Care Home: St Nicholas House

Similar services:

• Claremont House
• Oak Ridge
• Sun Court Nursing Home
• Ashville House
• Bilney Hall
• Hill Barn
• Mabbs Hall Nursing Home
• Henrietta House

What the care home does well What has improved since the last inspection? What the care home could do better: CARE HOMES FOR OLDER PEOPLE St Nicholas House Littlefields Dereham Norfolk NR19 1BG Lead Inspector Jenny Rose Unannounced Inspection 9th November 2007 09:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Nicholas House DS0000034973.V354581.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 Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Nicholas House Address Littlefields Dereham Norfolk NR19 1BG 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) 01362 692581 01362 699418 www.norfolk.gov.uk Norfolk County Council-Community Care Mrs Joanne Marie Bolton Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home is registered to accommodate 32 Service Users who are Older People, not falling within any other category. The accommodation is not suitable to accommodate people who need a wheelchair to assist with independent mobility at the point of admission. No service user who relies on a wheelchair to assist with mobility should be accommodated on the first floor due to the size of the lift. 11th December 2006 Date of last inspection Brief Description of the Service: St Nicholas House is a two storey residential care home providing accommodation and care for thirty-two older people. It is owned and run by the Local Authority, is situated within a short walk of all facilities and the town centre of Dereham and stands in its own, well kept grounds. All bedrooms are single, contain a washbasin, are arranged on both floors and are a mix of above or just at the minimum standard in size. On each floor there is a communal bathroom containing adapted bath and toilet and separate toilet facilities. The home has a passenger lift to the first floor that is not able to accommodate service users who use a wheelchair. There are four large communal lounges and several small sitting areas around the home and service users have the choice of eating in a large, downstairs dining room or in one of the lounges or their bedroom. A hairdressing facility is available and an independent chiropodist also visits the home. The gardens offer service users pleasant areas to sit and there is parking to the front and side of the building. The current fees are £368.72 a week as stated in November 2006. Additional costs include chiropody at £12, hairdressing at approximately £7.50, plus newspapers, magazines, toiletries, confectionary, optician and the payphone at varying costs. St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out, by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. This was a key, unannounced inspection carried out over a period of 9 hours, during which time a partial tour of the premises was undertaken; care plans, staff files and records for regulation were examined. The Manager was available throughout the day, together with two Care Coordinators and several other members of staff in the office. Discussions took place in private with four residents, five members of staff on duty, two visitors, the District Nurse and several residents in passing. The Annual Quality Assurance Assessment (AQAA), seven comment cards from residents and six from relatives/friends had been returned to the Commission prior to the Inspection which provided useful information and is reflected in this Report. What the service does well: • • The Home stands in pleasant gardens having many features affording enjoyment to residents and visitors. Residents and relatives speak of the staff team being kind, caring and helpful although there are some concerns about staff time constraints. There are good training opportunities for staff and career development appraisals. A comprehensive needs assessment is undertaken prior to people being admitted to the Home in order to assess whether the Home can meet those needs. Trial visits are offered before decisions are taken to live in the Home long term, as well as trying to ensure that the new resident has met at least one member of staff beforehand. Relatives and friends are able to visit whenever they wish and are made welcome. There are rooms designated for residents to see their visitors in private, other than their bedrooms, and a variety of other communal areas, which are homely and clean. • • St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 6 • Care plans are organised, indexed and reviewed and give clear instructions from which staff are able to support residents according to individual needs. The Home has a new restaurant style system for meals, hot/cold drinks, readily accessible fresh fruit and snacks which are available in the new ‘Bistro’ style dining room, which is furnished and decorated to a high standard. The Home is piloting a study, in conjunction with the University of East Anglia, on the effects of more flexible meal arrangements and choices on improved nutrition for residents. There are good medication practices in place tying in with the more flexible meal times and regular audits on a shift/daily/weekly/monthly basis. • • • What has improved since the last inspection? • Staff recruitment documents have been obtained from County Hall but there remain long standing members of staff for whom these documents did not exist originally. Annual staff appraisals have been completed for all staff, although there are still some gaps in recorded supervision. All residents’ monies are held on an individual basis, correctly recorded and audited. The Manager has organised a dependency assessment to be undertaken on all residents. Laundry Assistants’ hours have been increased to relieve care assistants from non-care