Inspection on 17/01/07 for Brookhaven

This inspection was carried out on 17th January 2007.

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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brookhaven 02/07/09

Brookhaven 09/07/08

Brookhaven 06/12/07

Brookhaven 12/01/06

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Simeon House Nursing Home Simeon House Gough Lane Bamber Bridge Preston Lancashire PR5 6AQ Lead Inspector Vivienne Morris Unannounced Inspection 17th January 2007 09:30 Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 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 Simeon House Nursing Home DS0000065154.V322313.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 and Care Homes for Adults 18 – 65*. 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. Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Simeon House Nursing Home Address 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) Simeon House Gough Lane Bamber Bridge Preston Lancashire PR5 6AQ 01772 315894 Optima Care Limited Care Home 34 Category(ies) of Dementia (6), Mental disorder, excluding registration, with number learning disability or dementia (34) of places Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 34 service users to include: Up to 6 service users in the category of DE - (Dementia). Up to 34 service users in the category MD - (Mental Disorder excluding learning disability or dementia). 12th January 2006 Date of last inspection Brief Description of the Service: Simeon House provides accommodation for up to 34 adults, aged between 18 years and 65 years, who are suffering from mental health problems. There are a small number of older people living at Simeon House. However, the home is no longer admitting people of 65 years of age or above. The accommodation is provided on two levels served by a passenger lift. The majority of bedrooms are single, although a few shared facilities are available if preferred. Service users are able to bring their own furnishings to the home and are encouraged to retain their personal possessions. Although only a small number of rooms have en-suite facilities, toilets and bathrooms are located at convenient intervals throughout the home. A variety of lounges and a large dining room are provided, although people have the choice of dining within the privacy of their own accommodation, if they choose to do so. Simeon house is conveniently situated on the outskirts of Bamber Bridge and is easily reached by road and public transport, with the motorway network being close by. Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced site visit, which formed part of the key inspection process, was conducted over one day in January 2007. The National Minimum Standards for Young Adults (18-65) were assessed on this occasion, not excluding a small number of elderly people living at the home. During the course of the site visit to the home, discussions took place with staff and relatives of service users and where possible service users themselves, who were also observed going about their daily lives. Relevant records and documentation were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas were seen. The care of three people living at the home was ‘tracked’ during the course of the day. Comment cards were received from twelve people involved with the service and their feedback is reflected throughout this report. The information provided by the home on the pre-inspection questionnaire has also been taken into consideration. Progress was assessed in relation to the requirement and recommendations made at the last inspection to see if these had been addressed. The total key inspection process focused on the outcomes for people living at the home. The Commission for Social Care Inspection had received one complaint about this service since the last inspection, which was referred back to the provider to investigate using the home’s complaints procedure. The scale of charges at the time of the site visit ranged from £452 to £643 per week. Additional charges were being incurred for hairdressing, toiletries, some outdoor activities, cinema and theatre visits, trips out, magazines and newspapers and transport for personal interests. What the service does well: The process of gathering information about people before they moved into Simeon House was found to be very thorough so that the home was certain that the staff team could adequately meet individual needs and so that those wishing to move in were sure that Simeon House was the right place for them to live. The care, which people needed had been planned from the information gathered from a variety of sources before admission to the home so that staff were provided with clear, detailed written guidance about how they could fully meet the needs of those in their care. Those living at the home were allocated a named key worker so that they had a familiar person to relate to. Where at all possible consideration had been Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 6 given to an appropriate match of key workers and service users, in relation to gender, culture and interests in order to make sure that all the people living at the home were given the same opportunities. The privacy and dignity of residents was respected and their rights to make decisions was upheld by staff providing support and guidance in relation to decision-making. People living at the home were supported to make decisions about taking responsible risks so that they continued to be involved in their normal daily activities. However, any restrictions, which needed to be implemented in order to protect the safety of residents or others, were well documented within individual care records to ensure that all concerned were aware of such programmes. People living at the home were supported, where possible to go out so that they could establish links with the local community and residents were encouraged to keep in touch with relatives and friends, if they wished so that they maintained contact with people they knew. Meal times were observed to be relaxed and unrushed so that people living at the home could enjoy their meals. Residents were supported with their dietary