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Inspection on 13/03/08 for The Normanhurst Residential Care Home

Also see our care home review for The Normanhurst Residential Care Home for more information

This is the latest available inspection report for this service, carried out on 13th March 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service is well managed. People interested in living at the home can easily access information about the services and facilities offered. They can visit and undertake short stays to inform their decision-making. The service provides a safe, comfortable homelike environment that is maintained to a high standard.Their are enough, well-trained staff on duty at all times to support people in the home. They demonstrate positive and professional attitudes` to their caring roles. The service is committed to developing staff. Staff` and residents speak positively about the service and the quality of care provided. Staff` feel well supported and informed. The service promotes independence and enables people living there to continue to lead an active life and make use of community facilities. The service listens to residents and uses this information to make improvements in service delivery. "The service provides training, equal opportunities and good management" "There are always enough staff" "I can talk to the manager about work and ideas comfortably" "I feel it is pleasant to live here in the Normanhurst" "Excellent care, which provides comfort to all"

What has improved since the last inspection?

The home has implemented improvements to the medication policy and procedure. Assessment of staff competency in medication administration has been introduced. Records relating to the movement of medication out of the home have been improved upon, and the home has ceased the practice of double dispensing. All written documentation is now signed and dated by the person completing it; the level of detail around preferred routines has been developed in support plans. Risk assessments have been undertaken for the whole home in respect of unguarded radiators, free standing heaters and air purifiers, in addition to hot water outlets. The home has actively listened to residents and changes have been made to menus and the quality of food provided, including the provision of more fresh fruit to residents. Policies and procedures for the protection of vulnerable adults have been organised better to aid easier access by staff.

CARE HOMES FOR OLDER PEOPLE The Normanhurst Residential Care Home De La Warr Parade Bexhill-on-sea East Sussex TN40 1LB Lead Inspector Michele Etherton Unannounced Inspection 13th March 2008 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 The Normanhurst Residential Care Home DS0000021254.V359608.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. The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Normanhurst Residential Care Home Address De La Warr Parade Bexhill-on-sea East Sussex TN40 1LB 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) 01424 217577 01424 734650 Normanhurst@btinternet.com www.normanhurst.com Mr David Lewis Mr Robert Hebbes Ms Claire MacMillan Care Home 82 Category(ies) of Old age, not falling within any other category registration, with number (82) of places The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. That only older people will be accommodated. The maximum number of residents to be accommodated is eighty two (82). Residents should be aged sixty five (65) years or over on admission. That one (1) named service user aged between 63 and 65 on admission may be accommodated 10th May 2007 Date of last inspection Brief Description of the Service: The Normanhurst Care Home is situated on Bexhill seafront and is interconnected with the Normanhurst Annexe and the Normanhurst Nursing Home. The three homes are independently registered with reference to the category of the residents catered for, although are under the same ownership. They run separately from each other apart from the laundry and catering, which are completed centrally within the residential Care Home. The home provides accommodation and personal care for up 82 older people and comprises of 64 single and nine double bedrooms. 43 of the single rooms have en-suite facilities, whilst all of the double rooms have en-suite facilities. There are three day rooms for residents to use in addition to a large dining area. The home is close to local shops with rail and bus services within easy walking distance. Carers are on duty 24 hours a day. The Normanhurst Care Home provides care to residents who are privately funded and also those who are funded by social services. The home’s fees as of 19th December 2006 range between £332.00 - £500.00 per person per week dependent upon needs. Additional costs are charged for hairdressing (from £3.50), chiropody (£10), outings, toiletries and newspapers (£ variable). Prospective residents/representatives are provided with written information regarding the services and facilities provided at the home. Copies of these documents are kept on display in the reception area alongside a copy of the most recent inspection report. The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good, quality outcomes. A Key inspection of this service has been carried out, which has included an unannounced site visit to the home on the 13th March 2008 lasting 7.15 hours; this has also included an appraisal of information received by CSCI about the home and from the home since the last key inspection in February 2007. All key inspection standards have been assessed for this inspection, in addition to any standards where outcomes became evident during the inspection. An AQAA (Annual Quality Assurance Assessment) has not been completed by the home in time to inform this inspection. The site visit comprised a tour of the premises including some bedrooms and communal areas. Samples of documentation including support plans, risk assessments, medication administration records (MARS), and staff recruitment and training files were examined. Survey information has been distributed to relatives, and people living in the home, in addition to staff, care managers and other professionals. People living in the