Care Home: St Paul`s Care Home

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What the care home does well All residents and visitors to the home said that it had a very friendly and welcoming atmosphere. The home is well maintained and kept clean; residents said they were comfortable living there. There is a well-trained staff group, who are supportive to residents and treat them with respect. Most staff, including the manager, have worked at the home for many years. Residents are able to make choices about their daily lives, such as what they want to eat, how and where they want to spend their time and what activities they want to pursue. They have good quality food provided and are able to choose from a range of alternatives at each meal. A visitor said `I`m satisfied that they care about my relative on an individual basis; they`re genuinely interested`. A resident said `I couldn`t wish for better care`. What has improved since the last inspection? Not applicable. What the care home could do better: The patio area is presently bare apart from a table and some chairs and does not present an inviting place for people to sit out in. CARE HOMES FOR OLDER PEOPLE St Paul`s Care Home High Street Waddington Lincoln Lincs LN5 9RF Lead Inspector Julie Western Unannounced Inspection 7th November 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Paul`s Care Home DS0000070144.V354110.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 Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Paul`s Care Home Address High Street Waddington Lincoln Lincs LN5 9RF 01522 721764 01522 721764 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) Majestic 3 Limited Mrs Paula Wheat Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered persons may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission are within the following category: Old age, not falling within any other category - code OP. The maximum number of service users who can be accommodated is 22. Not applicable 2. Date of last inspection Brief Description of the Service: St. Paul’s care home with nursing is situated in the village of Waddington on the outskirts of the city of Lincoln. The building is two-storey, with the second floor being reached by stairs or a shaft lift. There is a small patio area with seating to the rear of the building and parking for several cars to the front. There are two lounges and a dining room. The home is registered to give nursing and personal care for up to 22 older people. On the day of the inspection the home was fully occupied, with 19 nursing and three residential residents being accommodated. Since the last inspection the home has changed ownership and is now owned by Majestic 3 Ltd. The manager and staff have remained the same. A representative from the company visits on a monthly basis and completes a report about the operation of the home, copies of which are available to the commission. At the time of the inspection the home confirmed that the weekly fees ranged from £394 - £570, depending on the assessed needs of the resident. Additional charges are made for services such as chiropody and hairdressing. Information about these costs as well as the day-to-day operation of the home, including a copy of the last inspection report, is available in the reception area or the manager’s office. St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took into account any previous information held by CSCI including the home’s service history, any pre-inspection questionnaires completed by the Manager and any residents’ questionnaires sent to the home by the Commission prior to the inspection. The site inspection was unannounced, took place over three hours and consisted of tracking a sample of residents’ care records and assessing the care given. Some policies and procedures were examined and some records concerning the safety of the home were also seen. Three residents, three care and ancillary staff and two visitors were spoken with. The nurse in charge of the shift was present for the first part of the inspection and the manager was present for the latter part. What the service does well: What has improved since the last inspection? Not applicable. St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Residents benefit from a range of information that allows them to make a choice of where to live, and they are assured that their need can be met by way of a thorough assessment process. EVIDENCE: The staff member on duty said that either she or the manager visited prospective residents in their homes, or in a care setting such as a hospital. The new company’s pre-admission assessment had been used for the most recent three admissions and was clear and concise. An up to date statement of purpose is available in the entrance hall for people to read. The manager said that the service user guide was currently with the printers following the takeover of the company, but that service users could still access the previous service user guide. St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 9 Pre inspection information shows that there are policies for referrals and admissions. Admission assessments cover needs such as communication, hearing, eyesight, personal care and social profiles. There is also information about religious needs, community involvement and social contacts. On-going assessments are in place for pressure area care, moving and handling, falls, nutrition and continence. Records show that these assessments are reviewed on a monthly basis There is also evidence in individual files that residents and/or their representatives receive confirmation that their needs can be met within the home. Contracts are available for each resident, setting out the individual terms and condition of their placement. These are currently kept at the central office. The visitor said that she was able to visit at any time and was always made welcome and offered a drink. Two residents described how they had visited the home before moving in permanently while a third said that the move had been managed straight from hospital by relatives The home does not provide intermediate care. St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a supportive staff team who treat them with respect. There are comprehensive care plans in place to ensure that all of the residents needs are