Care Home: St Joseph`s Nazareth House

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What the care home does well The management team are committed to promoting high quality care and ongoing improvements have taken place in the home since the last inspection. The home has a quality assurance system in place which includes listening to people who use the service. As part of this exercise, feedback from completed questionnaires was made available to the inspector. Information had been provided by residents, relatives, students on placement and one health care professional. Overall, comments were positive with a high percentage of the feedback expressing satisfaction that personal choice, daily routines and wishes of residents were being respected. Constructive and suggestive comments had also been taken into consideration and as a result of this, improvements to the variety and opportunities for social activities have been achieved. One comment from a health care professional stated, "This home is very caring and excellent to work in. The staff are very supportive". Some of the residents spoken with commented on how staff are generally good, caring as well as taking the time to talk to people.Comments from relatives confirmed that in their experience, staff are good at talking to residents and explaining about the personal care being provided as well as respecting individual dignity. From the sample checks made of personal care records, pre-admission assessment information as well as the recording of care plans and risk assessments were generally detailed, clear to follow and updated regularly. There was evidence to show that the views of residents and/or relatives had been taken into consideration when reviews had taken place. The spiritual needs and aspirations of residents are well provided for in the home and arrangements are made for clergy of other denominations to make visits as required. A detailed recording system covering recruitment procedures was in place as well as a comprehensive record of induction and training courses attended by the staff team. Records were available to show the home continues to review on a regular basis, health and safety procedures as well as updating maintenance servicing contracts. What has improved since the last inspection? Since the last inspection, requirements and recommendations which had been identified in the report have been met. These include the regular reviewing and updating of care plans and risk assessments, clearer recording regarding the care provided by night staff and improvements in the safe administration of medication. Improvements have also been made in survey questionnaires enabling residents/relatives to give better feedback on the type of social and recreational activities required. In addition, two part-time social activity organisers have been appointed and a range of group as well as individual activities are held on a regular basis. This includes therapeutic activities involving musical instruments and life story books are in the process of being introduced. A book of symbols is now available as a means of assisting with communication for residents who may have developed dementia or other sensory impairments. Other improvements identified in the self-assessment form (AQAA) completed by the home, include monthly nutritional and accident audits, regular staff supervision, replacement soft furnishings and equipment. The home also has a policy for setting monthly targets and the records show what has been achieved and any comments. As part of this exercise, improvements to the sound system have been made throughout the home, which enables residents to hear services that are relayed direct from the chapel to individual bedrooms. What the care home could do better: Closer monitoring should take place of records, which are being maintained, in the kitchen adjoining the dining room and food hygiene arrangements. This relates to temperature checks of the refrigerator and freezer as well as the proper dating of food, which had been placed in containers. One of the care plans inspected, did not include specific information as to how and what action should be taken by staff in meeting the need identified. When requesting users of the service to complete survey questionnaires relating to the standard of service provided, a range of health care professionals who are involved with the home should be included. CARE HOMES FOR OLDER PEOPLE St Joseph`s Nazareth House 111 London Road Southend On Sea Essex SS1 1PP Lead Inspector Mr Trevor Davey Unannounced Inspection 10:45 23 . November 2007 rd 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 Joseph`s Nazareth House DS0000015549.V355170.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 Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Joseph`s Nazareth House Address 111 London Road Southend On Sea Essex SS1 1PP 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) 01702 345627 01702 430352 The Congregation of the Sisters of Nazareth Sister Mary Merriman Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Nursing and personal care to be provided to service users who are aged over 65 years. Total number of service users not to exceed 34. To provide care for a service user under the age of 65 whose name is known to the Commission 4th December 2006 Date of last inspection Brief Description of the Service: St Josephs is registered to provide personal and nursing care with accommodation for 34 older people over 65 years of age. St Josephs is one of two separately registered care facilities sited at Nazareth House, which also has its own chapel, kitchens and laundry. Facilities are sited on three floors and shaft lifts are available. Accommodation includes lounges and dining facilities as well as single and double rooms, some with ensuite facilities. A few of the residents have their own living accommodation. The premises are older in style and