Care Home: St Mary`s Nursing Home

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What the care home does well Interaction between staff and people that lived at the home was friendly and professional. During the inspection staff were observed to ensure that people`s privacy and dignity were respected. The staff group worked well as a team and communicated positively with each other. The home was clean and there were no unpleasant odours. The maintenance team worked to ensure that repairs were completed in a timely manner. The care plans of people that lived at the home were clear and detailed the support that people preferred and required to meet their needs. The relative survey asked what they felt the service did well and comments included `the staff are very devoted to the care of the residents. They are always available, cheerful, patient. Nothing appears too much`, `gives a feeling of being one big family, most people look out for each other (staff and patients)`, `top class nursing` and `personal care, make visitors feel welcome`. What has improved since the last inspection? Records were maintained which identified where staff had observed changes in people`s conditions, such as where they had noted areas of the body that were sore or where bruises were observed. People`s preferences regarding their personal hygiene were recorded and met, such as if they preferred a bath or shower. There was a programme of activities that people could participate in if they chose to and daily group activities were displayed on a notice board in the lounge. Staff spoken with had a clear knowledge of the fire evacuation procedures in the home and regular fire safety evacuation tests were undertaken. Dorguards were in good working order and there were no fire doors wedged open, which ensured that people were safeguarded in case of a fire. Repairs were routinely undertaken and during the inspection there were no identified areas that required attention. Staff recruitment records that were viewed included suitable references to ensure that the appropriate checks had been undertaken to ensure that people were safeguarded. What the care home could do better: The staff training records that were maintained in the home did not clearly identify that staff were provided with a Skills for Care Common Induction Standards induction when they started working at the home. CARE HOMES FOR OLDER PEOPLE St Mary`s Nursing Home Undercliff Road East Felixstowe Suffolk IP11 7LU Lead Inspector Julie Small Unannounced Inspection 3rd September 2008 08:55 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 Mary`s Nursing Home DS0000024500.V371239.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 Mary`s Nursing Home DS0000024500.V371239.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Mary`s Nursing Home Address Undercliff Road East Felixstowe Suffolk IP11 7LU 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) 01394 274547 01394 278131 Mrs Rema Jayarajan Mrs Lalitha Samuel, Mrs Shereen Jesudason Mrs Irene Geok Choo Margetts Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places St Mary`s Nursing Home DS0000024500.V371239.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 Up to a maximum of 5 places may be used to provide respite care to persons aged between 55 and 65 years of age. 8th May 2006 Date of last inspection Brief Description of the Service: St Marys is a privately owned care home, providing care with nursing for up to 40 older people. The accommodation is in a large, extended house set in its own gardens overlooking the sea in Felixstowe. There are 28 single bedrooms and 6 double bedrooms, most with en suite toilet facilities. St Marys is close to the town centre of Felixstowe and the beach, and amenities are accessible to more mobile residents. Rail and bus services are available from the town centre to Ipswich. The current weekly charges range from £481 to £675 per week. St Mary`s Nursing Home DS0000024500.V371239.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 2 star. This means the people who use this service experience good quality outcomes. The unannounced inspection took place on Wednesday 3rd September 2008 from 8.55 to 16.15. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. The registered manager was present during the afternoon of the inspection and the registered manager and staff provided the requested information promptly and in an open manner. During the inspection four staff recruitment records, the care plans of four people who lived at the home and fire safety records were viewed. Further records viewed are detailed in the main body of this report. Eight staff members and six people who lived at the home were spoken with. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) and surveys were sent to the home to provide people with an opportunity to share their views about the service. The AQAA, one service user survey, ten relative/visitor surveys and two staff surveys were returned to us. What the service does well: Interaction between staff and people that lived at the home was friendly and professional. During the inspection staff were observed to ensure that people’s privacy and dignity were respected. The staff group worked well as a team and communicated positively with each other. The home was clean and there were no unpleasant odours. The maintenance team worked to ensure that repairs were completed in a timely manner. The care plans of people that lived at the home were clear and detailed the support that people preferred and required to meet their needs. The relative survey asked what they felt the service did well and comments included ‘the staff are very devoted to the care of the residents. They are always available, cheerful, patient. Nothing appears too much’, ‘gives a feeling of being one big family, most people look out for each other (staff and patients)’, ‘top class nursing’ and ‘personal care, make visitors feel welcome’. St Mary`s Nursing Home DS0000024500.V371239.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 Mary`s Nursing Home DS0000024500.V371239.