Inspection on 06/12/07 for Brookhaven

This inspection was carried out on 6th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 9 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 17/01/07

Brookhaven 12/01/06

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

CARE HOME ADULTS 18-65 Simeon House Nursing Home Simeon House Gough Lane Bamber Bridge Preston Lancashire PR5 6AQ Lead Inspector Vivienne Morris Unannounced Inspection 6 December 2007 09:30 th Simeon House Nursing Home DS0000065154.V350795.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.V350795.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 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.V350795.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 vacant post 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.V350795.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). 17th January 2007 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 double rooms are available for those wishing to share facilities. People moving into the home 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. The scale of charges at the time of the site visit ranged from £424 to £1400 per week. Additional charges were being incurred for hairdressing, chiropody, magazines and newspapers. Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two regulatory inspectors from the Commission for Social Care Inspection conducted an unannounced site visit to this service over one day in December 2007, which formed part of the key inspection process. The National Minimum Standards for 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, discussions took place with those living at the home, as well as relatives and staff. Relevant records and documents 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. Comment cards were received from fourteen people involved with the service and their feedback is reflected throughout this report. Every year the provider completes a self-assessment, which gives information to the Commission about how the home is meeting outcomes for people using the service and how the quality of service provided is monitored. Some of this information forms part of this inspection report. The inspectors observed the activity within the home and ‘tracked’ the care of three people during the site visit, not to the exclusion of other residents. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The Commission for Social Care Inspection had received three complaints about this service since the last inspection, which were all referred to the provider for them to investigate using the home’s complaints procedure. 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 given to an appropriate match of key workers and residents, in relation to Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 6 gender, culture and interests in order to make sure that all the people living at the home were given the same opportunities. When asked on the self-assessment what they do well, the responsible individual wrote, “We have a relaxed and homely environment, which promotes good relationships between residents and staff. Visiting hours for relatives are open and staff greet all visitors in a polite and friendly manner”. 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. 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 people living at the home 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. When asked on the comment card, what the service does well, one member of staff wrote, “Simeon House cares very well for people with enduring mental Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 7 health issues of a complex nature. There is currently a mixture of residents and we maintain the full spectrum of care, encouraging maximum independence for the individual’s optimum level of functioning”. Staff spoken to knew what to do should an allegation of abuse be received and training in relation to safeguarding adults had been provided for those working at the home to ensure that all staff were aware of the correct policies and procedures to follow. What has improved since the last inspection? What they could do better: The provision of activities could be improved, by the appointment of an activities co-ordinator, in order that a more structured approach is adopted, so that everyone living at the home benefits from some form of uninterrupted stimulation and diversional activity. When asked on the comment card, what the service could do better, one staff member wrote, “We are looking to improve the daily activities to stimulate individuals to develop interests and skills that will improve their quality of life. A recent increase in staffing and introduction of proposed training can only improve this aspect of care”. The management of medications could have been better, so that the possibility of drug errors or drug misuse was reduced. We intend to request that the pharmacy inspector from the Commission visits the home in order to provide medication advice, so that the systems in place are improved in order to consistently protect those living at the home. The recording of complaints received could have been better, to ensure that accurate details are retained about any issues raised, so that complaints may be effectively monitored. Simeon House Nursing Home DS0000065154.V350795.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. One bathroom was ‘cluttered’, being used as storage space, which did not create a homely atmosphere and this impinged on people being able to use this bathing facility, if they so wished. The standard of cleanliness and the control of odour in some areas was poor and needed to be improved in order to reduce the risk of infection and so that all parts of the home were pleasant for those using the service. When asked on the self-assessment, what they could do better, the responsible individual wrote, “We have quite extensive plans to refurbish the home and through discussions we are looking at updating some of the bedrooms and lounges to provide more comfort for the people living at the home”. Training for staff could have been better, as it was established that structured training had not been provided for a while and mandatory courses had not always been up dated so that staff were kept abreast of current guidelines and legislation. The induction programme for new staff could have been more structured, so that the content of the training was recorded in detail, showing that people being employed at the home were made aware of their individual roles and responsibilities and the policies of the home. 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. 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.V350795.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. 