CARE HOMES FOR OLDER PEOPLE
Adeline House Nursing Home Queen Street Thorne Doncaster South Yorkshire DN8 5AQ Lead Inspector
Valerie Hoyle Unannounced Inspection 09:00 2 February 2006
nd 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 Adeline House Nursing Home DS0000015848.V279050.R01.S.doc Version 5.1 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. Adeline House Nursing Home DS0000015848.V279050.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Adeline House Nursing Home Address Queen Street Thorne Doncaster South Yorkshire DN8 5AQ 01405 815512 01405 813594 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) County Healthcare Ltd, a wholly owned subsidiary of Four Seasons Health Care Ltd Mrs Vivienne Jacqueline Castle Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability over 65 years of age of places (40) Adeline House Nursing Home DS0000015848.V279050.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To enable up to five service users to reside at the home under the age of 65 years. 6th September 2005 Date of last inspection Brief Description of the Service: Adeline is situated in the heart of Thorne village, and is in easy reach of local shops and amenities. Grounds are well maintained usually by the handyman and a gardener and the drive leading to the entrance is block paved leading to the conservatory entrance. A quadrangle in the centre of the home is easily accessed by a sloping ramp and is a popular location for service users, and visitors. The home has three lounge areas; one is designated as the smoking area. The main entrance is a conservatory area with domestic type seating including sofas and coffee tables. All lounges have comfortable chairs with a television and domestic type lighting in all communal areas. There is a reception leading to the main areas of the home. The home provides both nursing and residential care. Qualified nurses provide the necessary care to those with nursing needs, and trained care staff provides care to the residential service users. Adeline House Nursing Home DS0000015848.V279050.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the second unannounced inspection of this inspection year. (2005/06) This unannounced inspection was conducted over 6.5 hours where a partial tour of the building was undertaken. The inspector examined three service users care plans and supporting documentation. Six staff and five service users were spoken to during the visit. Staff was observed interacting with residents (service users) in a positive supportive manner, enabling them to participate in daily living skills. The views of the visiting relatives were also gained during this visit. The registered manager was available throughout the visit and assisted while examining records and procedures. Reference to a complaint investigated on 15th November 2005 by CSCI is included within this report. What the service does well: What has improved since the last inspection?
The registered providers continue to improve the decoration and refurbishment of the building, to enhance the environment for service users. A number of carpets have been replaced and the shower facility has recently been refurbished. Staffing levels appear to have been maintained following a period where sickness levels were quite high, resulting in some shortages. This was identified in a complaint visit in November 2005. The registered manager has now recruited into vacant posts to ensure appropriate levels can be maintained.
Adeline House Nursing Home DS0000015848.V279050.R01.S.doc Version 5.1 Page 6 The registered nurses have responsibility for the administration of all medication, following concerns raised during the above complaints visit. 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. Adeline House Nursing Home DS0000015848.V279050.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Adeline House Nursing Home DS0000015848.V279050.R01.S.doc Version 5.1 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 the following standard(s): 3 Service users are not admitted into the home without a full needs assessment undertaken by the registered manager, to ensure their needs are met. EVIDENCE: The placing authority provides information to the home prior to admission and the registered manager is able to make an initial judgement about the suitability of the service user, and assess if the staff are able to meet their care needs. Three assessment documents examined included sufficient information to ensure care needs can be met by the staff at the home. A service user who had only lived at the home for a few months said she/he was still adjusting to living at the home, although staff were very kind, and caring. Adeline House Nursing Home DS0000015848.V279050.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 The care planning systems are sufficiently detailed to enable staff to deliver the care to service users who have specific identified needs. Arrangements for dealing with service users health issues are adequately met by staff at the home, with support from health professionals. Medication policies and procedures are well managed and qualified nurses have responsibility to administer the medication to service users, ensuring their safety and protection. EVIDENCE: Three care plans examined and these were comprehensively written with clear methods of staff intervention. There is sufficient evidence to confirm staff on a regular basis reviews the care plans and comprehensive risk assessments ensure service users can maintain their independence while remaining in a safe environment. The organisation has recently introduced new risk assessment for service users who require the use of bedrails to maintain their safety. The registered manager is currently consulting with relative and service users to gain their consent, as part of the process.
Adeline House Nursing Home DS0000015848.V279050.R01.S.doc Version 5.1 Page 10 Staff are comfortable with their abilities to meet the needs of service users and they are well informed and trained to deliver the care. Records examined and discussion with the staff confirmed service users healthcare needs are met. The qualified nurses are able to carry out nursing requirements for those service users who fall into the nursing category. District nurses also attend the home to carry out injections, take bloods and attend to dressing for service users who are residential. An audit of medication stocks and records was examined and were found to be correct ensuring the health and safety of service users. Qualified nurses have responsibility for administering medications and the local pharmacist is contracted to undertake periodic checks to ensure the stock levels are maintained and procedures are followed. Examination of the store cupboard found new supplies of medication not recorded, as the supplying chemist had not provided to medication administration record used to record all new stocks. This potentially could pose a risk to service users and therefore the registered manager must ensure that all medication received must be appropriately recorded and stored. Waste medication had not been discharged into the secure containers as required by the safe disposal of medication policy. The registered manager must ensure arrangements are made for the safe disposal of medication to ensure the safety and protection of service users. Adeline House Nursing Home DS0000015848.V279050.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 12, 13 Social activities are arranged by the home and residents are able to participate if they wish, to enhance their lifestyle experience. The home has clear visiting policies and procedures to ensure residents can maintain contact with their family and friends. EVIDENCE: The home employs an activities organiser, she spends time in small groups or individually to ensure all service users have an opportunity to be involved in some form of activity. The next planned social event is a valentine party including a buffet and karaoke sing a long. Staff said a theatre company had produced a pantomime held at the home, which was a very enjoyable event. Raffles and fund raising events are used to fund the entertainment. There is evidence that service users have access to daily newspapers and magazines. Posters displaying forthcoming events were seen, including photographs of recent outings. A number of visitors were spoken to during this visit and they said staff always made them feel welcome and they were confident that staff had the skills and knowledge to meet their relatives care needs.