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Mary`s Nursing Home DS0000024500.V371239.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to be provided with the information that they need to make an informed choice about where to live and to be provided with a needs assessment before they move into the home to ensure that their assessed needs are identified and met. The home does not provide an intermediate care service. EVIDENCE: The Statement of Purpose and Service User’s Guide were viewed and included the information about the home which people needed to enable them to make decisions about where to live and about the services that were provided at the home. The Statement of Purpose and Service User’s Guide included the aims and objectives of the home, people’s rights and choices, fire safety, details of St Mary`s Nursing Home DS0000024500.V371239.R01.S.doc Version 5.2 Page 9 the manager and staff training and qualifications, activities that were provided by the home and the details about the environment. A service user survey stated that they had received enough information about the home that helped them to decide if it was the right place for them. The relative survey asked if they had received enough information about the home to help them to make decisions. Five answered always and five answered usually. The records of four people who lived at the home were viewed and they included needs assessments that identified the support that each person needed and preferred on a daily basis. The assessments included details of support and daily care needs, continence, dietary needs, communication, medical history and medication. The AQAA stated that prospective residents were provided with a needs assessment prior to them moving into the home to ensure that their needs could be met. People’s records included care plans, which identified how their assessed needs were met and they were regularly updated with the people’s changing needs and preferences. St Mary`s Nursing Home DS0000024500.V371239.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to have their needs and preferences set out in an individual care plan, to have their health care needs met, to be protected by the home’s medication procedures and to be treated with respect. EVIDENCE: The support that people needed and preferred to meet their assessed needs were recorded in an individual care plan. The care plans of four people who lived at the home were viewed and they included details of the person’s religious needs, personal care requirements and preferences, communication, mobility and dietary needs. The care plans included details of the preferences of people regarding when they wished to get up in the morning and go to bed and if they preferred to bathe using a shower or a bath. The care plans were updated regularly to reflect the person’s changing needs and preferences. St Mary`s Nursing Home DS0000024500.V371239.R01.S.doc Version 5.2 Page 11 The care plans viewed included risk assessments, which identified possible risks and methods of minimising the risks, in areas of people’s lives such as manual handling, falls and pressure areas. The service user survey stated that they were always provided with the care and support that they needed. People that lived at the home who were spoken with confirmed that their needs were met and that they were happy with the service that they were provided with. The relative survey asked if they felt that their relative’s needs were met at the home. Seven answered always and three answered usually and comments included ‘we are very pleased with the care given’ and ‘I cannot speak highly enough of the staff’. The survey asked if their relative was provided with the support that they expected or agreed. Six answered always, two answered usually, one answered sometimes and one did not answer. The staff survey asked if they were given up to date information about the needs of the people that they supported. One answered always and one answered usually. Two staff surveys stated that the ways that they passed information on about people always worked well. Staff spoken with had a clear understanding of people’s individual needs and how their needs were met. People living at the home were provided with support that ensured that their health care needs were met. Four people’s records that were viewed included details about their individual health care needs were met, which included details of the health care treatment that they had received, such as from the GP, dentist, chiropodist and optician. Daily records were maintained which identified people’s well being and daily activities. Records were maintained which identified where staff had observed changes in people’s conditions, such as where they had noted areas of the body that were sore or where bruises were observed. The treatment for the observed areas of concern were clearly recorded. There were clear records of people’s falls and actions which had been taken in the prevention of falls. Falls were regularly monitored on a monthly basis, which identified when and how falls had occurred, which the manager stated helped them to identify if there were patterns or triggers of falls. MUST (malnutrition universal screening tool) assessments were in place to ensure that people were supported with their specific dietary needs. A service user survey stated that they always received the medical support that they needed. People spoken with reported that their health needs were met and that the staff called a doctor promptly if they had concerns about their well being. It was noted during the inspection that people’s privacy was respected. Staff were observed knocking on bedroom and toilet doors and waiting to be invited St Mary`s Nursing Home DS0000024500.V371239.R01.S.doc Version 5.2 Page 12 in, before entering them. During a tour of the building a staff member introduced us to people that lived at the home and asked for their permission to enter their bedrooms. Staff were observed to be attentive to people’s needs and they were observed asking