home were observed and spoken with throughout the site visit; discussions were also undertaken with support staff, and the manager. Feedback from survey responses returned from staff and residents has also been assessed. All these responses and observations have been influential in the compilation of this report. Since the last inspection there has been one adult protection alert raised, the home has taken appropriate action to safeguard residents and is awaiting closure of the alert. What the service does well: The service is well managed. People interested in living at the home can easily access information about the services and facilities offered. They can visit and undertake short stays to inform their decision-making. The service provides a safe, comfortable homelike environment that is maintained to a high standard. The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 6 Their are enough, well-trained staff on duty at all times to support people in the home. They demonstrate positive and professional attitudes’ to their caring roles. The service is committed to developing staff. Staff’ and residents speak positively about the service and the quality of care provided. Staff’ feel well supported and informed. The service promotes independence and enables people living there to continue to lead an active life and make use of community facilities. The service listens to residents and uses this information to make improvements in service delivery. “The service provides training, equal opportunities and good management” “There are always enough staff” “I can talk to the manager about work and ideas comfortably” “I feel it is pleasant to live here in the Normanhurst” “Excellent care, which provides comfort to all” What has improved since the last inspection? The home has implemented improvements to the medication policy and procedure. Assessment of staff competency in medication administration has been introduced. Records relating to the movement of medication out of the home have been improved upon, and the home has ceased the practice of double dispensing. All written documentation is now signed and dated by the person completing it; the level of detail around preferred routines has been developed in support plans. Risk assessments have been undertaken for the whole home in respect of unguarded radiators, free standing heaters and air purifiers, in addition to hot water outlets. The home has actively listened to residents and changes have been made to menus and the quality of food provided, including the provision of more fresh fruit to residents. Policies and procedures for the protection of vulnerable adults have been organised better to aid easier access by staff. The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 7 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. The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People coming to live in the home are provided with enough information about it to support their decision. They can be confident that their needs will be assessed prior to permanent admission and that they will have an opportunity to visit or have a short stay at the home to inform their decision making and before making a more permanent commitment. Intermediate care is not provided by the home. EVIDENCE: The manager reported that service user guide information is made available upon request, the home has a direct dial number for ordering a brochure and user guide, a website has also been established from which information can be downloaded. Any prospective residents who visit the home or are visited for The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 10 the purpose of assessment are also given a copy of the guide. The manager is also considering making copies available in the reception area of the home. A previous recommendation regarding the updating of the user guide has not been addressed owing to difficulties in separating this computerised document from contractual information, permission to undertake this has now been obtained and the manager is hopeful of being able to update the user guide shortly, this remains outstanding at present. People surveyed all indicated they had access to information about the home, or knew about the home already and this prompted them to apply, the majority indicated they had been able to visit or test-drive the service before making a longer-term commitment. The files for four people most recently admitted for respite were examined; these contained completed assessment information in all cases. Three out of four were signed and dated by the person completing. The quality of detail recorded on two out of four examined could be improved upon and particular areas where information was lacking were discussed with the manager, who agreed with the comments made. The manager reported that initial assessment information about prospective residents is added to in developing support plans from their experience of supporting that person whilst in respite or on a trial stay/visit. The majority view of people living in the home gained through survey responses and direct discussion at the site visit indicates a very positive view of staff attitudes and skills, that in most cases staff have an awareness of individual needs and that the level support provided by them to meet these is appropriate. Resident records viewed were signed and dated by the person completing in the majority of cases, indicating that the home has responded to a previous required action to do so; it is considered therefore that the sample viewed are generally representative of the standard of such records. Completed terms and conditions/contracts were noted on permanent resident files. The home does not provide intermediate care, although people do sometimes come into the home when experiencing a period of illness or convalescence to aid their recovery, but the home does not undertake specialist support, occupational therapy or physiotherapy to those needing these inputs to enable them to return home. The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’ in the home are supported by staff to lead the life they wish, and are able to take responsible risks to maintain their independence. They benefit from improvements to