Adeline House Nursing Home DS0000015848.V279050.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 16, 18 Service users and their relatives are provided information to enable them the raise concerns about the home and their care. Adult protection Policies, procedures and training of staff ensure the protection of service users from abuse. EVIDENCE: There is a complaints procedure that is available to service users and visitors. The procedure is also referred to in the service users guide, identifying the stages to follow; this includes the time scales to respond to complaints. The address and telephone number of the Commission for Social Care Inspection is included in the procedure. One complaint was investigated by CSCI partially upheld. The complaint raised issues regarding the staffing levels, medication administration issues and the recording of risk assessments. The registered providers have responded to the requirements made with regard to the two elements of the complaint that was upheld, and timescales have been met to address the issues. There is a comprehensive Adult Abuse and Whistleblowing and staff follow the procedures to those standards. The registered manager would investigate fully any allegations of abuse and would follow the necessary procedures if any were substantiated. The registered manager holds discussions with staff to talk over issues and how to recognise different forms of abuse.
Adeline House Nursing Home DS0000015848.V279050.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 19, 26 The registered provider continues to improve the décor and furnishings at the home creating comfortable and safe environments for service users. The home is clean and free from odours and there is sufficient domestic staffs to maintain good hygiene standards. EVIDENCE: The home is located well within the community of Thorne and the single storey building ensures that service users have easy access to all parts of the building. Grounds are well maintained usually by the handyman and a gardener and the drive leading to the entrance is block paved leading to the conservatory entrance. New front doors enhances the approach to the home and provides added security to ensure service users are safe. A quadrangle in the centre of the home is easily accessed by a sloping ramp and is a popular location for service users, and visitors. Adeline House Nursing Home DS0000015848.V279050.R01.S.doc Version 5.1 Page 14 Redecoration of bedrooms and the replacement of carpets continue to enhance the environment and there is also a rolling programme for the replacement of some bedroom furniture. The home was clean and free from offensive odours and service users said that their bedroom was always kept clean and tidy. The domestic staff are commended for their efforts in maintaining the cleanliness of the home. Adeline House Nursing Home DS0000015848.V279050.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 Staff have the skills and knowledge to fulfil their roles within the home, and a stable staff group ensures continuity of care by staff that knows the service users. Recruitment policies are followed ensuring the safety and protection of service users. EVIDENCE: Staff rotas examined demonstrated there is sufficient nursing and care staff to meet the needs of service users. The staff at the home have achieved the required 50 NVQ level 2/3 and are commended for their efforts. The registered manager has demonstrated a continuing commitment to developing the workforce, including attaining ‘Investors in People award’ Discussion with the manager regarding the recruitment of staff demonstrates clear understanding of the procedures to ensure the safety and protection of service users. There is a stable staff group who have a clear understanding of the needs of service users. Two new staff have recently been employed at the home, and their recruitment files were examined and contained all the necessary employment checks including references and CRB checks. Adeline House Nursing Home DS0000015848.V279050.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 38 The registered manager is skilled and experienced to manage the home to ensure the safety and protection of the service users. The registered provider must develop method to actively seeks the views of service users. Staff and service users follow health and safety procedures and records provide evidence of servicing of essential equipment. EVIDENCE: The registered manager has a wealth of experience and knowledge and is able to demonstrate her ability to manage the home. She holds a nursing qualification and is working towards the required management qualification. She has indicated that she will be in a position to complete the award in February. She operates an open door policy to ensure she is accessible to staff and service users. Service users spoke highly of the manager and said she was very caring.
Adeline House Nursing Home DS0000015848.V279050.R01.S.doc Version 5.1 Page 17 Residents meeting are used to gain the views of service users, including suggestions for menus and activity programme. Annual quality surveys are not used currently, although the organisation provides a leaflet that asks for comments about the service provided. The registered manager must ensure that an annual development plan is developed, based on a systematic cycle of planning, action, and reviewing to reflect the aims and outcomes for service users Accident reports are analysed by the manager to ensure risk assessments are developed where required. Maintenance and service records examined were up to date and current to the services provided. The manager has the required Health and Safety policies and procedures and displays the relevant notices. Fire safety procedures are in place and service records were examined and were current, ensuring the safety of service users. Adeline House Nursing Home DS0000015848.V279050.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 3 Adeline House Nursing Home DS0000015848.V279050.R01.S.doc Version 5.1 Page 19 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 OP9 Regulation 13 Requirement The registered manager must ensure that all new medication is recorded and stored securely when it arrives at the home. The registered manager must ensure waste medication is disposed of in the appropriate containers. Timescale for action 01/03/06 2. OP33 24 The registered manager must 01/07/06 develop a systematic approach to gain the views of service users 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 OP31 Good Practice Recommendations The manager must gain the appropriate management qualification in 2005 Adeline House Nursing Home DS0000015848.V279050.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Doncaster Area Office 1st Floor, Barclay Court Heavens Walk Doncaster Carr Doncaster DN4 5HZ National Enquiry Line: 0845 015 0120 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 Adeline House Nursing Home DS0000015848.V279050.R01.S.doc Version 5.1 Page 21 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
