Care Home: St Joseph`s Nursing Home

Similar services:

• Claremont House
• Sun Court Nursing Home
• Bramley Avenue (73)
• 15 Bramble Close
• Dolphin Court
• Fen Road
• Wakes Hall

What the care home does well St Joseph`s nursing home provides high standards of personal and nursing care and is able to meet the complex nursing needs of people with palliative/end of life care needs. Assessments are comprehensive with good information provided and time spent with residents and their representatives to enable them to make an informed choice. The home has implemented the Liverpool Care pathway as part of the Gold Standards Framework for Palliative/End of life care that is recognised as best practice. There are close links with specialist nurses and the local hospice that provide advice, support and training. Access to health care services is good and there is good monitoring of health care needs with appropriate action being taken as necessary. A minister who completed a survey told us `I feel St Joseph`s is one of the very finest Nursing Homes I have had the privilege of being Chaplain to - a credit to all the staff`. A relative told us the care has been `Far better than we expected or hoped for`. Recruitment of staff is robust. There is good staff retention with a number of staff having been employed by previous organisation for some time. Staff are professional in their approach, well trained, motivated and well supervised. There is good interaction with residents who confirmed they were respected and had their privacy and dignity upheld. The home is cleaned to a high standard with safe infection control practices in place that are well adhered to. The home is pleasantly decorated and well maintained. The ambience of the home is relaxing with music being played in several of the small lounges. The laundry service is efficient and well organised. All food is cooked on site with home made soups, cakes and pastries and good monitoring of nutritional needs is undertaken. Efforts are made to ensure residents enjoy mealtimes with the dining rooms being very pleasantly laid with tablecloths, cutlery and condiments. The Manager operates an open door policy. Any complaints or concerns are addressed quickly and used to improve standards. Residents and their relatives are regularly consulted with and positive feedback was obtained from service users questionnaires recently distributed. What has improved since the last inspection? This is the first inspection of the service. What the care home could do better: The standard of medicines recording, handling, recording, administration, storage, and disposal were in the main good. However some unsafe practice was observed during a medication round. Medication was dispensed in unnamed containers to a number of residents at the same time and signed for without checking if all residents had taken the medication. Several omissions had not been followed up and the reason recorded. Prescribed creams were not referred to by name on the care plan/daily record to confirm they had been applied. Activities` records had not been kept updated for some months. Control of Substances Hazardous to Health (COSHH) assessed items were left unsupervised on a cleaner`s trolley and others were stored in an unlocked cupboard. Some radiators were without covers and there was no documented risk assessment in place to demonstrate how the risk had been minimised. CARE HOMES FOR OLDER PEOPLE St Joseph`s Nursing Home Gay Bowers Road Danbury Chelmsford Essex CM3 4JQ Lead Inspector Diana Green Unannounced Inspection 29th May 2008 09:30 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 DS0000071175.V365367.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. DS0000071175.V365367.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Joseph`s Nursing Home Address Gay Bowers Road Danbury Chelmsford Essex CM3 4JQ 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) 01245 223367 01245 226604 European Care (Danbury) Ltd Mrs Alison Dale Nellies Care Home 50 Category(ies) of Physical disability (50), Physical disability over registration, with number 65 years of age (50) of places DS0000071175.V365367.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Physical Disability - Code PD & PD (E). The maximum number of service users who can be accommodated is: 50. This was the first inspection of the care home since registration. Date of last inspection Brief Description of the Service: St Josephs Nursing Home provides nursing and personal care for 50 adults with physical disabilities. The home was a former convent that has been extended and refurbished and accommodation is provided in six units on two floors that are accessible by stairs and lifts. There is a range of communal rooms throughout both floors providing lounge and dining accommodation. The home has thirty-eight single bedrooms, some with en-suite, one shared room and two small wards. There are large attractive gardens surrounding the property and parking to the front of the premises. St Josephs is located in a rural setting near to the village of Danbury. The home is accessible by road and there are mainline railway stations at Chelmsford, Witham and Hatfield Peveral. The fees range from £790.00 weekly. Additional costs apply for chiropody, toiletries, hairdressing and newspapers. This information was provided to the CSCI on 29/05/08. DS0000071175.V365367.