met. EVIDENCE: The senior nurse on duty explained that the care plans are currently being changed to the new company’s care plans. These were clear and comprehensive, addressing needs such as falls, nutrition, catheter care, night care, pressure area care, personal care and medication. They also referred to making choices, likes and dislikes and they directed staff to give clear explanations to residents about any care they carry out. There is clear monitoring of health needs within the care plans for example, regular weight recording, optician, dentist and chiropody appointment records and monitoring of catheter changes. St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 11 There is evidence that the plans are reviewed monthly and signed where possible by the resident or their families. The manager said that a key worker system was present and this enabled residents to have one member of staff to have closer contact with and to discuss their needs. Staff members were observed to carry out personal support sensitively and with regard for their dignity, allowing them choice wherever possible. One resident said ‘They help me in any way I want’ and another said ‘they’re all lovely, all good’. All residents spoken with said that they could see their GP’s when they needed to. Medication records, storage and administration procedures were satisfactory and in line with relevant policies. The pharmacist, who last visited on 19/9/07 had no issues of concern. Staff were observed giving explanations to residents when administering their medications. St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to make choices about what they want to do in their daily lives, and they benefit from being able to maintain and develop social and leisure pursuits to whatever level they wish. EVIDENCE: There is an activity co-ordinator in post; she works three days per week. On the day of the inspection residents were making Christmas decorations for a Christmas fair. Information about resident’s social needs and community contacts is available in their files, together with their likes and dislikes for activity. Activity displayed in the entrance hall included activities such as flower arranging, baking, reminiscence, beauty care, coffee mornings and arts and crafts. There is evidence in records that resident’s individual religious needs are met either in the home or by supporting them to attend local churches. St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 13 Residents in the activities room were having a sherry before lunch; they described a recent summer fair and a champagne barbecue, to which relatives were invited, visits to Doddington Hall, manicures, Bingo and trips out in wheelchairs. One resident who did not like to leave her room described individual sessions with the activity co-ordinator and the visitor mentioned staff reading to residents with poor eyesight. . One resident had brought in some paintings she had done some years ago and all were admiring them. Residents said that they could choose where to spend their time, whether they wanted to join in activities and what they wanted to eat. A new menu is being developed; it shows a choice of meals that are based on what residents like. Residents and the staff said that they choose what they want from the menu but they can change their mind at meal times if they wish and an alternative is always provided. Residents said that the food is of a good quality and there is plenty of it. The kitchen staff described how they assisted residents who needed pureed food, or help with cutting up meals. Staff members were observed to be encouraging and supporting residents to be as independent as they were able to be with the lunchtime meal. The manager said that under the new management they are able to buy locally grown vegetables from the farmer and the food budget had risen, to enable them to buy better quality food for residents. St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 14 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. Residents are protected by a knowledgeable and responsive staff team, and by clear policies and practices. EVIDENCE: Complaints records showed that there had been no complaints or safeguarding adult referrals made since the new management took over. Policies were available for safeguarding adults, concerns and complaints, whistle blowing and risk assessing and management. The complaints policy was clearly displayed in the entrance hall, and residents and a visitor said that they knew how to make a complaint. They said that they were confident that their issues would be dealt with. Residents said that staff generally help them to feel safe and secure within the home and that staff answer their call bells very quickly; they rarely have to wait ‘more that a minute or two’ for a response. Records showed that staff members had received training in safeguarding adult issues, and during discussions with them they were able to demonstrate a clear knowledge and understanding of the issues, and what to do if they witnessed or suspected such. Risk assessments are in place for needs such as falls, general mobility, nutrition and the use of bed rails. The registered manager said that there were no residents currently using advocacy services, but the information was St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 15 available on a notice board in the entrance hall for residents to use if they wished to do so. St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe and pleasant environment that is designed to meet their individual needs. EVIDENCE: On the day of the visit the home was well maintained externally, although the outside patio area was bare of plants and did not look inviting. The manager said that there were plans to use part of the ‘dignity in care’ grant awarded by the government to improve this area with climbing plants and raised flowerbeds. A tour of the building showed that it was clean and tidy throughout internally. Décor and furniture was generally well maintained. The manager said that since the new owners took over the running of the home, three new profile beds had been purchased, plus a bed that was St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 17 adjustable to floor height. New scales for weighing residents had also been purchased. The home’s fire alarm