Care Home: St David`s Nursing Home

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What the care home does well This home has very good clear guidelines in place to care for people requiring residential or nursing care. The staff team are friendly and polite and work hard to make sure that the people living at St Davids are comfortable and well looked after. Written information is clear and straightforward to provide new residents the details they need to help them make up their mind whether the home would be right for them. Each new resident is assessed on their personal, nursing and social care needs before moving in to give the manager time to put in place any specialist equipment they may need to help care for them. The majority of residents has a named nurse who then assists them with the care plans and regularly reviews the care in place to ensure that they are comfortable and content. Care staff assist residents with their personal care and offer a selection of sociable activities geared towards their own personal taste. It was observed that residents are offered choices throughout the day in respect of meals, activities, and where they wish to spend there day. Any complaints are listened to and acted upon, and residents are protected from harm by the quantity and quality of staff on duty. Staff are encouraged to take part in the training that is offered with a variety of mandatory and vocational training courses. The nurses attend regular updates to enable them to carry out their role as a link nurse with each one specialising in either continence care, nutrition, skin viability and palliative care so that the home can offer a excellent standard of care. There are a variety of comfortable communal rooms for residents, with the addition of tea and coffee facilities within the dining room. There are several areas in the large gardens for residents to sit and enjoy the peace and quiet or to take part in outdoor games. What has improved since the last inspection? The manager and nurses have developed the care records to include residents personal preferences detailing their routine, likes and dislikes, fears and phobias about healthcare giving the staff more detail in how they can care for residents individually. This person centred approach to care is a good example of how residents needs are looked after. Comments received from both residents and their relatives confirmed that they have seen improvements with individual care and more equipment was being used. The provider has improved the environment for residents by trimming the trees at the rear of the building letting in more daylight to the rear bedrooms. There has been an increase in the number of special air mattresses and electric profiling beds to help reduce complications caused by pressure when on bed rest. The safety of residents has improved by the replacement of the fire alarms, fire doors and the addition of recliner chairs for some residents. There has been continuing redecoration of communal rooms and bedrooms, replacement of carpets and windows to ensure the building conforms to a good standard. What the care home could do better: There was one recommendation resulting from this inspection and this would be that staff should sign the cream chart when this has been applied to residents, that have been prescribed for them. Key inspection report Care homes for older people Name: Address: St David`s Nursing Home 52 Common Lane Sheringham Norfolk NR26 8PW     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: Hilda Stephenson     Date: 0 2 0 7 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 David`s Nursing Home 52 Common Lane Sheringham Norfolk NR26 8PW 01263822671 01263820005 caroline@st-davids.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Lakeshore Healthcare Limited care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home St Davids is a care home providing residential and nursing care for up to 35 older people or those with a physical disability. The home is owned by Mr Jeffrey Manning of Lakeshore Healthcare Limited. The registered manager is Caroline Whitbread. It is situated on the outskirts of Sheringham, Norfolk in a residential area and within easy access of local amenities. The accommodation for residents is on both ground and first floors of the building with access by a shaft lift. The home is set in extensive gardens with established trees and lawns. There is off street parking to the front of the premises. The fees range from £559.50 to £645.00. Additional charges are made for personal requisites, private telephone facilities, newspapers, hairdressing and private chiropody. Care Homes for Older People Page 4 of 25 Over 65 35 0 0 35 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: Care services are judged against the outcome groups, which assess how well the provider delivers outcomes for people using the service. The unannounced key inspection of this service has been carried out by using the information from previous inspections, written information provided by the manager, some residents and their relatives and others who work in or visit the home. This unannounced visit took place during the day of Thursday 2nd July 2009. The manager was away and the senior nurse was in attendance during the day. Prior to the inspection the manager provided a completed and very detailed Annual Quality Assurance Assessment (AQAA) giving details of what the homes strengths and weakness were and how these could be adapted to improve care for residents who live there. During the inspection a tour of the building was undertaken, staff practice was Care Homes for Older People Page 5 of 25 observed, records and files were read and residents and there relatives were consulted. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? The manager and nurses have developed the care records to include residents personal preferences detailing their routine, likes and dislikes, fears and phobias about healthcare giving the staff more detail in how they can care for residents individually. This person centred approach to care is a good example of how residents needs are looked after. Comments received from both residents and their relatives confirmed that they have seen improvements with individual care and more equipment was being used. The provider has improved the environment for residents by trimming the trees at the rear of the building letting in more daylight to the rear bedrooms. There has been an increase in the number of special air mattresses and electric profiling beds to help reduce complications caused by pressure when on bed rest. The safety of residents has improved by the replacement of the fire alarms, fire doors and the addition of recliner chairs for some residents. There has been continuing redecoration of communal rooms and bedrooms, replacement of carpets and windows Care Homes for Older People Page 7 of 25 to ensure the building conforms to a good standard. 