Care Home: St Judes Nursing Home

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What the care home does well We consider that St Judes provides a safe, well-maintained environment for its residents and that people are being well cared for there. We have made this judgement by talking to the people who are using the service and their relatives, by spending time with them during the inspection visit, by looking at records and speaking with the staff and management team. Many of the residents are very frail with advanced stages of dementia but several of them were able to talk with us. They said that staff were very kind to them and one lady told us "how hard they all worked". Those people who could not communicate with us looked clean and happy. Staff that we spoke with were cheerful and welcoming, and one relative said " they are always quick to show hospitality to visitors, very friendly and accommodating". Whenever we visit, the home always smells fresh and clean and there is an ongoing redecoration and refurbishment programme in place. Communal areas and bedrooms are pleasantly decorated and residents are encouraged to bring items from home such as photographs, pictures and small items of furniture to personalise their rooms. One lady told us "my room is really nice, it`s always kept very clean and I`m free to go in there or to stay in the sitting room as I please. It feels like my home. " So that staff know how they should be supported, all the residents have an individual and comprehensive plan of care, based on a pre-admission assessment, which is subject to regular review. Although there were areas where it was considered that these could be improved, they identify the care that resident`s need, risks, which could predispose to the development of pressure sores, and outline the support that is needed to maintain their independence and mobility. The lunchtime meal was served during the inspection and the food looked nutritious and well presented. Residents said that there was always a choice and several of them told us "I really like the dinners " The cook has been there for several years, she is very involved with the residents and knows them well so that she can cook the meals that they prefer. Policies and procedures are in place to ensure the health and safety of both staff and residents and staff training is ongoing. Some discussions were held with the manager about how this training could be improved to ensure that staff understood about the needs of the residents that they were caring for. What has improved since the last inspection? At the last inspection two requirements were made which have now been complied with. Automatic door closers have now been fitted to the bedroom doors of resident who wish to keep them open at night. These would ensure that the doors close at night in the event of a fire. Visits that are made by the Registered Provider are now documented in line with Regulation 26. These visits are made in order to check that everything in the home is in order and that residents are safe and comfortable in the home. The ongoing redecoration and refurbishment programme is continuing in order to make sure that the home remains a pleasant and safe place for people to live in. CARE HOMES FOR OLDER PEOPLE St Judes Nursing Home 29-31 Mayfield Road Sutton Surrey SM2 5DU Lead Inspector Alison Ford Key Unannounced Inspection 28th August 2008 10:45 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 Judes Nursing Home DS0000019126.V371123.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 Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Judes Nursing Home Address 29-31 Mayfield Road Sutton Surrey SM2 5DU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8643 1335 020 8643 9949 stjudes@btconnect.com Churchill Residential Care and Nursing Homes Ltd Manager post vacant Care Home 41 Category(ies) of Dementia (21), Old age, not falling within any registration, with number other category (20) of places St Judes Nursing Home DS0000019126.V371123.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: Old Age, not falling within any other category - Code OP (maximum number of places: 20) 2. Dementia - Code DE (maximum number of places: 21) The maximum number of service users who can be accommodated is: 41 23rd August 2006 Date of last inspection Brief Description of the Service: St. Judes is a nursing home registered, with The Commission for Social Care Inspection, to care for forty-one older people who may have dementia. The home is situated in a quiet residential area of Sutton and is within walking distance of the town centre. It was originally 2 large houses that have been joined to form one large home and accommodation is spread over the three floors of the building. There are two passenger lifts and two stair lifts to enable access for people with limited mobility. There is a range of communal space with lounges and dining areas in both houses. There are bathrooms, showers and toilet facilities throughout the home and an attractive rear garden that is well maintained and is accessible to everyone. There is limited car-parking space available to the front of the home although parking is permitted in the road. The home is staffed throughout the twenty-four hour period, seven days a week, by both trained nurses and care staff, supported by a full range of ancillary staff. St Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 5 Fees at the time of this inspection ranged from £650 - £700 per week. Those people who are funded by the local authority would be done so under separate arrangements and any extra charges such as those payable for hairdressing and chiropody services would be agreed prior to admission. A copy of the homes Statement of Purpose and their latest inspection report could be obtained from them. The report can also be downloaded from the website of The Commission for Social Care Inspection at www.csci.org.uk St Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star, This means the people who use this service experience good quality outcomes. This report was written following an unannounced visit undertaken as part of the inspection process for the year 2008/2009. When writing the report consideration has also been given to information received from other sources such as comments from people who use the service and their relatives, notifications which the home is required to send us, concerns and complaints. We assessed all of those standards thought, by The Commission for Social Care Inspection, to be key to the inspection process. We undertook a tour of the premises and, to try and find out what it might be like to live in the home, we spoke with several of the thirty-five