Care Home: St Quentin Nursing Home

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What the care home does well Since we carried out the last Key Inspection of the service there have been many improvements made as identified below. Staff who work at the home are focused on delivering a high standard of care to the people who live there. Staff are attentive to the needs of individual people and people tell us that they are treated with dignity and respect. What has improved since the last inspection? The system for care planning has been changed and care plans are now more person centered. This ensures that care is delivered in a more holistic way. The routines of the home are more flexible and varied and individual choices and preferences are promoted. The system for raising concerns has improved. People are listened to and have a "voice". The staff training programme has developed further, ensuring that staff are equipped with the skills required to meet peoples` needs. The Quality Assurance system has improved and the service regularly assesses itself and makes improvements where identified. What the care home could do better: We did not make any legal requirements as part of this inspection and the following are good practice recommendations areas where the service could improve The system for the administration of medication should be reviewed. This is in order to ensure that medication is only administered to people directly from the medication trolley and is not transported from one area of the home to another in medication pots. This will help to ensure that no mistakes occur and that people are safeguarded. Some of the staff were not clear about the procedures for the reporting of abuse and poor practice. Staff should receive further instruction in this area in order to ensure that correct procedures are adhered to and people are safeguarded. The service should provide a walk in shower facility so that people who would prefer to have a shower rather than a bath are given this choice. The deployment of staff over the lunchtime period should be reviewed in order to improve the dining experience for people and to ensure that people are not waiting for too long for their meal to be served. Key inspection report Care homes for older people Name: Address: St Quentin Nursing Home Sandy Lane Newcastle Staffordshire ST5 0LZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Yvonne Allen     Date: 2 0 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: St Quentin Nursing Home Sandy Lane Newcastle Staffordshire ST5 0LZ 01782662911 01782620255 st.q@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): St. Quentin Residential Homes Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 31 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 31 Date of last inspection Brief description of the care home St Quentin Nursing Home provides accommodation for up to 33 older people who may require 24 hour nursing care. The home is a large detached property that has been extended to provide comfortable accommodation on two floors. A passenger lift provides access between the floors. There are two lounges and a dining room situated on the ground floor. The home is set in approximately one acre of very pleasant Care Homes for Older People Page 4 of 28 Over 65 31 0 1 1 0 8 2 0 0 9 Brief description of the care home gardens, a mile or so from the wide range of community facilities provided in the town of Newcastle-under-Lyme. There are adequate parking facilities. As no information is included in this report in relation to fees charged by the home, readers of this report are advised to contact the service directly for this information. Care Homes for Older People Page 5 of 28 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 Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The overall quality rating for this service is 2 Stars. This means that the people living at the home experience GOOD quality outcomes. This unannounced Key inspection visit took place over one day and was undertaken by two inspectors. The inspection process was commenced several weeks prior to the visit and included surveys completed by people who live at the home. All of the Key minimum standards were assessed and for each outcome a judgment has been made, based on the evidence we gathered. These judgments tell us what it is like to live at the home. Prior to this inspection visit the service had completed a self-assessment tool, which is known as the Annual Quality Assurance Assessment (AQAA). Completion of this assessment is a legal requirement and it enables the service to undertake a self Care Homes for Older People Page 6 of 28 assessment, which focuses on how well outcomes are met for people living at the home. This AQAA was very detailed and provided us with a lot of information about the service. The ways in which we gathered our evidence to make the judgments are as follows, We looked at any information we had received about the service since the last Key inspection. We spoke with people who live in the home. We spoke with some of the staff who work at the home. Discussions were held with the manager (Provider) of the service. We examined relevant records and documentation in the home. We walked around the home and visited all communal areas and some bedrooms. We observed staff interaction with people who live in the home. At the end of the inspection visit we discussed our findings with the Manager (Provider). Since we carried out the last Key Inspection of this service the acting Manager Mr Nick Frain has become one of two Clinical Managers and Mrs Emma Averill, who is also the Provider, is in the process of registering as Manager with the us. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 28 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 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 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who move into this home can be assured that their assessed needs will be met. Evidence: People are only offered a place at this home following an assessment of their needs. This is carried out by one of the clinical managers. This is comprehensive and often includes assessments from funding bodies and other health care professionals. People who were visiting their relative told us that they had been involved in the assessment and admission process and had received information from the clinical manager. They also confirmed that the clinical manager had been out to assess their relative and that he had been very helpful. Staff have the necessary skills and training to be able to meet the needs of the people who live in the home. Care Homes for Older People Page 11 of 28 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. Peoples health, personal and social care needs are set out in an individual plan of care. People make decisions about their lives with assistance as needed, are treated with respect and dignity is upheld. Evidence: The service has made improvements in this outcome area and is continuing to implement these. Individual care plans are now more person centered and are adapted to meet the specific individual personal, nursing and health care needs of people. Plans contain individual risk