retain many of the characteristics including a large main hall, which is used for activities and entertainment. The home also has its own beach hut at Shoeburyness that residents can use. The grounds include well maintained gardens and ample car parking facilities. The home is near to the town centre at Southend, railway station, the theatre and all local amenities. The current rate of fees range from £379.47 to £498.17 per week. Additional charges are made for hairdressing, chiropody, toiletries, newspapers as well as personal telephone calls. Information about the home is made available to prospective residents in the Statement of Purpose and Service Users’ Guide. Plans for future development have been discussed with the local authority to develop Nazareth House complex into a care village. St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Key Inspection site visit covered a period of 9.25 hours and covered all key standards. The responsible individual for the home, registered manager, facilitation and care co-ordination manager together with staff, residents and some relatives, were available during the site visit and were spoken with. Their comments and contributions received were helpful in assisting the inspector to prepare the report. As part of the site visit, a tour of the premises took place. Personal care records and other official records within the home were inspected. The information included in the annual quality assurance assessment form (AQAA) which had been submitted to the Commission for Social Care Inspection, was also used in compiling the inspection report. This form gives homes the opportunity of recording what they do well, what they could do better, what has improved as well as future plans for improving the service. Feedback from survey information, which the home itself had obtained, was also inspected. Matters relating to the outcome of this inspection were discussed with the responsible individual and registered manager. Full opportunity was given for discussion and/or clarification both during and at the end of the site visit. What the service does well: The management team are committed to promoting high quality care and ongoing improvements have taken place in the home since the last inspection. The home has a quality assurance system in place which includes listening to people who use the service. As part of this exercise, feedback from completed questionnaires was made available to the inspector. Information had been provided by residents, relatives, students on placement and one health care professional. Overall, comments were positive with a high percentage of the feedback expressing satisfaction that personal choice, daily routines and wishes of residents were being respected. Constructive and suggestive comments had also been taken into consideration and as a result of this, improvements to the variety and opportunities for social activities have been achieved. One comment from a health care professional stated, This home is very caring and excellent to work in. The staff are very supportive. Some of the residents spoken with commented on how staff are generally good, caring as well as taking the time to talk to people. St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 6 Comments from relatives confirmed that in their experience, staff are good at talking to residents and explaining about the personal care being provided as well as respecting individual dignity. From the sample checks made of personal care records, pre-admission assessment information as well as the recording of care plans and risk assessments were generally detailed, clear to follow and updated regularly. There was evidence to show that the views of residents and/or relatives had been taken into consideration when reviews had taken place. The spiritual needs and aspirations of residents are well provided for in the home and arrangements are made for clergy of other denominations to make visits as required. A detailed recording system covering recruitment procedures was in place as well as a comprehensive record of induction and training courses attended by the staff team. Records were available to show the home continues to review on a regular basis, health and safety procedures as well as updating maintenance servicing contracts. What has improved since the last inspection? Since the last inspection, requirements and recommendations which had been identified in the report have been met. These include the regular reviewing and updating of care plans and risk assessments, clearer recording regarding the care provided by night staff and improvements in the safe administration of medication. Improvements have also been made in survey questionnaires enabling residents/relatives to give better feedback on the type of social and recreational activities required. In addition, two part-time social activity organisers have been appointed and a range of group as well as individual activities are held on a regular basis. This includes therapeutic activities involving musical instruments and life story books are in the process of being introduced. A book of symbols is now available as a means of assisting with communication for residents who may have developed dementia or other sensory impairments. Other improvements identified in the self-assessment form (AQAA) completed by the home, include monthly nutritional and accident audits, regular staff supervision, replacement soft furnishings and equipment. The home also has a policy for setting monthly targets and the records show what has been achieved and any comments. As part of this exercise, improvements to the sound system have been made throughout the home, which enables residents to hear services that are relayed direct from the chapel to individual bedrooms. St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 7 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 Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 8 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 Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 9 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): 3 (standard 6 is not applicable in this home) People who use the service experience good quality outcomes in this area. Residents can expect to have their care needs assessed by the home to ensure that the proposed placement is suitable. This judgement has been made using available evidence including a visit to the service. EVIDENCE: A sample check was made of pre- admission information which was available for two residents and who had been admitted to the home since the last inspection. This included a photo of the residents concerned and in one case, information that had been obtained by the manager when visiting the hospital. Where appropriate, relatives had also been involved in this process. Details included medical history and information regarding vision, eating and drinking, communication as well as personal care and skin condition. Information relating to behaviour and mobility had also been recorded. In some cases, families had also been supportive in providing a social history and St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 10 background information. Individual preferences, likes and dislikes had been recorded to give staff the information they needed to provide appropriate care and support. Other information regarding sleep patterns, mood presentation and social issues had also been included. From this information a care plan and risk assessments had been drawn up. A resident’s profile was also in place as well as a needs assessment, which had been provided by the Primary Care Trust. One of the residents who had been recently admitted to the home, told the Inspector that they liked their room and that they had been provided with a special chair with a footrest. Overall, staff were said to be gentle, kind and explained things clearly. One of the visitors spoken with and who visits the home regularly, confirmed that the manager had visited the potential resident in hospital prior to admission. This visitor also confirmed that staff were good at explaining to new residents in detail about the individual care being provided and other activities available to them in the home. It was evident from conversations and records inspected, that residents had been appropriately assessed to ensure the home could meet their needs. The home has also identified in their pre-assessment (AQAA) form, the need to include on the pre-assessment admission form, more information of any history relating to mental illness/depression. The home does not provide intermediate care. St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 11 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 and 10 People who use the service experience good quality outcomes in this area. Residents can expect to have a plan of care drawn up by the home that details all their assessed needs and the management of risk and can expect to receive the services of health care professions. Residents can expect the home to manage the administration of medication in accordance with accepted good practice guidelines. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Three sets of personal care records were inspected which included care plans, risk assessments, reviews and daily record sheets. Other care records were also sampled. Since the last inspection, improvements had been made in the setting out and recording of information. Care plans had been drawn up which showed identified needs as they related to individual residents. Examples of care plans inspected, included dealing with breathlessness, personal cleaning and dressing, artificial ventilation and the use of oxygen. St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 12 Care plans identified the area of need and problem, the goal/aim as well as the action required. Entries were dated and monthly evaluations had been recorded and signed. Nutrition monitoring charts had also been included for people with poor appetite. Risk assessments for waterlow scores, nutrition, moving and handling had been regularly updated. Other records had details of the treatment that had been provided by community nurses, local doctors and other health care professionals. In one of the care plans inspected, panic attacks had been identified as a potential risk but there was little specific information to enable staff to be clear as to how they should respond appropriately in these situations. This was pointed out to the registered manager who agreed to arrange for further information to be included. One of the residents spoken with, confirmed that the community nurse had visited that morning to treat pressure areas, which had been identified after having been admitted to the home from hospital. Another resident also confirmed that her local doctor visited every two months and any consultation took place in the privacy of her own room. Overall, staff were said to be kind, gentle and competent in the way personal care is provided although concern was expressed by one resident regarding the poor handling received from one of the night care staff when being assisted with pressure care. The inspector raised this issue with the registered manager who confirmed that the incident, involving an agency member of staff, had been brought to her attention. Action had since been taken to ensure good care practices are followed by appropriately skilled staff at all times. One of the residents spoken with was in bed had recently returned from hospital after having an operation. Staff were said to be good in the way they provided personal care, which also involved the use of hoisting equipment. This resident had previously been at home where they had experienced several falls but now feels they are well cared for by the staff. One comment was made by a resident to say