residents living there and the members of staff on duty. We also talked to some visitors about their experiences of the home and their impressions of the care that residents receive there. Various records that the home is required to keep, as evidence of its commitment to the protection and health and safety of its residents, were seen and also a sample of care plans that show us how resident’s assessed healthcare needs are being met. The home must make sure that people who have been judged as being unsuitable to work with vulnerable adults are prevented from doing so and we checked the personnel files of new members of staff to make sure that they contained all of the necessary documentation. Staff training schedules were also looked at to make sure that the training staff are attending is relevant to the needs of the people who live in the home. In addition to this, the homes manager had sent us an Annual Quality Assurance Assessment. This is a document that they have to send us every year and it tells us how well they believe that their service meets its objectives as set out in its Statement of Purpose, and about their plans for the future. The Commission has not received any complaints about the service since the last inspection. St Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 7 What the service does well: We consider that St Judes provides a safe, well-maintained environment for its residents and that people are being well cared for there. We have made this judgement by talking to the people who are using the service and their relatives, by spending time with them during the inspection visit, by looking at records and speaking with the staff and management team. Many of the residents are very frail with advanced stages of dementia but several of them were able to talk with us. They said that staff were very kind to them and one lady told us “how hard they all worked“. Those people who could not communicate with us looked clean and happy. Staff that we spoke with were cheerful and welcoming, and one relative said “ they are always quick to show hospitality to visitors, very friendly and accommodating”. Whenever we visit, the home always smells fresh and clean and there is an ongoing redecoration and refurbishment programme in place. Communal areas and bedrooms are pleasantly decorated and residents are encouraged to bring items from home such as photographs, pictures and small items of furniture to personalise their rooms. One lady told us “my room is really nice, it’s always kept very clean and I’m free to go in there or to stay in the sitting room as I please. It feels like my home. ” So that staff know how they should be supported, all the residents have an individual and comprehensive plan of care, based on a pre-admission assessment, which is subject to regular review. Although there were areas where it was considered that these could be improved, they identify the care that resident’s need, risks, which could predispose to the development of pressure sores, and outline the support that is needed to maintain their independence and mobility. The lunchtime meal was served during the inspection and the food looked nutritious and well presented. Residents said that there was always a choice and several of them told us “I really like the dinners “ The cook has been there for several years, she is very involved with the residents and knows them well so that she can cook the meals that they prefer. Policies and procedures are in place to ensure the health and safety of both staff and residents and staff training is ongoing. Some discussions were held with the manager about how this training could be improved to ensure that staff understood about the needs of the residents that they were caring for. St Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: Although we consider that this home provides good care and that residents are safe, we have recommended that they could make some improvements in various areas. Since the last inspection a new manager has been appointed and she has already recognised most of these herself and is beginning to address them. Our knowledge of this home, and the providers, means that we are confident that the home can manage these issues well therefore, recommendations have generally not been issued and progress in implementing them will be monitored at future visits. Some documentation is produced for residents and their relatives to read, to tell them about the home, and would be better if it was produced in a more easy to read format. It was suggested that this information, along with a copy of the latest inspection report should be displayed in the entrance hall for everyone to read. A copy of the complaints procedure must also be available for any one who might need to raise any concerns about the home. Care plans need to be compiled in a more collaborative way with contributions from residents and their families so that they are able to influence the care that is given. There should be more information available about residents past lives and achievements to help staff understand more about them and arrange activities, which will suit them. They also need to be updated to include information about resident’s wishes in the event of their death so that everyone is aware of these. Although they are improving, activities within the home are still very limited. There is something planned every day but this does not happen until late afternoon. This leaves residents unoccupied for a long time, just sitting around the lounge, and it was observed that not all staff maximise the opportunities for engagement with them. Staff need to be encouraged to spend time interacting with the people that they are caring for, not only when it is time for St Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 9 organised activities to take place. The manager has recognised that this may indicate a training need and it will be addressed. Although mealtimes seem to be a pleasurable experience for residents the manager tells us that they will be introducing some homely touches that will make it even better. This will include the purchase of new crockery and the use of tablecloths, condiments and menus. Many of the residents have dementia and although the home is pleasantly decorated it was considered that they would benefit from seeing some pictures on the walls of things that they would recognise and be able to relate to. This might help to provide some reality orientation for them. The training schedules showed that for some, staff training has been limited, there are now plans to address this and the manager is intending to access training that is being provided by the local authority. 