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This was an unannounced key inspection lasting 6 hours and the first inspection of the care home since change of ownership. The inspection process included: discussions with the registered manager, the activities coordinator, two residents, five care staff, two relatives and feedback from health and social work professionals; a tour of the premises including a sample of residents’ rooms, bathrooms, communal areas, the kitchen, the laundry and the sluicerooms; an inspection of a sample of policies and records (including any records of notifications or complaints sent to the CSCI since the last inspection). Twenty-six standards were inspected (five were commended) and one requirement and three recommendations were made. The manager and staff were welcoming and helpful throughout the inspection. What the service does well: St Joseph’s nursing home provides high standards of personal and nursing care and is able to meet the complex nursing needs of people with palliative/end of life care needs. Assessments are comprehensive with good information provided and time spent with residents and their representatives to enable them to make an informed choice. The home has implemented the Liverpool Care pathway as part of the Gold Standards Framework for Palliative/End of life care that is recognised as best practice. There are close links with specialist nurses and the local hospice that provide advice, support and training. Access to health care services is good and there is good monitoring of health care needs with appropriate action being taken as necessary. A minister who completed a survey told us ‘I feel St Josephs is one of the very finest Nursing Homes I have had the privilege of being Chaplain to - a credit to all the staff’. A relative told us the care has been ‘Far better than we expected or hoped for’. Recruitment of staff is robust. There is good staff retention with a number of staff having been employed by previous organisation for some time. Staff are professional in their approach, well trained, motivated and well supervised. There is good interaction with residents who confirmed they were respected and had their privacy and dignity upheld. DS0000071175.V365367.R01.S.doc Version 5.2 Page 6 The home is cleaned to a high standard with safe infection control practices in place that are well adhered to. The home is pleasantly decorated and well maintained. The ambience of the home is relaxing with music being played in several of the small lounges. The laundry service is efficient and well organised. All food is cooked on site with home made soups, cakes and pastries and good monitoring of nutritional needs is undertaken. Efforts are made to ensure residents enjoy mealtimes with the dining rooms being very pleasantly laid with tablecloths, cutlery and condiments. The Manager operates an open door policy. Any complaints or concerns are addressed quickly and used to improve standards. Residents and their relatives are regularly consulted with and positive feedback was obtained from service users questionnaires recently distributed. What has improved since the last inspection? What they could do better: The standard of medicines recording, handling, recording, administration, storage, and disposal were in the main good. However some unsafe practice was observed during a medication round. Medication was dispensed in unnamed containers to a number of residents at the same time and signed for without checking if all residents had taken the medication. Several omissions had not been followed up and the reason recorded. Prescribed creams were not referred to by name on the care plan/daily record to confirm they had been applied. Activities’ records had not been kept updated for some months. Control of Substances Hazardous to Health (COSHH) assessed items were left unsupervised on a cleaner’s trolley and others were stored in an unlocked cupboard. Some radiators were without covers and there was no documented risk assessment in place to demonstrate how the risk had been minimised. DS0000071175.V365367.R01.S.doc Version 5.2 Page 7 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. DS0000071175.V365367.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 DS0000071175.V365367.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): Quality in this outcome area is excellent based upon sampled inspected standards 1, 3, 4 and 5. Residents were very well informed, and had their needs fully assessed prior to moving in to the home to ensure they could be appropriately met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a new statement of purpose and service user guide that had been produced for registration of the service. A copy was provided during the site visit and was confirmed to meet regulatory requirements. A relative spoken with during the site visit confirmed that when they visited the home staff were very informative, spent time with them and provided them with a copy of the statement of purpose/service user guide. Copies were displayed in the entrance of the home for visitors’ information. DS0000071175.V365367.R01.S.doc Version 5.2 Page 10 The manager stated that she undertook pre-admission assessments either at home or hospital where possible to ensure needs could be met at the home. Care management assessments were obtained where relevant and seen on the care records viewed. A sample pre-admission assessment form was seen, and included all elements of need as indicated under this standard. A relative spoken with during the site visit confirmed that the manager had assessed their loved one in hospital prior to admission being agreed. The home does not provide intermediate care. DS0000071175.V365367.