Care Home: St Vincent`s

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What the care home does well People who use the service and their relatives have the information they need to decide whether St Vincents is the right home for them to move into. The admission procedure shows that staff make sure they can meet the persons needs but also means that they are assessed to ensure they would `fit in` with other people in the home. People receive a good standard of personal care. One person wrote `This home is the best around by far". Communication with health care professionals in the community is good. The care people receive is good and provided in a safe and respectful way. Medicines are also well managed at the home by the senior staff. Staff at the home ensure people see the doctor or other health care professionals when they need to. The care planning systems and documentation at the home are generally good and mean that staff know how to care for some one in a safe way. Most people have access to a satisfactory programme of activities, all are able to maintain contact with their family and friends. People tell us that the food is good at the home and any issues regarding dietary requirements, preferences or weight issues are sensitively managed. People who use the service and their relatives can be confident that their complaints and concerns will be listened to and acted on. People are safe at the home. Staff have had training to recognize signs of abuse and know how to report any suspicions or poor practice. St Vincents is safe and pleasant place to live and work. The manager and her staff group have suitable qualifications and experience to care for people who require personal care. Pre employment checks are performed on staff to show they are suitable to work with vulnerable adults. Once employed staff are supported to continue to learn new skills and methods which enrich and enhance peoples lives at the home. The home is well managed. What has improved since the last inspection? Care planning has improved since the last inspection; they now contain good clear information and are reviewed frequently. Medication practice has improved, accurate recording was seen. Staff recruitment has improved and all the necessary checks are undertaken. What the care home could do better: No requirements were made at this inspection. Several recommendations were made in respect of some elements of care practice. Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Vincent`s 79 Fore Street Plympton St. Maurice Plymouth Devon PL7 1NE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Caroline Rowland-Lapwood     Date: This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.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 Vincent`s 79 Fore Street Plympton St. Maurice Plymouth Devon PL7 1NE 01752336205 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : matron@stvincentnursinghome.co.uk Convent of Sisters of Charity care home 25 Number of places (if applicable): Under 65 Over 65 3 25 old age, not falling within any other category physical disability Additional conditions: 0 0 The maximum number of service users who can be accommodated is 25 The registered person may provide the following catergory of service only: Care Home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following catergories: Physical disability aged 65 years or over on admission (Code PD (E)) Old age, not falling within any other category - Code OP - maximum of 3 places Date of last inspection Brief description of the care home St Vincents is situated in a conservation area of Plympton St Maurice near the city of Plymouth in Devon. The building was originally a malt house, converted in the 1700s into a private residence and opened as a nursing home in 1944 by the Anglican sisters of charity. The accommodation is provided on 2 floors - accessed via a passenger lift or stairs and comprises; 21 single rooms (11 with en suite) and 2 double rooms (1 with en suite) and 4 communal areas, the gardens are attractive, safe and accessible. Care Homes for Older People Page 4 of 28 Brief description of the care home The home is registered to provide nursing and/or personal care for a maximum of 25 people, over the age of 65 of either gender, with physical disability, frailty and/or illness. The atmosphere within this home is quiet and peaceful. The home benefits from a stable staff team and achieved the investors in people award in 1998, which was renewed in 2002 and 2004 in recognition of their commitment to staff development and training. Information about the home including a copy of the last inspection report can be obtained on request from the administration office. Information given to the Commission by the provider indicates the current range of fees is from £504 to £550 per week. Additional charges are made for chiropody, hairdressing, optician, dentist and toiletries. 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 quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key unannounced inspection consisted of a visit to the home on Monday 18th and Tuesday 19th May 2009. One inspector performed this inspection. During this time we spoke to the general manager, the registered manager who is the person with day to day responsibility for the service was on annual leave, the deputy manager , the chef and several care and ancillary staff. We spoke to 6 people who live in the home. We case tracked three people who use the service. Case tracking means we looked in Care Homes for Older People Page 6 of 28 detail at the care three people receive. We spoke to staff about their care, looked at records that related to them and made observations if they were unable to speak to us. We looked at five staff recruitment records, induction and training records and policies and procedures. We did this because we wanted to understand how well the systems work and what this means for people who use the service. All this information helps us to develop a picture of how the home is managed and what it is like to live at ST Vincents. 