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 Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 10 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 Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 11 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): Standards1, 3,6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. No one is admitted into the home before having an assessment done to make sure that their needs can be met. Although, there is written information available to help people decide if the home will suit, them amendments are needed to make sure that it is up to date and it would benefit from being produced in a more easy to read format. EVIDENCE: We looked at the care plans of four residents. They all included assessments from the residents care manager and also showed that someone from the home had visited them as well. These assessments help to ensure that the home would be suitable for people and that it will suit their needs. They also provide a basis for future care planning. St Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 12 It was noted in one, that a residents mental health needs had been identified at this stage. Discussions with the staff revealed that this information had not been made available by the hospital at the time however, had since been addressed and appropriate support was being provided. People who are considering coming to live in the home or to placing someone there, need to be able to access all of the information that they need to help them choose if the home will suit them. There is a Service User Guide and a copy was in some of the resident’s bedrooms. It was noted that some of the information in it is not up to date. It is also not in a particularly easy to read format. Discussions were had with the homes manager about improving it and making it more accessible both to the people who currently use the service and also to people who may be considering coming to the home. St Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 13 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): Standards 7,8,9,10 People using the 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 all have an individual care plan, which informs staff how they need to be supported although there are areas where these could be improved. Residents are always treated in a manner, which ensures that their privacy and dignity are respected and medication policies and procedures are in place to protect them from errors in drug administration. EVIDENCE: The Annual Quality Assurance Assessment tells us that health and personal care that residents receive is based on their individual needs and that they would be involved, where possible, in the decisions made relating to their care. We looked at the care plans of four residents in the home. We found that they contained basic information about how residents need to be supported and that this was reviewed regularly to ensure that any changes were identified. We St Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 14 saw that regular monitoring of those at risk of developing pressure sores was in place and appropriate equipment was in use for these people. There was evidence of regular visits from the doctor who visits the home and also from other healthcare professionals who had been asked for advice. We saw little to suggest that residents or their relatives had been consulted about what was in their care plans. In one, we found an extensive list of a residents food preferences even though their relative had said that no one had ever asked about these and they had concerns about some of the food that was served. This would confirm our views that the compilation of care plans is not collaborative between staff, residents and their relatives. People should be given the opportunity to influence the way their care is delivered so efforts must be made to ensure that happens wherever it is possible. There was also limited information available about residents past lives and achievements although staff that were spoken with seemed to have a good understanding of these. It is recommended that this information should be documented so that everyone is aware of it and opportunities to interact with residents can be maximised. If staff know about residents interests they can engage in conversation with them more easily and also arrange activities, which will suit them. Although it is acknowledged that it is often difficult to gather information about resident’s wishes in the event of them becoming unwell or their death, this should also be included in their care plans. This will help to minimise unwanted hospital admissions and ensure that people are cared for according to their preferences. The homes manager is fully aware of the shortfalls in the care plans and there are plans to address them. She is also hoping to implement The Gold Standard Framework, which is concerned with excellence in care for those at the end of their lives. Medication storage and administration procedures were seen, these were in order and it seems that people are receiving their medication as the doctor has prescribed it. It was noted that the information box on administration sheets, which indicates any allergies. was not completed. We were told that this meant that there were no allergies known. We recommended that this should be documented as a precaution. We observed staff that were working in the home and considered that residents were being treated with kindness and respect. Staff were gentle in their approach and, during the inspection, there were several examples of them dealing well with people who were very confused. St Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 15 St Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 16 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): Standards 12,13,14,15 People using the 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 would be supported to exercise choices in their lives as far as they are able so that they can maintain their independence. There is a limited range of activities arranged for them and visitors would always be made welcome. Meals that are served in the home are varied and suit the needs of the people who use the service. EVIDENCE: Many of the residents have advanced stages of dementia and appreciate a structured day however; they are encouraged to make choices, which affect their daily living as much as they can. Some residents told us that times for getting up and going to bed were flexible, an extra bath was always possible and choices could be made about the clothes that they wear and the food that they eat. The relatives that were spoken to during this visit confirmed that they