Inspection on 28/02/08 for Alveston Leys Nursing Home

This inspection was carried out on 28th February 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Alveston Leys Nursing Home Kissing Tree Lane Alveston Stratford On Avon Warwickshire CV37 7QN Lead Inspector Lesley Beadsworth Key Unannounced Inspection 11:45 28 & 29th February 2008 th 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 Alveston Leys Nursing Home DS0000070593.V360083.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. Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alveston Leys Nursing Home Address Kissing Tree Lane Alveston Stratford On Avon Warwickshire CV37 7QN 01789 204391 01789 263896 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) www.bupa.co.uk BUPA Care Homes (ANS) Ltd Mrs Julia Elizabeth Joy Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old Age, not falling within any other category - Code OP, maximum number of places 37 The maximum number of service users who can be accommodated is: 37 02 March 2007 2. Date of last inspection Brief Description of the Service: Alveston Leys Nursing Home was purpose built in 1999 and is situated in the village of Alveston. Local buses run to the town of Stratford upon Avon, which is situated a few miles from Alveston Village. The home is registered to provide accommodation and care to service users over the age of 65 who may require nursing care. The current owner BUPA Care Homes Ltd has owned the home for six months. The en suite accommodation is provided on three floors with access to these via passenger lift or stairs. The home’s décor and furnishings are homely and of a high standard. The gardens are mature and well maintained being accessible to all current service users. The cost of living at this service was not published in the Service User Guide although there was information about the extra costs for private medical care (chiropody, physiotherapy, dental care), hairdressing, newspapers, beautician, connection of a private telephone line, dry cleaning, taxis, activity outings and visitors’ lunch. Alveston Leys Nursing Home DS0000070593.V360083.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. The inspection included a visit to Alveston Leys Nursing Home. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA), which is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Information contained within this, from surveys that had been provided by us and completed and returned, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place over two visits, between 11.45am and 9:30pm on the first day and 2pm and 4pm on the second day. What the service does well: The home has an up to date Statement of Purpose and Service User Guide that gives people information they need to help them to make a decision about moving into the home and about the services provided. All care files contained a pre admission assessment carried out so that the home could establish if they are able to meet the person’s needs. Residents spoken to said that they had been visited by member of staff from the home or had visited the home prior to admission. Care plans had been devised from the assessments, which had been reviewed monthly and signed by the residents and the member of staff involved. ‘Acute’ Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 6 short term care plans were in place, which is good practice as it ensures that all needs however temporary are considered. Residents spoken with said that they were well cared for, with positive comments made by residents and visitors regarding the care given by staff, including, “They’re very good really.” “Staff are very good”. They’re quite nice.” “(the staff) look after me well.” The home had two medication trolleys that were locked and stored securely. Observations showed that there was a safe system for administering medication. All records, observations and discussion showed that residents health and welfare are safeguarded by the medications systems.. As was confirmed by residents were cared for in a respectful manner and this ensures that their dignity and self-esteem are maintained. Time was spent in the communal areas with residents and staff were gentle and caring. A resident volunteered the comment, “ Staff are very respectful”. Residents were occupied and stimulated. The home displayed several notices to inform residents and visitors of forthcoming events and activities, which were very varied and differed each week. Residents meetings were held monthly, giving residents the opportunity to have an affect on the way the services at the home are delivered. Links with family and friends are maintained. Visitors spoken with said that they were happy with the home for their relative and that they were always made welcome. Observations made and discussion with residents and visitors showed that people living and staying at the home have the opportunity to make choices throughout the day including when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time. Meals were prepared in the kitchen shared with the adjoining residential home and offered choice, variety and nutrition. They were well presented and residents made such comments as, “Wonderful meals” “The food is beautiful.” “The food is always good.” The kitchen was clean and in good order and had a current Gold Award from Environmental Health. Catering staff work 8am to 7pm each day, enabling Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 7 good provision of food for residents without nursing and care staff having to take time away from their care. The home has appropriate policies and procedures related to complaints and adult protection to safeguard residents. Complaints had been taken seriously and managed appropriately. All recruitment practices safeguard residents from the employment of unsuitable people. The home has very comfortable surroundings. The home is furnished to a good standard and offers attractive indoor and outdoor surroundings, which are generally well maintained, clean and free of offensive odour. All bedrooms had ensuite facilities, were well furnished and were supplied with a remote control television and with telephone