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): Quality in this outcome area is excellent based upon sampled standards 7, 8, 9 , 10 & 11. The health and personal care needs of residents are well met through care planning that is closely monitored and regularly reviewed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four residents’ care files were viewed. All files contained a pre-assessment form completed prior to admission and used to develop care plans. Additional individual assessments had been completed in regard to specific needs (e.g. risk of falls, moving and handling, continence, nutrition, skin condition, etc.) and regularly reviewed. The records included evidence that nutritional intake was monitored with weight monitoring undertaken two weekly and appropriate action taken to provide supplements as needed. A range of care plans were present on the care files viewed, and these contained a good level of detail of the action required by staff to help the person meet their needs. DS0000071175.V365367.R01.S.doc Version 5.2 Page 12 The records confirmed evidence of good monitoring of health care needs with prompt referral to GPs and health care professionals and appropriate follow up action being taken. The AQAA stated that advice and support had been accessed on the care of people with Parkinson’s from a local support group to gain further skill and knowledge and this was also confirmed in discussion with the manager. The records confirmed that residents were enabled access to chiropodists, dentist, district nurses, GPs and opticians. Responses to the home residents’ and visitor’s questionnaires were viewed and contained the following comments: One relative stated that their loved one ‘feels that the home has vastly contributed to how well (they are) now. (They feel) ‘safe and contented’ and another relative stated ‘The nursing home was recommended to me as the best in this area. It certainly lives up to its excellent recommendation’. Another relative told us their loved one had ‘excellent support and advice ….to regain mobility after fall’. The home had medication policy and procedures that were available for staff guidance. Registered nurses administered all medication at the home and all had current NMC registration. Medication was supplied through a local pharmacy in pre-dispensed packs and individual containers and appropriate ordering and disposal procedures were in place. Supplies were stored in two locked trolleys in the corridor of the ground floor and a further two on the first floor; all trolleys were secured to the wall as required. Additional storage was provided in wall cupboards and a Controlled Drugs (CD) cupboard that were located in the nurses office on the first floor. The drug fridge was also stored in the office and regular monitoring and recording of room and refrigerator temperatures were undertaken ensuring medication was stored within safe recommended levels. Administration of medicines was undertaken by registered nurses. The administration of medicines to residents in Lingwood and Riffhams Units was observed. Medicines were seen to be pre-dispensed for several residents into unnamed medicines pots prior to them being given to them and to several other residents using a loose paper handwritten label to identy them, which is unsafe practice. The registered nurse then confirmed by signature that all medication had been given to several residents. However medicine had been left with one resident to take themselves when they had finished lunch. This was checked following lunch and the medication remained where it had been left and therefore had not been taken. The medication administration records and supplies for four residents were inspected. All medication was available as prescribed and the medication administration records (MAR) were generally well recorded. However there were several ommissions of signature evident that had not been followed up and the reason recorded; some medicines with a short shelf life did not have the date of opening recorded to ensure they were taken within date. Prescribed creams were not all being recorded as given, although two were recorded on the daily record but were not named. CD drugs were recorded in the CD register and advice was given to ensure that the name as well as the address was recorded on receipt and disposal. Temazepam DS0000071175.V365367.R01.S.doc Version 5.2 Page 13 was not being recorded in the CD register and advice was given to ensure that this is stored in the CD cupboard and also recorded in the CD register (recommended good practice). The home’s philosophy of care, contained in the statement of purpose states that St Joseph’s ‘recognises and respects the dignity of everyone in the home’ and ‘the right of the person to personal privacy is acknowledged’. During the site visit, staff were observed to treat residents with courtesy and dignity and residents spoken with also confirmed this. Staff were seen to preserve one residents privacy and dignity by screening them prior to them being hoisted and were also heard explaining how they were going to assist them which was good to hear. The home provided palliative care and as stated in the home’s philosophy of care, aimed to ‘treat with special care residents who are dying, and sensitively assist them and their relatives at the time of death’. Strong links had been established with the hospice, Macmillan nurses who provided advice and support as relevant. The AQAA stated that ‘the home operates by the Gold Standard Framework for palliative care which encourages residents to discuss their end of life care and think about advance directives’. The manager said that all care staff had received training on the Liverpool Care Pathway (a recommended best practice system of care planning used in care of the dying) from the Marie Curie Coordinator. This was also confirmed form the training records viewed. The spiritual needs of residents were assessed on admission and efforts made to ensure these were met through representatives of various faiths attending the home for communion. One minister who completed a survey told us they ‘Always requests spiritual care and seeks advice accordingly’ and ‘Most especially when the person is terminally ill, the care given is faultless’. DS0000071175.V365367.