were always made to feel welcome in the home and could visit whenever they wished. One particularly commented on the hospitality of the staff and their friendliness. St Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 17 A limited range of structured activities is offered to residents. These tend to occur after 4pm when staff sit and play games and chat with them. This leaves a long period of time when residents are not occupied. During this time it was noted that staff do not take the opportunity to engage with residents, who are left just sitting in the lounge often in a row around the walls. This was discussed with the manager who has already identified a training need for staff so that there is an increase in the interaction between them and the people that they are caring for. Some outside entertainers visit and recently some residents were able to go on a trip out of the home. Spiritual needs are addressed by representatives from local churches who visit regularly. The lunchtime meal was served during the inspection either in the dining area or on small tables in front of residents. It was well presented and people told us that they enjoyed it. There were enough staff around to help those who needed it. It was considered that there were some improvements that could be made to make dining a more pleasurable experience for people. Tables are laminated and easily cleaned however; they would look better with a cloth on. There was no salt and pepper on the table and the only menus displayed are outside in the hall and could not be seen by residents. The manager has plans to address these issues and also to replace the melamine crockery with china. The cook has worked in the home for some time and knows the residents well. She is able to cater for individual requests due to either dietary or cultural preferences and meal choices are always available. St Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 18 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): Standards16, 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People say that they are confident that any complaints would be taken seriously and dealt with. However they might not always be aware of the procedures to be followed. The home endeavours to protect from people from harm and also from those who have been judged as being unsuitable to work with vulnerable adults. EVIDENCE: Residents and their relatives that we spoke with said that they could raise any issues with Matron or the other staff and they would deal with them. The home has an appropriate complaints procedure however, it does not seem to be displayed anywhere in the home. It is incorporated in to the service user guide but not all residents have a copy of this in their rooms. This procedure must be available to anyone wishing to make a complaint; it is recommended that a copy should be made available in the entrance hall. There has been one concern raised since the last inspection. This was investigated according to the local authority’s safeguarding procedures and was found to be unsubstantiated. The home has a policy regarding the protection of vulnerable adults and any concerns would be referred to the appropriate agency. St Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 19 All staff have attended training in recognising and reporting adult abuse, although training schedules showed that for some this was not recent and needs to be updated. Staff that were spoken with knew about the procedures that they should follow if they had any concerns although they were not aware of the term whistle blowing and the protection that would be afforded to them should they report issues. Information about this will need to be included in any training that is arranged. The home must ensure that people who live there are protected from those who have been judged as being unsuitable to work with vulnerable adults. We looked at the personnel files of staff who have been employed since the last visit to make sure that all of the relevant checks had been carried out. All of the files contained clearance from the Criminal Records Bureau and the Protection of Vulnerable Adults Register. However, it appeared that this clearance had not been available before they had started work. We were told that confirmation had been obtained via the Nursing Home Association, verbally, before documentary evidence was available. The manager was reminded of her responsibilities with regard to this procedure. St Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 20 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): Standards19, 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are living in a safe, clean and well maintained home, which suits their needs. EVIDENCE: St Judes is situated in a quiet residential area of Sutton within walking distance of the town centre. It was originally 2 large houses that have been joined to form one large home and accommodation is spread over the three floors of the building. There are two passenger lifts and two stair lifts to enable access for people with limited mobility. There is a range of communal space with lounges and dining areas in both houses. There are bathrooms, showers and toilet facilities throughout the home and an attractive rear garden that is well maintained and is accessible to everyone. St Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 21 Adaptations, such as handrails, ramps and assisted bathing and toilet facilities have been put in to the home to enable those with limited mobility to retain as much independence as possible. The home is well maintained and pleasantly decorated and there is an ongoing improvement and refurbishment plan. Resident’s bedrooms are bright and airy and people have been encouraged to bring items from home so that they can personalise them. It was noted that some of the bedrooms were rather hot. We were told that although radiators are individually controllable it is not easy to access the controls because of the radiator covers. The maintenance man has apparently been made aware of this and is going to modify them. Wooden flooring has been laid in communal areas of the home. It is acknowledged that this is easier to keep clean and the home now smells much fresher, however it looks quite bare. Discussions were held with the manager about adding pictures etc. to help brighten it up. If these were of subjects that had some relevance to the people living in the home this would also provide some reality orientation for those with dementia. There is an intention to provide more structured activities for residents and it was suggested that craft items and pictures that were produced might be displayed. The home was clean, tidy