related tasks and pre-admission assessments are more rigorous to ensure that the Home can meet prospective residents’ needs. An Annual Quality Assurance has been completed together with an Annual Development Plan. Staff training and assessments of residents is taking place in the use of the MUST (Malnutrition Universal Screening Tool). Some areas of the Home have been redecorated and refurbished; the Home has the services of a maintenance person on a part time basis. Costings have been sought for the creation of a shower room, the alteration of two upstairs toilets to assist moving and handling of residents with walking frames and the revamping of the existing nonassisted bathroom; work has yet to be started on these. DS0000034973.V354581.R01.S.doc Version 5.2 Page 7 • • • • • • St Nicholas House What they could do better: • • The Home still does not possess adequate bathing facilities, or suitable upstairs toilet facilities for those with walking frames. The lift is too small and cannot safely accommodate wheel chair users. Metal window frames need to be replaced and these have become part of a five year development programme. Areas of the Home are still awaiting redecoration, particularly in relation to wheelchair scuffs. There were some documents, which were undated, as found at the last inspection. There were delays in replacing staff vacancies, due in part to the delays in CRB checks, which again were due in part to the Mail strike, and long term staff sickness. These all resulted in some staff shortages making necessary the use of agency staff, which the Manager finds unsatisfactory. Although staff appraisals had taken place, regular recorded staff supervision was still not entirely satisfactory, although it was evident that continual ‘work based’ staff supervision is taking place. Care staff are further encouraged to undertake NVQ qualifications by agreeing to undertake such training as and when they join the staff team. There is room for improvement in building upon the details of personal life histories, with the resident’s permission, in conjunction with the activities programme in order to further improve the more person centred, holistic care already offered. The return to the use of individual books for recording the administration of Controlled Drugs would further serve to eliminate errors and protect residents. It would be advantageous for advice to be sought from a Fire Safety Expert for the Manager in completing the necessary Fire Risk Assessment for the Home. • • • • • • • • 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 Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living in the Home have their needs comprehensively assessed prior to admission to ensure that the Home is suitable for them. The Home does not provide intermediate care. EVIDENCE: The AQAA states that on receipt of a referral a member of the senior team will visit potential residents and carry out a comprehensive assessment to ensure that the Home can meet their needs. All relevant information is given at this assessment including a comprehensive Service Users’ Guide and it is planned to also put together a fact sheet for prospective residents. Where possible prospective residents are encouraged to visit the Home. It was confirmed by a new resident that although she had been unable to visit the Home, her relatives had done this for her. The Manager confirmed that assessments are carried out by two staff members whenever possible; there was evidence that a review is held after 4 weeks and that these assessments form the basis of the care plans which are regularly reviewed. St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 10 The AQAA also states that the Home endeavours to ensure good practice in that the person who carried out the initial assessment is on duty when the new resident arrives. In addition, there are plans to improve documentation regarding pre-admission assessments and a fact sheet to be put together for prospective residents for pre-admission in order to further facilitate decision making. The Home does not offer intermediate care. Residents’ comments: “Used to come for respite breaks prior to admission” All comment cards were positive in relation to the necessary information being received before admission. St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the Home are very satisfied with the delivery of their care and respect for their privacy and dignity. EVIDENCE: Four care plans were examined. Each contained a photograph of the respective resident and these residents were spoken to. The care plans were well organised and indexed, gave good detail in all respects of the residents’ care, including their emotional needs and were signed by the residents. The care plans were reviewed regularly and the residents spoken to felt their needs were met. Comment cards overall were positive concerning the standard of care received. The District Nurse who was visiting on the day of the Inspection, (as she does weekly) spoke of the good communication with staff and that she is involved in training staff in various aspects of residents’ medical care. There were good records of medical visits and other healthcare professionals are involved where necessary. Two visitors confirmed that the Home had coped well with the complex medical needs of their respective relative over the past two years. St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 12 One of the Care Co-ordinators is the link person in the Home for staff working with the Malnutrition Universal Screening Tool (MUST). Food Diaries are kept and fortified meals provided for those residents as required. Observation of part of the medication round found the medication records well recorded and containing a photograph of the resident, as well as a staff signature chart all