assessments and these are updated and reviewed regularly. People tell us that the care they receive is good and that they feel that all their care Care Homes for Older People Page 12 of 28 Evidence: needs are met at the home. Individual plans of care are discussed and agreed with people and they are given the opportunity to be involved in the reviews of these. Individual Mental Capacity is assessed and where people lack Capacity then representatives are provided with information about care. Where people do not have representatives then advocates are sought. We observed care practices and noted that staff care for people with sensitivity and that dignity is promoted and upheld. Records of daily care are completed and demonstrate that people receive regular personal care and attention including pressure area care. There was one exception to this where a gentleman we visited who was in bed in his room complained of being thirsty and wanting to get up. The records of care identified that this person had not had a mid-morning drink nor had received any personal care that morning. On further investigation it became apparent that the staff member who was responsible for the care of this gentleman had gone next door to sign for her training and that communication regarding the care needs of the gentleman had not been relayed to other staff. The gentleman was later seen up and about, well dressed and well presented, and came to the dining room for his lunch. He told us that he was feeling much better. We met with some visiting relatives during the inspection and they spoke about the care of their mother - We are very pleased with everything Staff have made her very welcome and they have got time for her. The lady told us I have a both once a week and enjoy the bubbles. When we asked if she would prefer a bath more often or a shower she told us No I have a wash every day and the staff are very good. People also said They give on hundred per cent in care and support not only to the people they care for but also relatives. They make you feel welcome. Nothing is too much trouble. Someone else told us that there is a warm caring atmosphere. Staff told us that the home provides a good homely place and respects residents dignity at all times. Another staff member said that the home delivers a high standard of care, a homely atmosphere and that people are cared for as individuals and relatives made to feel Care Homes for Older People Page 13 of 28 Evidence: welcome. Another staff member told us about the importance of promoting privacy and dignity. People have access to health care professionals who visit the home and offer advice and treatment. This includes visits from doctors, opticians, chiropodists and specialist nurses such as tissue viability nurses. People are also supported to attend outpatient appointments. People are able to manage their own medication if they wish to following a suitable risk assessment but otherwise this is managed and administered by nursing staff. Accurate records are maintained relating to medication receipt, storage, administration and disposal. We observed the lunchtime medication round being administered by one of the nurses on duty. We noted that, at one stage, medication was being administered into pots and given to people sitting downstairs on the ground floor whilst the dug trolley was located on the second floor. This practice is unsafe as it allows for errors to occur and should cease in order to keep people safe. One of the areas we discussed with the manager was the documentation contained within care plans relating to Do Not Attempt Resuscitation (DNAR). The manager highlighted the need for the original discussion around this to include the multi disciplinary team and for the assessments to be regularly reviewed. Care Homes for Older People Page 14 of 28 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 lifestyle of the home is made flexible and varied and peoples individual social and therapeutic needs are met. People are helped to exercise choice and control over their lives. Evidence: The service has made improvements in this area and there is a plan of therapeutic activities in place which is geared around meeting the needs of individual people. Group activities usually take place in the communal rooms in the morning with more one to one therapy in the afternoon. This is particulalry beneficial for people who are nursed in bed or prefer to stay in their own room. People are informed of the days activities by a notice displayed in the hallway plus staff talk to people about what is taking place each day. We met with the activities coordinator who was holding a Craft therapy session during the morning. During the afternoon staff put an old film on in the lounge for people to enjoy whilst other people were receiving one to one therapy in their rooms. Care Homes for Older People Page 15 of 28 Evidence: People also enjoy trips out and a small group of people had recently enjoyed a trip to the pub. Peoples choices and preferences are documented in their plan of care in respect of rising and retiring times, food preferences and preferences in relation to personal care. We did note, however that the home does not have a separate walk in shower. People who would prefer a shower are therefore unable to benefit from this facility. We spoke about this with the manager and have recommended that this be provided to enable people to have the choice. People are given the opportunity of having their own telephone installed into their rooms. These are provided in large dial (numbers) if required. People also adapt their bedroom to suit their needs and bring in personal possessions to make their rooms more homely. People are offered choices at mealtimes with an alternative to the main menu always being available. Special diets and preferences are catered for . People can choose where to take their meals, from a choice of the dining room, the lounge or their own bedroom. We observed staff asking people what they would prefer for lunch. Staff also told us that if a person does not feel like taking a meal at specific mealtimes then they can have this later. People we spoke with confirmed the above and told us that the meals served in the home are very good. We noted that, in respect of people needing help to eat their meal, there was some some confusion over who had received their meal and who hadnt. Staff appeared somewhat disorganized over lunch, resulting in one person being fed with their meal and others waiting at the table for a further thirty minutes before receiving theirs. The meal appeared attractive and nutritious including the soft diet which was separately portioned out on the plate. People who required assistance to eat their meals were provided with adapted cutlery, plat guards and beakers. We noted one staff member was feeding a person using a very large spoon which looked like a serving spoon. This was inappropriate and was discussed with the Care Homes for Older People Page 16 of 28 Evidence: manager. People observed Care Homes for Older People Page 17 of 28 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. People who live at the home can be confident that any concerns they might have will be