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): Quality in this outcome area is good based upon sampled inspected standards 12, 13, 14 and 15. People living at St Joseph’s can expect to mantain contact with their family and friends and to have a lifestyle that satisfies their cultural expectations and needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the site visit discussions were held with the home’s activities coordinator who explained that she worked 30 hours over 5 days per week including Saturday. The coordinator had an NVQ level 3 qualifications that was confirmed from the training records inspected and also has an aromatherapy qualification and therefore able to offer hand and foot massage to residents. A weekly programme of activities was displayed for residents and visitors’ information. This was seen to include a range of group and individual activities comprising art and crafts, painting, cake making, quizzes, bingo, gardening, manicures, crosswords, etc. DS0000071175.V365367.R01.S.doc Version 5.2 Page 15 The coordinator stated that care staff were encouraged to become involved in group activities where possible and five volunteer students who were undertaking A’ levels also assisted with taking residents out to the gardens and for walks in the local countryside. Following training given by a physiotherapist and speech and language therapist aftercare exercises were also provided to residents as required. The coordinator said that current events were discussed, for example ‘Lady Day at Ascot’, where residents were encouraged to make hats and ‘Tennis at Wimbledon’ where staff dressed in tennis wear played for residents to watch. Several residents were seen to be reading newspapers and the coordinator said that time was taken to read items to residents during individual activities sessions. Several residents were observed taking part in various activities during the site visit that included board games, ball games and individual activities such as nail manicures whist others had chosen to watch television and listen to music. However whilst residents were able to confirm the activities they took part in, records had not been updated for several months and therefore did not provide clear evidence of the activities each person had enjoyed. The home’s statement of purpose included the policy on visiting. A relative spoken with said that they were able to visit at any time. The manager stated that residents’ friends and relatives could visit at any time, and they could meet with them in private in their rooms or have a meal with them. A number of communal rooms were also available for them to meet and small kitchens with tea making facilities were accessible to them. Several visitors were seen to come and go throughout the inspection. The home’s statement of purpose and service user guide detailed the arrangements made for residents to maintain their faith by representatives of different faiths attending the home as relevant. Residents were observed to have some choice about their daily life in the home, especially in regard to where they spent their day, ate their meals etc. Two residents who completed surveys told us they could choose whether to stay in their room or to take part in activities. Many of the rooms seen were well personalised, showing that people could bring their own possessions into the home with them. Information on advocacy services was included in the statement of purpose and available in the home. The menus viewed provided a varied range of meals with alternatives available and with seasonal variations. Staff said that all meals were home cooked on site and pastries and cakes baked at the home. Breakfast comprised cereals and toast with a cooked breakfast on request. Residents were observed enjoying the lunchtime meal that comprised roast turkey, potatoes, courgettes, swede followed by blackberry and apple pie. Supper was a light meal and that planned for later in the day comprised Stilton and broccoli soup and corned beef with chips. Alternatives were also made available including sandwiches and cakes. Residents spoken with said they enjoyed the food at the home. A resident who completed a survey said ‘Lunches are very good but DS0000071175.V365367.R01.S.doc Version 5.2 Page 16 evening meals leave a lot to be desired. One can ask for alternative main courses at night such as sandwiches, eggs or salad’. Feedback in a visitors’ questionnaire stated ‘I am very impressed with that served to residents’. Staff were observed assisting residents with eating as required in a sensitive and discreet manner. DS0000071175.V365367.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): Quality in this outcome area is excellent based upon sampled inspected standards 16 & 18. People living at St Joseph’s can expect to have their complaints listened to and acted upon and to be protected from abuse by robust policies, procedures, staff training and practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints procedure that was included in the statement of purpose/service user guide and displayed in the entrance of the home. The procedure included the timescales within which complainants can expect a response and advised them of their right to refer to senior personnel within the organisation. Reference was also made to complainants’ right to refer to regulatory authorities. However this needed to be reviewed to clarify CSCI role as regulator in receiving complaints (i.e. to deal with issues through the regulatory process, not investigation). One complaint had been received since registration of the new company that had been investigated through the home’s procedures. The manager operated an open door policy (confirmed through discussion with a relative) so that any issues could be raised with her directly and dealt with promptly. A book was also made available for anyone to record any concerns, complaints or suggestions. The manager stated that she DS0000071175.V365367.R01.S.doc Version 5.2 Page 18 viewed this on a daily basis to monitor any issues of concern and take appropriate action. Discussions were held with the manager during the site visit with regard to the home’s safeguarding procedures. The home had comprehensive policy and procedures and whistle blowing procedures that were kept under regular review and were viewed. Local Essex procedures were also available for staff guidance. The manager had undertaken training in protection of vulnerable adults and the training officer had undertaken a ‘train the trainer’ course to enable her to provide staff training on abuse. The records confirmed that all staff had received relevant training. DS0000071175.V365367.