the safety of medication administration systems. EVIDENCE: Care plans viewed for newer residents are in place but are evolving as staff’ understanding of individual needs and preferences increases. The manager reported that permanent residents discuss their support plan with their key worker on a monthly basis, they are not routinely asked to sign but are consulted in its initial development, an example of a care plan where part has been written by the resident themselves was also noted. In response to a previous inspection required action the content and detail within care plans has The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 12 been improved upon. Care plans viewed were found to contain greater detail in respect of individual preferred routines and aspirations. Discussion with individual residents during the course of the site visit revealed they thought staff universally had a good understanding of their needs and supported them in the manner they were happy with. Care plans viewed were signed and dated; these are to be transferred to the computer to enable easier access for staff on duty and updating as changes occur. The content of resident files viewed is compliant with Schedule 3 of the Care Homes Regulations 2001. Observations of staff responses to residents during the site visit reflected good working relationships and positive and professional attitudes displayed by staff. Care staff were observed actively acknowledging residents even when not working with them, they were noted checking and clarifying with residents specifics relating to personal daily routines or health matters and did not assume the level of support required but asked the resident what was needed. Discussions with people living in the home highlighted a range of dependency levels, with a clear emphasis on them retaining independence for as long as possible and using staff support flexibly as and when they need to, residents expressed positive comments about the quality of support they receive and this was confirmed in survey responses. People in the home find staff helpful, kind and understanding of their needs. A sample of comment’s received are as follows: “My relative is happy with the staff here and finds them helpful”. “Staff’ are good, they always listen carefully” “Excellent care, which gives comfort to all” “Very good care” “Staff’ are very kind and patient” People living in the home are enabled to take risks and lead the lifestyle they would wish, some were observed during the site visit coming and going from the home either walking to the shops or using their own motorised scooters, people spoken with said that staff accompany residents to town if they need support, and this was also noted during the site visit. Residents have their own keys, and manage their own money. Where residents wish to access facilities in the community in the evening independently there was evidence that the staff on duty take precautionary measures to ensure their safe arrival and return. Survey feedback and responses from people in the home on the day of the site visit indicates that residents feel their dignity is preserved by staff offering The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 13 personal care support, and that there is a mutual respect between staff and residents, with some residents viewing staff in the light of extended family. People were observed during the site visit dropping downstairs to reception for their post and papers and returning to their rooms, the home is large but has managed to attain an atmosphere more hotel like than care home and this is an image they like to project; it fits well with the majority of residents views about their independence and the way they use the home and facilities to support their lifestyle. One resident said she felt safe and was happy to get on and amuse herself, she found she was often too busy to access the activities in the home, but liked to go down for dinner, she liked being able to do what she wanted with her time in the knowledge that staff would check on her and were available to support her if she was unwell. Discussion with individual residents confirmed access to routine healthcare checks, and where possible people in the home retain their own dentist or optician. A sample of MAR sheets were checked these were completed satisfactorily the home manager was advised to retain the photo file of residents that is kept with the medication trolley to ensure that names can be matched to faces where more than one person has a similar or same name. The drugs fridge was viewed and contained medications’ that are dated upon opening, and require refrigeration. The home were asked previously to review medication policies and procedures and this has now been addressed, however, a policy developed for use of homely and discretionary medications by residents needs further expansion and clarity in some areas and this was discussed during the inspection and is a recommendation of this report. Additional required actions issued to the home as the result of a pharmacy inspector review have mostly been addressed. All administering staff are trained to do so in addition to an assessment of competency, a sample of such competency assessments were examined during the visit. Competency is not routinely reviewed and the manager agreed this would be of benefit and will look at ways of doing so, one possible method being an observational element within staff supervision that enables administration practice to be observed. Another area identified by the pharmacy inspector for improvement was in the development of individual PRN guidelines, this has not been satisfactorily implemented at present and remains an outstanding requirement, although the manager having clarified what is needed felt confident of implementing these guidelines shortly. The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 14 The home has implemented a system for recording the movement of medication in and out of the home, thereby minimising the risk of misappropriation. The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 15 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are supported to maintain their interests and lead the life they would wish, including