CARE HOMES FOR OLDER PEOPLE
Alderwood Nursing Home Rectory Place Bensham Gateshead Tyne & Wear NE8 1XD Lead Inspector
Mrs Katie Tucker Unannounced Inspection 26th January 2006 12:00 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 Alderwood Nursing Home DS0000018167.V267880.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. Alderwood Nursing Home DS0000018167.V267880.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Alderwood Nursing Home Address Rectory Place Bensham Gateshead Tyne & Wear NE8 1XD 0191 477 7833 0191 478 3212 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) Mental Health Concern Mr Philip Samuel Green Care Home 32 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (23), Mental disorder, excluding learning of places disability or dementia (9), Mental Disorder, excluding learning disability or dementia - over 65 years of age (9) Alderwood Nursing Home DS0000018167.V267880.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 5th July 2005 Brief Description of the Service: The local authority first built Alderwood nursing home in the late 1960’s. In the 1990’s it was leased by Mental Health Concern and registered to provide nursing and personal care for people with mental health needs and dementia-type illnesses. Recently Mental Health Concern purchased the property and the staff who remained on NHS contracts transferred under TUPE arrangements to the organisation payroll. The home is divided into three units. The downstairs unit provides nursing care for people who require long term care because of the nature of their mental health needs. The upstairs contains a unit for the long term nursing care of older people with dementia type illness. The other unit on this floor provides respite nursing care for older people with dementia type illnesses. Alderwood nursing home is in the Bensham area just off the main road leading to Gateshead. There are local shops and bus stops on this main road. The home stands on an elevated site and is surrounded by a mix of houses. Alderwood Nursing Home DS0000018167.V267880.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Alderwood inspection was carried out as part of the routine yearly programme. No one working for Mental Health Concern was told that the visit was to take place. An inspector visted and spent part of the day at home. The inspector looked at staff training records and staff information. The staff were asked about the residents’ records, the guidelines for protecting residents, their training, staffing levels and changes to working practices. The residents were asked about life at the home. Alderwood provides a service for people with mental health needs and people with memory loss. So some of the people have difficulty making their views known. Therefore staff practice, attitude and approach were watched and judgements made on how well staff worked with people. During this inspection key standards were focused on but not all were checked. What the service does well:
The manager and deputy managers have a passion for delivering good quality care for people with dementia care needs as well as for those with mental health needs. The qualified staff and care staff understand the needs of the service and care a great deal about the resident’s. The manager and nurses keep abreast of new developments around looking after the people who live at the Alderwood. Where new practices are appropriate for the service they help staff introduce them at the home. Staff work well with residents and clearly care a great deal about them. Staff chatted to residents and listened to people’s views. Plus, there was lots of friendly banter going on through the day, which everybody enjoyed. Relatives comment regularly about how the staff value residents and provide an excellent service. Mental Health Concern’s staff training department is extremely active and all of the staff have access to a wide range of training. The type of training offered includes access to degree and masters level courses as well as secondments onto nurse training. One of the deputy managers has taken on the responsibility for making sure staff receive all of the training they need. Mental Health Concern is not only the owner of Alderwood but also a charity. Headquarters and Alderwood staff actively promote the recognition of people with mental health needs as full citizens. They run service user boards and provide opportunities for people with mental health needs to access
Alderwood Nursing Home DS0000018167.V267880.R01.S.doc Version 5.1 Page 6 employment. Some people who use other Mental Health Concern services now work at Alderwood and this has both benefited the home and employees. What has improved since the last inspection? 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. Alderwood Nursing Home DS0000018167.V267880.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 Alderwood Nursing Home DS0000018167.V267880.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): 1 and 3 Wide ranges of records are available and staff make sure these are completed in full. EVIDENCE: The home uses an assessment document specifically designed to give information about the needs of people with a dementia- type illness and younger adults with mental health needs. They are very comprehensive tools, which provides a lot of information about all aspects of people’s lives and needs. Staff complete assessments for all of the residents. The staff work hard to make sure they are well written. They see the development of the assessment tools as an ongoing process whereby amendments can and will be made and reviewed. Staff know that residents’ life histories are vital in this type of service. People with dementia tend to revert to previous routines and patterns of behaviour. When staff know the history they can work more effectively with people and reduce people’s anxieties and frustrations. Once the staffing issues have been resolved they are intending to concentrate on this aspect of the service.
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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 and 10 Although the staff in practice help service users to make decisions about their lives, are aware of associated risks and plan people’s care, this is not always reflected within the care plan or risk assessments. EVIDENCE: The staff have a very in depth knowledge of the people using the service and their needs. The staff are writing in a style that allows this information to be shared. Also the staff can recognise where they need to develop the records. Residents, if able, or their relatives can work with staff to write the service user plan. Because of the nature of their needs some of the residents cannot do everything they would want. Staff need to record information about people’s choices and wishes that cannot be respected. Also Alderwood’s house rules need to be recorded in a standard contract. Risk assessments are in place but these tend to refer physical needs and not other risks such aggression, social and emotional vulnerability. Also no risktaking actions are not recorded. These would identify the strengths people have and the common day risk that would be acceptable for someone to take. Alderwood Nursing Home DS0000018167.V267880.R01.S.doc Version 5.1 Page 10 Staff have formed very good links with the local hospitals. Many of the residents continue to see consultants. Also staff have repeatedly shown that they can seek out medical support when it is needed. The staff use a wide range of skills to find out what is upsetting residents and how best to resolve people’s concerns. Staff worked well with people. They were very respectful and valued people. Residents were very relaxed and able to spend time as they wished. Alderwood Nursing Home DS0000018167.V267880.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, 14 and 15 Staff recognise the need to make sure residents make choices about their lives and as far as possible help people remain independent. Activities are available but limited by availability of staff time. EVIDENCE: Currently there is no one responsible for organising activities and staff do this as part of their daily routine. This can lead to days when little can be organised or some staff being naturally better at finding interesting things to do. Residents were chatting to visitors, listening to music and watching TV. The provision of an activities co-ordinator can assist staff to make sure interesting, stimulating and individualised activities are on offer each day. Residents’ were making some chooses about how they spent their time. But staff need to be mindful of the need to show that people can wherever possible follow a routine that suits their needs. If because of people’s health they are unable to make informed choices this needs to be recorded in their care plans. Alderwood operates a cook/chill method for providing meals. Thus meals are sent to home prepared and staff then heat them. The home does not have kitchen staff and care staff complete this as part of their daily routine. Kitchen facilities have been provided in the younger adults unit and it is hoped that people will start to make some of their own meals.