points. Several residents spoken with said that they were happy with their personal accommodation. Appropriate facilities of soap dispensers and disposable towels were available in all communal hand washing areas to aid in maintaining infection control. The normal complement of staff provided sufficient nursing and care staff to meet the needs of the people living at the home. The home has exceeded the required target of 50 of the care staff to have the National Vocational Qualification Level 2 in Care qualification with 70 having achieved this qualification, which shows that staff have been assessed as competent in their role. The senior cook and catering assistant have also gained a National Vocational Qualification. The importance of training is recognised and in addition to induction training and National Vocational Qualifications staff have undertaken mandatory training in health and safety areas and further training to meet specialist needs of people living at the home. A person with the appropriate nursing and management qualifications and appropriate experience manages the home. Staff and residents spoke positively about her and she showed a supportive and loyal stance towards the staff team. Quality Assurance systems indicated that the home is monitoring the service in order to enable growth and improvement. What has improved since the last inspection? Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 8 Staff supervision takes place at regular and appropriate intervals. The manager supervises senior staff who cascade the supervision to other staff. the manager is supervised by the Regional Manager of the organisation. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. The statement in the ‘Gold Standard’ referring to not carrying out resuscitation and treatment in palliative care has been removed in order that no poor care decisions are inadvertently made. The use of mystery shoppers had been introduced by the organisation and assisted in identifying areas where improvement was needed. The home had started the BUPA Night Bite system to ensure that food is available 24 hours a day for the people living at the home. Abuse training had recently been implemented so that all staff will have undertaken this training and thereby have the knowledge and skills to identify abuse and to safeguard residents. The home had implemented the organisation’s national Quality Assurance programme that is supported by a Quality and Compliance team of experts. What they could do better: The charges for living in the home should be included in the Service User Guide in order to inform prospective residents of the costs involved. There were some omissions from care plans related to two residents’ health care needs. Staff were aware of these needs but were relying on staffs’ memory and verbal communication, which could cause these needs to be overlooked. Care plans contained a great deal of paperwork, some of which was repeated information. Whilst some of this was due to the changing over period from the old organisation’s paperwork to the new ones it could make finding information difficult. The manager said that this would be looked at. One bedroom had protective clothing (plastic aprons, disposable gloves and sanitizer) stored outside the room for staff’s use. Discussion revealed that this person had an infection but displaying these items does not uphold the dignity of the resident and could label them as ‘infectious’ to other people in the home. The home should seek advice from an infection control nurse regarding the need for these items to be outside a bedroom. Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 9 One resident said in a survey that there was a large gap between teatime and breakfast but the home provides a ‘Nite Bite’ menu that the person was not aware of. Residents’ need to made aware/reminded of this, especially those that rarely leave their room, as they may be reliant on staff to inform them of the services available. The carpet on the ground floor by the laundry doors and garden exit was in need of replacing but this was in hand and new carpet was due to be provided. Bedroom and laundry doors were wedged open. The need for door open devices had been identified by the home and these devices were to be provided later in the year but in the meantime created a risk in the event of a fire. The waste bin in the staff/visitor’s toilet was overflowing with disposable towels and was without a lid, creating a risk of cross infection. The manager said that this would be attended to promptly. Staff also must dispose of protective clothing at the site of where protection was needed. 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. Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 10 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 Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is good. Information required to make a decision about choice of home is available when needed. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had an up to date Statement of Purpose and Service User Guide that had been revised since the current owners had purchased the home. There was also a colourful and well presented folder containing this information with photos that were representative of the home. The costs charged for living at the home were not included in the Service User Guide although stated that the details were available in the contract of admission. The additional costs were clearly listed in the Service User Guide. One resident said in a survey that they had received sufficient information about the home before moving to be able to decide if it was the right place for them and other residents spoken with confirmed this. Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 12 Three care files were looked as part of the case tracking process. All files contained a pre admission assessment of each person’s needs and abilities, using a format provided by the organisation that includes all the necessary headings and sufficient detail to decide if the home could meet the person’s needs or not. The format is a tick box system but with ample space for the assessor to make more detailed comments. The assessment is meant to identify where there is a need that requires support, which then directs the staff to devise a care plan and appropriate risk assessments to meet that need. The assessments had been signed and dated by the assessor. Residents spoken to said that they had been seen a member of staff from the home prior to admission. Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is good. Residents’ needs are met; there are minor shortfalls in some care plans that may result in these needs not being met. Residents have access to health care professionals and are cared for in a respectful manner. Medication systems safeguard the residents’ health and welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans were included in each of the three care files looked at. These had been devised from the assessments using a format provided by the organisation. Those seen in general set out the care required in sufficient and up to date detail to ensure that all aspects of the social, health and personal care needs of residents were met. However one plan looked at did not reflect the doctor’s instructions related to breathing problems and the need for a nebuliser; a second did not show the instructions from the speech therapist although the visit was recorded there. Whilst staff were aware of these needs when omitted from the care plan, relying on staff memory and verbal handover of information creates the risk of needs not being met. Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 14 Care plans were reviewed and revised monthly and were signed by the resident and the member of staff to show that the resident and/or their representative had been involved in drawing up the plan. Staff had good, clear guidelines available to them on how to draw up care plans and risk assessments. ‘Acute’ short term care plans were in place. This is good practice as it ensures that all needs however temporary are considered. The care plans consisted of a great deal of paperwork that could make finding the appropriate information difficult. The manager said that some duplication was due to the change over of paperwork from one organisation to another and that she would look at where any repeated paperwork could be removed. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist and Speech and Language Therapist being identified in the care files looked at. Records for falls, pressure areas, weight, bathing and nail checks were in place within the files looked at. Completed risk assessments for nutritional risk screening and a manual handling risk assessment were also in place. These would help to minimise any risk. Risk assessments related to pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area) were in place for each resident so that any risk could be identified and the appropriate action taken to minimise that risk. Preventative measures such as pressure relieving mattresses and cushions were in use where assessed as needed. The statement in the ‘Gold Standard’ that referred to not carrying out resuscitation and treatment in palliative care had been removed in order that no poor care decisions were inadvertently made. All residents observed or spoken with during the visit were well groomed and looked well cared for. Residents spoken with said that they were well cared for, with positive comments made by residents and visitors regarding the care given by staff, including, “They’re very good really.” “Staff are very good”. They’re quite nice.” “(the staff) look after me well.” The home had two medication trolleys that were locked and stored securely. Observations showed that there was a safe system for administering medication. Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 15 Medication Administration Record Sheets were examined. Each contained a photograph of the resident, to ensure correct identification, and notes of advice regarding the resident’s mental awareness, their ability to swallow, any allergies or any other relevant information. The receipt and disposal of medication was recorded satisfactorily and copies of prescriptions were kept in order that they could be used to confirm what was received against what was ordered. There were no unexplained gaps or inappropriate codes used on the Medication Administration Record Sheets (MARS). However one Medication Administration Record Sheets, received that day, had very misleading instructions over several pages, for a resident who was receiving end of life care and whose medication dosage was complex. Whilst the nurse spoken with fully understood the instructions it was agreed that anyone not having had a full explanation would have difficulty in giving the correct medication. The deputy manager, who was also responsible for medication in the home, said that she would request that the pharmacist rewrite this. A random audit of tablets was carried out, all balances were correct, and there was no excessive storage of medication. Controlled drugs were looked at found to be in order. All medication records, observations and discussion showed that residents health and welfare are safeguarded. All bedrooms had a telephone point for residents to arrange for their personal line if they wished, which would be at their own cost. There was also a payphone sited in such a way that calls could be taken in private. Residents confirmed that they were cared for in a respectful manner and this ensures that their dignity and self-esteem are maintained. Time was spent in the communal areas with residents and staff were gentle and caring. A resident volunteered the comment, “ Staff are very respectful”. Terms of preferred address were on the residents care plan and heard to be used by staff. One bedroom had protective clothing (plastic aprons, disposable gloves and sanitizer) stored outside the room for staff’s use. Discussion revealed that this person had an infection but this display of equipment does not uphold the dignity of the resident and labels them as ‘infectious’. Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. Residents were occupied and stimulated. Visitors were made welcome. Residents had choices and control over their daily lives and enjoyed the nutritious and varied meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home displayed several notices to inform residents and visitors of forthcoming events and activities. These differed each week and the variety offered included, Quizzes, board games, Book Club, Movie Matinee, Holy Communion, ‘What the Papers Say’ and movement to music. Events included a Caribbean Night a few days before the visit and ‘Proms at Home’. In the ground floor sun lounge, also used as an activity room, an on-going Word Search puzzle was on an easel and a jig saw was partly done on a table. Residents spoken with said that they had plenty to do. One resident said when spoken with, and in a survey they completed, that they chose not to join in the activities. The staff continued to encourage joining in but left the choice to the resident. Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 17 The notice board displayed photographs and a newsletter from the Activity organiser. A large font could be considered for these notices to enable everyone to read them more easily. The registered manager advised that residents meetings were held monthly, giving residents the opportunity to have an affect on the way the services at the home are delivered. Large screen televisions and a media centre were available in communal areas and a large variety of videos and library books could be borrowed from the sun lounge on the ground floor. A ramp led from this room to the attractive gardens which residents spoken with said that they enjoyed. Links with family and friends are maintained. Visitors spoken with said that they were happy with the home for their relative and that they were always made welcome. A resident had relatives visit very early in the morning and late in the evening each day and when spoken with one of them said that they always felt welcome. Observations made and discussion with residents and visitors showed that people living and staying at the home have the opportunity to make choices throughout the day including when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time. Residents were encouraged to personalise their rooms and some had brought small items of furniture into the home with them. This was referred to in the Service User Guide. Meals were served in the small dining room or in the residents’ bedrooms. the dining room had recently been reduced in size and would only comfortably cater for 26 people. However there were far less than this using the room at mealtimes during the visits and staff said that there were always people who either preferred to eat in their room or were not well enough to come to the dining room. Lunch on the first visit was turkey casserole with cauliflower and potatoes. The meal was well presented, tasty and nutritious. He menu was varied and offered ample choice. Other choices available included baked potatoes with a choice of fillings, omelette with a choice of fillings, salads or sandwiches. Residents said that they enjoyed the meals at the home with such comments as, “Wonderful meals” “The food is beautiful.” “The food is always good.” Staff gave assistance as required in a sensitive manner, in particular when feeding a resident. Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 18 In a survey returned to us after the visit one resident said that there was a long gap between teatime at 5.30pm and breakfast. However the home advocates that there are evening drinks and snacks available at 8pm onwards as well as a ‘Nite Bite’ menu for snacks at night.. Residents need to made aware/reminded that this menu is readily available, especially those that rarely leave their room as they may be reliant on staff to advise them. The kitchen was visited and found to be clean and organised. It is shared with the adjoining residential home and had a current Gold Award from Environmental Health. Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is good. The home has appropriate policies, procedures and training to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the organisation’s complaints procedure was displayed in the reception so that visitors knew what to do if they had any concerns. Residents had a copy in their individual bedrooms. Residents spoken with knew who to speak to if they did have concerns and said that they felt they would be listened to. In a completed survey returned by a relative a comment was made that the manager had responded and acted upon concerns raised. Two complaints had been made to the home since the last inspection. One was related to the cleanliness of a bedroom and the other to an poor response to a call bell. There was evidence that both complaints had been dealt with promptly, sensitively and to the satisfaction of the complainants, showing that complaints are taken seriously. There is an appropriate policy related to Protection of Vulnerable Adults, with the home holding the local Authority policy and that provided by the organisation. Staff had undertaken recent training, which was on going and staff spoken with had an awareness of adult protection. Residents are therefore safeguarded from abuse as staff know how to identify abuse and to protect people at the home from abuse. Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 20 All recruitment practices safeguard residents from the employment of unsuitable people. Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 21 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, 20, 21, 24, 26 Quality in this outcome area is adequate. The home offers the people living there very comfortable surroundings, which are clean, free of offensive odour and generally safe and well maintained but with minor shortfalls. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is approached from a large car park and attractive gardens and via ramp or a flight of steps to a terrace that has a fountain feature and seating for residents. The home is a sympathetic extension to the adjoining residential home and due to the terrain of the site the first floor is level with the entrance and the ground floor one flight down from the reception. The reception was welcoming and attractive, with fresh flower arrangements and good quality furnishing. The administrative office is located here, although at the time of the visits the nursing staff were using it whilst the clerical position was vacant. A new nurses/care office had been provided on the second floor. Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 22 The reception leads to the first floor corridor with the managers’ office and the dining room to one end and bedrooms and communal rooms to the other end. The dining room had originally been part of a lounge/dining room but had been reduced in size to make the current office used by the nursing home and residential home managers. The dining room was comfortable and attractively decorated and, as in the rest of the home, with good quality pictures displayed on the walls. The inside of the cutlery drawers in the dining room were very worn and would be difficult to clean and may become a source of contamination. Adjacent to these rooms are the staff and visitors toilet. The bin to be used for used paper towels was overfull throughout the visit and was without a lid. This is a source of infection, particularly as staff were also disposing of disposable gloves there. The bin should have a lid and be emptied frequently. The manager said this would be resolved promptly. The communal lounges offered comfortably furnished, bright and attractive living space for the people living at the home. Fresh pot plants and flowers were displayed around the communal areas of the home. All areas were furnished in an attractive domestic manner and to a high standard. All floors accommodated bedrooms, toilets and a bathroom and the ground floor had access to the garden. The floor covering leading to the garden exit was threadbare and as well as being unsightly was a potential trip hazard. The manager later advised that the carpet was about to be replaced. The outer and inner laundry doors were wedged open, which would permit the passage of flames and/or smoke in the event of a fire in the high-risk laundry area. Bathrooms were clean and uncluttered and sufficient assisted bathing facilities were provided for the needs of the home. All bedrooms had ensuite facilities, were well furnished and were supplied with a remote control television and with telephone points. Ground floor bedrooms had patio doors to the garden. Several residents spoken with said that they were happy with their personal accommodation but one survey returned to us said that shortage of domestic staff had created less than adequate “housekeeping”. Those rooms looked at were clean and free of offensive odour. There had been a domestic assistant vacancy for some time but a new member of staff was beginning employment at the home the following week. Several bedroom doors were wedged open at the occupants’ request. Risk assessments related to these advised staff to remove them if the fire alarms sounded. The need for stay open devices, that closed the doors when the fire alarms sounded, had been identified and were to be provided later in the year. The organisation should seek advice from the fire service regarding the approved types of device. Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 23 Windows in bedrooms were without restraints, although they had been budgeted for and there were plans for them to be fitted later in the year. Risk assessments were in place in the meantime. Appropriate facilities of soap dispensers and disposable towels were available in all communal hand washing areas to aid in maintaining infection control. Staff had access to protective clothing to further maintain infection control. However some of these had been disposed of in the staff toilet waste bin rather than at the site of use, which could cause cross infection. A diagnosed infection was being managed in a rigorous manner. It was the home’s practice to have protective clothing and sanitising items available outside the room of anyone with whom such an infection had been identified. This did not uphold the dignity of the resident and may be unnecessary. The home should seek advice from an infection control nurse for further advice. The large laundry area was on the ground floor of the nursing home and shared by the adjoining residential home. It was clean, in good order with clearly defined clean and dirty areas, washable walls and floor covering and with appropriate and clean laundry equipment. There was no separate hand washing facilities in the laundry but there was an adjacent WC had a hand washbasin with a soap dispenser and paper towels. There were other storage areas in the basement. Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is good. There are sufficient care staff available to meet the needs of the residents. Satisfactory recruitment practice protects residents. The importance of training is recognised and a high ratio of staff have National Vocational Qualifications. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The usual staffing complement is two registered nurses and five care assistants each morning, 2 registered nurses and four care assistants in the afternoon and evening and one registered nurse and two care staff during the night. The manager said that if necessary the number of care staff are increased at peak times. Any absence is covered where possible by offering existing staff overtime in order to maintain continuity of care but unplanned absences can be covered by agency staff. Two new care staff and a registered nurse were commencing employment at the home the following week. Some of the day shifts and all of the night shifts were 12 hours in duration, which are considered long shifts to work. The normal complement of staff provided sufficient nursing and care staff to meet the needs of the people living at the home. Catering staff are ‘shared’ with the adjoining residential home. Two cooks are employed who cover the homes from 8am to 7pm each day, and work together on one or two days a week, and a catering assistant works 8am to 4pm on Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 25 three to four days a week. This