following correct procedures. The medications are now dispensed at a time convenient for the resident who have the choice of flexible meal times. There is a daily sheet recording a four hourly gap between medications for each resident, which is continuing good practice. Other examples of good practice are the auditing of medications in the trolleys on a daily basis and the checking of the daily sheet with the MAR sheets. The Care Coordinator administering the medication on the day of the Inspection spoke of the good relationship which exists with the Pharmacy and GPs and further checks have been devised with the surgeries to ensure the safe administration of certain medications Staff administering medication have received training and extra training is provided on site by the District Nurse. The medication is stored in the medication room properly equipped with an air conditioning machine. Controlled drugs are appropriately stored. A complicated, slow process of cross referencing in the Controlled Drugs record, was immediately rectified, but there is a recommendation that Controlled Drugs should be recorded in individual books, as had been the previous practice, in order to further eliminate errors as far as possible. All the residents spoken to said that the staff treated them with respect and it was seen that they knocked on doors before entering. The member of staff responsible for the laundry that day, spoke of the pride she took in carrying out her job with sensitivity of residents’ dignity. The Manager spoke of a pilot scheme taking place by the Premises Procurement Department of the County Council in investigating computer assistive technology to further promote residents’ autonomy by providing residents with individual call pendants in addition to the general call system, which is another example of good practice. Relatives’ comments: “We are very grateful for the expert and professional care that St Nicholas House provides”. My relative is very happy in the Home and I am very pleased with the care she receives due to the staff who look after her”. “The Care Home staff are excellent and treat my relative as an individual”. “Staff very informed and always there to discuss anything”. Great at caring for (relative) stops me worrying. Have expertise to meet needs”. St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 13 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 excellent. This judgement has been made using available evidence including a visit to this service. People living in the Home have excellent opportunities to exercise both choice and control over their lives. EVIDENCE: There is evidence from the large print Minutes that social activities and outings are discussed at each monthly residents’ meeting and Bingo is held weekly according to residents’ requests. TVs, Video’s and DVD’s are available in a number of areas of the building and a quiet room with reading material and craft items. A computer is available in one quiet area, but online connection is not set up, therefore there is a recommendation for this, in line with a relative’s comments. Outings are made for lunch, as well as fish and chip suppers, strawberry teas, family BBQ’s and seasonal specials arranged in the Home. There are weekly religious services. Visitors are encouraged to take meals with residents. Manicures are available. Entertainers visit the Home. The staff have also devised their own version of ‘Play your Cards Right’, popular with the residents. However, one resident spoken to said that she preferred to spend time in her room, knitting, where she also has tapestries she has worked displayed. However, she said she enjoyed going to the Bistro for her meals and two St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 14 visitors confirmed that their relative preferred to spend time in his room, except for meals when he was feeling well. In the summer many residents enjoy the garden; plant tubs and containers have been planted up by residents and other areas are tended by relatives and friends as well as by the general maintenance agency. A gazebo had proved a popular sitting place for residents in the summer months according to several people spoken to. The Manager reported that staff input for social activities is limited due to staffing constraints and in view of comments from relatives and residents there is one recommendation that consideration should be given to designating an activities organiser to develop a programme in line with the needs, wishes and life histories of the people living in the Home. Two residents spoken to and two visitors confirmed that they were welcomed in the Home at any time. One resident goes shopping for others and two other residents go out on a regular basis and others go out with their families/friends. The residents and visitors spoken to commented favourably on the range of choices open to them. For example they said that they could get up when they like as breakfast is available from 8.30 to 10.00 am and there were residents in the dining room taking breakfast on the morning of the Inspection. Many of the residents choose to have a full cooked breakfast. On the day of the Inspection one resident was observed asking for the vegetarian option to be liquidised. Comment cards and residents confirmed that meals could be taken where the residents chose. In the Minutes of the residents’ meeting in November it was recorded that the residents had asked that on Christmas Day there should be only one sitting so that all the residents could have lunch together. The residents spoken to showed much appreciation of the innovative restaurant ‘Bistro’ style dining room and meals. This is also a source of some pride with the staff spoken to, both in the kitchen and care staff who were providing a waitress service at the