and free from malodour on the day of the inspection. Measures to help prevent cross infection such as protective gloves and aprons are available for staff. Planning permission has been granted to extend the home on the ground floor and increase the lounge/dining area. St Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 22 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): Standards 27,28,29,30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are always enough staff working in the home to meet the needs of the people who are living there. The manager has identified shortfalls in staff training and is working to address them. Recruitment procedures are in place to prevent those people who have been judged as being unsuitable to work with vulnerable adults from working in the home. EVIDENCE: The home is staffed throughout the 24-hour period by both trained nurses and care staff, in sufficient numbers to meet the needs of the people who live there. They are supported by a range of ancillary staff such as cooks and domestic workers. In addition the manager is also a trained nurse and in the home from Monday to Friday. The majority of care staff have either gained an NVQ to at least level 2 or are working towards one. The home also employs nurses on the Overseas Nurses Programme. These are nurses who have qualified abroad and are undertaking a period of supervised practice prior to being employed as a nurse in the United Kingdom. St Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 23 The home must ensure that people who live there are protected from those who have been judged as being unsuitable to work with vulnerable adults. We looked at the personnel files of staff who have been employed since the last visit to make sure that all of the relevant checks had been carried out. All of the files contained clearance from the Criminal Records Bureau and the Protection of Vulnerable Adults Register. However, it appeared that this clearance had not been available before they had started work. We were told that confirmation had been obtained via the Nursing Home Association, verbally, before documentary evidence was available. The manager was reminded of her responsibilities with regard to this procedure. We looked at the list, which shows the training that staff in the home have undertaken and saw that for some staff this has been quite limited. The manager has identified the shortfalls in training and has plans in place to address these. We were able to see the list of training that is provided by the local authority and she is intending to access these sessions for her staff. It will include more training about dementia awareness and responding to challenging behaviour. St Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 24 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): Standards 31,33,35,38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by an appropriately qualified and experienced person and in the best interests of the people who live there. The health and safety of the people who live and work in the home is promoted and respected and resident’s financial interests are safeguarded. There are some opportunities for them to influence the provision of care in the home although these could be improved. EVIDENCE: Since the last inspection a new manager has been appointed, although an application for her registration with The Commission is still awaited. She is very experienced, having been employed in a similar role in the past, and has completed The Registered Managers Award. St Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 25 She displayed a good understanding of both the problems experienced by the people who live in the home and the needs of the staff team. She is supported by a deputy manager and a senior nurse both of whom have also attained The Registered Managers Award. There are some opportunities for residents and their relatives to comment on the running of the home. There have always been regular residents/relatives meetings held in the home and they are well attended. The Registered Provider is often in the home and carries out monitoring visits, in line with Regulation26, to make sure that everything is in order and that residents are happy. However, the manager is aware that this is an area, which could be developed further in order to gain the views of both the people who use the service and others who visit the home on a regular basis. No money is held on behalf of residents, invoices are sent to their representatives when needed. One resident, whose allowances are paid to the home as a part of her funding arrangements, was concerned that this was not being done correctly. The manager has agreed to look into this for her. Records and documentation that the home is required to keep, as evidence of their commitment to the health and safety of the people who use the service, were in order. Recommendations made by the Environmental Health Officer have been complied with and a 4 star rating was given to the kitchen earlier this year. The home tells us that all of their equipment has been maintained appropriately and fire training for all staff has been arranged. It was noted that the fire risk assessment needs to be updated and the manager is aware of this. St Judes Nursing Home DS0000019126.V371123.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 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 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 St Judes Nursing Home DS0000019126.V371123.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 OP16 Regulation 22(5) Requirement The homes complaints procedure must be available to anyone who might need it so that they are aware of the processes to be followed should they wish to raise any concerns. Documented evidence of the confirmation of clearance against the POVA register must be available for all staff, prior to employment, to help ensure the safety of people who live in the home. Timescale for action 28/09/08 2 OP18 19, (5) 28/08/08 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 OP1 Good Practice Recommendations It is recommended that the Service User Guide and any other documentation intended to be read by residents and their relatives, should be produced in a more easy to read format. DS0000019126.V371123.R01.S.doc Version 5.2 Page 28 St Judes Nursing Home 2 OP9 It is recommended that where residents have no known allergies to any medication that this should be recorded on the MAR sheet to protect them. St Judes Nursing Home DS0000019126.V371123.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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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