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 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 Care Homes for Older People Page 8 of 28 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. The information provided means that people and their relatives have accurate information to decide whether St Vincents is the home for them to be in. The admission procedure is good and means that staff have enough information to decide whether they are able to meet the needs of the person. Evidence: The Statement of Purpose and Service User guide include the information that is needed for people to decide whether the home is the right place for them to be. Relatives told us they were given sufficient information when moving to the home. Each person is admitted following an assessment performed by nursing staff at the home. This assessment is used alongside assessments made by other health care Care Homes for Older People Page 11 of 28 Evidence: professionals. Together this information is used to make an initial plan of care. Evidence was also seen of involvement of the person and their family. Staff told us the manager/matron perform the initial assessments not only to assess the persons needs but to assess suitability to fit with other people living at the home. Care Homes for Older People Page 12 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. The health and personal care people receive is provided in a respectful and person centered way. The care planning systems at the home are generally good and reflect how health and personal care needs are identified and met in a safe way. However some improvements are needed to ensure staff know how to care for the individual properly. The management of medicines is good and helps protect people from risk. Evidence: Ten surveys were sent out to people living at the home nine said they always get the care and support they need and one said they usually do. Health care professionals who visit the home are largely satisfied with the standard of health care provided. One health care professional comments that the home provides very good care. When we looked at the care of the three people we found that their health care needs are generally met. These people are registered with a doctor and see the chiropodist optician, physiotherapist or any other professional needed when necessary. Care Homes for Older People Page 13 of 28 Evidence: We looked at these peoples care plans and found that most were relevant and contained the information needed to care for the person properly.However,one persons care plan had comments in for example can be aggressive and use distraction techniques but had no instruction or specific instruction for staff to follow. This means that this persons care needs are not been wholly met. Staff were able to describe how individual care is delivered and had a good knowledge of the individual needs of each person. We saw people being moved properly with the appropriate equipment needed in a kind and sensitive way. However several people were seen being moved in wheelchairs with no footplates attached. This is poor practice. We were told this was because the individual did not like them, this was not recorded in the care plan nor was there a risk assessment in place to clarify this. The management of medications is performed well at the home. We looked at where medications are stored in trolleys or locked cupboards. The senior trained nurses are responsible for management of the medication from receipt to disposal. Medicines are supplied mainly in a monitored dose system. The medication trolleys were clean, tidy and securely stored. A spot check of controlled drugs was performed and found to be correct and managed well. The records of administration were clear. To aid identification of the person to receive medication the records have photographs of each individual person living at the home who were in receipt of medication. All medications for disposal are recorded and signed for on collection as per the company and government policy. We received feedback from some health care professionals it said people are always treated with respect. We saw evidence of this, for example, staff were heard to talking to people in a kind and sensitive way and were seen knocking on bedroom doors before entering. However one room we visited had photographs up on the wardrobe door which were undignified as were the instructions on how to carry out fairly intimate care tasks. This should be addressed so that peoples dignity is promoted at all times. During the inspection people looked cared with the finer details such as eye care, nail care and appropriate foot wear present. People told us that they were pleased with the attention they received from the majority of the staff. One person said I get on very well all of them they are really kind, the best. Surveys showed that people and their relatives were also pleased with the care. Staff work hard to ensure that people are receiving the expert care they need at the end of life. The manager and other registered nurses ensure that staff are aware of the care pathway options for people at the end of their life. This will ensure that best practice is followed and people receive the best possible care. Care Homes for Older People Page 14 of 28 Care Homes for Older People Page 15 