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): Quality in this outcome area is excellent based upon sampled inspected standards 19, 22 and 26. People living at St Josephs Nursing Home can expect to live in a homely environment that is well decorated, well maintained, clean and odour free. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was made during the site visit that included communal areas, several bathrooms, a number of residents’ rooms, the sluices and the laundry. The home was well maintained and well decorated. The gardens were attractive and well maintained and provided a particularly pleasant outlook from the rear of the premises. The gardens to the front of the premises were fully accessible and partially accessible to wheelchairs to the rear with some paths and ramps provided. Records provided evidence that the building DS0000071175.V365367.R01.S.doc Version 5.2 Page 20 complied with the requirements of the local fire and environmental health department. The home had a passenger lift to enable access throughout the premises. There were grab rails and aids in bathrooms and toilets to meet the needs of residents. Assisted baths and toilets were provided. Call systems were provided throughout all individual and communal rooms. A range of specialist pressure relief equipment was available to meet the needs of residents and the manager said that investment had been made to ensure additional equipment was available. All equipment was serviced as per manufacturers recommendations and confirmed from the records inspected. The home had infection control policies and procedures for staff guidance. All staff received training during induction and at regular updated sessions as seen from the records viewed. The home was cleaned to a high standard with no malodorous smells evident. The laundry comprised two separate rooms that were used for organisation of clean and dirty laundry. The laundry was clean and well organised with systems for sorting residents’ personal laundry. There were two washing machines and two driers. Systems were in place to minimise risk of infection via the use of red bags for any laundry soiled by body fluids, placed directly in the washing machines and washing machines had the capacity to carry out sluice wash cycles. The home had two sluices on each floor of the home with mechanical sluices in each of them. Staff hand washing facilities (liquid soap and paper towels) were provided in clinical areas and in rooms where personal care was provided to ensure adherence to safe infection control practices. DS0000071175.V365367.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): Quality in this outcome area is excellent based upon sampled inspected standards 27,28, 29 & 30. People living at St Joseph’s Nursing Home can expect to be cared for by a stable and skilled staff team with staffing levels that are appropriate to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were forty-five residents at the home. Staffing levels comprised two registered nurses and eleven care assistants to meet the dependency levels of residents; from inspection of the staff duty rota and discussion with staff and residents, there was evidence that staffing levels were well maintained, and met the needs of residents. Ancillary staffing compromised an administrator, a maintenance person, one cook, a catering assistant, two breakfast hostesses, one laundry assistant and three domestic staff. The home had with 13 care staff with NVQ level 2 qualifications or above. The percentage of staff with NVQ level 2 training or equivalent was therefore less than the 50 needed to meet the standard. The manager stated that this was being addressed by the appointment of an in house trainer with clinical nurse tutor experience to undertake NVQ assessment of some care staff. DS0000071175.V365367.R01.S.doc Version 5.2 Page 22 One member of staff had been recently recruited and the recruitment file was viewed. The included evidence that the required checks had been obtained (two satisfactory references, CRB/POVA checks) and evidence of identification and photographs obtained before the individuals commenced employment at the home. The file also included evidence that the home’s induction had been provided (policies, procedures and practical sessions) and the records confirmed that training was booked for fire safety, manual handling and health and safety training. The manager said that once the trainer returned from sick leave Skills for Care Induction would be provided, in the interim the care assistant was working under supervision. The home had an established training programme and a designated trainer. The training records for four staff were viewed and confirmed that staff had completed Skills for Care Induction, training on Protection of Vulnerable Adults, fire safety, moving and handling and health and safety. Training had also been provided on infection control and assessment, understanding dementia and Parkinson’s Disease. A minister who completed a survey told us ‘I have never experienced any care staff who does not appear to have appropriate care skills. They are generally pastorally skilled too which is a great help to Chaplaincy work’. DS0000071175.V365367.