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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): 18 The manager follows the local authorities protection of vulnerable adults procedures. EVIDENCE: Alderwood has an appropriate protection of vulnerable adults policy and follow Gateshead Social Services Department guidance. This guidance does, however, require Mental Health Concern to put in a section about what they would do if an allegation of abuse were made. Staff have had training around protecting residents. The Social Service Department is in the process of organising training for all the staff working in care. Alderwood Nursing Home DS0000018167.V267880.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 and 26 The refurbishment programme of Alderwood nears completion and the environment is meeting the needs of the residents. EVIDENCE: The local authority originally built Alderwood and the building is accessible for those with a wheelchair plus it is close to local amenities. However the road leading to Alderwood is on a slope as is the main road leading to the turning for Alderwood. Thus accessing shops for those using wheelchairs will at times be difficult. Alderwood is being refurbished and all communal areas will be redecorated. All of the windows have been renewed and residents, staff and relatives were complimentary about the changes these had created. Plus the lounge downstairs and kitchenette are being extended so more space can be provided. The bedrooms throughout the home have been changed to create more space provided. Various decking areas have been created outside and these have been enclosed so people can come and go safely and with little supervision.
Alderwood Nursing Home DS0000018167.V267880.R01.S.doc Version 5.1 Page 14 Changes upstairs will improve bedrooms, communal areas and signage. Also consideration is being given to using colour, as this has been proved to assist people with dementia-type illness orientate to the building. The option of providing similar domestic facilities upstairs has been discussed as research completed by the University of Stirling advocates maintaining everyday activities, such as completing domestic task because it follows peoples lived experiences and reduces anxiety plus provides meaningful activities for people. On the upstairs units windows are located above bedroom doors. These mean that during the night light will always penetrate rooms and can lead to disturbed sleep patterns and disorientation. The manager completed a survey of people and monitored behaviour and has found that on the whole this does not cause problems for people. Alderwood Nursing Home DS0000018167.V267880.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 and 29 The high staffing levels and introduction of domestic staff will further enhance the care service provided. An activities co-ordinator would further improve the quality of life experienced by the residents. EVIDENCE: The staffing levels at the home remain well in excess of those required by the previous registering authority and this greatly benefits the residents. The organisation has set their staffing level at a minimum of 2 first level nurse (RMN) and 8 care staff during the day. During the night 1 first level nurse (RMN) and 4 care staff are provided. Domestic staff are now being employed to complete tasks around the home. At present activities co-ordinators are not in post and activities can be limited. Mental Health Concern has a dedicated training department. This department provides staff with opportunities to go on a wide range of training. Most of care staff have completed NVQ training. The nurses and care staff are able to go on various courses including degrees. Plus secondment opportunities are provided for staff that wish to complete nursing qualifications. Staff records are kept centrally but these can be seen via an intranet link. Personnel staff make sure that CRB checks are completed, references obtained and full employment histories taken. The manager was made aware that there have been some changes to the regulations around employment and new staff now need to be supervised until the induction training has been completed.
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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, 35 and 38 The manager and senior staff are competent and make sure the service meets the needs of residents. EVIDENCE: The manager is very competent and holds appropriate management qualifications as well as being a registered nurse. His management team are skilled and provide strong overall management of the home. A team of finance staff at the head quarters look after the personal allowance records. Relatives and resident’s when they need information can get this from the manager via the intranet system. Only small amounts of money are held on behalf of residents. Receipts are kept. When money collects in the accounts held at head quarters this is sent to the appointee or relative to put in people’s savings accounts. No health and safety issues were noted at the time of the inspection.
Alderwood Nursing Home DS0000018167.V267880.R01.S.doc Version 5.1 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 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 Alderwood Nursing Home DS0000018167.V267880.R01.S.doc Version 5.1 Page 18 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 OP3 Regulation 15 (2) Requirement Social profiles for the service users with dementia-type illnesses must be included in the assessment. Information must be recorded around restrictions that are imposed. (Required at previous inspections – timescale 5/07/05) Risk assessments must include information about risk-taking. The decoration within the dementia care units must meet the requirements of the Disability Discrimination Act 1995 and be user friendly for people with a dementia. Activities co-ordinators must be employed to ensure personcentred approaches are used so culturally and individually appropriate activities are provided in the home. (Required at the last inspection – timescale 6/12/05 The owners must make sure the recruitment practice reflects the amendments and requirements of the regulations.
DS0000018167.V267880.R01.S.doc Timescale for action 29/06/06 2 OP7 12(2) Sch 3(3) (q) 29/06/06 3 OP19 23 (2) (a) 28/03/06 4 OP27 16 (2) (n) 27/07/06 5 OP29 17 (1) (c) 19 27/07/06 Alderwood Nursing Home Version 5.1 Page 19 A full career history must be recorded on the application form. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Alderwood Nursing Home DS0000018167.V267880.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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