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. People who use this service enjoy a peaceful, pleasant yet varied life, with family and local community links maintained and encouraged. Various formal and informal impromptu activities are made available on a regular basis. Good quality meals are provided. Evidence: During the inspection, some people were seen sitting in the lounges. Other people were seen spending time in their rooms, reading, listening to music, or watching television. Staff were seen encouraging and enabling people to engage in meaningful conversation. People living at the home told us that routines were generally flexible, and that they could go to bed and get up when it suited them. One person told us, We can choose what we do. People responding with surveys gave a mixed response with regards to activities within the home. 3 people felt that there was always activities arranged by the home that Care Homes for Older People Page 16 of 28 Evidence: they could take part in and 6 said there were usually activities provided. During our visit to the home there was evidence to show that there was to be some activity that day, this being a member of staff who would read to the people in the lounge. One person said they were a bit bored. Activities were recorded these included, armchair exercises, a sing a longand the hairdresser we were told that when she visits it is made a social event a mini coffee morning. People told us that they are able to attend church services both within the home and in the local parish. Some people that were unable to get out of bed had the television on and it was quite loud and obtrusive. There was no evidence in the care plans to suggest that the person would enjoy this. Peoples interests and hobbies are recorded but this needs to be further explored to to ensure that individual needs can be met. We spoke with one relative during our visit to the home . They said that they can visit at any time and that they are always made welcome. Their comments included; They are very friendly, They always keep me up to date with whats going on with Mum and Nothing is too much trouble. Able bodied people that are living at the home are able to make choices about their daily routines, and that they could go to bed and get up when it suited them. One person told us, We can choose what we do. Staff assured us that they were able to give choice to those people that cannot speak for themselves as they had known them a long time and knew what they liked. Surveys received from people living at the home showed a mixed response with regards to the food. Six people said the food was always to their liking, three said they usually liked the meals. The majority of people spoken with during our visit told us the food was good, hot and that there was always plenty of it. Other comments included, The food is really very good. A daily choice of main meal is provided and dietary needs are also considered. 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 use the service and their relatives can be confident that their complaints and concerns will be listened to and acted on. The knowledge procedures and training in place for the Protection of Vulnerable Adults help to protect people. Evidence: People said they felt able to complain to staff and the manager in the home. Surveys also told us that people were able to complain. Comments included Yes I do know how to complain but never have had the need to, its fine and We have never needed to complain but could do if needed I suppose. The home has not received any complaints but prefers to manage any daily problems informally. The CQC has not received any complaints since the last time we inspected (May 2007). We did not see anyone who was unnecessarily restrained in the home. Everyone we spoke with, without hesitation said they felt safe living at the home. Staff we spoke to said they felt able to talk to the manager about any worries or concerns. The home also operates a supervision and appraisal system in which staff raised concerns that are discussed, recorded and acted upon. Staff told us they would have no hesitation to complain if the situation arose and would report any concerns they had. Care Homes for Older People Page 18 of 28 Evidence: Staff said they had attended Protection of vulnerable adult (POVA) training and had been informed of the different types of abuse and how to report them. All staff were aware they could speak with the CQC if they were concerned about abuse. All staff have a criminal records bureau police check and a POVA register check performed before they are able to work. 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. The standard of the environment within the home is good providing people with homely, clean surroundings, which are well maintained. Evidence: The premises appeared homely, and generally well maintained. There is a programme of routine maintenance and re-decoration. For example the upstairs lounge has recently been redecorated and re carpeted and further upgrading is planned for the hallways and downstairs lounge. A few bedroom carpets were in need of replacement and we were told this was also planned for the near future. Individual bedrooms seen were personalized with sentimental items, photographs and small pieces of furniture. People told us they were happy with their accommodation. The communal space at the home consists of two lounge areas, one on the ground floor and one on the first floor, and a separate dining area situated on the first floor. All radiators are covered to reduce the risk of burns to peole and water temperatures are controlled by thermostatic valves to reduce the riks of scalding. The home has a dedicated team of cleaners and the housekeeper takes pride in Care Homes for Older People Page 20 of 28 Evidence: ensuring that the home is clean and free of offensive odours. The home was clean, no unpleasant smells were found on the day of our visit. People responding with CQC surveys said that the home was Always fresh and clean. One relative told us that the home was always clean. Staff spoken with had a good understanding of infection control; All staff were seen to wear gloves and aprons when providing personal care. Alcohol gel is freely available to promote infection control measures. The laundry facilities are generally well organised. There are dedicated staff to look after the laundry they had a good knowledge of their responsibilities. There is a system in place for dealing with soiled laundry, which reduces the risk of infection. 