Care Home: St Nicholas

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What the care home does well Clear procedures and documentation are in place for assessing people`s support needs and choices before they move into St Nicholas. The level of information obtained helps everyone to decide if St Nicholas is the right place for the person to live. It also helps staff to plan how they can provide the care and support the person needs and wants. People`s health and personal care needs are identified and managed well within St Nicholas. Staff liaise with other professionals to support people with their health care needs. The people living at St Nicholas told us that they like the meals provided. Staff take time to make sure people receive the support they need at mealtimes and to ensure they are offered choices so they can have the meals they prefer. There are activity staff working in the home five days a week. They support people with day to day activities such as bingo and quizzes as well `one off` activities such as themed nights and events, to make sure that everybody who wants to can take part. The people living at St Nicholas are confident that they know who to talk to if they have any concerns. We found during our inspection that staff are clear about their role in dealing with concerns or safeguarding issues and that they make sure appropriate action is taken to deal with people`s concerns and to protect them. We saw that staff have built good relationships with the people living at St Nicholas. Staff have a good understanding of how to support people safely and well and take time to establish their choices and meet these. This is backed up with a good training plan for staff that helps to ensure they have the skills and knowledge to support people safely and well. Clear systems are in place for checking the quality of the service St Nicholas provides. These systems, along with clear planning for any improvements needed, help to ensure that the views of the people living there are listened to. They also help to ensure that any potential issues can be quickly identified and addressed. What has improved since the last inspection? A new assessment and care planning system has been introduced at St Nicholas. This is detailed enough to provide information about the support people need and their choices in all areas of their daily lives. The assessment process is well completed by staff and ensures they can identity the areas the person needs support with. Care plans are personalised and well completed, providing a good basis for staff to plan and provide care. Staff working in Huskinson unit have received more training in supporting people who have dementia. During our visit we noted that they had a good understanding of why people may become upset and how to support them with this. Staff working in Brocklebank unit are undertaking nationally recognised training in supporting people who have a learning disability. This helps to ensure they are up todate with current good practice in this area and can provide good support for the people living in this unit. The refurbishment of a small kitchen in Brocklebank unit provides a facility for people to take part in everyday tasks such as cooking and laundry to help them stay as independent as possible. What the care home could do better: The planned dementia care mapping on Huskinson unit should take place as soon as possible. This will enable the organisation to establish whether there are sufficient staff at all times to support the people living there safely and well. The organisation should consider giving unit managers some supernumerary hours. This would help to ensure they have the time to carry out their supervisory role and ensure records are up to date. Staff should take part in regular fire drills. This alongside the current fire tests and training would help to ensure that people are supported safely and well in the event of a fire within the home. The way in which the mini bus at St Nicholas is funded needs to be reviewed. This will help to ensure that people are only contributing if it is in their individual best interests. The people who live on Brocklebank unit require support as they have a learning disability. Due to the size of the unit it is not possible to provide this support in an `ordinary` or domestic setting. However increasing the daily support for people living there to become involved in every day tasks such as laundry, shopping and preparing meals, would enable them to live a more ordinary lifestyle. Working with the people living on Brocklebank unit to access community facilities such as college classes, would enable them to meet new people and become more a part of their local community. Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Nicholas 21 St Nicholas Drive Netherton Liverpool Merseyside L30 2RG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lorraine Farrar     Date: 2 2 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: St Nicholas 21 St Nicholas Drive Netherton Liverpool Merseyside L30 2RG 01519312700 01519321216 humphrj@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Julia Maria Humphreys Type of registration: Number of places registered: BUPA Care Homes (CFHCare) Ltd care home 176 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies 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: 90) Learning disability - Code LD (maximum number of places: 26) Dementia - Code DE (maximum number of places: 60) The maximum number of service users who can be accommodated is: 176 Date of last inspection Brief description of the care