listened to and acted upon. People are kept safe and protected form abuse by the systems in place at the home. Evidence: The service has a clear complaints procedure in place which is displayed within the home and contained in the Service User Guide. Formal complaints, investigations and outcomes are recorded by the manager and action is taken, where necessary, to make improvements as a result of complaints received. People told us that they know who to raise concerns with and that these are usually dealt with quickly. The service protects people who live at the home from harm or abuse. There is a robust recruitment procedure in place where staff are carefully chosen to work at the home. The service has a policy on Safeguarding and Whistle blowing and staff receive training in this area. Care Homes for Older People Page 18 of 28 Evidence: Staff are given training in the Protection Of Vulnerable Adults (POVA). Most of the staff we spoke with had some knowledge of this but there was some confusion over the correct procedures to follow for Safeguarding referral. It is recommended that staff are given further instructions on this so that each staff member understands their role with regards to reporting abuse and poor practice. Care Homes for Older People Page 19 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe well maintained environment which is clean, pleasant and hygienic. Evidence: The home is clean, well presented and has been adpated to meet the needs of people living there. Communal rooms are spacious, well decorated and domestic in character. The service has purchased a large screen television for people to enjoy in the lounge. The dining room is well presented and conducive to the dining experience. Bedrooms are also clean, well maintained and adapted to meet the specific needs of individual people. People bring in personal possessions and make their bedroom more homely. There is a team of domestic staff on duty each day with an organized cleaning schedule. Staff are given training in infection control and are provided with personal protective equipment. Care Homes for Older People Page 20 of 28 Evidence: The laundry and kitchen are well organized and adhere to the requirements of the Environmental Health department. Externally there are large attractive grounds for people to enjoy. Care Homes for Older People Page 21 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by a staff team who are safe, skilled, competent and trained to meet their needs. Evidence: The service has improved in this outcome area and there is a staff training and development plan in place which is geared around meeting the needs of the people who live in the home. Staff tell us that they feel supported with their training needs and feel equipped with the required skills to be able to meet the needs of the people who live there. Records of staff training are completed and provide further evidence that staff receive update training sessions in mandatory training. This includes manual handling, infection control, fire safety, health and safety, food hygiene, first aid and protection of vulnerable adults. Staff are encouraged to undertake National Vocational Qualification (NVQ) in care and more than fifty per cent of care staff are now trained to NVQ level 2 and above. Other training undertaken includes dementia care training and some staff have completed this and a few staff members have completed a course on managing Care Homes for Older People Page 22 of 28 Evidence: challenging behavior, although this was not recently. There are a some people living in the home with these specific needs. We discussed staff training needs with the manager and she confirmed that it was in the plan to increase training for staff in more specialist areas such as dementia care. There is a robust recruitment procedure in place and staff are carefully selected to work at the home. Relevant checks are carried out on prospective staff including Criminal Records Bureau (CRB) checks. Checks are also carried out to ensure that staff are safe to work with vulnerable adults. There is a comprehensive induction training programme in place for new staff. Staff are provided in sufficient numbers in order to meet the needs of the people who live in the home. This is monitored and adjusted according to the dependency needs of people. Care Homes for Older People Page 23 of 28 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. The home is well run and is managed in the best interests of the people who live there. Evidence: There has been a change in manager since we carried out the last inspection of the service. The person who was acting manager is now one of two clinical managers and the Provider Mrs Emma Averill is now the acting manager and is awaiting registration by CQC. The management structure is working well and people who live in the home and staff who work there feel supported by the management team. The manager has employed the services of a consultant in order to help bring about improvements in the quality of care. This has had a positive effect on the home as we noted improvements in all of the outcome areas. Care Homes for Older People Page 24 of 28 Evidence: The manager monitors the quality of the services provided in various ways including quality auditing and obtaining the views of the people who live in the home. Regular meetings are held for people who live in the home and staff and the home is run in an open and transparent way. Ideas from staff and others are welcomed and everyone is treated equally. The service provides a secure facility for the safekeeping of peoples monies and the records relating to the maintenance of this are accurate with a clear audit trail. People are able to access their monies whenever they wish to. Formal staff supervision is managed well and staff receive regular one to one supervision. The service has a health and safety policy statement in place and relevant policies, procedures and risk assessments. The service complies with the requirements and recommendations of the local fires safety department, Environmental Health department and other relevant legislation. Staff receive regular update training in areas of health and safety. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R 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 26 of 28 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 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 9 It is recommended that medication is dispensed directly from the medication trolley to people in the immediate area only. This is to avoid any mistakes and to help keep people safe. The service should provide a walk in shower facility so that people who would prefer to have a shower rather than a bath are given this choice. The deployment of staff over the lunchtime period should be reviewed in order to improve the dining experience for people and to ensure that people are not waiting for too long for their meal to be served. It is recommended that staff receive further instructions in the reporting of abuse so that they are clear about the procedures for this. 2 14 3 15 4 18 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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