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 8 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 9 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New residents have their individual needs assessed, are invited to visit the home and are given details about the facilities offered at the home prior to moving in. Evidence: Residents who wish to move into St Davids are visited by the manager to assess there individual needs and are given information both verbally and written guidelines about what the service would offer them. The service user guide contains good clear detail about the layout of the building, facilities offered, fees and extra charges, staff numbers, and the services that are offered. The manager visits prospective residents to meet them, talk about the nursing home and assess there personal care needs. This is recorded on a pre-admission form and helps the manager decide whether the prospective resident would need any special equipment putting in place before moving in. The manager invites new residents to visit the home at this stage or their relatives to view the bedroom and facilities at the Care Homes for Older People Page 10 of 25 Evidence: home to make sure that its the right place for them. There are improvements in the pre-admission format after reading the care plan of the latest resident to be admitted. These contain more personal details of the new residents wishes, likes and dislikes and preferences as well as the personal, nursing and social care, making them more person focused. New residents are invited to meet up after an initial four week settling in period to make there decision whether St Davids is the right place for them. A contract is drawn up to explain the fees and charges, period of notice,which room they are to occupy. The home does take residents for short respite or intermediate care where the same admission procedure is followed. The current fees range from £559.50 - £645.00 per week, this is based on individual care needs. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents care needs are assessed, reviewed and changed on a regular basis. Evidence: Three care plans were read during this visit of residents with different dependency needs. All three care plans contained clear guidelines of their individual care, nursing, social needs and their preferences with the assessment of risks for them to be able to live the life they wish. Improvements since the last inspection is the amount of personal information of the residents routine contained in the care plans. One care plan contained a vast amount of detail for staff to be able to care for this resident very easily, it contained there preferences at the beginning of the care plan following on were risk assessments and the required care for the activities of daily living, including social care and contact with family and friends. The care plan was reviewed on a regular basis with daily notes recorded for staff to communicate any changes. The care plans were very person centred and are a good example for other nursing homes to follow. The nursing staff and manager should be commended for the effort they have put into these records and show a good example on how residents Care Homes for Older People Page 12 of 25 Evidence: whatever disability they have are still consulted about there care. One aspect of the care plan that lets them down is the cream recording sheet has not always been filled in by care staff when they have applied the prescribed creams to the resident making this difficult to know whether the resident had received this. The care plans contained details of the specialist equipment that some frail residents needed, a sample of these were seen during the tour of the rooms. The proprietor has increased the total of air mattresses and electric profiling beds ensuring that pressure relief equipment is put in place. There are hoists on each floor to enable staff to move residents safely from there bed to a chair, there also appeared to be an increase in comfortable and reclining chairs taking into account residents comfort, showing that standards have continued to improve. The senior nurse explained that each nurse has taken on the role as a link nurse for specific topics such as palliative care, continence care, nutrition and skin viability to enable the best up to date care is offered to residents to make their stay in the home as comfortable as possible. The senior nurse demonstrated how medicines are delivered and administrated. The medication is delivered to the home on a monthly basis and these are checked by the nurse before being distributed. There is locked trolley for both floors and all medicines other than the creams are administered by the nursing staff. A sample of the controlled drugs were checked and all the medication records apart from the cream recording sheet were accurate and correct. Returns of medication back to the pharmacy and destruction of controlled drugs followed the medicine policy. There has been a regular audit carried out for the medicines to reduce the overstocking of medication which is good practise. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to make choices regarding their lifestyle, they are offered a varied and nutritious menu. Evidence: The majority of the residents within St Davids are frail and dependent so rely on staff to assist them. The care plans contain residents personal preferences including what they want to do during the day. There are events organised on a monthly basis such as the entertainers, Tonally Different, Hank, and Sounds of Rowen and Class Act as well as a clothes party for residents to be able to purchase there own clothes. The staff organise small group activities during the week such as painting, exercise, bingo, and a film, many of the residents confirmed they like to sit out in the garden during the summer and that some were going to the local Flower Show in the town. Staff said that they spend time with residents in there rooms talking about there past and family events as well as reading or writing letters for them. One resident has used the emailing service to keep in touch with there family. It was observed that the library changes the books on a regular basis and several residents had books in there rooms. There were a few visitors seen and spoke about how they were welcomed into the home and found the staff very helpful and friendly. Care Homes for Older People Page 14 of 25 Evidence: It was noted that members of local churches visit residents and that a small service is arranged for residents who wish to attend. Evidence of past events and parties were included within the photo album in the front hall. Visitors are able to use the tea and coffee facilities in the dining room. There has been a change of chef since the last inspection which has brought about a change in menu choices. All the residents gave a positive opinion about the quality and quantity of the food and felt they had plenty of choice from the various dishes on the daily menu. The lunch was served by the chef in the dining room and was nicely prepared. The days lunch menu was chicken korma, hot pot with freshly prepared vegetables or cheese salad, with desserts being chocolate mousse, pineapple upside pudding with custard or ice cream and fresh fruit salad. The menu is served over a four weekly period and takes into account seasonal changes. The chef confirmed that he caters for several dietary needs and monitors alongside the nurses if any residents appetite changes, this was also seen in various care plans and is an example of good practice. The nurses and care staff monitor fluid intake of the more vulnerable residents and have increased the offer of drinks during the recent hot weather which again is a good example. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents views are listened to and acted upon within a safe environment. Evidence: There is advice within the written service user guide and displayed on the noticeboard about how complaints are dealt with. The senior nurse explained the procedure of dealing with any complaints. They are recorded within the complaints log and investigated in a non biased manner, with the results sent to the complainant. Since the last inspection the Commission received one complaint regarding staffing levels which was dealt with extremely quickly by the manager. The record of compliments were also kept these were usually in the form of cards and letters from relatives thanking the staff for the care and attention of their kin. Staff receive adult protection training during there initial induction training and then further updates throughout the years. Staff files and confirmation from staff gave enough evidence that this had been carried out and the staff who were spoken to knew about the various protection policies. The manager is a local trainer of adult protection and invites staff from other local homes to the training events. 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. Residents live in a tidy, homely environment. Evidence: During the day of inspection there were electricians renewing and testing some of the smoke alarms and the gardener was mowing the lawns and tidying the flower beds. There was also removal of excess furniture by a removal firm. The gardens are extensive surrounding the home and are kept neat and tidy with several seating areas for residents to enjoy the outdoors. The proprietor has had some of the trees at the rear of the building reduced allowing more daylight into the upstairs bedrooms. A resident on that side of the building commented on these improvements. There have been major improvements to the building since the last inspection, with areas around the home having been redecorated making it lighter in appearance. The laundry has been renewed, fire alarms have been changed and new fire signs throughout. Several bedrooms have been completely refurbished and changes in the bathrooms making them less clinical. There are plans to renew the fishbowl on the first floor to become a staff facility with the addition of a computer and files. Care Homes for Older People Page 17 of 25 Evidence: The fire doors on the ground floor have been replaced and residents have an easier access out to the garden. All of the communal rooms were found to be tidy and contained comfortable furniture. The information received prior to the visit confirmed that there had been a rolling programme for the maintenance of the call bell system, heat regulation in each bedroom, supplies of mobility equipment, electric profiling beds and air mattresses purchased. There was evidence that safe handling of chemicals was in place and that the home has a dedicated member of staff who undertakes the laundry for the residents. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are cared for by well trained staff who have their best interests at heart. Evidence: The rota for staff showed that the home usually has two nurses and five care staff on duty during the morning shift, changing to one nurse and four care staff until the night staff of one nurse and two care staff changed over. There are also domestic, laundry, kitchen, administration and maintenance staff on duty during the day, with the manager working during the week. The senior nurse has taken on some administration work two days a week to ensure care records, supervision and medication audits are up to date. The nurse confirmed that the home does use agency staff on occasion to ensure staffing numbers remain consistent. The recruitment of staff was not looked at on this occasion due to the manager being away, past evidence has shown that they follow a clear procedure by checking new staff references and crb, before employing them for a supernumerary induction period. Staff files were read and training records were checked and by speaking to staff they appear to have regular updates in the mandatory training such as moving and handling, infection control, food hygiene, dementia awareness, nutrition, palliative Care Homes for Older People Page 19 of 25 Evidence: care, mental capacity act and the deprivation of liberty and NVQ in care. Extra training is arranged for nursing staff to enable them to continue to be link nurses for palliative care, nutrition, skin viability and continence to maintain or improve the care offered to residents. The extra training for the nurses continues towards keeping in line with their professional number. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe environment and well managed home. Evidence: The manager was away from the home at the time of this inspection, the senior nurse was in attendance during the day. Past records and the AQAA showed that the manager is very well qualified, has kept up to date with her own training needs and continues to be a trainer for adult protection issues. Comments received from staff confirmed that they can attend regular staff meetings, although the majority of these are smaller group meetings to enable staff to discuss items within their own staff group. Minutes of some of the meetings were seen. The manager organises an annual quality assurance survey of the service with questionaires being sent out to people who have an interest in the service. Feedback is displayed on the noticeboard. The proprietor completes monthly audits checking health and safety issues, residents and staffing needs and monitoring the environment, as an ongoing method of improving standards. Care Homes for Older People Page 21 of 25 Evidence: Residents can safely store finances with the manager and a sample of these records were checked and found to be accurate. Staff files record when staff receive supervision, the nurse explained the manager supervises them, which in turn they supervise the care staff, with written details of how this is undertaken. During these sessions this gives the staff a chance to discuss any issues and plan future training needs. The maintenance staff were spoken with and a random selection of the health and safety records were checked. These records were more detailed since the last inspection and showed that the required checks were being carried out satisfactorily, ensuring the environment and equipment is safe for residents. One visitor commented that they were pleased the manager was available to speak to and that they were happy with the care and attention their relative received. 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 9 The daily application of cream for residents must be recorded each time. 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. 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