CARE HOMES FOR OLDER PEOPLE
Adamstan House Nursing Home 187 Mill Lane Sutton, St Helens Merseyside WA9 4HG Lead Inspector
Diane Sharrock Unannounced 11 August 2005
th 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 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. Adamstan House Nursing Home F53 F03 S5446 Adamstan House V244273 110805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Adamstan House Address 187 Mill Lane Sutton St Helens Merseyside WA9 4HG 01744 819815 01744 850330 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Adamstan Limited Care Home 34 Category(ies) of OP - Old Age registration, with number of places Adamstan House Nursing Home F53 F03 S5446 Adamstan House V244273 110805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 34 OP. 2. The service ahould, at all times, employ a suitably qualified and experienced manager who is registered with the CSCI. 3. One named service user under pensionable age may be accommodated within the overall number of registered places. Date of last inspection 13th May 2005 Brief Description of the Service: The home is registered for 34 beds to provide nursing care for older persons over 65 years of age. The home is a limited company and the registered Provider is Mrs. A Stanaway, the Registered Manager has recently left and the current Manager yet to be registered with CSCI is Mr Kevin Jolley.The home is located close to local amenities and has 34 single bedrooms and is fitted with a passenger lift. It has a variety of shared spaces, which include a dining room, communal lounge and quiet areas. The home is purpose built and offers single accommodation only. Service Users are encouraged to personalise their private bedrooms. The home benefits from a variety of communal seating areas. A large communal lounge and separate dining room, conservatory which also looks at onto a lake. It is set in gardens, which are accessible to the Residents with outside seating and lakeside views Adamstan House Nursing Home F53 F03 S5446 Adamstan House V244273 110805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 3 hours and was unannounced. It took place as sufficient evidence had not been provided by the Owners to show evidence of compliance of all outstanding requirements issued at the previous inspection in May 05. A partial tour of the premises took place, Resident care plans and various other records were inspected. All areas of the inspection and findings were discussed with the Manager at the end of this inspection. An immediate requirement was made to update Residents care plans. What the service does well: What has improved since the last inspection?
The Manager explained that he had only been in post for a week but emphasised that he wanted to show evidence of compliance with all parts of the standards and the outstanding requirements, he was able to verbally give information regarding the planned repairs to the scrapes to baths and the installation of radiator covers to the home.. The previous inspection identified a 2 hour decrease in care hours in the afternoon and the Manager showed staffing rotas that now reflect an increase of those 2 hours so that the home is staffed according to the previous health authorities staffing notice. Adamstan House Nursing Home F53 F03 S5446 Adamstan House V244273 110805 Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Adamstan House Nursing Home F53 F03 S5446 Adamstan House V244273 110805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Adamstan House Nursing Home F53 F03 S5446 Adamstan House V244273 110805 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not measured during this inspection EVIDENCE: Adamstan House Nursing Home F53 F03 S5446 Adamstan House V244273 110805 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7.10 There continues to be progress made within care plans which include details for health, personal and social care needs of Residents however care plans seen needed further developments and updated reviews to their care. Privacy needs to be reviewed within the home especially regarding the practice of wedging bedroom doors open. EVIDENCE: The care records seen had a lot of detailed information however 2 care plans seen needed further review and updates to their care especially in relation to protecting a persons privacy and respecting individual requests around their care, clinical updates to pressure area care and ensuring all Residents have access to a “nurse call bell”, these points were discussed in detail with the Manager who agreed to updates these plans following this inspection. Some bedroom doors were seen wedged open and the issue around promoting a persons privacy and safety was discussed with the Manager who acknowledged the need to implement risk assessments and take the appropriate action to reduce any risks. Adamstan House Nursing Home F53 F03 S5446 Adamstan House V244273 110805 Stage 4.doc Version 1.40 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) This was not measured EVIDENCE: Adamstan House Nursing Home F53 F03 S5446 Adamstan House V244273 110805 Stage 4.doc Version 1.40 Page 11 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not measured at this inspection EVIDENCE: Adamstan House Nursing Home F53 F03 S5446 Adamstan House V244273 110805 Stage 4.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19.26 The environment is well managed and kept clean and tidy risk assessments are still in need of being updated and put in place.. There is an outstanding requirement regarding the home not producing a maintenance and decorating programme. EVIDENCE: The home was very clean and tidy especially the sample of areas seen. The home does not have a maintenance and decorating plan to show a planned approach to all parts of the home which would keep the Residents and Staff informed of changes to the home, it should be developed as previously discussed to show compliance and to provide a structured development plan for the Manager to use for future planning of the home. The Manager agreed to develop this plan following this inspection. Some baths still had scrapes to the enamel which needed attention to reduce risks of cross infection, they still need to be included in a maintenance programme to show whether they are to be replaced or repaired. The Manager