them if they would like drinks and if they were comfortable. The interaction between staff and people that lived at the home was observed to be caring and professional. It was noted that staff answered call bells promptly and people looked clean and tidy. People who lived at the home that were spoken with confirmed that their privacy was respected and that the staff were caring and treated them with respect. Comments that were made by people that lived at the home were ‘you cannot fault the staff’ and ‘they are very kind’. The AQAA stated that they did well by ‘ensuring privacy, dignity and respect’. Medication was stored, handled and administered in a safe way, ensuring that people who lived at the home were safeguarded. There were two secured medication trolleys (one trolley for the top and ground floor residents and one trolley for the first floor residents) which were stored in a secured room in the home. The medication room also contained hand washing facilities, an appropriately secured controlled medicines cabinet and a fridge where medication that must be kept refrigerated was stored. Records of regular temperature checks of the fridge and the medication room were viewed, which ensured that medications were stored in the recommended temperatures. The majority of people’s medication was stored in MDS (monitored dosage system) blister packs. The medication record keeping safeguarded people with regards to the administration of medication. MAR (medication administration record) charts were viewed and were completed appropriately to show when people had taken their medication and when they had refused it and the reasons for refusing the medication, for example if they were not in pain and did not wish to take PRN (as required) pain relief medication. People’s care plans that were viewed included a list of their prescribed medication. The controlled medication book was viewed and completed appropriately, which included the signatures of two staff to show that people had taken their medication and a running total of the administered and stored medication. Part of the lunchtime administration of medication was observed and a staff member clearly explained the procedures for the safe handling of medicines. Two staff members were responsible for administering medication, one person worked with one of the medication trolleys for the people that resided on the top and ground floors of the home and one staff member worked from the other medication trolley for people that resided on the first floor of the home. A staff member explained that the methods used ensured that people were St Mary`s Nursing Home DS0000024500.V371239.R01.S.doc Version 5.2 Page 13 provided with their medication in a timely manner. One person at a time was assisted with their medication, the staff members checked the records to ensure that they were administering the correct medication and dosage to the correct person. Training records were viewed and evidenced that staff who were responsible for administering medication were provided with medication training. Further training included syringe driver provided by St Elizabeth’s Hospice, wound care, peg tube and medication for the elderly with swallowing difficulties. The home had a medication procedure which clearly explained the safe handling, storage and handling procedures of medication. The AQAA stated ‘the home has a policy for the receipt, storage, handling, administration and disposal of medication’ and ‘the manager did random checks on medications to ensure that the staff are following policies and procedures’. St Mary`s Nursing Home DS0000024500.V371239.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, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to be provided with a choice of activities which they could choose to participate in, to be supported to maintain contacts, to be supported to make choices in their lives and to be provided with a balanced diet. EVIDENCE: The daily activity programme was displayed on a notice board in the lounge, the days activities included conversation and puzzles. Further activities included visiting entertainers, manicures, weekly religious worship service, quizzes, weekly hairdresser visits and board games. The manager explained that they ensured that people were provided with one to one activities such as conversation with staff. They said that people’s friends and family supported the activities programme, such as a relative read to their family member and a relative played cards with their family member on a regular basis. It was recommended that the home maintain records of which people participated in the provided activities to ensure that all people were provided with the opportunities to participate in activities of their choice. St Mary`s Nursing Home DS0000024500.V371239.R01.S.doc Version 5.2 Page 15 The AQAA stated ‘the local community and church is involved in the homes activities’ and that they have improved in the last twelve months ‘I have identified a therapy practitioner who can offer hand massage and reflexology’. A relative survey stated that people were provided with varied routines and two stated that the home could improve by providing more activities. People spoken with reported that there were activities that they could enjoy that were provided at the home. A person was spoken with and stated that they enjoyed reading and had a good supply of books that they could read, which their family had bought in for them. During the inspection people were observed to be watching television, enjoying the views of the sea and reading newspapers and books. During the inspection a person from the local church visited the home and discussed with the manager people that may benefit from visits from volunteers. The manager explained that people who had no visitors would benefit from the befriending service that was offered. The person was spoken with and stated that they would arrange for volunteers to visit individual people and that they could choose what they wanted to do, for example to chat or play games. They confirmed