system had been completely renewed. There was a new carpet in the activities room. Residents spoken with were very pleased with their rooms and were very comfortable living at the home. A visitor said that her relative moved into a freshly painted room that was newly painted, warm and comfortable and they were able to bring pictures from home. The bedrooms were pleasantly personalised and had space to accommodate any equipment required. Call bells were within easy reach of beds and seating in the bedrooms. The environmental health officer visited the kitchens on 6/7/07 and awarded the home three stars according to the local council’s system, which equalled a good score. The manager said that the kitchen was to undergo a deep clean and issues arising from the environmental health officer’s report would then be dealt with. Substances that could be hazardous to health were stored appropriately, and there were information sheets and risk assessments in place to ensure that use of these was managed safely. The home smelled clean and fresh throughout St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff members are sufficiently competent and qualified to care for the residents safely and appropriately. There are sufficient numbers of staff to meet the residents’ needs. EVIDENCE: Recruitment records contained application forms, references, criminal record bureau checks, and identification. The new owners had just delivered sent employee handbooks for all staff and these were very comprehensive about all aspects of staffing issues. The duty rota showed that the staff hours provided are more than the hours of care required, and staff members said that there were enough staff on duty to meet the needs of the residents. Staff members were observed to be taking time to interact socially with residents, and there was a calm and relaxed atmosphere within the home. Residents and the visitor all said that there were enough staff members to attend to their needs. This is a stable staff group with most staff members having worked at the home for many years and they are therefore able to provide continuity to residents. St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 19 Members of the staff team said they had received training in subjects such as fire safety, bed rail use, care planning, nutrition, catheter care, food hygiene, medication and supervision under the previous ownership. During discussions the manager confirmed that the training plan is still with the central office. Staff said that they felt listened to and respected by colleagues, and they had opportunities, such as staff meetings, to share their views and opinions. They demonstrated through discussion and observation of their practice that they have a detailed knowledge of residents’ needs, including likes and dislikes and daily routines. Records showed that 3 staff members had achieved the National vocational Qualification [a nationally recognised qualification] at level three with one member working towards it; 2 staff members had achieved the NVQ at level two and two were working towards it. A member of the kitchen staff was undertaking NVQ level two in catering. Residents said that staff members were ‘very friendly, always say hello’ and ‘they’re lovely and caring’. The visitor said that e staff members helped to make the home part of the community and showed a real interest in residents. St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by good record keeping practices, policies and procedures, and an effective management approach. EVIDENCE: The registered manager is a qualified nurse with extensive experience of working with older people. She has worked in this home for 24 years, several of these as deputy manager, and has managed the home for 18 months. Staff and residents commented that she is approachable and very supportive and rotas show that she spends a proportion of her working time providing direct care. She said that this helps her to maintain her understanding of the needs of the residents and staff. St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 21 The home was taken over in May of this year and the chairman of the new company has visited on several occasions to talk with residents, relatives and staff members. The information showed that a representative of the provider organisation visits the home on a monthly basis, to monitor standards within the service and staff members confirmed this. Records show that regular audits are carried out in relation to medication arrangements, care planning and accident monitoring. The manager said that currently there is a fortnightly ‘heads of department’ meeting with the operational manager, the deputy manager, a care assistant nominated by the staff, maintenance, housekeeper and cook. The manager said that resident satisfaction surveys are carried out and satisfactory comments have been made about the care and accommodation provided within the home. Good infection control procedures were in place and staff demonstrated through their practice of hand washing and wearing protective clothing that they understood the issues relating to this. Safety information such as the safe use of bedrails was available in the nurses’ station. There were records to show how residents were supported to manage their finances and a sample of residents’ monies was found to balance. Staff said that they had regular one to one supervision sessions as well as daily and on-going support from the registered manager and colleagues. Records showed that that policies were available for issues such as accidents, quality assurance, emergencies and crises, equal opportunities, fire safety, general health and safety, and record keeping. The information also showed that there were regular fire safety checks and fire risk assessments. St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 22 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 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/a STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP19 Good Practice Recommendations The patio should be made to look more inviting for residents to sit out in good weather. St Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Paul`s Care Home DS0000070144.V354110.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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