maintaining important relationships and their visitors made welcome. A selection of nutritious, plentiful and wholesome food is provided although not to every ones taste; people in the home are encouraged to make choices from the daily selection, and are consulted about menu development. EVIDENCE: During the site visit twelve residents were spoken with in particular. One resident felt that they had changed since coming to the home, felt more dependent and less active, another with visual impairment expressed similar views. This was not reflected in discussions with other residents or in survey feedback generally, and consideration of these views must take account also of the loss of independence experienced by these residents in particular through their deteriorating conditions The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 16 Survey feedback indicated that whilst on the whole people in the home are satisfied with the range and frequency of activities, some minority groups including those with visual impairment within the home feel more could be offered for their specific needs. The manager reported that as a result of feedback from resident meetings and surveys the activities programme had been revised, and she acknowledged that some activities were not so inclusive of men and as a consequence is trying to develop additional activities for them including trips out, a monthly meal is also now organised outside the home for those residents who want to go. It is recommended that the home investigate activity options for visually impaired people and how these can be incorporated into the home. “I enjoy the knitting circle best of all” “More activities are needed during the day” “More trips and better food” I feel it is very pleasant to live here in the Normanhurst” “I am very content with this place – right place for me” Several people indicated that prior to entering the home they had mastered the use of computers and were using email facilities to stay in contact with friends and family, whilst this contact had been replaced by use of the telephone when they entered the home, some people thought that the provision of a computer resource within the home with internet access would be of benefit to residents and might encourage the development of new skills for others and be reflective of the general increased use of computer and internet services by older people within mainstream society. It is clear from bedrooms visited during the site visit with resident permissions that where possible residents are enabled to bring in a range of personal possessions to furnish their rooms to their own tastes, discussion with staff confirmed that residents manage their own money, or this is managed by their’ representatives for them. Residents have keys to their own rooms. Visitors were in evidence during the site visit, one commented that whilst she felt her friend was well cared for and the home provided a good service, she was aware that her friend was shy and unlikely to ask staff for things until she felt more comfortable, she thought that with new residents staff should be more pro-active in ensuring that they have everything they need rather than leaving it to residents to approach staff with queries. Whilst predominantly responses and comments about the home are very positive, one or two surveys indicated some comments from relatives that they are not always kept informed, the manager reported that where this involves The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 17 an admission to hospital, illness and death next of kin are always advised, however, minor incidents are not always made known and sometimes relatives who are not deemed as having a close relationship or in position of next of kin may object to not being kept informed. The home should make clear within resident records what the arrangements are for informing relatives of minor and major events affecting individual residents. Surveys that were completed some months prior to the site visit had raised issues about quality of food; similarly surveys conducted by the home and residents meetings had also highlighted issues in relation to menus and food quality. Much work has been done with kitchen staff and by kitchen staff to take on board comments from residents, menus have been revised, more fresh fruit is made available and is also available for purchase at reception if residents want more. Comments regarding food quality are also captured in a separate record at reception for monitoring purposes, during the course of the visit, none of the residents spoken with commented negatively on the food, a sample lunch was also undertaken with a resident and this was satisfactory, A number of alternative meals are available to choose from, tea and coffee is offered after the meal and residents can have their own sherry or wine with their meal. A number of care staff’ are available in the restaurant to offer support to residents and provide a waitress service. The home is aware that food is an important issue and will continue to listen to residents and work with them to develop a range of meals they enjoy, however, they recognise that there may always be some people for whom no amount of change will be acceptable. Staff’ were observed asking individual residents if they had everything they needed. A resident spoken with commented that she sometimes rings down in the middle of the night if she can’t sleep to ask for a cup of tea and staff will bring one up. “Cooking for so many cannot be easy to satisfy everyone but most meals are very good” “I like all the different choices he makes” “I enjoy the meals very much” The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 18 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home feel confident about raising concerns, and that these will be listened to and acted upon. Systems are in place to safeguard residents from harm or abuse. EVIDENCE: The Manager reported no formal complaints have been received since the last inspection, minor concerns mainly in respect of food etc are recorded separately at reception for monitoring purposes and where needed would be addressed immediately. CSCI have not received any information concerning complaints from