home St Nicholas is owned and operated by BUPA a large national organisation who provide a variety of care and health services across the country. It is in a residential area of Care Homes for Older People Page 4 of 33 Over 65 0 0 90 60 26 0 Brief description of the care home Netherton on the outskirts of Liverpool and is well located for accessing local shops and transport links. There are six care units across the site and a main administration block which houses the manager and deputy, administrators, a main kitchen, laundry, hairdressing salon and staff room. Outside there are large grounds with walkways. Brocklebank, Huskinson and Gladstone units have enclosed gardens, the other units have identified courtyard areas. Each unit has single bedrooms, sufficient bathrooms, a large living / dining room, small kitchen, medication room, sluice and office. The units are dotted around the site and accessed by covered walkways. Alexandra, Canada and Langton units all provide care with nursing for older people. Brocklebank provides care with nursing for adults who have a learning disability. Huskinson provides care with nursing for people who have dementia and Gladstone unit provides care without nursing for people with dementia. There are nursing and care staff available 24 hours a day to support the people living at St Nicholas. In addtion the home employs, domestic staff, chefs, maintainance staff and activities coordinators. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two stars. This means that people who use the service experience good quality outcomes. We gathered information for this inspection in a number of different ways. We carried out an unannounced visit to St Nicholas on 21 and 22 October 2008. The visit took fifteen hours in total. On 21 October an expert by experience accompanied us. An expert by experience is someone who has experience of using care services. In this instance we were accompanied by an expert who had experience in using care services for people who have a learning disability. She spent time talking with people who live in the Care Homes for Older People Page 6 of 33 Brocklebank unit of the home about what is it like to live there. She gave us feedback and we took this into account in writing this report. On 22 October two CSCI inspectors visited the home. During these visits we spoke with thirteen people who live there and twenty staff. We also spent time observing the day to day support that is provided. We looked at records, including care records to see what care people who live at the home need and how this is provided. We also walked round the building to look at the shared spaces such as lounges, dining rooms and bathrooms, as well as some of the bedrooms. Any information we have received about the home since our last big inspection in October 2007 is taken into account. This includes the findings of a short inspection we carried out on Huskinson unit in August 2008 as a result of concerns we had received about the home. Before we visited we sent comment cards to some of the people who live and work at St Nicholas. Nine members of staff and four of the people living there replied. In addition the manager completed a self assessment form we sent her. We used this information to help plan our visit and write this report. Weekly fees include meals and basic laundry. It currently costs between four hundred and ninety three pounds and six hundred and twelve pounds each week to live at St Nicholas. The exact fee is based upon the type of support the person requires. What the care home does well: What has improved since the last inspection? A new assessment and care planning system has been introduced at St Nicholas. This is detailed enough to provide information about the support people need and their choices in all areas of their daily lives. The assessment process is well completed by staff and ensures they can identity the areas the person needs support with. Care plans are personalised and well completed, providing a good basis for staff to plan and provide care. Staff working in Huskinson unit have received more training in supporting people who have dementia. During our visit we noted that they had a good understanding of why people may become upset and how to support them with this. Staff working in Brocklebank unit are undertaking nationally recognised training in supporting people who have a learning disability. This helps to ensure they are up to Care Homes for Older People Page 8 of 33 date with current good practice in this area and can provide good support for the people living in this unit. The refurbishment of a small kitchen in Brocklebank unit provides a facility for people to take part in everyday tasks such as cooking and laundry to help them stay as independent as possible. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed information is obtained about peoples support needs and their choices before they move in to St Nicholas. This ensures that staff can plan how to support the person successfully in the way the person prefers. Evidence: One of the people living at St Nicholas explained to us that before she decided to move in, staff visited her whilst she was in hospital to discuss her support needs and choices. Staff we spoke with confirmed that before anyone moves in they carry put a full assessment of the persons needs and choices. A senior member of staff explained that the only exception to this is if someone moves into the home as an emergency. She told us that in those circumstances staff ensure a full assessment is carried out as soon as possible. We looked at care records for several people who had moved into St Nicholas recently. Care Homes for Older People Page 11 of 33 Evidence: All contained a fully completed assessment form that had been completed with the person and their representatives. In addition a copy of the persons social services assessment is also obtained to help staff draw up care plans that cover all the persons needs. The assessment forms used are comprehensive and cover different areas of the persons health and personal care, as well as their lifestyle choices. This includes looking at any support they need with their culture, religion, mobility, medication and meals. Where an assessment identifies that the person requires some support it notes that staff need to complete a care plan. The level of information obtained via these assessments, along with the clear system for identifying when a care plan is needed, helps to ensure that St Nicholas can support the person in the way they prefer. It also helps staff to compile clear care plans on how they can support the person successfully. The information provided by the manager before our visit confirms that people are able to make trial visits to St Nicholas before they make their decision about where to live. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at St Nicholas receive support so their health and personal care needs are met in a way they prefer. Evidence: The people living at St Nicholas told us in their comment cards they sent back to us that they usually receive the support and help they need with their personal care. During our visit one person who lives at the home described staff as lovely, telling us they come and see if you want anything all the time. Another person living there and her visitors described the care she receives as wonderful. It was clear that people who live at the home receive regular support to maintain their appearance. There is an on site hair salon at St Nicholas, which the people living there are able to use. One person told us that due to her health she had not been able to visit the salon and therefore have her hair cut for some time. The manager told us she was aware of this and was looking into finding a visiting hairdresser who could see people in their bedrooms if needed. Care Homes for Older People Page 13 of 33 Evidence: BUPA, which runs the home, has introduced new documents for assessing and planning how to meet peoples support needs and choices. All of the care plans we looked at had a full assessment of the persons needs and choices completed. Wherever an assessment identified that the person needed support, we found a completed care plan in place to guide staff on how to do this. For example, clear records are maintained of the risk to the person of developing pressure sores and how to minimise this. Records showed that where someone has a pressure sore, these are dealt and there is clear record keeping, reviews of the care and guidance to staff. We also saw clear care plans for supporting people with their religion, environment, nutrition, personal care and medication. The amount of detail in care plans, along with the regular system for ensuring they are reviewed, helps to ensure that people receive the care they need and that any changes to their support needs can be quickly noted and acted upon. Records show that staff work with the person and their representatives in writing care plans. This is good practice as it enables people to express their point of view and take as active a role as possible in the care the receive. For example one record we looked at showed that the person did not want to use bed rails. His decision was recorded along with his and staff agreement to try without and review the situation later. This shows a respect for peoples rights to make their own decisions about their care. Staff told us in their comment cards that they get enough information about the needs of those people they support. During our visit they explained that although time consuming to write, they find the format of the care plans easy to follow and use. One member of staff explained,, I am always given information relevant to my role and the service user. Some information is not relevant therefore I am not shown these parts. I think this is good practice for confidentiality. On Brocklebank unit, care plans we saw were completed and up to date, as they were throughout St Nicholas. However they are not made available in an easy to understand format. It is good practice when supporting people who have a learning disability to look at different formats such as large print, pictures and photographs. This enables people to understand as much as possible about the information and therefore contribute to their care. A senior manager from BUPA told us that this is something BUPA is aware of and plans to address. The people living at St Nicholas told us in their comment cards that they always receive the medical support that they need. Records we saw showed that staff support Care Homes for Older People Page 14 of 33 Evidence: people to access health care professionals, such as the mental health team, district nurse and GP, when needed. We looked at how staff at St Nicholas manage medication by looking at the records of a number of people who live there. We found that medication records are well maintained and tallied with the stocks held. We also found that clear records are in place for dealing with anything unusual. For example, one person needs their medication via a stomach tube and written permission from their GP had been obtained for this. Another person needs to be given their medication covertly and is unable to give their agreement to this. Staff had discussed and agreed the practice with her family and consultant and documented the reasons why. This clear record keeping is good practice as it helps to ensure peoples rights are respected and also to lessen the risk of any mistakes occurring. Medication was stored correctly and clear audit trails are in place. This helps to prevent the risk of errors occurring and also provides a way to quickly note and act on any potential issues that may arise. Throughout our visit we observed staff speaking respectfully to the people living at the home and respecting their dignity. They ensured bedroom and bathroom doors were closed when supporting people and regularly consulted them about their choices. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at St Nicholas are supported so they can make choices and live a lifestyle of their choosing. This could be further enhanced for the people living on Brocklebank by providing more support with every day living skills and tasks so they can become as independent as possible. Evidence: The people living at St Nicholas told us in their comment cards that there are activities arranged by the home that they can take part in. There are several activity staff employed at St Nicholas who provide activities part time on each unit. The exception is Brocklebank unit which has two activity staff providing support Monday to Friday. During our visit we saw activity staff supporting people with armchair exercises, crafts and a trip to the local garden centre. Activity staff explained they do a range of activities such as bingo, quizzes and outings to a local church cafe. Regular theme nights are organised, with recent events including a cruise week, when different meals and activities were provided from countries across the world. At the time of our visit units were decorated for Halloween with a special menu planned. Care Homes for Older People Page 16 of 33 Evidence: Weekly Catholic and monthly Church of England services are held in the home. Staff also advised that they can contact religious ministers at any time if people wish. The expert by experience spoke with some of the people living on Brocklebank unit about the support they get with their everyday skills and activities. Some people felt they did not get to do a lot, whilst others said they enjoyed, holidays, swimming, coffee mornings and the holistic therapist who visits. Support is provided to the people living on Brocklebank unit with a range of activities including everyday domestic tasks, crafts and outings. Staff we spoke with had a good knowledge of the different things people liked to do and how to support them with this. However although the people living there get some support to cook, a couple of people told the expert by experience that they would like to be more involved in cooking everyday, so they can learn more. The newly refurbished kitchen on the unit provides a good facility for people to become more involved in the running of their daily lives, for example by learning and practising making meals regularly and doing their laundry. Although the people on Brocklebank unit get support to go to local shops, garden centres and so on, none of them attend local colleges or classes. This would provide people with a way to make new friends and become part of their local community. Throughout our visit we saw peoples visitors come and go and spend time with the people living there either in communal areas or in private as the person preferred. Information about how to contact local advocacy and support groups is clearly displayed on notice boards around the home. This provides the people living there and their relatives with easy access to obtain further information if they wish to do so. The people living at St Nicholas told us in their comment cards that they like the meals provided. During our visit one person told us, meals are fine, explaining, We get lovely homemade soup. You get what you like for breakfast. We observed mealtimes on some of the units and noted that meals are nicely presented and tables nicely laid. A choice of main meals is available as well as a lite bite menu from which people can choose an smaller meal or snack. In addition all units have sufficient food stocks so that people can request a hot or cold snack at any time. St Nicholas operates protected mealtimes. This involves ensuring mealtimes are quiet, people have time to eat their meal and are uninterrupted. We observed that Care Homes for Older People Page 17 of 33 Evidence: staff took time to establish peoples choices, and to provide discreet support where needed, in a way that promoted peoples dignity and encouraged them with their meal. The atmosphere was relaxed with warmth and humour between the people living there and staff, making for a warm and homely mealtime. The views of the people living at St Nicholas about the home were obtained in a survey in May 2008. Once the results were back menus were changed based upon the things people said they did and did not like. Each new menu is formally assessed by the chef to look at its nutritional value. This helps to ensure that people can eat a diet that will promote their health. Special diets are catered for and BUPA provides a book advising staff on how to cater for and meet different cultural and religious diet requirements. This is good practice as it helps staff to assess and plan how to met someones individual needs before they move in. Care records we looked at showed that regular checks are made on peoples weight, nutritional assessments are carried out and a food diary is kept for a least the first fourteen days they live at St Nicholas. This monitoring helps to ensure people are getting the nutrition they need and to quickly identify and deal with any issues that arise. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear procedures are in place and are acted upon with regards to any concerns or complaints raised. This helps to ensure the people living there and their representatives are confident they are listened to and their concerns acted upon. Evidence: The people living at St Nicholas told us in their survey forms that they know how to raise any concerns they have and how to make a complaint if they need to. This was confirmed during our visit when one person and her visitor told us that although they had no complaints, they were confident staff would deal with any that arose. Another person told us I feel very safe whilst living there. Information about how to raise any concerns or complaints is made freely available to the people living at St Nicholas. They are given a complaints leaflet in their welcome pack and further copies of this are also displayed in the entrances to all units. Staff told us in their comment cards that they knew how to deal with any concerns that were raised with them. This was further shown by staff we spoke with who displayed a clear understanding of their role in dealing with complaints or safeguarding issues. Clear records of complaints and safeguarding issues are maintained at the home. Care Homes for Older People Page 19 of 33 Evidence: These show that any complaints are responded to within a twenty eight day period. Within the past year St Nicholas has made twenty two safeguarding referrals to social services for investigation. The majority of these related to people who receive support with their dementia and occurred between people living on the unit. St Nicholas has responded to this by sending a member of staff on a training course so they can teach other staff how to support people whose behaviour can be challenging. Staff we spoke with had a clear understanding of how to support people in this way, the triggers to look out for and the reasons why people may behave in an inappropriate way. Clear records and risk assessments are in place for supporting people to manage their behavior. These help staff to plan and deal with any issues that may arise. In the past few weeks the number of safeguarding referrals from the home have decreased. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. St Nicholas is kept clean and tidy so it provides a warm, comfortable home for people to live in. This will be further enhanced once the planned decor and security plans are completed. Evidence: St Nicholas is in a residential area of Netherton within easy reach of local shops and public transport. Support and accommodation is provided in six separate units, each with a small kitchen, bathrooms, single bedrooms, office and communal lounge / dining room. In addition there is a main block with a central kitchen and laundry, a hairdressing salon and offices. Each unit has a small courtyard and there are large grounds with walkways surrounding the buildings. The people living at St Nicholas told us in their comment cards that the home is usually fresh and clean. During our visit to the home, we saw that all the areas we visited were clean and tidy. One person we spoke with told us that she thinks her bedroom is lovely and that cleaning staff, keep it beautiful. They do it everyday. All of the bedrooms at St Nicholas are single rooms that people are able to personalise with their own possessions to help them feel more at home. Various equipment is provided throughout the home to support people to move around Care Homes for Older People Page 21 of 33 Evidence: as independently as possible. This includes call bells, adapted baths, grab rails and portable hoists. All areas are on the ground floor and are easy to access for people with mobility difficulties. Huskinson unit is for people who have dementia nursing care needs. The unit has been refurbished within the past year and is in good decorative order. Although there are three baths that are adapted so people can receive support with their personal care, there is no adapted shower on the unit. The addition of an adapted shower would enable people to have more choice about how they receive their personal care. We noted that there are few orientation aids on the unit such as photographs and signs. Staff did explained that some of these have been removed by the people living there. However the use of such aids helps people to find their way around more easily and should be encouraged. Brocklebank unit supports people who have a learning disability and need nursing support. As with the other units there is a large lounge / dining room. This makes it difficult to provide domestic style living for people. However the room is nicely furnished and decorated and staff have used settees to create smaller areas within the lounge. This enables people to engage in different activities within the room. In addition the unit has a smaller lounge, which is used for activities such as crafts, and a newly refurbished kitchen. This provides the people living there with a facility to learn everyday skills such as cooking and laundry. Some areas of the home are beginning to look shabby and would benefit from redecoration and refurbishment. For example on Gladstone unit we noted that carpets were stained and the floor in the small kitchen was worn. The manager explained that a bid has been put