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): Quality in this outcome area is good based upon sampled inspected standards 31, 33, 35, 36, 37 and 38. St Joseph’s Nursing Home is well managed and run in the best interests of residents. The health and safety of residents and staff is safeguarded by the policies, procedures and practices at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is an experienced registered nurse and holds the N.V.Q. level 4 qualifications in management and care. She has ten years experience of managing the home and previous senior ward management experience. From discussion with the manager, former knowledge and an DS0000071175.V365367.R01.S.doc Version 5.2 Page 24 inspection of the records it was evident that she was skilled and competent and had undertaken recent updated training relevant to a manager of a care home for older people. The manager explained that the home had a quality assurance programme based on the Blue Cross Mark of Excellence Quality Assurance system that included consultation with residents and their relatives. A quality committee had been established with representatives from management, services and care. Representation included the registered manager; activities coordinator; cook; a registered nurse and four care assistants. Meetings were held three monthly and regular audits undertaken, for example obtaining service users views on the care home and other topics included the environment and bereavement. The manager explained that surveys were distributed to residents and their relatives randomly by members of the committee (not including the manager) and their comments used to develop an action plan to improve services. Two of the three visitors questionnaires sampled responded ‘excellent’ or 5 (on a scale of 1-5) to all questions when asked about the quality of care, friendliness of staff, response to phone calls, décor and ambience, response to complaints/concerns, laundry service and meals. Responses from the third visitor were either 4 or 5. Neither the manager nor staff were appointee for any resident at the home. Some residents managed their own finances and all other residents had a representative/advocate to manage their finances on their behalf. No residents’ money was held at the home. All expenditures (fees and sundries) were invoiced directly to the resident or their representative. From discussion with the manager and the staff records viewed it was evident that staff supervision was provided for all staff. The manager explained that she supervised registered nurses and nurses supervised care assistants. Regular nurses’ meetings were also used as a forum for group supervision and to discuss issues such as care planning. The manager held regular meetings with other disciplines to discuss their practice. Annual appraisals were held where training needs and opportunities were discussed. Records held on behalf of residents were kept up to date and were stored safely in secure facilities. Records viewed at this inspection included: the statement of purpose, service user guide, assessments/care plans, medication records, a sample of policies and procedures, complaints, staff meetings, staff recruitment and training records, maintenance records and fire safety records. The home had health and safety policies and procedures that were regularly reviewed. The records confirmed that staff had attended relevant health and safety training. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment and utilities and there was evidence of appropriate weekly and monthly internal checks being carried out (e.g. checks on fire equipment fire alarms and emergency lighting DS0000071175.V365367.R01.S.doc Version 5.2 Page 25 etc.). All accidents, injuries and incidents were well recorded and confirmed that appropriate action had been taken. However Control of Substances Hazardous to Health (CoSHH) assessed items were found stored in an unlocked cupboard and one radiator that had not been covered had no risk assessment completed to evidence how the risk has been minimised. DS0000071175.V365367.R01.S.doc Version 5.2 Page 26 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 X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 2 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 3 X X 3 X X X 4 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 2 DS0000071175.V365367.R01.S.doc Version 5.2 Page 27 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 OP9 Regulation 13(2) Requirement To ensure the safe administration of medicines: 1. Staff must only sign that medication has been given immediately following administration to individual residents. 2. Omissions must be followed up and the reason recorded. 3.The date of opening of medicines with a short shelf life must be recorded. 4.The CD register must include the name and address on receipt and disposal. Timescale for action 30/06/08 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 OP9 Good Practice Recommendations Temazepam should be recorded in the CD register to ensure robust monitoring of administration and stock levels as recommended good practice. DS0000071175.V365367.R01.S.doc Version 5.2 Page 28 2. 3. OP38 OP38 Uncovered radiators should have a documented risk assessment to demonstrate the risk has been minimised. COSHH assessed items should be stored in locked facilities when unsupervised to ensure there is no risk to residents or staff. DS0000071175.V365367.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 DS0000071175.V365367.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!