staffing enables provision of food for residents without nursing and care staff having to take time away from their care. The designated laundry staff are also ‘shared’ by the adjoining residential home. The staff budget allows for three domestic staff but there has been a vacancy for some time. This had just been recruited to and a new employee was due to start the following week. In addition an administrative assistant was also starting work at the home the following week and would be shared with the residential home. The home has exceeded the required target of 50 of the care staff to have the National Vocational Qualification Level 2 in Care qualification, which show that staff have been assessed as competent in their role. The senior cook and catering assistant have also gained a National Vocational Qualification. All recruitment practices safeguard residents from the employment of unsuitable people, with all three staff files looked at having the appropriate references, Criminal Records Bureau, Protection of Vulnerable Adults and employment checks. The organisation has a comprehensive induction programme and there was evidence that new staff undertook this training, giving them the information they needed to start their job. Other training undertaken by staff included, all mandatory training related to health and safety issues and training related to continence management, Huntingdon’s, ‘Swallowing Awareness’ and Protection of Vulnerable Adults. Some training is carried out as cascade training and by the watching of videos. The manager and other staff said that they had had more opportunities for training with the new organisation and looked forward to this continuing. Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 26 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): Quality in this outcome area is good. A person with the appropriate nursing and management qualifications and experience manages the home. Monitoring and auditing of the service and practices ensure that all services operate in the best interests of residents. Health and safety and financial practices safeguard the people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager had been in post for four years, is a registered nurse and has achieved the Registered Managers Award, making her appropriately qualified for the registered manager role. Her previous employment had given her appropriate experience. She was currently undertaking a Diploma in Management Studies. Staff and residents spoke positively about her and she showed a supportive and loyal stance towards the staff team. Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 27 The organisation had a Quality Assurance department and the system that is supported by a Quality and Compliance team of experts had been implemented in the home. Monthly-unannounced visits were made to the home by a representative of the organisation and a report on the findings sent to them and a copy to us. A survey had recently been carried out by the organisation showing that the home was offering a very good service. Further feedback about how the service is doing is provided at residents and relatives meetings. There was evidence that action is taken to make necessary improvements and changes. The use of mystery shoppers had been introduced by the organisation and assisted in identifying areas where improvement was needed. These systems indicate that the home and organisation are monitoring the service in order to enable growth and improvement. The home does not hold any money on behalf of residents, although some have money held by the organisation in bank accounts. When the resident requires money a request is made to head office and the home is then able to collect it from the local post office. Records are kept on computer at the home but the head office of the organisation does all billing. All current residents were supported by their family or friends and did not require the services of an advocacy service but the manager was aware of how to access these services if required. The residents’ financial affairs are therefore safeguarded by the home. Staff supervision takes place at regular and appropriate intervals. The manager supervises senior staff who cascade the supervision to other staff. The Regional Manager of the organisation supervises the manager. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. Health and safety checks and maintenance and servicing records were looked at on a random basis. There was evidence that these were completed as required. There were some shortfalls in safety issues due to the use of door wedges and lack of window restraints but there were plans for these issues to be addressed and generally the home was a safe place to live and to work. Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 28 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 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X 4 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 3 X 3 X 3 3 X 3 Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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. 3. 4. 5. 6. 7. Good Practice Recommendations The costs of living at the home should be included in the Service User Guide. All health care needs should be included in the care plans of the people living at the home. Staff should ensure that residents are kept informed and reminded of the services available to them. The floor covering on the ground floor should be replaced as soon as possible. The cutlery drawers in the dining room should be made impermeable to enable effective cleaning. The home should consider the dignity of the residents when dealing with infection control and seek advice from the infection control nurse regarding this. The plans for addressing the need for door wedges and the lack of window restraints should be addressed as planned. OP1 OP7 OP15 OP19 OP26 OP26 OP38 Alveston Leys Nursing Home DS0000070593.V360083.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Alveston Leys Nursing Home DS0000070593.V360083.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. 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!