other agencies or members of the public. Staff’ receive adult protection training, the home has a copy of new protocols and abuse and protection policies have been separated out into folder which makes it easier for staff to access them. There is currently one outstanding adult protection alert, CSCI are advised that the home has acted appropriately in managing the situation and upon confirmation that referrals have been made to the POVA register the alert will be closed. The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 19 Feedback from those surveyed and spoken with during the site visit indicates that most people living at the home feel confident of approaching staff or the manager, the majority feel listened to and that issues would be acted upon. Most said they didn’t have anything to complain about but would do so if they had. The home has appropriately notified CSCI of significant events as required. The home does not manage the finances of people in the home but is able to hold money on behalf of residents until they request it, a system for signing this in and out is in place; people also have a locked facility in their room for valuables. The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 20 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a safe comfortable and homelike environment that is maintained to a good standard EVIDENCE: The Normanhurst is a large home laid out over four floors, a tour of all floors was undertaken that enabled the viewing of a range of bedrooms with residents permissions, toilets and bathing facilities in addition to the kitchen, laundry and communal areas on the ground floor. The home is maintained to a good standard of cleanliness, no unpleasant odours were detected. The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 21 A previous requirement that risk assessments are undertaken on uncovered radiators, free standing heating and air purifiers, and hot water outlets exceeding 43C has been addressed, in addition some remedial measures have been put in place by the reduction of water temperatures from the boiler to ensure that water outlets and radiators are kept at a lower temperature, this has not been welcomed by some residents who enjoy a much hotter bath. The manager reported that as upgrading occurs and radiators are replaced these would be low surface ones. All rooms have call bells, some residents have been provided with these in a phone format, and confirmed their use of the system and the speed of response by staff. The home is generally maintained to a good standard, some toilet and wash areas on the fourth floor would benefit from upgrading and the manager reported these will be included in upgrading programmes but could not say when, discussion with individual residents confirmed that a redecoration programme is in place, and the views of residents are taken account of. The manager reported that there is a large maintenance team with responsibilities for maintaining the three homes in the group in a good condition. Any maintenance issues are reported by phone and recorded at reception. The reception area acts as focal point for residents, they book in and out and collect post and papers from there, a small shop is also run from the reception where residents can purchase toiletries and treats. People whose rooms were viewed confirmed they were enabled to bring amounts of furniture from home dependent on the size of their room and were very comfortable with their things around them. Testing weekly and monthly of fire alarm equipment/alarm emergency lighting etc is by maintenance staff’, a test was undertaken during the site visit. The manager reported that a fire risk assessment has been updated in line with changes in legislation. Stocks of gloves and aprons were noted in various places around the home and staff’ were observed accessing these. The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’ in the home are flexibly supported by enough well trained staff when they need them. Systems are in place to check the suitability of staff through necessary vetting and checks, this would benefit from improvements to recording of interviews and exploration of employment histories. Staff performance and practice is routinely monitored, this could be further improved by introduction of an observational element. EVIDENCE: Whilst there is a domestic staff team to undertake cleaning, laundry and kitchen duties, care staff are assigned to the dining room on a rota basis to provide waitress service, the manager reported that this arrangement provides a useful starting place for new staff to learn to know individual residents. Staffing levels did not feature as an issue for residents or staff either in survey responses or direct discussions during the site visit. Staff reported through survey information that they feel happy and content in their work, they feel they are given enough information about residents to The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 23 support them effectively, that they have a good training programme, and feel well supported by manager. “Care plans are regularly updated and given verbal information on a daily basis on handover re special care for ill residents” “Records are updated as soon as changes happen” “Always enough staff” “Good high standard of care for residents” One survey comment from a staff member reported that some residents are not seen at night, discussion with residents confirmed that some are seen and others are not, this is determined not only by choice but also by those who are a source of concern at the time, the manager should ensure that resident preferences are recorded with regards to night-time checks by staff other than if they are unwell, most people living in the home found staff attentive but not intrusive. People in the home commented positively about the quality of the staff in the home that they find, helpful and friendly. People spoken with at the site visit gave various examples of where staff’ were flexible or available to support them both inside and outside the home. “Staff are good” “Excellent care” “I am very happy with all aspects, care is especially good” “Staff are kind and patient” The manager reported that she now has over 