Adamstan House Nursing Home F53 F03 S5446 Adamstan House V244273 110805 Stage 4.doc Version 1.40 Page 13 stated that all baths are to be repaired although a date was not given at the time of inspection. Following this inspection the Manager has written to CSCI stating that all scrapes to baths have now been repaired. A large number of bedroom doors were seen wedged open and one person was anxious that anyone could walk into their bedroom. These points around privacy and safety were discussed with the manager who agreed to update the Residents care plan and ensure that detailed risk assessment s were in place identifying steps to reduce any risks. Adamstan House Nursing Home F53 F03 S5446 Adamstan House V244273 110805 Stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27.29 Staffing levels have been reviewed and the home is now staffed as it was within the previous health authorities staffing notice. Personnel files are in need of being updated to provide accurate information for each Staff member. EVIDENCE: The Staffing rotas showed an outstanding issue from the previous inspection in March 05 and May 05 were the homes Care Staff levels were short by 2 hours in the afternoon compared to the homes printed staffing notice previously agreed with the Health Authority. The new Manager has now increased the Staffing levels to the original staffing levels so there is no longer a decrease of 2 hours in the afternoon. The Manager acknowledged that the rota was not accurate on the day of inspection and explained that he was in the process of changing the duty rota to identify all hours worked by each staff member. Staff personnel files were found to be detailed, however one file was noted to have an out of date professional registration number for one Staff member, the Manager agreed to take appropriate action regarding this registration and inform CSCI of the outcome. Adamstan House Nursing Home F53 F03 S5446 Adamstan House V244273 110805 Stage 4.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33.38 There is an outstanding requirement regarding the Owner not producing an update and action to reduce risks identified in the homes own risk assessments for uncovered radiators. Regulation 26 reports have not been carried out by the Provider and a requirement has been made. EVIDENCE: One outstanding requirement from the previous inspection in March and May 2005 was regarding some “uncovered radiators” and the risk assessment identified various risks. The Manager explained that the Owners were now taking action to trial various types of radiator covers, one was seen in the dining room, however no date was given for the installation of such covers and there was no written changes made to the homes risk assessment. The Manager has now forwarded an updated written risk assessment to CSCI following this inspection which states that all radiators will eventually have covers within a 3 month timescale. Other health and safety issues were also
Adamstan House Nursing Home F53 F03 S5446 Adamstan House V244273 110805 Stage 4.doc Version 1.40 Page 16 noted during this inspection ie one window restrictor was broken to one window, clothing was being aired in a corridor, one person sat in their room could not reach their “nurse call bell due to how they were positioned in their bedroom . The Manager agreed to carry out a health and safety check to the home and agreed to take appropriate actions to all areas identified during this inspection and the Manager has also sent a written plan updating CSCI on all actions taken by him to reduce all identified risks. The Provider has not submitted monthly reports to the CSCI in which they should document at least monthly visits to the home in which they review certain records and interview Staff, Residents and Visitors to the home. Adamstan House Nursing Home F53 F03 S5446 Adamstan House V244273 110805 Stage 4.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x 2 x x x x 2 Adamstan House Nursing Home F53 F03 S5446 Adamstan House V244273 110805 Stage 4.doc Version 1.40 Page 18 yes Are there any outstanding requirements from the last inspection? 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 19 Regulation 23 2 Timescale for action The Responsible Person must The produce an updated Manager maintenance and decorating has forwarded plan, including baths that currently have scrapes to the a written enamel/surface and submit this plan to plan to the CSCI, Describing the CSCI stating all actions taken to meet this regulation..(This was made at repairs the previous inspection ). have been completed. The Responsible Person must The take appropriate action to reduce Manager the associated risks as recorded has in the homes own risk forwarded assessments for uncovered a written radiators. and all other areas of plan to health and safety noted within CSCI this inspection and submit an stating all action plan to the CSCI, updated describing the actions taken to actions to meet this regulation. be taken to reduce identified risks. The Responsible Person must The ensure all personnel files meet Manager the requirements in line with has Schedule 2 of the Care Home forwarded Regulations 2001 and submit an a written action plan to the CSCI, plan to
Version 1.40 Page 19 Requirement 2. 25 13 4 c 3. 29 19 9 c Adamstan House Nursing Home F53 F03 S5446 Adamstan House V244273 110805 Stage 4.doc Describing the actions taken to meet this regulation... 4. 33 26 5. 7 15 1) 2) b The Responsible Person must submit Regulation 26 reports to the CSCI each month...(This was made at the previous inspection ). The Responsible Person is 22/9/05 required to provide evidence that all Service Users will be provided with a detailed, accurate and appropriate care plan according to their needs. Please submit an action plan to the Commission detailing what actions will be taken to meet this regulation. CSCI stating all updated actions taken to update personnel file. 22/9/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 38 19 Good Practice Recommendations To implement dates and signatures to all risk assessmenst to ensure they are all up to date. To implement and develop a maintenance and decorating plan to show a planned approach to all parts of the home which would keep the Residents and Staff informed of changes to the home 3. Adamstan House Nursing Home F53 F03 S5446 Adamstan House V244273 110805 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection 2nd Floor Burlington House Crosby Road North Waterloo, Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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