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 we were at the home. The care records showed that extremely detailed information had been obtained prior to admission in order to determine individual needs, providing staff with a clear picture of individual strengths and needs, so that the service was certain that the staff team could deliver appropriate care to each person admitted to the home. The assessments carried out before admission were conducted by people who held appropriate qualifications and had experience in caring for people with mental disabilities, so that assessed needs were clearly identified. Six of the eight comment cards received from residents indicated that they had been asked if they wanted to move into Simeon House, two said that they had not, but their admission had been arranged by the local authority. Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 11 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 residents 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 peoples’ needs were to be fully met. Records showed that those involved with the care of residents 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 residents, 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. Residents 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.V350795.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of people living at the home were effectively planned, their rights were upheld and they were supported to make informed decisions about the routines of daily life. EVIDENCE: All of the comment cards received from people living at the home indicated that they were able to decide what they wanted to do at all times. One person added, “Decisions with regard to shopping and outings are mutually agreed”. In general comment cards indicated that staff listened to the people living at the home and acted upon what they said. The manager of the home told us that people were offered a choice of menu and at lunchtime we observed people being served with different meals, showing that they were able to choose what they wanted to eat. The self-assessment stated that, “The home provides residents with choices appropriate to them individually and the home allows them to make their own Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 13 mind up even if there is a potential risk involved. This is always supported by an in-depth risk assessment, care plan and staff member”. The care records of three people living at the home were examined. The plans of care 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 reviewed on a monthly basis or more often, if necessary, reflecting any changes in the care of residents so that staff were aware of people’s current needs. However, some documents were not fully completed and some important information was missing, which could have, in one case, provided a clearer picture of the individual, such as a photograph of the resident for identification purposes, the key worker’s name, a property inventory and the person’s interest’s and activities. The plans of care outlined any limitations that needed to be implemented for the safety of the individual and others. However, there was no evidence to show that two of the people whose care was ‘tracked’, or their relative had been involved in the care planning process, enabling them to have some input into the care delivered. 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 residents, 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. 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. 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. Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 14 When asked what had improved in the last year, we were told, “Providing empowerment and autonomy for the residents that live at Simeon House. Improving independence in their daily lives and allowing more risk taking”. 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 residents knew how much money they had. Receipts were retained of any expenditures showing that a clear audit trail was in place. A system had been implemented so that a more structured approach was adopted by the home to independently monitor and audit residents’ money, to ensure that the finances of people living at the home were adequately protected. Those living at the home were able to take responsible risks within a risk management framework and the information recorded was very detailed, although residents or their relatives had not always been consulted about the risk assessment, to enable them to make some decisions about the risks they wished to take. 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.V350795.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those living at the home were able to experience a private and dignified lifestyle, which matched their expectations in relation to social care, leisure activities and hobbies, both inside the home and within the local community. EVIDENCE: The care records seen, in general, 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. Good records were retained of what activities people had joined in or declined to participate in, so that the manager could monitor the level of activities provided and identify any possible incidents of isolation. The home’s self-assessment showed that a variety of activities were provided, both in and outside the home. However, the provision of activities could be Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 16 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 us that an activities co-ordinator had been appointed and was waiting to start employment, so that a more structured approach may be adopted in relation to the provision of activities. When asked what the home could do better, we were told, “Finding stimulating personal activities for individuals. We are working harder to find out how we can continually motivate our clients and as we get to know their likes and dislikes further we can develop a more structured individual support strategy to enable them to feel more valued in our community, in association with the key worker”. 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. We were told that the home tries to maximise residents independence to enable them to reach their full potential and achieve there own personal aspirations through the home’s support structure”. Eight comment cards were received from people living at the home and all indicated that, in general, carers listened to them and acted upon what was said and that staff treated them well. One wrote, “I am happy to be at Simeon House”. 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. Some residents were able to go out into the community without supervision and it was evident that one person living at the home could come and go as he pleased. Another resident was a member of the local gym and attended regularly with a member of staff so that she could exercise and swim in order to maintain her interests whilst living at the home. 