tables. The Manager said that the residents chose the name “Nick’s Bistro” including the pictures and the decorations for this room. An individual menu is displayed on each table and a fruit bowl and a coffee and water dispenser is readily available for those able to help themselves. A display fridge containing sweet and savoury snacks is always available and the menus are varied and nutritious and the food was displayed attractively on the servery and looked appetising. The residents can come and go as they like and the administration of medication has been organised flexibly on an individual basis. All the care staff have undergone MUST training and the ‘Bistro’ project is the subject of ongoing UEA research into its effect on the nutrition and health of the residents. St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 15 Residents’ Comments: How can the Home improve? “A few more activities would be nice.” “I am very happy here.” “More residents’ meetings required.” Relatives’ comments: “I think it would be good to get residents involved in activities. Internet access would also be good.” “I know my mother is very happy to be where she is.” “If my relative doesn’t want to go or is not well enough to go to the dining room for his meals they are taken to his room and he has good meals.” What does the Home do well? “Looks after all aspects of our relative’s care as well as considering the feelings of our family members.” “May be a few more social activities.” “Good relationship with family.” St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 16 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 living in the Home feel that complaints and concerns are listened to and acted upon, and that the Home’s policies and procedures ensure that residents are safeguarded. EVIDENCE: All comment cards said they would know how to make a complaint as well as visitors spoken to. The Home has a clear policy and procedure for dealing with complaints; a record is also kept of compliments. Since the last inspection three complaints had been received; and all had been dealt with appropriately. However, one complaint was undated and this is the subject of a recommendation. There had been a compliment describing the care in the Home as “gold standard”. Examination of training records and from speaking to staff it was evident that staff have received training in recognising the signs and symptoms of abuse. All residents spoken to felt they were well treated by staff. Resident comment card: “Yes, I know how to make a complaint, but no need to.” St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 17 Relatives’ comment card: “I would ask if I needed to.” “If I have any concerns we discuss them and make a decision on how to proceed.” They are also very good at alleviating fears.” St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 18 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): 19,26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living in the Home have a clean, safe, well maintained environment, but there are insufficient bathrooms and unsuitable toilet facilities and although there are plans to improve this situation, this has not yet taken place. EVIDENCE: The garden is pleasant for residents to sit in the summer; one resident was seen to be enjoying the winter sunshine sitting outside on the day of the Inspection. One resident planted up pots during the summer, the pond is looked after by a relative of a staff member and the Manager said that the new gazebo was well used in the summer, together with the new hardwood furniture. A tour of the premises demonstrated that the Home has a homely and welcoming atmosphere and is generally maintained with the assistance of a part time maintenance person, whose hours have been increased to 10 hours per week. There are many areas within the Home for residents to sit, including St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 19 three large lounges, five alcoves where residents can have more privacy, a coffee lounge and a visitors’ room, situated next to the Bistro where it is possible to buy cards, although this doubles as a room for administering medication during the flexible mealtimes. There is another area where residents can access a computer and the Internet. The District Nurses have the use of a room in which they keep their notes and where a new floor has recently been laid and redecoration taken place. A hairdressing room is available. Redecoration and refurbishment has been taking place in many areas of the Home and one corridor has been rewired. An upstairs room unused by residents has been changed to a training suite for staff with video equipment etc. As mentioned in the last inspection, the good practice continues of residents’ bedroom doors have individual nameplates on, originally initiated by the administrator, but now some relatives have taken on this task to illustrate residents’ interests around their names. There are wheelchair scuffs, especially in one bathroom, which the Manager explained would come into the redecoration programme, but there remains a repeated requirement for this work to be commenced. Although progress has been made in the planning for improvements in bathroom/shower facilities, there is in effect only one fully working bathroom in the Home. This is decorated to a high standard. There was email evidence on the day of the Inspection that the plan is for tenders to be invited from designated contractors with a view to achieving contracts to be awarded prior to the Christmas holiday period. Pre-start meetings are scheduled to be held early January 2008 and works to commence mid-late January 2008. However, there is a repeated requirement, highlighted in the last four inspections for sufficient bathrooms/shower rooms to be provided for the people living