that all visitors would be CRB (criminal records bureau) checked to ensure that people were safeguarded. Care plans that were viewed included information about the contacts that people maintained with their family members and friends. People spoken with said that their family and friends were welcomed into the home. A person said that their family were always welcomed with a cup of tea when they visited. During the inspection people were observed to receive visitors from family members and friends. The interaction between staff and visitors was observed to be friendly and professional. People spoken with said that the staff at the home listened to them and that they could choose what they wanted to do each day. A service user survey stated that the staff usually listened to them and acted on what they said. The care plans that were viewed detailed the preferences that people had, which included the times that they preferred to go to bed, how they wished to be addressed by staff, their likes and dislikes with food and drinks and how staff should provide them with daily choices, such as what clothes they wished to wear. The minutes of residents meetings that had taken place in 2007 were viewed and showed that people were provided with the opportunity to discuss the support that they were provided with in the home and to offer their suggestions to the food that was provided with an annual barbecue. The relative survey asked if they felt that people were supported to live the lives that they chose. Five answered always, three answered usually and comments included ‘(the person) said that (the person) was quite happy and St Mary`s Nursing Home DS0000024500.V371239.R01.S.doc Version 5.2 Page 16 fortunate to be where (the person) is’ and ‘…those that do still have choices, are supported in whatever they wish to do’. The AQAA stated ‘service users are individuals with complex needs and we adopt a flexible daily routine, privacy and dignity is the essence of our person centred care with choice and control over their lives’. During the inspection it was noted that people were provided with choices such as their meal and drink choices and what they wanted to do during the day. A person said that they chose to take their breakfast in their room but liked to come downstairs for their lunch and that the staff respected their choices. People spoken with said that the quality and the quantity of food was very good, that they were provided with choices of alternatives if they did not wish to have the meals that were on the menu. A service user survey stated that they usually enjoyed the meals at the home. People who lived at the home were provided with a diet which was appealing and nutritious. The menu was viewed and it was noted that the planned meals were balanced and nutritious. On the day of the inspection the main meal was chicken or honey glazed gammon and a choice of mashed potatoes, macaroni cheese and fresh vegetables. People said that they enjoyed their meal and comments included ‘lovely’. People were observed to be provided with drinks regularly throughout the day and people said that they could ask for a drink at any time. There were jugs of water and squash that people could help themselves to or ask staff to help them with, that were provided in the dining room throughout the day. The dining room was provided with sufficient tables for people to enjoy their meals at. People that required assistance to eat their meals were supported by staff who sat next to them during their meal and remained with them until they had finished their meal. People’s care plans that were viewed clearly identified people’s specific dietary requirements, food allergies and the support that people required. Care plans included MUST assessments for people who required specific support with their nutrition and diet. Training records that were viewed showed that staff were provided with malnutrition training from a dietician and training on nutritional assessments for the elderly (MUST). St Mary`s Nursing Home DS0000024500.V371239.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, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to be protected from abuse and to have their complaints and concerns listened to and acted upon. EVIDENCE: People were provided with the information that they needed to enable them to make a complaint about the service that they were provided with. The home had a complaints procedure and a summary of the procedure was included in the Statement of Purpose and Service User’s Guide. The AQAA stated ‘the service users are informed of the concerns/complaints procedure and are supported by staff in making their complaint’. The AQAA stated that they had improved in the last twelve months by ‘reduced official complaints by listening and responding effectively’. The complaints book was viewed and there were no complaints made since the last inspection. The manager stated that they had not received any complaints since the last inspection. A range of cards and letters of thanks were viewed, which were from family members of former residents thanking the staff for the care and support that they had provided their relative with. St Mary`s Nursing Home DS0000024500.V371239.R01.S.doc Version 5.2 Page 18 Two staff surveys said that they knew what to do if a resident, relative, advocate or friend had concerns about the home. Eight relative surveys stated that they knew how to make a complaint and two stated that they did not. The relative survey asked if the home had responded appropriately if they had raised concerns. Six answered always, two answered usually and comments included ‘senior staff are always available for discussions’, ‘this circumstance has not yet arisen’ and ‘no experience as yet’. A service user survey stated that they always knew who to speak to if they were not happy and that they knew how to make a complaint. People spoken with stated that they were aware of how to make a complaint if they were not happy with the service that they were provided with. Staff were informed of their responsibilities in safeguarding adults who lived at the home by the home’s safeguarding policy and procedure and by attending adult safeguarding training. Staff spoken with were aware of their responsibilities in the protection of people who lived at the home. The AQAA stated ‘staff trained in protection of vulnerable adults and work to these regulations, procedures are in place to respond to evidence or suspicion of neglect. St Mary`s Nursing Home DS0000024500.V371239.