that although staff are kind and very caring, the home is sometimes short staffed. Other comments from residents were positive in that staff responded promptly when the call bell was activated although staff sometimes took longer at night to respond. During the inspection, staff were observed to be responding appropriately and attending to residents in a friendly and professional manner. One of the staff team spoken with, talked about how they explain to residents about the care being provided ,particularly with hoisting arrangements. They were also aware of the need to follow the care plan and risk assessments. A check was made of the medication administrative arrangements in the home with one of the nurses of the staff team. From the sample checks made, the St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 13 medication administrative records (M.A.R.), were being completed in accordance with agreed procedures. Entries made corresponded with prescription instructions and the community pharmacist gives updated training every year. Copies of the prescriptions had been kept and a record made of any queries with any subsequent follow- up action which had been taken. A register of returned/discontinued drugs was in use and had been appropriately recorded and signed by appropriate members of staff. Only nurses from the staff team have responsibility for administering medication and samples of their signatures were available for inspection. Where appropriate, discharge summaries were available which had been issued by the hospital for residents to show current medication being prescribed. Where one-to-one staff input was required, detailed instructions and care plans were in place together with the arrangements for calling other health care professionals when necessary. Detailed records had been completed to show the intervention of other health care professionals and when this had been provided. At the time of inspection, only one of the residents was receiving controlled drugs. The controlled drugs register had been regularly completed with two staff signatures in accordance with agreed practice. This is also checked at the end of each shift to ensure administration has taken place correctly. The auditing of medication was one of the improvements identified by the home when completing their self-assessment (AQAA) form. The home is also planning to encourage visitors to have more participation in the health and well-being of their relatives. Some of the residents spoken with, confirmed that they received their medication regularly and that other health care professionals make visits. St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 14 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 People who use the service experience good quality outcomes in this area. Residents can expect to receive a balanced diet and assisted in maintaining family/friend/community contact. Residents can always be assured of a meaningful activities/recreational programme that meets their needs and interests. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Since the last inspection, the range of social and recreational activities has improved. Two part-time social activity organisers have been appointed who are responsible for arranging group activities as well as meeting individual interests. A record was shown to the inspector of the various activities, which had taken place as well as the residents who had attended. These activities included quizzes, debates and a number of residents had been involved in occupational activity by making Christmas baskets. One of the positive aspects of the social/activity programme is that residents have been involved themselves by participating in individual items including sketches, sing-along, acting and dancing. St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 15 One of the organisers spoke to the inspector and said they had attended a course on providing social activities in care homes. Some of the activities arranged include a therapeutic element where musical instruments are used. The home is hoping to further develop the social stimulation of residents by introducing life story books. Part of the survey questionnaire which the home issued to residents and relatives in June 2007, asked for ideas for new social activities, which could be introduced. Responses received included needlework and basket weaving, indoor golf and more local outings to such places as local parks. Since the last inspection, a new sound system has been introduced into the home and it is now possible to give residents the opportunity of listening to church a services which can be directly relayed to their rooms. A new sound track cinema screen has also been installed in the main hall. Although a number of residents enjoy taking part in a range of activities, individual choice is respected by the home. Some of the residents told the inspector that they enjoyed spending time in the privacy of their own rooms although they had been given the opportunity of attending social activities such as bingo, art classes and armchair exercises. One-to-one activities included foot massage which some residents enjoy. Some of the residents who have limited mobility, told the inspector that staff sometimes help by going shopping when requested. Other positive comments from residents confirmed that the home respected individual dignity, choice and privacy. Some residents appreciated the opportunity of maintaining their independence that included in some cases, the use of mobility chairs. Residents were observed in the dining room having lunch and alternative meals were available. A number of residents were enjoying fish and chips and others had chosen salmon. Fresh fruit was also available on the tables. One of the dining room assistants showed the inspector menus and records of meals that had been provided to individual residents. This demonstrated that