into BUPA for refurbishment of large parts of the home in 2009. There have been some incidences of attempted or actual break-ins at the home. BUPA has responded to these by liaising with the local crime prevention officer and setting up a risk management plan. Staff we spoke with told us that they check all external doors and windows each evening and one of the people living there confirmed that staff check her patio doors every night. In addition firm plans are in place for fitting new window locks, signs and extra railings. These measures should help to make St Nicholas a safer place to live. We spoke with some staff who explained that at times they have not had infection control equipment such as gloves and water soluble bags available. This was discussed during our visit with the manager. She responded by holding a meeting with staff to address these concerns and putting a plan into place to ensure they have access to Care Homes for Older People Page 22 of 33 Evidence: appropriate equipment at all times. Records we saw showed that staff receive training in infection control and we observed staff taking infection control measures during our visit. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There staff at St Nicholas are experienced and have received training so they can meet the needs of the people living in the home safely and well. However, at times there may not be enough staff working in one unit to provide support as quickly as people need. Evidence: The people living at St Nicholas told us in their comment cards that staff usually listen to them and act on what they say. During our visit staff displayed a good knowledge of the people living at St Nicholas and of their support needs and choices. We observed that staff had built good relationships with the people living there, taking time to talk with them and establish their choices as well as providing support with their personal and health care. During a visit we made to the home in August 2008 we identified that staff and relatives of the people living on Huskinson unit felt that at times there were not enough staff working in the unit to support the people living there fully. During our visit this time staff told us that they felt there were usually enough staff across the site. However on Huskinson unit they told us that they can feel under pressure during the evening meal to provide the support needed and this can impact on peoples agitation levels. The manager is aware of this and has met with staff and relatives. Care Homes for Older People Page 24 of 33 Evidence: She has drawn up an action plan stating that BUPA will send in a compliance and monitoring team to carry out a dementia mapping exercise so that they can assess the appropriate input of care to provide. Each of the units has a designated unit manager. Records show that these managers undertake training relevant to needs of the people living on their unit. For example the manager of Brocklebank has recently completed a learning disabilities award. This helps to ensure unit managers have the knowledge to guide staff on how to support people safely and well. Unit managers work shifts and do not have any hours when they are not directly responsible for care during their shift. Some of the unit managers told us that as the amount of paperwork is increasing they find it difficult to do this within their working hours. One unit manager explained they sometimes stay behind after their shift has ended in order to complete the necessary paperwork. Some identified management hours for managers on each unit would help to ensure they have the time to carry out their supervisory role and complete documentation whilst other staff are available to support the people living there directly. Records we saw and discussions we had with staff confirmed that before anyone starts work at St Nicholas a series of checks are carried out. These include obtaining written references and checking with the Criminal Records Bureau (CRB) and register of people unsuitable to work with vulnerable adults. These checks help to ensure staff are suitable to work with people who may be vulnerable. Staff told us in their comment cards that they get good training opportunities and feel they have the experience and knowledge to support people successfully. Staff we spoike with during our visit were able to tell us about recent training they had attended and what they had learnt from this to help them in their role. BUPA has a clear induction and training programme in place which ensures staff are trained in basic areas such as fire safety, moving and handling, and food hygiene. Records also showed that staff undertake more specialist training such as providing care for people with dementia or learning disabilities as well as with personal and health care issues such as continence, pressure sores and conditions relating to old age. Over 50 of the staff hold a national qualification in care (NVQ). The training provided helps to ensure staff are knowledgeable and up to date in how to support people safely and well. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. St Nicholas is safely managed so it is run in the best interests of the people who live there. Evidence: The manager of St Nicholas, Julie Humphreys, is an experienced manager who has undertaken several courses the field of care. In addition she is working towards the registered manager award which she told us she intends to complete by the end of 2008. There are several systems in place within St Nicholas for checking the quality of the care provided there. These include regular checks and audits of care records, medication and maintenance, as well as the environment. The views of the people living there are also obtained. A survey about the catering was carried out in May 2008 and the manager advised general surveys have recently been distributed to everyone. These provide the people living at St Nicholas with a way to formally express their Care Homes for Older People Page 26 of 33 Evidence: views and influence how the home operates. A senior manager from BUPA carries out monthly documented visits. These look at different aspects of the support provided and include discussions with the people living there and with staff. Once completed an action plan is drawn up for future improvements. Records we saw showed that where an audit is carried out managers follow up on this to ensure any identified action is taken. Following our visit in August 2008 the manager put together an action plan stating how they intended to meet our requirements and recommendations. This clear planning and following up of actions needed helps to ensure that St Nicholas can continue to improve the service provided for the people who live there. Clear procedures are in place for dealing with money belonging to the people living at St Nicholas. Wherever possible BUPA does not act as appointee for peoples money. Where they hold any money for people this is held in a residents bank account and clear records are made of any transactions. We looked at a sample of records and found that these tallied with bank statements. A monthly reconciliation is carried out and checked by the home manager and a senior BUPA manager. This helps to avoid or quickly note and deal with any errors that may rise. Brocklebank unit has a mini bus that is funded by some of the people living there. This is an historic agreement that the person or their relative agreed to some years ago. However, as people move on or as some people get less mobility benefit than others, this arrangement may mean that some people are contributing a higher amount than is reasonable for them, whilst others may benefit without contributing. Records and certificates showed that regular checks are carried out on equipment and the building to ensure they are safe. This includes regular checks of the fire system, gas supply, lifting equipment and electrics. However records showed that staff have not taken part in a fire drill recently. These help to ensure that staff know what to do to make sure the people who live in the home are safe if there is a fire, so should be carried out regularly. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 33 Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 27 18 The planned dementia care mapping on Huskinson unit must be completed and any findings in relation to peoples dependency levels and appropriate staffing levels for them acted upon. This will help to ensure there are sufficient staff available to support the people living there at all times. 23/01/2009 2 35 12 The arrangements for 28/02/2009 funding the mini bus used by people living in Brocklebank unit must be reviewed. This review must take into account, via assessment and consultation, the best interests of each individual. This will help to ensure that peoples best interests are met and their money managed safely and well. Care Homes for Older People Page 30 of 33 3 38 23 A system must be set up for ensuring all staff participate in regularly fire drills. This will help to ensure staff are aware and familiar with the correct action to take in the event of an unexpected fire alarm sounding. 09/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care plans for the people living on Brocklebank should be made available in easy to understand formats such as large print, pictures and symbols. This will provide as much opportunity as possible for people to understand and contribute to their plan. Arrangements should be made for a visiting hairdresser who can see people in their bedrooms if they wish. This will help people to maintain their appearance in a way they prefer. The people living on Brocklebank unit should be supported to access more regular activities outside of the home. This will provide them with the opportunity to meet new people, become a part of their local community and widen their everyday experiences. Where possible, the people living on Brocklebank unit should be supported to take a more active role in the everyday running of their lives. This should include involvement on a regular basis in household tasks such as cooking and laundry. This will support people to lead a more ordinary lifestyle and to have more direct control of their daily lives. The home should consider providing accessible showers on units where these are not available. This will give the people living there more choices in how they receive their personal care. Carpets on Gladstone unit should be deep cleaned to remove stains. This will help to make the unit a more attractive place to live. 2 8 3 12 4 12 5 19 6 22 The use of orientation aids and signs should be encouraged Care Homes for Older People Page 31 of 33 on Huskinson unit. This will help the people living there to find their way around more easily. 7 27 Consideration should be given to providing unit managers with some supernumerary management hours. This will help to ensure they have the time to carry out their supervisory duties and complete relevant documentation, within their set working hours. Care Homes for Older People Page 32 of 33 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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