70 of staff trained to NVQ2/3 and one staff member wishing to progress to NVQ4. “With NVQ 3 I’ve learned a lot” “Completing NVQ3 and supported throughout” A training matrix is in place and evidenced that a full rolling programme of mandatory skills training in addition to more specialised training is available with the majority of staff having completed basic core skills training. Recruitment files were examined for three newer staff, all necessary checks and vetting were in place, the manager was reminded of the need to monitor the quality of references and to ensure rules were applied equally irrespective The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 24 of whether an applicant was known to the home or not. The manager was also reminded of the need to ensure that records of interviews are maintained to evidence that gaps in employment histories, questions about health etc are fully recorded and this is a recommendation. Files viewed provided evidence that new staff are completing induction training and this was confirmed in staff feedback in survey responses and discussions at the site visit. “I went through everything, felt happy with induction” “There was a lot to go through at induction some things were covered later” Staff have commented positively in survey responses and direct discussions with them concerning the support they receive from the manager, personnel files viewed provided evidence of regular supervision, following discussions with the manager about monitoring staff practice and competencies it is recommended that an observational element be introduced into the supervision process. “Supervision is held but sometimes a little overdue” “I can talk to the manager about work and ideas comfortably, report and deal with things as best I can” The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is well run in the best interests of the residents. EVIDENCE: The home benefits from having an experienced manager who has the respect of staff, and residents, she has shown a commitment to her own personal development, through undertaking additional professional qualifications and training, and is supportive and enabling of the development of staff, who find her approachable. The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 26 The manager shows a willingness to work with the commission staff to make necessary improvements and is open to new ideas that will benefit residents and improve their overall experience of life in the Normanhurst. In response to previous comments about the standard of some policies and procedures the home has invested in purchasing a set of policies and procedures developed by “The care homes association”, and are adapting these to suit the home. Staff commented: “ I have worked in other homes and feel this is the best run home I’ve come across” “The home provides good training, equal opportunities and good management” The manager reported that resident meetings are held regularly and this was confirmed in discussions held with people in the home at the site visit. In addition people in the home are regularly surveyed to find out their views about various aspects of the home, their responses are followed up by the manager, an analysis of the homes own survey highlighted similar themes to those received by CSCI for the purpose of this inspection, as a consequence of responses the manager could evidence that actions had been taken in response to food quality and activities, the main areas that provoke responses. An analysis of resident responses has been published and residents have received feedback on this. A newsletter is also provided to residents regularly. People living in the home manage their own money, they have a locking facility in their bedroom for securing money and valuables, although they can ask the home to look after larger sums of money or valuables if they need to and residents are asked to sign such items in and out for security purposes. The manager indicated that 19 minor accidents have taken place since the new accident book was started in Mid February 2008; none have required admission to hospital. Individual resident files viewed provided evidence that accident reports are being recorded and stored appropriately. The manager commented that People who experience a series of accidents would precipitate closer monitoring by staff and possible referral to an appropriate health care professional The manager reported that the maintenance team are responsible for ensuring all equipment and alarm systems are routinely serviced, and a sample of these including the electrical installation and gas boiler servicing certificates were examined and are due for renewal in 2009. The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 27 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 132 Requirement To have guidelines in residents care plan on medicines prescribed on a ‘when required’ basis (not met within timescale of 30/6/07) new timescale issued. Timescale for action 30/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations Those details of the home’s procedures for signing into and out of the home are included within the home’s Statement of Purpose and Service Users’ Guide. That the policy for the administration of homely remedies and discretionary medications by residents is further developed to take account of current best practice and professional guidance, and to detail clearly staff and resident roles and responsibilities. That the home explore activity options for visually impaired residents to aid their inclusion into the daily DS0000021254.V359608.R01.S.doc Version 5.2 Page 29 2 OP9 3. OP12 The Normanhurst Residential Care Home activity programme. 4. OP29 The manager to ensure records are maintained of interviews and that gaps in employment histories and the verification of reasons for leaving previous care roles are clearly explored and documented. The manager to introduce an observational element into the supervision process 5. OP36 The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 The Normanhurst Residential Care Home DS0000021254.V359608.R01.S.doc Version 5.2 Page 31 - 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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