in the Home. Two toilets situated next to each other on the first floor are very small and if a resident uses a walking frame this would have to be left outside the door. The Manager pointed out that if a resident fell staff would have difficulty in gaining access to them. There have been plans submitted to the Commission for plans to remedy this situation by making two larger toilets, but this work is scheduled for 2008/09 and therefore the requirement is repeated. By January 2008 every toilet in the Home will have some upgrading according to the Manager. From the Minutes of the residents’ meetings it is evident that the residents are aware of these intended improvements and are looking forward to them being completed. St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 20 The lift is too small and cannot accommodate a wheelchair safely. This is in the plan for refurbishment for 2010/11; no residents are admitted to the Home using a wheelchair and this is in the Statement of Purpose. . All bedroom doors are fitted with a lock and residents may hold a key, if they so wish. The Home has four EVAC chairs on the first floor in case of emergency. Work has been carried out to fit new fire doors with automatic closures on all bedroom doors. The Home has old metal windows, but the Manager says that these are not too draughty but it is planned to replace these in 2010/11. All windows have restrictors fitted on the first floor. There is weekly/monthly Legionella testing and training in infection control for staff. On the day of the Inspection the Home was clean and tidy. Relatives’ Comments: “Provides a caring, well organised environment for our relatives.” “Very friendly and homely” St Nicholas House DS0000034973.V354581.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 living in the Home are satisfied with the delivery of their care, but swifter recruitment to vacant posts would further improve the quality of the service. EVIDENCE: All the residents spoken to, together with the relatives’ comment cards received, were positive about the staff team, although some recognise that there are some shortfalls in staff numbers and that staff time was limited. The members of staff spoken to also confirmed that they would like more time to be spent one-to-one with residents. The Manager said that there had been delays in filling recent staff vacancies due to the time taken in receiving Police checks; in part also due to the Mail strike. Although the AQAA states that the rota is revised to cover the busiest parts of the day and that additional hours have been allocated to cover early morning and breakfast times in particular, there is a high use of agency staff, which the Manager does not find satisfactory. Therefore the requirement is repeated in this area; although it is acknowledged that the Manager has undertaken to comply with the requirement from the previous inspection to the effect that the dependency levels of residents are monitored in order to determine staffing levels and the Laundry Assistant hours have been increased to free up Care Assistants from undertaking some of these non-care related tasks. There are also several staff members who are on long term sick leave from a variety of causes. St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 22 It was evident on the day of the Inspection, including talking to staff in private that there is an enthusiastic staff team who enjoy working with residents in a caring and respectful way and promoting individual’s dignity and choice. Staff members undertaking kitchen and laundry tasks were enthusiastic about their duties and took obvious pride in performing them well. From examination of files Induction training is completed by all staff and all are offered various training opportunities in addition to Induction training, such as training in Diabetes and MUST training The Manager confirmed that 15 out of 34 staff had gained NVQ2 qualifications or above and that with the 4 people undertaking these qualifications would amount to fifty percent of the staff team with this level of achievement. Newly recruited members now need to agree to undertake NVQ2 qualifications before starting employment. One Care Co-ordinator has a Registered Managers’ Award, two others are completing NVQ3 and another member of staff has an NVQ Assessors Award, as well as management experience. The documents and information needed prior to making staff appointments were seen to be in place before a new member of staff started work and the requirement from the previous inspection complied with. All members of staff spoken to were aware of the issues involved in Safeguarding Adults and had received training in this area. There is a key-worker system, which works well according to residents and staff spoken with. The AQAA states that it is the Home’s intention “to appoint a Dignity Champion to be aware of equality and diversity issues for residents.” All staff have received Staff Appraisals within the last year; there are regular staff meetings which all members of staff said they found helpful. Staff also said that they felt there is sufficient time at the beginning and end of shifts together with support within the staff team which enables them to carry out their work in a competent manner. However, there are still some gaps in regular, recorded supervision (see “Management”) although there was evidence of continuous ‘on the job’ supervision. Residents’ comments: “More staff required” (Other comments were all positive) Relatives’ comments: “The staff are friendly, it’s a lovely atmosphere.” “Due to being short staffed, the staff haven’t always got time to get my friend up as early as he liked.” St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 23 Relatives’ comments (contd) “St Nicholas House already provides excellent care home facilities. I hope that it continues to receive sufficient funding to continue to provide first class service and adequate care staff.” “I think the staff do a very good job and the Home emanates a warm feeling to one and all.” “They have supported my relative and me in ways I never thought possible”. “The staff are amazing.” St Nicholas House DS0000034973.V354581.