intake as required, although independent eating was also encouraged by the provision of specialised equipment. Nutritional risk assessments had been conducted to ensure that residents’ dietary needs were being appropriately met. Prompt charts were provided with the as and when required medications so that staff were aware of when such drugs should be given, which was good practice. The recruitment procedures were thorough enough to adequately safeguard those living at the home and at the time of the site visit the number and skill mix of staff on duty was appropriately meeting residents’ needs. The policies of the home demonstrated that service users were adequately protected from abusive situations and staff were fully aware of the procedure to follow should an allegation of abuse be received. New staff had been given a detailed induction period and the staff team received a variety of training courses on a regular basis to ensure that core training and training specific to the client group was provided, demonstrating that those working at the home were appropriately trained to meet the assessed needs of those living at Simeon House. The systems and equipment in the home had been appropriately serviced to ensure that they were in good working order so that the health, safety and welfare of people living at the home were protected. What has improved since the last inspection? Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 7 The double-glazing unit in the conservatory near the office had been repaired so that those wishing to sit in this area were provided with a clearer and more pleasant view of the grounds of the home. Staff were seen sitting with service users who needed some help with their lunch, which created a more friendly and relaxed atmosphere at mealtime. The Home had reviewed the medication policies and procedures, so that staff involved with handling medications were aware of the correct procedures for the disposal of medicine waste and the administration of medication away from the home. Criteria for the administration of when required and variable dose medication was clearly defined and recorded for all service users prescribed such items to reduce the possibility of drug errors. The number of single rooms had been increased since the last inspection, so that people living at the home were given more privacy and personal space. Some communal areas had been decorated and a new carpet had been fitted in the first floor lounge, providing people with pleasant communal areas in which to spend their time. Some bedrooms were nicely decorated, providing pleasant surroundings for people living in these rooms. New light fittings had been installed in the corridors, which made these areas brighter and safer for residents, visitors and staff. The windows in some bedrooms and the conservatory had been replaced in order to improve the outlook for people living at the home. What they could do better: The home should ensure that all residents are aware of who their key worker is, so that they know who to speak to should they have any concerns or should they require any information. The provision of activities could be improved so that a more structured approach is adopted by a person who is able to devote uninterrupted periods of activity for residents, so that everyone living at the home benefits from some form of stimulation and diversional activity. The management of medications could be improved, so that the possibility of drug errors or drug misuse is reduced. The documentation relating to the administration of controlled drugs was not an accurate record and therefore did not show medication administered. Written entries on the Medication Administration Records had not been signed, witnessed and countersigned by a second member of staff to reduce the possibility of transcription errors. The reason for the omission of medications was not always clearly recorded so that staff were aware of why a drug had not been given. Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 8 Some areas of the home were looking tired and worn and were in need of painting and decorating in order to enhance the environment for people living at Simeon House. Some areas were ‘cluttered’, being used for storage space, which did not create a homely atmosphere and in one case impinged on a resident’s private space. The standard of cleanliness and the control of odour in some areas was not good and needs to be improved in order to reduce the risk of infection and so that all parts of the home are pleasant for those using the service. Accident records should be retained in line with Data Protection Regulations so that people’s identity and personal information is protected. The systems for monitoring the quality of service provided should be extended to include obtaining formal feedback from relatives and stakeholders in the community as to how the home is achieving goals for residents. The results of residents’ surveys should be published so that anyone thinking about moving into the home could see what life was like living at Simeon House. 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. Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 (Adults 18 – 65) Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The health, personal and social care needs of people had been thoroughly assessed before they moved into the home to ensure that the staff team could fully meet all their requirements. EVIDENCE: The care of three people living at Simeon House was ‘tracked’ whilst the inspector was at the home. The care records showed that extremely detailed information had been obtained prior to admission in order to determine individual needs, so that the service was certain that the staff team could meet the needs of people admitted to the home. The assessments carried out before admission were conducted by people who held appropriate qualifications and had experience in Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 11 caring for people with mental disabilities so that assessed needs were clearly identified. Information was gathered from a variety of sources before admission to the home so that external professional people were also involved in