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, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to live in an environment which is clean, safe and well maintained. EVIDENCE: People were provided with a clean, safe and well maintained environment to live in. At the time of the inspection it was noted that the home was clean and tidy and there were no unpleasant odours. A tour of the building was undertaken and it was noted that the communal areas were clean and tidy. People spoken with were complimentary about the environment that they lived in and they reported that the home was always clean and tidy. A service user survey stated that the home was always fresh and clean. St Mary`s Nursing Home DS0000024500.V371239.R01.S.doc Version 5.2 Page 20 The large communal lounge was light and airy, with sufficient comfortable seating for people to use. The dining areas provided sufficient seating and tables for people to use to enjoy their meals. The manager was spoken with and agreed that the communal areas home would benefit from redecoration to ‘refresh’ the environment. It was noted that the communal areas were not in a state of disrepair. The AQAA stated that they ‘have a continuous programme of refurbishment’ and ‘we have recently re-carpeted the sun lounges, dining area, the corridors upstairs and replaced carpets in most of the rooms’. People’s bedrooms that were viewed were clean, well maintained and held their personal memorabilia which reflected their individuality and choice. Two maintenance workers were spoken with and confirmed that the bedrooms were redecorated when they were vacated, this was confirmed in the AQAA. The gardens of the home were attractive and well maintained. There was seating provided for people to use if they chose to. People spoken with said that they enjoyed the grounds and sat outside when the weather was good. The laundry area was clean and contained washing and drying machines and hand washing facilities, including liquid soap and disposable paper towels. Communal toilets and bathrooms provided hand wash liquid and disposable paper towels, which reduced the risks of cross infection. Staff were observed using good infection control procedures during the inspection, which included washing their hands and wearing protective clothing when working with food and issues of personal care, which protected people from cross infection. Staff spoken with had a knowledge of good infection control procedures. Staff training records were viewed and staff were provided with infection control training. St Mary`s Nursing Home DS0000024500.V371239.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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to be supported by staff that are trained and competent to do their jobs and to be protected by the home’s recruitment procedures. EVIDENCE: During the inspection staff were observed to meet the needs of people, they responded to call bells promptly and they were attentive to people’s needs. The staff rota was viewed and it was noted that the home was staffed throughout the twenty four hour period. A staff survey stated that there were always enough staff to meet the individual needs of the people who lived at the home and one stated that there were usually enough staff. Staff spoken with reported that they felt that there were sufficient staff on duty at all times to meet the needs of people. A service user survey stated that staff were always available when they needed them. People that lived at the home that were spoken with reported that there was adequate numbers of staff that worked at the home and that staff were available when they were needed them. St Mary`s Nursing Home DS0000024500.V371239.R01.S.doc Version 5.2 Page 22 Four staff recruitment records were viewed and two held all the required documentation that was required to ensure that people were safeguarded by the home’s recruitment procedures. The recruitment records included CRB (criminal records bureau) checks, work history and two written references. Two staff surveys stated that their employer carried out checks, such as their CRB and references, before they started work. The AQAA stated ‘staff checked for health status, criminal record bureau checks and POVA (protection of vulnerable adults) checks’. Staff training records viewed evidenced that newly appointed staff were provided with an in house induction, which included instruction on the expectations of them in the home and the in house methods in areas such as health and safety and reporting and recording. There was no evidence that the newly appointed staff had been provided with Skills for Care Common Induction Standards. However, training records viewed showed that staff were provided with regular training courses. The manager was spoken with and stated that all newly recruited staff were provided with manual handling, first aid, safeguarding, fire safety and health and safety training. They stated that they were in the process of improving their training records and would ensure that records of newly appointed staff would reflect the induction training that they had been provided with which met with the Common Induction Standards. Two staff surveys stated that their induction covered everything that they needed to know to do the job when they started. Staff spoken with confirmed that they were provided with an in house induction when they started working at the home and several training courses (as above) which provided them with the information that they needed to meet the needs of people. Staff were provided information about how to meet