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): 31,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. People living in the Home have confidence in the positive lead given by the management team in the delivery of their care. EVIDENCE: The Manager has been in post for some years. She has the NVQ Registered Managers Award and is shortly to complete the NVQ4 in Care. She has valuable experience of previously undertaking various roles in residential care from Domestic to Night staff roles. She is keen to maintain and improve her own skills and has recently received training in the implications of the Mental Capacity Act and has completed her own Personal Development Plan in Management Development training. From observation and from speaking to staff it is evident that there is a strong management team in place consisting of four Care Coordinators and four Senior and three relief Senior Carers who are seen as open and approachable by the staff. This was also confirmed by St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 25 two visitors spoken to. The Care Coordinators are qualified and have their own special areas of responsibility, such as overseeing medication, staff rotas and care plans. The Local Authority monitors the quality of the Service. This includes questionnaires to residents, their relatives, relatives and other interested parties. The Manager has also completed the AQAA and an Annual Development Plan. There are regular staff, senior staff and residents’ meetings; copies of the latter were seen. Regular Regulation 26 visits take place and copies of these are sent to the Commission. Residents’ finances are audited regularly by the Local Authority and a recommendation from the previous inspection had been complied with in that residents’ monies are now being kept individually and a random sample was checked on the day of the Inspection and found to be correct. Since the last inspection, all staff have received annual staff appraisals as part of their career development; staff supervision on a regular basis has improved, but the Manager said there were still some gaps, although supervision on the job takes place and staff spoken to confirmed that they could always go and seek advice, but this is not always recorded. Therefore the requirement from the previous inspection is repeated. Staff files contained evidence that all staff receive training relating to Moving and Handling, First Aid, Food Hygiene, Fire Safety and Infection Control; this was confirmed by members of staff spoken to. Accidents and Incidents were seen to be recorded and Regulation 37 forms completed as appropriate. Door closers have been fitted on all bedroom doors in the Home. Fire Alarms are tested weekly; Legionella testing takes place on a regular basis. However, it is recommended that advice is sought from a Fire Safety Expert to assist the Manager in completing the current fire risk assessment for the Home. Staff Comments: “The Senior team are open, transparent and effective.” St Nicholas House DS0000034973.V354581.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 X X 4 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 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 1 X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP21 Regulation 23 (2) (j) Requirement The Registered Person must implement the plan to ensure there are enough bathrooms available for the number of people living in the Home. The Registered Person should continue to implement the plan to repair and redecorate any wheelchair damage to doorways and to redecorate bathrooms and toilets making them more homely for the people living in the Home The Registered Person must implement the plan to make all toilets accessible to residents, including those using a walking frame. Staffing ratios should continue to be determined according to the assessed needs of residents, to ensure that the needs of the people living in the Home come first, (this refers to the frequent use of agency staff). Timescale for action 30/04/08 2. OP19 23 (2) (b) (d) 30/04/08 3. OP21 23 (2) (a) (j) 30/04/08 4. OP27 18 (a) 09/11/07 St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 28 5. OP36 18 (2) Formal staff supervision should take place at least 6 times a year. This will ensure monitoring of care practice within the Home for the benefit of the people living there. This is a repeated requirement 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP9 OP14 Good Practice Recommendations It is recommended that care is taken to enter the date on records. It is recommended that Controlled Drugs should be recorded in individual books as had been the previous practice in order to eliminate errors as far as possible. Consideration should be given to appointing a designated Activities Organiser to develop the present activities programme in line with the needs, wishes and life histories of the people living in the Home. Consideration should be given to Internet connection for the computer already available for residents in order to facilitate communication with family and friends for the people living in the Home who wish to do so. Consideration should be given to seeking advice from a Fire Safety Expert for the Manager in completing the Fire Risk Assessment for the Home. 4. OP13 5. OP38 St Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Nicholas House DS0000034973.V354581.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!