alternatives had been provided when requested. Records of refrigerator and freezer temperatures were made available for inspection but it was noted that some of these records had been completed in advance up until the end of November. It was also noted that grapefruit which had been opened that morning and marmalade were being kept in plastic sealed containers but these had not been dated. These issues were brought to the attention of the member of staff in the dining room at the time as well as the registered manager. Some of the residents spoken with were complimentary about the overall presentation and standard of meals provided and confirmed that they were given alternative meals to choose from. One of the residents commented that they enjoyed the roast pork but not the fish fingers. In the survey questionnaire that had been completed by users of the service, 92 confirmed that a choice was given between eating in the dining room or bedroom particularly where mobility was restricted. St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 16 Some residents spoken with could not recall whether staff had discussed their dietary needs with them. In their self-assessment (AQAA) form, it was recognised that they need to involve relatives, friends and volunteers more in activities. From conversations, observation and records available, the home has been able to demonstrate its ability to ensure equality and diversity is promoted as part of the quality of life and experience of residents who live in the home. St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 17 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 People who use the service experience good quality outcomes in this area. Residents can expect to have their complaints taken seriously and be assured that they will be protected by the home’s safeguarding adults from harm procedures. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The Statement of Purpose and Service User’s Guide clearly explains the complaints procedure. Copies are given to all residents and/or their relatives. When complaints have been made, the Commission has been notified and kept informed of any investigation and outcomes. Where appropriate, relatives have been kept informed and involved in this process. Policies and procedures on safeguarding adults from harm were in place and the home have re-worded these procedures and reporting instructions to give staff and residents a clearer understanding of the action to be taken should abuse be suspected. Where appropriate, the home have also liaised closely with the Safeguarding Unit of the local authority and have demonstrated their willingness to co-operate and respond in a robust and positive way where issues have arisen. Some of the residents spoken with were also reassured by any action the home had taken and that appropriate procedures were in place. St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 18 In their self-assessment (AQAA) form, the home have recognised the need to ensure complaints are investigated promptly and to implement any changes required to avoid re-occurrence of incidents. All staff are updated annually in the training of safeguarding adults from harm. Training records were made available which confirmed that this had taken place. One of the members of staff spoken with also confirmed that they had attended training on ‘safeguarding adults from harm’. St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 19 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 and 26 People who use the service experience good quality outcomes in this area. Residents can expect to live in a clean, safe and comfortable enviroment. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The premises of the home were clean and hygienic and no concerns were expressed by residents regarding the cleanliness of their rooms. In their selfassessment (AQAA) form, the home states that a high standard of refurbishment and decoration is maintained throughout. This includes new flooring for residents’ rooms, the decoration of the dining rooms and renewal of curtains. Some new equipment has also been provided in the kitchen areas. Records were being maintained to provide evidence of where maintenance had taken place of equipment and services in the home. The inspector was advised St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 20 that the Environmental Health Officer had visited the home the previous week and no serious issues had been identified. One of the domestic staff was spoken with by the Inspector who confirmed that they had completed training regarding infection control as well as control of substances hazardous to health (COSHH). Apron and glove dispensers have now been installed and separate anti-bacterial sprays provided for all dining rooms and kitchen servers. Paper towels and liquid soap dispensers had been provided in the toilets and bathrooms in order to minimise the risk of infection. In their plans for improvement in the next twelve months, the home is to implement an action plan for infection control. St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 21 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 People who use the service experience good quality outcomes in this area. Residents can expect to be cared for by suitable numbers of staff on each shift, which meets their needs. Residents can be assured that records will be able to demonstrate that the home has followed robust recruitment and employment procedures. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Staff rotas were available and the normal provision of staff allows for the manager, lead nurse and six care assistants to be available for the early shift and a similar arrangement applies for the afternoon shift except there are five care assistants on duty. Night cover is provided by one nurse plus two care assistants who are on awake duty. Since the last inspection, one additional nurse has been appointed to cover three shifts per week to provide extra cover. The staffing establishment also allows for domestic and laundry assistants and the main kitchen for Nazareth House has its own chef and staff who provide meals for St Josephs and Maristella. Two part-time social activity organisers have now been appointed who have been successful in engaging with residents and organising social and recreational activities. St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 22 Recruitment records were checked for recent members of staff who had been appointed. These included application forms, proof of identification, references as well as P.O.V.A. First and Criminal Record Bureau disclosures. Letters of appointment and job descriptions were also on file together with medical declarations. Other staff had applied for posts and been interviewed, but had not commenced their employment at the home because of Criminal Record Bureau checks which had not been fully processed. At the time of inspection, there were two full-time vacancies for care assistant posts. Where possible, regular staff are used to cover vacancies and if necessary, agency staff are requested but only those people who are familiar with the home and its routines. As already referred to in this report, the overall response of residents and relatives was positive regarding the kindness and professional support received from the staff team. Students are also accepted in the home on placement and on one of the questionnaires completed, the home was said to be very caring and excellent to work in, the staff are very supportive. Detailed records were also available of staff induction which is based on the Skills for Care model. Certificates were available which had been awarded to new staff. Topics covered included moving and handling, data protection, infection control and how to use an individuals care plan when providing support. The induction course comes complete with a workers guide. Other training records were available including a matrix of courses completed by staff. In the self-assessment (AQAA) form completed by the home 60 of the permanent care staff have achieved National Vocational Qualification (NVQ) Levels 2/3. The remaining 40 are working towards achieving these qualifications. St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 23 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): 31,33,35 and 38 People who use the service experience good quality outcomes in this area. Residents can expect to live and be supported in a home where the management and administration of the service is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The responsible individual for the organisation, registered manager and the facilitation and care co-ordination manager, have continued to develop the service to ensure that it is run in the best interests of residents. Evidence is available to show that residents’ meetings have taken place and the home has also included survey questionnaires as a means of obtaining the views of residents and their relatives regarding the service provided. St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 24 By doing this, the home have demonstrated that it is prepared to listen to the users of the service with the result that changes and improvements have been made since the last inspection. It is recommended that any future surveys also include the views of other health care professionals who regularly visit and are in touch with the home. Monitoring visits have regularly been undertaken by the responsible individual and reports prepared under Regulation 26 of the Care Homes Regulations. As already referred to in this report, records and certificates were available regarding maintenance and servicing agreements in relation to the health and safety of the premises. A fire risk assessment was in place which was seen by the fire officer when visiting the home in September 2007. Other examples of current certificates available included electrical safety, portable appliance testing, mechanical aids and hoists. A gas safety inspection was carried out in October 2007 and a new certificate is expected shortly. Regular staff supervision takes place and in their self-assessment (AQAA) form, the home acknowledges that these sessions provide staff with the opportunity to address issues such as training, and care practices. The home is also intending to ensure regular management meetings take place and to ensure all health and safety issues will continue to be addressed promptly. The home has met all the requirements and recommendations set out in the previous inspection report. St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 25 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x 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 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 4 x 3 x x 3 St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 26 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. Standard Regulation Requirement Timescale for action 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. Refer to Standard OP15 Good Practice Recommendations Closer monitoring should take place to ensure food hygiene regulations are strictly maintained. This relates to the dating of food stored in the refrigerator and correct recording on the actual day, of refrigerator and freezer temperatures. This is to ensure that food served to residents is wholesome and free from contamination. When carrying out an assessment and quality assurance of the service, the views of other health care professionals should also be obtained. This gives an opportunity for responses from a professional perspective to be taken into consideration when evaluating the service provided. 2. OP33 St Joseph`s Nazareth House DS0000015549.V355170.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. 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