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 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 Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 17 welcome to the home and were able to visit residents in private, which we observed at the time of the site visit. The policies and procedures of the home 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. We observed staff treating residents 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 care-planning documentation supported this. Those sharing accommodation were provided with privacy screening to ensure that dignity was maintained when personal care was being carried out. We saw that people living at the home 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 and were able to dine within the privacy of their own accommodation, if they wished to do so. The menu was clearly displayed in the dining room and meals provided on the day of the site visit were plentiful and were presented in an attractive manner in order to maintain appetite and aid in nutrition. We noticed that one resident had been provided with a special diet, which was to the individuals satisfaction and that everyone was offered a second helping, which a lot of people accepted, showing that they enjoyed the food and were able to have more, if they so wished. 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, “The food is always very good. I enjoy everything we get” and “We can choose what we want from the menu, but you can have something else, if you want to”. 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.V350795.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. 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. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People received appropriate personal and health care support, although the management of medications did not consistently protect those living at the home. EVIDENCE: The home’s self-assessment submitted to the Commission before the site visit showed that a designated key worker system was in place at Simeon House, 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 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. One resident commented, “The staff are all very kind to me”. Surveys conducted for residents during the year showed that 100 felt that they were respected and that their privacy and dignity was always promoted. Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 19 The manager told us that people living at the home had access to a wide range of external health care professionals, showing that their health care needs were being met. A lot of evidence was available to support this information. Care records seen showed that medical advice was sought as required and that health care checks were conducted on a regular basis to ensure that the health of people living at the home was periodically monitored. One resident stated, “If I need a doctor, then the staff ask my GP to visit”. 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. We saw 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. Staff who sent in comment cards indicated that, in general, staff are given up to date information about the needs of people and that communication between staff usually works well. Information was available telling people about the use of advocates, should they wish someone to act on their behalf. It was established that some people living at the home had an independent person assisting them with decisionmaking, including financial advice so that they were able to make informed choices. 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. The home’s self-assessment showed that only registered nurses were responsible for the control of medications within the home so that the possibility of drug errors was reduced. Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 20 The management of medications within the home could have been better, so that the possibility of drug errors or drug misuse was minimised. Although the receipt of medications into the home were recorded on the Medication Administration Records, the prescriptions were being dispensed without firstly being seen by staff at the home, to ensure that there were no prescription errors. Controlled drugs were being appropriately stored but there was no expiry date on the box of controlled drugs checked, so that staff were aware of the shelf life of this particular medication. One bottle of tablets had a hand written label, which could have been wrongly transcribed, could become illegible or could be misread by mistake. There were many items stored in the drug fridge, which they should be stored in a cupboard. The balance of tablets for one resident was incorrect and the Medication Administration Record was not always signed to indicate that the drug had been given or omitted. One General Practitioner indicated on the comment card that the health care needs of people living at Simeon House were usually met and that staff usually had the right skills and experience to support individuals’ social and health care needs. Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. 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 although complaints were well managed, they could have been more effectively monitored. 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. Eight comment cards were received from people living at Simeon House, all of who indicated that they would know who to speak to if they were not happy about something at the home and seven of these people said that they would know how to make a complaint, should they wish to do so. The home’s self-assessment showed that Simeon House had received nine complaints during the past year, all of which had been responded to within a suitable time frame. The Commission had referred three of these complaints back to the provider to investigate, using the home’s complaints procedure. The managers told us that more residents and relatives’ forums could be held to give people the opportunity to make complaints if needed and the response time to complaints could be further improved. Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 22 A system was in place for the recording of complaints received by the home, so that issues could be monitored and audited. However, the complaints log was not up to date and therefore a clear record of issues raised was not evident. All four staff who sent in comment cards said that they would know what to do if a resident, relative or advocate had concerns about the home. 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. Staff had been provided with training in relation to safe guarding adults, to ensure that they were all fully aware of the policies and procedures of the home. Secure facilities were available for residents 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 expenditure to ensure that the finances of people living at the home were adequately protected. Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Not all areas of the home were found to be well maintained, pleasant smelling or homely for those living at Simeon House. EVIDENCE: The Environmental Health Officer had visited the home in August 2007 and his report showed that some areas of the kitchen required cleaning. We found the catering facilities not to be up to a good standard of cleanliness at the time of our visit to this service and it is suggested that the cleaning routines are reviewed in order to promote good hygiene practices. We toured the premises during the site visit, when a random selection of bedrooms were seen and all communal areas were viewed. Some bedrooms were nicely decorated, providing pleasant surroundings for the people living in them and it was evident that the bedrooms were individualised with people’s own belongings and electrical equipment suitable for the age of the people living at the home. One resident commented, “It is lovely here. The staff are Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 24 lovely”. However, in general, the standard of cleanliness throughout the home was poor and in areas cobwebs were seen on the ceilings and in covings, which did not provide a pleasant, homely environment for people to live in. The management of the home told us that they had experienced a problem with the domestic input and that they were aware of the situation, which was being addressed. There were many discarded cigarette ends seen on the floors of several areas of the home, including bedrooms, toilets, bathrooms and communal areas, which provided a dirty and untidy appearance for any visitors and an unpleasant environment for those living at the home. Many of the furnishings were old and worn and in need of replacement. Some areas of the home were looking tired in need of redecorating and painting in order to enhance the environment for people living at Simeon House. The carpets in several bedrooms were badly stained and in need of thoroughly cleaning or replacing to make these rooms more homely and hygienic for the people living in them. The corridor carpets were dirty and other 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 for those living at Simeon House. The games room was sparse and uninviting. It was in need of a thorough clean and completed refurbishment and redecoration, so that people wishing to use this area of the home were provided with pleasant surroundings. Some bed heads were in poor condition and in need of replacement so that people living at the home were provided with fittings of a good quality and one bedroom carpet tread was creating a trip hazard as it was not flush to the floor. One bathroom on the ground floor was identified as needing full refurbishment as the fixtures were in poor condition, the wall tiles were chipped and the floor was dirty, which did not provide a pleasant facility for people to use. A bathroom on the first floor did not have a working light and this facility was ‘cluttered’ with doors, a toilet frame and weighing scales, all of which were in dirty condition and the flooring by the side of the bath needed some attention so that this bathroom floor could be adequately cleaned. Using this area for storage purposes did not allow people living at the home to use this facility, if they wished to do so. The shower room on the first floor needed a thorough cleaning and was in need of re-grouting around the shower base so that people living at the home could enjoy the use of pleasant shower facilities. The bed linen was, in general, of poor quality and did not provide people with a good standard of furnishings in order to create a homely environment within their bedrooms. Many of the clocks throughout the home were set at incorrect times and therefore did not aid in orientation for the people living at the home. Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 25 The home’s self-assessment 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. However, many of the waste bins, including those in the kitchen were without lids and some were full and overflowing with rubbish, which did not promote good infection control procedures. The kitchen assistant was not wearing gloves in order to promote good food hygiene practices within the home. When asked on the comment card, what the service does well, one staff member wrote, “The home offers a safe and relaxed environment for residents”. Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The recruitment procedures adopted by Simeon House adequately protected the people living there. However, the staff team were not all sufficiently trained to ensure that the individual needs of people were being appropriately met. EVIDENCE: There were a core number of staff working at the home who had been there for many years and whom residents had learned to trust. These staff members were fully aware of the individual needs of the people living at the home and although agency staff were sometimes utilised there was generally consistency in the staff supplied to ensure the continuity of care. Those spoken to said that they felt comfortable discussing anything with the staff, as they were all very approachable and friendly. The four staff who sent in comment cards indicated that there were usually enough staff on duty to meet the needs of people living at the home and that they usually had the right support, experience and knowledge to meet the different needs of people. Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 27 There were staff on duty who were able to communicate well with people living at the home and it was evident that those working at Simeon House were aware of special communication methods recognised by individual residents. However, it was established that although a training matrix was in place, staff had not been provided with structured training for a while. We were told that mandatory training for staff needed to be updated and training specific to the needs of the people living and the home needed to be implemented, so that the staff team was fully competent to provide the care required. The home’s self-assessment showed that 53 of care staff had received a recognised qualification in care at level 2 or above, showing that an acceptable percentage of the work force had received this award. The home’s self-assessment showed that policies and procedures were in place in relation to recruitment practices and that Criminal Record Bureau disclosures had been obtained for all staff employed by the home. The records of two staff members were examined at the time of the site visit, which demonstrated that thorough checks had been conducted before staff were employed to ensure that people living at the home were adequately protected by the recruitment procedures. All staff who sent in comment cards indicated that relevant checks had been conducted before employment to ensure that they were fit to work with vulnerable people. Although we were told that all new members of staff had received thorough induction training, there was no recorded evidence to show that this was carried out to ensure that staff were aware of their individual roles and responsibilities and the routines of the home. Three of the staff who sent in comment cards said that their induction period covered most things that they needed to know and another said that the induction covered everything very well. When asked what the home could do better, the responsible individual told us, “Our induction programme for staff needs updating, but this is currently being worked upon to bring it in line with current guidelines. Staff training is currently under review and new training providers are being sought so that the training is accurate and appropriate to the staff needs”. Records showed that some training had been provided for staff during the previous year, although this area could have been better, to ensure that all staff had received thorough training to enable them to competently deliver the care required. One member of staff told us, “Training is currently under review, but mandatory training has gone ahead”. Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 28 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.V350795.R01.S.doc Version 5.2 Page 29 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. 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 home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and safety of those living at the home was not sufficiently protected and the monitoring of the quality of service provided could have been better. EVIDENCE: Although standard 37 is a key standard, it was not fully assessed on this occasion as the manager of the home had only recently been appointed and had not been registered with the Commission for Social Care Inspection. However, it was established that she is a first level registered nurse, specialising in mental health and staff spoken to were happy with the current management arrangements of the home. Minutes of meetings had been recorded and were available to those concerned, so that a record of discussions, which took place were retained. Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 30 Residents’ surveys had been conducted and the overall results published so that any interested parties were able to see what life was like at Simeon House. 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. Feedback from relatives was often obtained during 1:1 meetings and views of stakeholders was normally received through multidisciplinary meetings, but none of this information was recorded in order to effectively monitor the quality of service provided. The home’s self-assessment 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 self-assessment was correct and up to date. The home routinely conducted and recorded a wide range of internal checks on systems and equipment to ensure that it was safe for use. Accidents had been appropriately recorded, in line with data protection and 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. Detailed policies and procedures were in place in relation to safe working practices for the protection of those employed at the home and the home’s self-assessment showed that these had been reviewed and up dated recently, to ensure that current information was being provided for staff. The health and safety of those living at Simeon House was not consistently protected as the control of infection was poor, the risk of fire was increased by people smoking in none designated areas of the home and not all parts of the home were free from hazards to ensure the safety of people living there. Simeon House Nursing Home DS0000065154.V350795.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. 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 2 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 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 Score 3 4 2 X X X 2 X X 2 X Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 32 YES. 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 YA6 Regulation 15(1)(2) Requirement People living at the home, or their relative, must be given the opportunity to be involved in the planning of their care. Arrangements must be made for the safe handling, accurate recording and safe administration of all medications. (Timescale of 15/02/07 not met) The premises to be used as the care home must be kept in a good state of repair so that people living at the home are provided with a pleasant and safe environment in which to live. All parts of the home must be kept clean and reasonably decorated, so that people living there are provided with pleasant surroundings in which to live. (Timescale of DS0000065154.V350795.R01.S.doc Timescale for action 31/01/08 2. YA20 13(2) 31/01/08 3. YA24 23(2)(b) 30/06/08 4. YA24 23(2)(d) 31/03/08 Simeon House Nursing Home Version 5.2 Page 33 31/05/07 not met). 5. YA24 23(2)(l) Suitable provision must be made to store equipment belonging to the care home, so that residents’ private and communal space is not compromised. (Timescale of 15/02/07 not met). 30/06/08 6. YA24 16(2)(c) Adequate furniture, bedding 30/06/08 and other furnishings, including floor coverings must be provided in rooms occupied by residents so that they can live in a comfortable environment. All parts of the home must 31/03/08 be kept free from offensive odours, so that a pleasant environment is provided for people to live in. (Timescale of 28/02/07 not met). 31/03/08 7. YA30 16(2)(k) 8. YA30 16(2)(j) 9. YA42 The areas identified by the Environmental Health Officer as needing improvement must be addressed, particularly in relation to the standard of cleanliness in the kitchen. 13(2)(3)(4)(a)(c) The health and safety of those living at the home must be protected at all times, ensuring that good infection control measures are implemented, the risk of fire is not increased by people smoking in none designated areas of the home and by ensuring that all parts of the home are free from hazards for the safety of people living there. 30/06/08 Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 34 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA9 Good Practice Recommendations People living at the home or their relative should be given the opportunity to be involved in the development of their own risk management framework, so that they can decide what risks they wish to take within their daily life. It is recommended that an activities coordinator be employed so that a more structured approach to the provision of activities can be established. The record of complaints received should be kept up to date so that issues could be effectively monitored and audited. It is recommended that the registered person conducts a full audit of every area of the premises and from the findings, then develops a structured programme of routine maintenance. This needs to include the general cleanliness of the home throughout, the maintenance of the premises, the condition of the fixtures, fittings and furnishings, infection control measures and the control of odour. Once this is complete a copy should be forwarded to the Commission with a plan of action as to how the standard of the environment is to be improved. The provision of staff training should be improved, to ensure that all staff receive regularly mandatory training and training specific to the needs of people living at the home, including equal opportunities, disability and race equality training. A formal, structured process should be developed so that any new employees receive thorough recorded induction training, to ensure that they are aware of their individual roles and responsibilities and the routines of the home. 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. 2. 3. 4. YA12 YA22 YA24 5. YA35 6. YA39 Simeon House Nursing Home DS0000065154.V350795.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway 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.V350795.R01.S.doc Version 5.2 Page 36 - 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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