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 stable well trained staff group who have had sufficient pre employment checks carried out. Evidence: Without exception, comments regarding staff were very positive. People and relatives used descriptions such as the staff are great, they work so hard and they are brilliant. Off duty records are maintained and show that staffing levels are stable and supplied in sufficient numbers to meet the complex needs of people who use the service. In addition to the care staff, additional ancillary staff to clean, cook and attend to the laundry. The manager told us that staff at the home continue to cover shortages themselves. The care staff have received training in both general care duties such as manual handling, food hygiene, fire safety, health and safety and infection control. Some care staff have had additional training to understand the more complex needs of mental health problems including dementia. Staff told us that many care staff have an NVQ in care at level 2 or above. Recruitment is well managed at the home. The administrator processes the actual application and chases CRB and references, whilst the manager interviews potential staff. Staff recruitment folders showed that the recruitment process is consistent with all Care Homes for Older People Page 22 of 28 Evidence: staff being interviewed following completion of an application form. Applicants are asked to complete a criminal declaration and health questionnaire. Staff files also contained CRB and POVA recording information two written references and proof of identity including photograph from the driving license or passport. All staff files showed evidence that staff had completed an induction programme and had had a recent supervision session although the supervision process was not always a open and transparent process but one that has been inherited from past management. We discussed this and the supervision process is being improved upon so that staff will be better supported. 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 competent Management and staff at the home manage the home in an effective and efficient way. Evidence: There is a good management structure in place to ensure that the home is well managed. The manager is a registered nurse and has the required experience to run the home and has obtained the necessary qualifications (Registered Managers Award RMA). She is ably supported by a general manager of the home who deals with all other aspects other than direct care. Staff felt valued by the manager and we were told, The matron treats everyone fairly and is good. Staff surveys show that they receive regular supervision in order to assess their overall standard of work and identify training and development needs. This also provides staff an opportunity to give direct feedback about their work experience to the manager or Care Homes for Older People Page 24 of 28 Evidence: other senior staff. There are a number of ways that the home seeks peoples views, in order to review the services provided and ensure there is continuous improvement. Questionnaires are sent out and the results from these are collated. Regular meetings are held with people living at the home and staff. Minutes showed that these meetings were well attended and that a variety of issues were discussed, including menus. The home is not involved in managing peoples finances but will administer personal allowances. The monies held on behalf of three people were checked. The system used is secure, clear and auditable. Receipts are kept for all monies spent and two people check any monies received. The account was found to be in order, with accurate records kept. Staff and records confirmed that mandatory training was undertaken, such as infection control, health and safety, and COSHH for domestic staff. Care and nursing staff had completed manual handling, infection control and fire safety. Fire records were well managed, all drills, training, equipment checks were up to date. There was a fire risk assessment in place. Records looked at, including the AQAA and maintenance and servicing certificates, showed that regular maintenance was undertaken on all equipment, such as hoists and lift, and gas & electrical systems. 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 7 Footplates should be used on wheelchairs at all times. However, if this is not appropriate then this must be recorded and a risk assessment completed. Care plans should give detailed instruction for staff to allow them meet all the care needs of the individual. Activities should be in place for all people living at the home including those people that spend most of their day in bed. Social histories should be used to make individual plans for activities. 2 3 7 12 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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