people’s needs and safeguard people who lived at the home by the provision of training courses. Staff training records were viewed, which was a book, which identified the training that staff had attended. Training provided to staff included manual handling, fire safety, health and safety, food hygiene, safeguarding adults, medication, infection control and confidentiality. Staff spoken with stated that they received appropriate training to support them in meeting people’s needs. Two staff surveys said that they were provided with training which was relevant to their role, helped them to understand and meet the individual needs of people and kept them up to date with new ways of working and that they felt that they had the right support, experience and knowledge to meet the different needs of people. The home had met the target of 50 staff to have achieved a minimum of NVQ (National Vocational Qualification) level 2 by 2005, which was identified in the National Minimum Standards relating to older people, which showed that staff had been assessed as competent in their job in meeting people needs. The Statement of Purpose stated that there were fifteen care assistants that worked at the home and eight had achieved a minimum of NVQ level 2 in care. St Mary`s Nursing Home DS0000024500.V371239.R01.S.doc Version 5.2 Page 23 There were eight pre registered nurses who were undergoing adaptation courses. Two nursing staff were spoken with and had achieved their adaptation courses and were undertaking registered nurse roles within the home. The AQAA stated ‘the home has qualified workforce with at least 50 staff holding a nursing qualification NVQ level 2 and NVQ level 3. The management ensures that adequate suitably trained staff are on duty 24 hours’. St Mary`s Nursing Home DS0000024500.V371239.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): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to live in a home which is managed by a person that is fit to be in charge, that is run in their best interests, that their financial interests are safeguarded and that their health and safety is promoted and protected. EVIDENCE: The home was managed by a person that was fit to be in charge, who had been assessed as fit by the CSCI registered manager application process and who had achieved a registered nurse qualification and NVQ level 4 in management. The manager had an understanding of their role and St Mary`s Nursing Home DS0000024500.V371239.R01.S.doc Version 5.2 Page 25 responsibilities. The manager reported that they had regularly updated their knowledge by attending regular training courses. There were Regulation 26 visit reports available in the home, which had been undertaken by the providers to show that the running of the home was monitored on a regular basis. The Regulation 26 reports were routinely forwarded to CSCI for information. Annual satisfaction questionnaires were undertaken, which identified if the people that lived at the home were satisfied with the service that they were provided with. The questionnaires were viewed and the outcomes were positive. The AQAA stated ‘the service user is sent an annual satisfaction questionnaire so that we can monitor whether we are doing well or not’. The home’s procedures for safeguarding people’s finances were viewed and it was noted that they were detailed and provided sufficient information to staff who supported people with their spending monies. The records for people’s finances that were kept in the home for safekeeping were viewed. The records included a running total of people’s money, their spending and receipts for the spending. The balance of two people’s money was checked and it was noted that the records were correct. People’s health and safety was promoted and protected in the home. The maintenance workers were spoken with and provided us with the health and safety monitoring records that they maintained. Health and safety records were viewed and it was noted that regular safety checks were routinely made, such as water temperature, fridge and freezer temperatures and electrical appliance safety. Fire safety records were viewed and regular checks were undertaken of fire safety equipment. There were regular fire safety evacuation exercises undertaken. The home had a fire risk assessment. It was noted during the inspection that fire doors were closed in line with fire safety. The maintenance book was viewed which showed where repairs had been identified and when they had been completed in a timely manner. Staff training records viewed and discussions with staff evidenced that they were provided with health and safety related training such as food hygiene, manual handling, fire safety and infection control to ensure that staff had been notified of safe working practices. The home’s policies and procedures were viewed and included food hygiene, manual handling, fire safety, health and safety and the COSHH (control of substances hazardous to health) which were available for staff reference to ensure that people were supported in a safe manner. St Mary`s Nursing Home DS0000024500.V371239.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 3 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 Mary`s Nursing Home DS0000024500.V371239.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. 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 OP12 Good Practice Recommendations It is recommended that a clear record of activities be maintained to evidence that people are provided with an activities programme which meets with their needs and preferences It is recommended that the records of training be improved to show that newly appointed staff are provided with a suitable induction programme within 6 months of commencing their role 2. OP30 St Mary`s Nursing Home DS0000024500.V371239.R01.S.doc Version 5.2 Page 28 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 St Mary`s Nursing Home DS0000024500.V371239.R01.S.doc Version 5.2 Page 29 - 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. 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