Inspection on 11/10/06 for Autumn House Nursing Home

This inspection was carried out on 11th October 2006.

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

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

Other inspections for this house

Autumn House Nursing Home 06/04/09

Autumn House Nursing Home 21/04/08

Autumn House Nursing Home 03/10/07

Autumn House Nursing Home 09/08/05

Autumn House Nursing Home 13/04/05

Autumn House Nursing Home 08/09/04

Autumn House Nursing Home 27/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Autumn House Nursing Home 2 Station Road Worsbrough Dale Barnsley South Yorkshire S70 4SY Lead Inspector Christine Rolt Key Unannounced Inspection 11th and 12th October 2006 09:20 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 Autumn House Nursing Home DS0000006470.V312422.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. Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Autumn House Nursing Home Address 2 Station Road Worsbrough Dale Barnsley South Yorkshire S70 4SY 01226 243057 01226 247651 none 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) Mrs Nurjahan Hossain Mrs Vijay Kumari Singh Post Vacant Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Persons accommodated shall be aged 60 years and above with the exception of three persons who can be 55 years or over. Of the 35 beds registered, all can be used for personal care. Twenty of these can alternatively be used for nursing care. 9th August 2005 Date of last inspection Brief Description of the Service: Autumn House is a care home providing personal and nursing care for up to 35 older people. The home is situated in a residential area of Worsborough Dale, close to all local amenities and bus routes. Accommodation is provided over two floors served by a passenger lift and stairs. The home has 23 single and six double rooms, three of the double rooms have en-suite facilities. Communal accommodation consists of two lounges, one dining room and a visitors’ lounge. Sufficient bathing facilities are available, with aids and adaptations in place. A central kitchen and laundry serve the home. The home is in an elevated position in its own grounds, and is reached by a steep tree lined driveway. Car parking is available. Information supplied in the Pre-Inspection Questionnaire dated September 2006 stated that the weekly fee was from £315 to £449.25. Hairdressing was not included in the weekly fee and was charged separately. Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection and comprised information already received from or about the home and a site visit. The site visit was from 9:20 am to 6.00 pm th The on 11 October and from 9.15 am to 1.00 pm on 12th October 2006. home did not have a registered manager. The acting manager Mrs. Shirley Smith was present and provided assistance throughout the two days. The majority of the residents were seen throughout the two days. Four residents and four relatives were asked detailed questions about their opinions of the home. Three residents were tracked throughout the inspection. A sample of records was examined and a partial inspection of the building was carried out. The inspector wishes to thank the manager, staff, residents and relatives for their assistance and co-operation. What the service does well: What has improved since the last inspection? Requirements relating to furnishings and furniture that were highlighted in the last inspection report have been addressed. The home has a rolling programme of redecoration and an annual development record is now kept. Residents’ consent to medication is now recorded on care plans Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 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 Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 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 and 6. Quality in this outcome area is good. This judgement has been made from evidence gathered before, during and after the visit to this service. The home does not provide intermediate care. Residents only moved into the home after their needs had been assessed and been assured that the home could meet their needs. Prospective residents had the information they needed to make an informed choice. EVIDENCE: The acting manager said that prospective residents were assessed to ensure that the home could meet their needs. Copies of the assessments were seen on residents’ files. The reasons for choosing this home were “Liked the people”, “Clean and seemed sociable”, “Came in for respite and decided to stay”, “Visited others and this was most friendly”, “Home atmosphere and cleanliness” and “Dad visited a few…liked this one best…nice atmosphere and friendly”. The acting manager said that prospective residents and their Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 9 families were informed that they could visit and view the home at their convenience; they were shown the communal areas and the bedrooms available. They were given verbal information and questions were answered. Copies of the service user guide and statement of purpose were displayed on the notice board. Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 10 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, 10 and 11. Quality in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service Residents’ health, personal and social care needs were set out in individual care plans, health care needs were met and changing needs were reflected in the care plans. Medication procedures did not ensure that residents were protected. Residents’ privacy and dignity were respected. EVIDENCE: Residents and their relatives considered that care and health needs were met and that the staff were helpful. Discussions with residents and relatives showed that medical interventions were sought where necessary. Three care plans were checked and these provided detailed information of residents’ individual care needs and risk assessments to ensure that residents Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 11 were protected. The daily records were separate from other information relevant to residents’ care. The necessity of ensuring that all information relating to residents was to hand to meet residents’ needs was discussed with the acting manager. On the files seen, there were no inventories of residents’ clothing and personal possessions and residents’ preferences regarding funeral arrangements were not always stated. Accidents and falls were recorded and 72-hour monitoring sheets were implemented. Care plans and risk assessments were reviewed monthly but there was no consistent information of consultation with residents or their representatives. There was written evidence that residents had given consent for medication. Nursing staff dealt with the medication. The home used a monitored dosage system but many residents also had some medication in packets and bottles. Medication was checked on a sample basis and there were several discrepancies. Medication was being shared with other residents who were on the same medication i.e. stock bottles; medication already in stock was not carried forward onto new sheets, therefore no stock control; medication was not being signed for and dated on receipt; the correct procedure for handwritten entries on MAR sheets was not being followed. An immediate requirement was issued. In addition to the above, medication keys were kept with other keys and medication that required refrigeration was not stored at the correct temperature (2 to 8 degrees C) and temperatures were not monitored. Residents and relatives considered that residents were treated with respect and dignity. Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 12 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, 14 and 15. Quality in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. Residents’ lifestyle in the home did not always match their expectations and preferences. They were encouraged to maintain contact with their family and friends and had some choice and control over their lives. A good choice of menu was offered and special dietary needs were catered for. EVIDENCE: Residents and their relatives said that there was not much to do in the home and considered that the staff were always busy. Residents’ relatives organised bingo sessions and made arrangements for outside entertainers to come into the home but the home had no programme of activities, no activity coordinator and on the days of the site visit there was very little social interaction or stimulation between residents and staff, except when dealing with residents physical needs. Therefore there were no group or individual activities to meet residents’ emotional and social needs. The acting manager said that a church minister visited the home. Residents said that they could get up, go to bed and use their rooms when they wanted. Records on Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 13 residents care plans verified this with the times that residents liked to get up and go to bed and where they chose to have their meals. Residents and visitors comments about the meals were positive - “good”, “very good” and “excellent”. There were choices at all meals and at breakfast on the day of the site visit residents were enjoying various options of cooked breakfasts and cereals. A menu board was displayed which informed residents of the options available. Comments from residents and relatives indicated that special dietary needs were catered for including vegetarian diets, soft diets and liquidised meals. The cook said that they also provided diabetic diets and they could provide vegan and gluten free diets if required. Residents were weighed regularly and records kept and monitored. The dining room was pleasant. Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 14 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 and 18. Quality in this outcome area is good. This judgement has been made from evidence gathered before, during and after the visit to this service. Residents and their relatives were generally confident that their complaints would be listened to and acted upon. Residents considered that they were protected from abuse. EVIDENCE: Residents and relatives said that they would tell the acting manager or one of the staff on duty if they were not happy about anything and action would be taken. One relative found it frustrating that information or queries had not been passed on from one member of staff to another. See Standard 37. The home had a complaints procedure and the complaints book was checked during the site visit. There were no allegations of abuse. However, the home had previously been involved with an adult protection issue relating to an ex member of staff. The correct procedure for reporting adult protection issues had not been followed by the previous acting manager. The current acting manager was aware of her responsibilities regarding adult protection issues. Advice was given on improvements that could be made to the home’s adult protection procedures to ensure that everyone involved in the home was aware of their responsibilities. The acting manager said that the majority of staff had undertaken adult Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 15 protection training the previous week. about the staff were positive. Residents and relatives comments Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 16 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. Quality in this outcome area is good. This judgement has been made from evidence gathered before, during and after the visit to this service. Residents lived in a safe, well-maintained environment. pleasant and hygienic. EVIDENCE: The home was welcoming and there were no offensive odours. Residents considered that they had pleasant bedrooms and that the home was clean and hygienic. Several residents and relatives commented that this was the reason they had chosen this home, “Clean” and “Homely atmosphere and cleanliness” A partial check of the environment was carried out. All areas seen were well decorated, clean and tidy. The lounges were comfortably furnished with a good range of furniture. Bedrooms were well furnished. Two residents said their bedrooms had recently been redecorated. Audits of the environment Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 17 The home was clean, were carried out monthly and a rolling programme of redecoration and refurbishment was in place and records verified this. Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 18 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 and 30. Quality in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. The numbers and skill mix of staff did not fully meet residents’ needs. Staff were trained and competent to do their jobs. Residents were generally supported and protected by the home’s recruitment practices but improvements could be made. EVIDENCE: There was very little social interaction between staff and residents (i.e. sitting and chatting, assisting with residents’ personal leisure pursuits). Residents and relatives said that the staff were always busy and didn’t have time. Therefore the home needs to determine whether there are sufficient numbers of staff to meet residents’ needs (including their social and emotional needs). The home did not operate a key worker system. This was discussed with the acting manager. Staff training was ongoing. According to the Pre-inspection Questionnaire, 45 of the care staff had attained NVQ Level 2 or above and others were in the process of completing this qualification to meet the minimum 50 ratio. The acting manager said that all new employees undertook formal induction training in line with TOPSS. Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 19 Five staff files were checked. All contained CRB and POVA disclosures to ensure that residents were protected. To achieve this, evidence of identity would have been seen, however, copies of these were not always obtained and placed on staff’s files. The pre-inspection questionnaire gave information of training undertaken and planned training adult protection. Staff verified the training they had undertaken. Residents and relatives spoke positively about the staff’s attitude and care practices. Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 20 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, 34, 35, 37 and 38. Quality in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. The home did not have a registered manager. Improvements could be made to ensure that the home is run in the best interests of residents. Residents’ financial interests were safeguarded. Improvements could be made in the recording of information. Residents’ health, safety and welfare were generally promoted but improvements could be made. EVIDENCE: The home’s acting manager was a registered nurse. She was in the process of applying to the CSCI for registration. She had also enrolled to undertake the Registered Managers Award. Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 21 The handyman carried out repairs and maintenance within the home. The home had a Quality Monitoring system that included an annual development plan, checks of the environment and audits of residents’ finances and the medication system. Residents and relatives said that they had not been asked for their opinions about the home and had not been asked to complete any questionnaires or surveys. The need to ensure that the home is run in the best interests of residents was discussed with the acting manager (e.g., questionnaires, surveys, residents and relatives’ meetings, further development of monitoring systems, staff issues and observations). The home’s Certificate of Registration was displayed. date insurance cover. The home had up to The home had safe storage for residents’ personal allowances. These were checked. All entries were signed and countersigned and audited by the acting manager. All monies tallied with the records. Receipts for purchases on behalf of residents were available. During discussions with residents and relatives, one relative considered that there was sometimes a lack of communication between staff and found it frustrating that information or queries had not been passed on from one member of staff to another. This was further exacerbated because carers did not record information in residents’ files but passed information on to the senior on duty. The need to improve communication by better documentation in residents’ files was discussed with the acting manager. Staff training was ongoing, but some staff needed refresher courses for some aspects of mandatory health and safety training (i.e. moving and handling, basic food hygiene, first aid and emergency aid, infection control, adult protection and fire awareness). Fire drills were held regularly to ensure that staff were conversant with the correct procedures. The Pre-Inspection Questionnaire provided information on the dates that systems and equipment had been serviced and maintained. Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 22 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 3 3 X 2 2 Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 17 Requirement An up to date inventory of each resident’s personal furniture, equipment and other belongings must be recorded on their personal file. Care plans and risk assessments must be reviewed in consultation with the residents or their representatives. Arrangements must be made for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Residents’ wishes concerning terminal care and funeral arrangements must be discussed and recorded in their personal files. (Outstanding requirement from or before 2005) Residents must be consulted about their social interests and arrangements made for them to engage in local, social and community activities. Residents must be consulted about a programme of activities arranged by the care home and DS0000006470.V312422.R01.S.doc Timescale for action 03/01/07 2 OP7 15 06/12/06 3 OP9 13 13/10/06 4 OP11 12 06/12/06 5 OP12 16 03/01/07 6 OP12 16 03/01/07 Autumn House Nursing Home Version 5.2 Page 24 7 OP27 18 8 9 OP28 OP29 18 19 10 11 OP31 OP33 8 24 12 13 OP37 OP38 17 13 provide facilities for recreation suitable to their needs and abilities. Sufficient staff must be employed to ensure that all the needs (including social and emotional needs) can be met. A minimum ratio of 50 care staff must be trained to NVQ Level 2 in care. An audit of staff files must be carried out to ensure that they contain all the relevant documentation, specifically proof of identity and a recent photograph. Application must be made to register a manager. The home’s Quality Assurance system must extend to seeking the views of residents and other interested parties to ensure that it is effective and ensures quality. Record keeping in residents’ care plans must be kept up to date to ensure continuity of care. To ensure that all staff are up to date with mandatory health and safety training (i.e. infection control, moving and handling, basic food hygiene, adult protection, first aid, fire awareness), an audit must be carried out and application for training made as necessary. 06/12/06 03/01/07 06/12/06 06/12/06 03/01/07 06/12/06 06/12/06 Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP18 OP18 Good Practice Recommendations Simplifying the Adult Protection Procedure and Whistle Blowing Policy on display would ensure that all staff were aware of their responsibilities. A simple step by step local procedure of how to deal with an allegation of abuse and who to contact both inside and outside the company would assist staff left in charge of the home. The implementation of a key worker system would provide individual responsibilities for care staff and a first line point of contact for residents and their relatives. 3 OP27 Autumn House Nursing Home DS0000006470.V312422.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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. 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