the care of service users to ensure that all their assessed needs were fully met. People wishing to move into Simeon House were involved in the assessment process and were invited to spend some time at the home before making a final decision so that they could meet other service users and staff and so that they could briefly experience what life was like at Simeon House. The assessed needs of those admitted to the home were clearly recorded within the care plans so that staff were provided with detailed information as to how service users’ needs were to be fully met. Records showed that people involved with the care of service users had conducted a periodic review of placements to ensure that the home remained a suitable environment to meet the continuing needs of people living at the home. Staff were appropriately qualified and had also received specific training in relation to the category of people living at Simeon House in order to widen their knowledge and improve their skills in caring for people with mental health needs. Those living at the home were allocated a named key worker so that they had a familiar person to relate to, with whom they had learned to trust. Where at all possible consideration had been given to an appropriate match of key workers and service users, in relation to gender, culture and interests in order to help them develop close bonds and to make sure that all the people living at the home were given the same opportunities. Service users were involved in the selection of their key workers so that they felt comfortable with them and so that they were happy with the allocation. Key workers spoken to had a sound understanding of the needs of the people they were looking after, showing that they were competent to deliver the care, which was required. Key workers also knew how to access the care plans, policies and procedures, which showed that they were able to obtain relevant information if they needed it. Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. (Adults 18 – 65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ needs were effectively planned, their rights were upheld and they were supported to make informed decisions about the routines of daily life. EVIDENCE: The care records of three people living at the home were examined. The plans of care had been developed with the service user and were extremely well written documents, providing clear, detailed guidance for staff about how individual needs could be met and how people could be supported to make decisions within their daily life. The information obtained before people were admitted to the home was transferred onto the care plans, which had been Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 13 reviewed on a monthly basis or more often, if necessary, reflecting any changes in the care of service users so that staff were aware of people’s current needs. The plans of care outlined any limitations that needed to be implemented for the safety of the service user and others. The statement of purpose showed that those living at the home were offered choices in relation to daily activities and were allocated a named key worker so that they had a familiar person to relate to, with whom they had learned to trust. Records showed that where at all possible consideration had been given to an appropriate match of key workers and service users, in relation to gender, culture and interests in order to help them develop close bonds and to make sure that all the people living at the home were given the same opportunities. However, one service user said that his key worker had recently left the home and that he did not know whom his key worker was at the time of the site visit. The care records seen provided information about the preferences and choices of residents and the plans of care included details about their social care needs and leisure activities with details of how people may be supported to continue these interests whilst living at the home. Freedom of movement within the home was evident and those living there were able to access their own private accommodation and all communal areas as they wished. The Pre-inspection questionnaire showed that people were offered a choice of menu and the inspector noted that people were served with different meals at lunchtime. Staff were observed allowing people living at the home to make decisions about what they wanted to do during the day and the service users’ guide told people about the availability of advocacy services, so that residents could have an independent person acting on their behalf if they chose to do so. Records confirmed that in some cases people living at the home had solicitors acting on their behalf so that they were supported to make informed decisions about their lives. Of the 12 comment cards received from residents 6 said that they were always able to make decisions about what they do each day, 4 said that they were sometimes able to make decisions, 1 said that they were hardly ever able to make decisions, particularly in the evenings and 1 said they are never able to make such decisions. 5 comment cards received from residents indicated that staff sometimes listen to them and act on what they say, the remaining 7 stated that carers always listen to them and act on what they say. Where any restrictions had been introduced for the safety of the resident or others, then this was included in the plan of care and agreed by the resident. Clear records were maintained of any monies retained at the home on behalf of people living there, showing any expenditures and incoming money so that Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 14 residents knew how much money they had. Receipts were retained of any expenditures showing that a clear audit trail was in place. However, a system needs to be implemented so that a more structured approach is adopted by the home to independently monitor and audit residents’ money, to ensure that the finances of people living at the home are adequately protected. Those living at the home were able to take responsible risks within a risk management framework, ensuring that they had enough information on which to base decisions. A wide range of assessments had been conducted on an individual basis and included in the care plans provided a lot of information for staff about individual risks and systems implemented to reduce any potential harm to people. The statement of purpose showed that people were able to retain the freedom to take personal risks, so that they continued to participate in daily activities. Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15, 16 and 17 (Adults 18 –65). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 16 Those living at the home were not consistently able to experience a lifestyle, which matched their expectations in relation to social care, leisure activities and hobbies. However, they were encouraged to maintain links with friends, relatives and the local community, their privacy and dignity being respected at all times. EVIDENCE: The care records included detailed accounts of social care needs, interests and hobbies so that staff were aware of what people living at the home liked to do. Daily records showed that where possible some people were supported to continue their interests and those spoken to in general enjoyed what activities were provided, although these were not always provided in accordance with the activities programme so residents were not able to decide in advance which activities they wished to join in and therefore able organise their time accordingly. The Pre-inspection questionnaire showed that a variety of activities were provided, both in and outside the home. However, the provision of activities could be improved by the home employing a person specifically to plan and organise activities suitable for those living at Simeon House in accordance with their preferences. Care staff were responsible for providing activities, but were not able to devote uninterrupted periods of activity for residents. The manager told the inspector that the home was in the process of recruiting an activities co-ordinator so that a more structured approach may be adopted in relation to the provision of activities. Some of the people were involved with independent advocates or solicitors to act on their behalf to ensure that their finances were adequately protected and that they were supported in making informed choices. The inspector noted that families took out some residents on the day of the site visit so that they were able to participate in community life. Relatives spoken to said that this was a regular occurrence. Some outings from the home were arranged for small groups of residents to local places of interest, which were accessed in the home’s minibus or by public transport. The residents’ notice board displayed information about a variety of events in the local community, so that people living at the home were able to attend if they so wished. One resident was able to go out into the community without supervision and it was evident that this person could come and go as he pleased. People of different cultures were living at the home, who were, as far as possible supported by members of staff from similar backgrounds so that they shared similar cultural interests. The care records of individuals and the policies of the home showed that residents were encouraged to maintain contact with relatives and friends to Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 17 ensure that their social care needs were being appropriately met. However, it was evident that if residents did not want someone to visit, then their wishes would be respected. Relatives spoken to said that they were always made welcome to the home and were able to visit residents in private, which was observed by the inspector at the time of the site visit. They also said that they got on well with staff and felt happy visiting the home, as Simeon House was a friendly place for residents to live. The policies and procedures demonstrated that the arrangements for health and personal care ensured that the privacy and dignity of those living at the home was respected at all times. The Inspector observed staff treating service users with respect by knocking on doors before entering and allowing those living at the home some personal space. Independent living was encouraged as far as possible and careplanning documentation supported this. Those sharing accommodation were provided with privacy screening to ensure that dignity was maintained when personal care was being carried out. Of the 12 comment cards received from residents, two stated that the staff sometimes treat them well, the remaining ten said that staff always treat them well. It was noted that residents had keys to their bedroom doors so that they were able to get some privacy and so that their personal belongings could be protected. The policies of the home demonstrated that meal planning and nutritional requirements were fully considered when assessing individual needs and that people were given a choice of menu. Meals provided on the day the inspection were presented in an attractive manner in order to maintain appetite and nutrition. The inspector noticed that one resident had been provided with a special diet, which was to the individuals satisfaction. Those spoken to felt that the meals provided were in general very good and confirmed that they were able to access something to eat and drink at any time of the day or night. Comments received from residents in relation to meals included, “this is the best meal of the week”, “the food here is great” and “I enjoyed my lunch, it was really good”. Staff were ready to offer assistance with eating as was necessary to ensure that adequate nutrition was being maintained. Appropriate equipment was being used as required, such as plate guards and non-slip mats in order to encourage independent eating. Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 (Adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents received appropriate personal and health care support, although the management of medications did not consistently protect those living at the home. EVIDENCE: The pre-inspection questionnaire submitted to the Commission prior to the site visit showed that a designated key worker system was in place at the home, and that in general residents had been matched up with key workers of the same gender and cultural background, which promoted equality and diversity. Qualified nurses, with relevant qualifications were responsible for planning and Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 19 overseeing care so that people living at the home received the level of care intervention, which they required. The care plans were very well written documents, providing detailed guidance for the people working at the home so that staff were fully aware of how personal and health care support should be provided to individuals. The pre-inspection questionnaire showed that residents had access to a wide range of external health care professionals, showing that their health care needs were being met and care records showed that medical advice was sought as required. One visitor spoken to said that when their relative was recently poorly at Simeon House the staff really looked after them and got medical advice very quickly. The care records showed that health care checks were conducted on a regular basis to ensure that the health of people living at the home was monitored from time to time. One comment card received from a GP stated that he was satisfied with the overall care provided. Out of the 12 comment cards received from service users, two stated that the staff sometimes treat them well, the remaining 10 said that staff always treat them well. Staff were observed being sensitive and flexible to the needs of people living at the home and the care records showed individual preferences, such as what time people liked to go to bed and what time they liked to get up in the morning. The inspector observed that any assistance with personal care was carried out within the privacy of residents’ bedrooms and those spoken to confirmed that this was always the case. Even though a high percentage of people living at the home were fully mobile and not at risk of falling, moving and handling assessments had been conducted for everyone to ensure that residents would be appropriately handled should the need arise. Specialised pressure relieving equipment and moving and handling equipment were available for those requiring it and staff had received specific training to ensure that appropriate care was delivered and that safe moving and handling techniques were used. Information was available telling people about the use of advocates, should they wish someone to act on their behalf. The pre-inspection questionnaire showed that some people living at the home had an independent person Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 20 assisting them with decision-making, including financial advice so that they were able to make informed choices. The manager had submitted an updated medication policy to the Commission, which included the current regulations for the disposal of medications and the administration of medications away from the home so that staff were familiar with the changes in legislation. The care plans showed that General Practitioners carried out medication reviews at regular intervals to ensure that people were continuing to receive the most effective form of treatment. Residents, relatives and staff also confirmed this information. The preinspection questionnaire showed that only registered nurses were responsible for the control of medications within the home so that the possibility of drug errors was reduced. The plans of care showed that no-one living at the home administered their own medications, and reasons for this were recorded. The management of medications within the home could be improved so that the possibility of drug errors or drug misuse is minimised. There was one recent incident where a controlled drug had not been entered into the controlled drug register, but the manager of the home was already addressing this matter with the agency supplying the nurse responsible for the omission. All hand written entries on Medication Administration Record charts should be signed, witnessed and countersigned to reduce the possibility of transcription errors. The reason for the omission of medications was not always clearly recorded so that staff were aware of why a drug had not been given. Prompt charts were provided with the as and when required medications so that staff were aware of when such drugs should be given, which was good practice. Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those living at Simeon House Nursing Home were adequately protected from abusive situations and complaints were well managed. EVIDENCE: A clear complaints procedure was in place at the home, with acceptable timescales for issues to be fully investigated. This was displayed in a prominent position within the home and was also included within the service users’ guide so that people were aware of how to make a complaint, should they so wish. Comment cards received from residents indicated that some would know who to speak to if they were not happy and wanted to make a complaint, others said that they would not know who to speak to if they wished to complain about something. The home had received one complaint since the last inspection, which was also referred to the Commission for Social Care Inspection. The home had done a Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 22 thorough investigation into the issues raised to ensure that the complaints procedure was followed. Clear policies were in place at the home in relation to safeguarding adults, which included appropriate ‘whistle blowing’ guidance for staff to ensure that those working at the home were aware of the correct procedures to follow should they have any concerns about possible abuse or should an allegation be received by the home. All staff had been provided with appropriate abuse awareness training to ensure the protection of residents. Secure facilities were available for service users to deposit any money or valuables which they wished the home to retain on their behalf. Clear records were kept of all money deposited with the home and of any expenditures to ensure that service users finances within the home were adequately protected. Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 (Adults 18-65). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all areas of the home were found to be homely, clean and hygienic for those living at Simeon House. EVIDENCE: The inspector toured the premises during the site visit to the service, when a random selection of bedrooms and communal areas were viewed. Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 24 The Pre-inspection questionnaire showed that two shared rooms had been converted into single facilities so that people living at the home were given more privacy and personal space. The pre inspection questionnaire showed that a new carpet had been fitted in the first floor lounge and decoration had taken place in the lounges, corridors and dining room, providing pleasant communal areas for people to spend their time. Some bedrooms were nicely decorated, providing pleasant surroundings for people living in them. However, although a programme of routine maintenance was in place at the home, some areas were looking tired and worn and were still in need of redecorating and painting in order to enhance the environment for people living at Simeon House. The carpet in one bedroom was badly stained and in need of thoroughly cleaning or replacing to make this room more homely and hygienic for the person living in it. Some areas of the home were ‘cluttered’, being used for storage space, which did not create a homely atmosphere. One resident was in a bedroom, part of which was being used as storage for old furniture and equipment, which impinged on the individual’s private space and which looked unsightly. New light fittings had been installed in the corridors, which made these areas brighter and safer for residents, visitors and staff. The windows in some bedrooms and the conservatory had been replaced in order to improve the outlook for people living at the home. The pre-inspection questionnaire showed that policies and procedures were in place in relation to infection control, including guidance about the safe handling and correct disposal of clinical waste so that staff were aware of procedures to be followed in order to control the spread of infection. Although a cleaning schedule was in place at the home, the standard of cleanliness in some areas was not good and needed to be improved in order to promote infection control and so that all parts of the home are pleasant for those using the service. Some bedroom carpets were in need of hoovering and there was an unpleasant odour in some areas of the home, which did not promote a homely environment. Residents spoken to were happy with their private accommodation and some were proud and eager to show the inspector their bedrooms. However, several comment cards received before the site visit indicated that the home was not always fresh and clean, although a number did state that the standard of cleanliness was always good. Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 (Adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team effectively supported those living at the home and individual needs were being met by the number and skill mix of staff. Staff were appropriately trained and competent to do their jobs ensuring that the assessed needs of those living at the home were consistently met. EVIDENCE: There were a core number of staff working at the home that had been there for many years and whom residents had learned to trust and although agency staff were sometimes utilised there was generally consistency in the staff supplied by the agency to ensure the continuity of care. Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 26 There were staff on duty who were able to communicate well with service users and it was evident that those working at the home were aware of special communication methods recognised by individual service users. Staff spoken to were fully aware of the needs of individual residents and had the skills and experience necessary for the tasks they were expected to do so that the needs of people living at the home were fully met. The Pre-inspection questionnaire showed that a variety of training programmes were provided for staff and that training had been planned for the future, including mandatory courses to ensure that all staff were able to fulfill their job descriptions and roles. The Pre-inspection questionnaire also showed that 66.6 of care staff had received National Vocational Qualification training at level 2 or above, showing that a good percentage of the work force were appropriately trained. The number and skill mix of staff on duty was effectively meeting the needs of the people living at the home. The Pre-inspection questionnaire showed that policies and procedures were in place in relation to recruitment practices, informing people of methods used by the home when employing staff. The Pre-inspection questionnaire showed that Criminal Record Bureau disclosures had been obtained for all staff employed by the home and that all qualified nurses were registered with their professional body, the Nursing and Midwifery Council, so that people living at the home were adequately safeguarded. The records of three staff members were examined at the time of the site visit, which demonstrated that thorough checks had been done before people were employed, so that those living at Simeon House were protected by the recruitment practices adopted by the home. All members of staff had received thorough induction training to ensure their awareness of their individual roles and responsibilities and the routines of the home. Records showed that a lot of training was provided for staff on a regular basis, including training specific to the client group, so that those working in the home were competent to complete the duties expected of them. Individual training needs for staff had been identified through formal supervision, which formed the basis for individual assessments and staff profiles so that staff training could be accurately audited and monitored. Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 27 There was no evidence available to demonstrate that staff had received training in relation to equal opportunities to show that all staff had an awareness of the home’s policies in relation to equality and diversity. Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42 (Adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Both residents and staff were provided with a safe environment. However, the standards within the home were not monitored thoroughly enough to Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 29 determine if everyone involved in the care of the residents were satisfied with the overall service provided. EVIDENCE: Although standard 37 is a key standard, it was not assessed on this occasion as the manager had only been in post for 10 days. Minutes of meetings had been made and were available to those concerned, so that a record of discussions, which took place were retained. The inspector was informed that the responsible individual visited the home at least once a week and it was evident that monthly reports were completed, showing that the quality of service provided was being monitored. The home had received accreditation from an independent professional organisation, showing that an external body periodically monitored the quality of service provided. Residents’ surveys had recently been conducted, the results of which had been produced in graph format, so that the home was able to receive some feedback about what life was like living at Simeon House. It is recommended that surveys are conducted from time to time, the results of which should be published, so that any prospective residents or interested parties can determine what the quality of service is like. Views of relatives and stakeholders in the community had not been formally sought about how the home was achieving goals for the people living at Simeon House. The pre-inspection questionnaire showed that competent people had appropriately checked all systems and equipment in order to protect the health, safety and welfare of those living and those working at the home. A random selection of service certificates were checked, which demonstrated that the information provided on the pre-inspection questionnaire was correct and up to date. A variety of risk assessments had been conducted, which identified any possible hazards and appropriate action plans were in place to eliminate or minimise the identified risk so that those in the home were protected. A high percentage of staff had completed all core training requirements demonstrating that the staff team were competent and had been updated in line with changes in legislation and current good practice. Detailed policies and procedures were in place in relation to safe working practices for the protection of those employed at the home. Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 30 All staff had received a thorough induction period, which included safe working practice tropics, followed by detailed foundation training to ensure that those living in the home were in a safe environment and their needs were being met by competent staff. Accidents books were retained, which showed that accidents had been documented. However, although the written information was detailed, the records were not maintained in line with the Data Protection Regulations so that people’s identity and personal details were protected. Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 X 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT Standard No Score 37 X 38 X 39 2 40 X 41 X 42 2 43 X 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Simeon House Nursing Home Score 3 3 2 X DS0000065154.V322313.R01.S.doc Version 5.2 Page 32 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Timescale for action The registered person shall make 15/02/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home, including retaining accurate records of the administration of controlled drugs. The registered person shall 31/05/07 having regard to the number and needs of the service user ensure that all parts of the home are kept reasonably decorated. The registered person shall 15/02/07 having regard to the number and needs of the service user ensure that suitable provision is made for storage for the purposes of the care home, so that residents’ private and communal space is not compromised. The registered person shall 28/02/07 having regard to the number and needs of the service user ensure that all parts of the home are kept clean and free from offensive odours. DS0000065154.V322313.R01.S.doc Version 5.2 Page 33 Requirement 2. YA24 23(2)(d) 3. YA24 23(2)(l) 4. YA30 23(2)(d) 16(2)(k) Simeon House Nursing Home 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 YA6 YA7 Good Practice Recommendations Service users should be informed of whom their key workers are, so that they are aware of whom to speak to should they have any concerns. The records of service users’ incoming and outgoing personal allowance payments should be independently audited and monitored, in accordance with standard 7 of the National Minimum Standards for Care Homes for Adults (18-65). It is recommended that an activities coordinator be employed so that a more structured approach to the provision of activities can be established. All hand written entries on Medication Administration Record charts should be signed, witnessed and countersigned by a second member of staff. The reason for the omission of medications should be clearly identified on the Medication Administration Records. All staff should receive equal opportunities training, including disability and race equality training. The monitoring of the quality of service provided should be further extended to include formal feedback from relatives and stakeholders in the community as to how the home is achieving goals for residents. Any residents surveys conducted should be published so that prospective service users and other interested parties can see what it is like living at Simeon House. Accident records should be retained in line with Data Protection Regulations. 3. 4. 5. 6. 7. YA12 YA20 YA20 YA35 YA39 8. 9. YA39 YA42 Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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. Simeon House Nursing Home DS0000065154.V322313.R01.S.doc Version 5.2 Page 35 - 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. 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