor rooms and improving the security of the building to prevent one resident with dementia from wandering. St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A more cohesive staff team has been established. The professional development of staff is given a high priority. EVIDENCE: The staffing levels remain the same as at previous inspections, with one RGN and one Health Care Assistant on each shift, including nights. Additional support is provided by the Community Superior and other Sisters. An increase to the staffing budget has been agreed to provide additional staff to meet changes in residents’ needs and to cover for training and staff meetings. The Manager said that the move from day shifts to nights by a long-standing member of staff has created a more consistent night care team, which has resulted in residents being more settled at night. The records of two staff were looked at. These showed that all recruitment checks had been carried out and that both staff had undertaken a structured induction. Records show that staff receive supervision at two monthly intervals. Two staff meetings have been held this year, with records kept. In addition seven study days have been held for all staff. A comprehensive training and development programme is available for staff, who are encouraged in their professional development. Two Health Care Assistants are undertaking nurse training and their rotas have been adjusted to allow them to continue to work at St Catherine’s while they are training. Health Care Assistants are being supported on a one to one basis to contribute St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 18 to care planning to develop their professional skills. Three Health Care assistants are undertaking NVQ2 and one is enrolled on NVQ3. There is no evidence of the previous tensions within the staff team. All current staff have attended workshops in communication and equalities and diversity, which the Manager believes has contributed to the improved working relations between staff. Discussion with the RGN on duty confirmed that she had received a sound induction to work at St Catherine’s. She commented that she received good support from the Manager, who had encouraged her to consider further professional training, though she did not want to make a commitment to additional training this year. The member of staff also commented on the usefulness of the study days and training workshops. St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37 and 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is run by an experienced Manager who has the support of the Community Superior and an interested and involved Management Committee. EVIDENCE: The Manager is a Registered Nurse, with many years experience of providing services for older people. The Manager is applying for registration. She is supported by the Community Superior, who was on retreat at the time of the inspection visit, and by the Management Committee. The Manager has continued to take steps to improve the standard of care for residents, in particular by developing the professional skills and confidence of staff. St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 20 The Management Committee meets every three months, with a member of the Committee carrying out the monthly visits on behalf of the provider. Copies of reports of the visits are available in the home and are forwarded to CSCI. The personal finances of the residents are managed by the Community Bursar. Recording is generally of a high standard. All relevant information regarding consultations with a resident and her family regarding her decision to refuse treatment should be recorded in one place. It is recommended that notes made by night staff, which are well written, should also include the time that care is given. Training records show that staff regularly receive training in health and safety including refresher training. Accident records show a marked decrease in the incidence of falls, with only three recorded this year, one of which occurred off site. The fire risk assessment was reviewed in January this year. A visit by the LFEPA in March was satisfactory with no requirements or recommendations made. The fire detection system and fire fighting equipment is regularly serviced. Records show that the fire alarm is tested weekly. One fire drill was recorded as taking place in June and a number of unplanned evacuations had also occurred, mostly in response to incidents in the kitchen. The Manager said that a fire drill for the whole site had also taken place. In addition to the unplanned evacuations, planned fire drills should take place at least four times a year. A schedule of planned maintenance is available, which is monitored by the Manager. The Manager now has oversight of all relevant contracts for the service. A new contractor is servicing the hot water system, including testing water quality. The new handyman has taken over the checking of hot water temperatures, which records show are carried out monthly. A visit by the EHO to the kitchen in July this year found some issues that needed attention. The Manager confirmed that the catering company has taken the required action. St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 2 2 St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP37 Regulation 17 Requirement Steps taken to consult with a resident and her family regarding refusal of treatment should be recorded on the person’s file or cross referenced to records held elsewhere. Fire drills must be held at least 4 times a year with records kept of staff present, time taken to evacuate the premises and any issues that arise. Timescale for action 31/10/07 2 OP38 23 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP1 OP37 OP38 Good Practice Recommendations Consideration should be given to revising the service user’s guide. Night staff should note times that care and monitoring is provided. Incident reports should be stored together for monitoring purposes, rather than stored on residents’ files. St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Catherine`s House Nursing Home DS0000026017.V348427.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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