Inspection on 09/07/08 for Brookhaven

This inspection was carried out on 9th July 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brookhaven 02/07/09

Brookhaven 06/12/07

Brookhaven 17/01/07

Brookhaven 12/01/06

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

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 9th July 2008 09:00 Simeon House Nursing Home DS0000065154.V365078.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.V365078.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.V365078.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 jon.whitton@optimacare.co.uk Optima Care Limited Manager post vacant 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.V365078.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). 6th December 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 places for older people, who are currently living at the home. 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 £449.50 to £1524.27 per week. Additional charges were being incurred for hairdressing, chiropody, magazines and newspapers. Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. This unannounced site visit to the service was conducted over one day in July 2008 and formed part of the key inspection process. The pharmacy inspector also visited the home on the same day in order to assess the management of medications. The National Minimum Standards for Adults (18-65) were assessed on this occasion, not excluding a small number of older 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 eighteen people involved with the service and their feedback is reflected throughout this report. Every year the provider completes an Annual Quality Assurance Assessment (AQAA), which is a selfassessment and 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, taken from the last AQAA forms part of this inspection report. The inspectors observed the activity within the home and ‘tracked’ the care of two 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 not received any complaints about this service since the last inspection. 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 one person needed had been planned from the information gathered from a variety of sources so that staff were provided with clear, Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 6 detailed written guidance about how they could fully meet the needs of this individual. 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 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, it said, “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 were 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 could continue to be involved in their normal daily activities. 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. Meals served were nutritious, providing a well balanced diet for people living at the home and through nutritional assessments, people’s dietary needs were being met. Residents were supported with their dietary intake as required, although independent eating was also encouraged by the provision of specialised equipment. Specialised diets were catered for, including those associated with cultural needs. Staff were seen to provide sensitive and flexible support to people living at the home and a wide range of external professionals were involved in the care of residents. 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. The systems and equipment in the home had been, in general, 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 being protected. 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. Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 7 The accident records were in line with data protection in order to maintain the confidentiality of people living at the home, so that information about them was sufficiently safeguarded. People living at the home were aware of who their key workers were and they were happy to discuss any concerns with them. What has improved since the last inspection? What they could do better: The care planning process could have been better, to ensure that staff were provided with clear guidance about how all the assessed needs of people living at the home were to be met, including health, personal and social care needs. The care records could have been more accurate and the care plans could have been reviewed more regularly, to ensure continuity of care. The resident or their relative could have been given the opportunity to be involved in the planning of their care, so that they had some input into the care to be delivered. The resident could have also been invited to have some say in the management of risks concerning themselves so that they could decide what risks to take. 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. Any programmes of activity for individual residents could have been followed in day-to-day practice to ensure that people’s social care needs were consistently being met. The management of medications could have been better, reducing the possibility of drug errors or drug misuse, so that people living at the home were better protected. Simeon House Nursing Home DS0000065154.V365078.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. 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 updated 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 recruitment procedures could have been more thorough in order to adequately safeguard those living at the home. An application needs to be submitted to the Commission as a matter of urgency by the person taking on the role of manager 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.V365078.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.V365078.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 two 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. 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 Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 11 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. 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. Staff 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.V365078.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 adequate. This judgement has been made using available evidence including a visit to this service. The needs of people living at the home were not always planned effectively, although their rights were upheld and they were supported to make informed decisions about the routines of daily life. EVIDENCE: The management of the home told us that the service was striving to move towards people being more supported to take risks as part of an independent lifestyle and within a risk management framework. This would enable them to have some control over their lives and the decisions they make. 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. However, systems had been implemented to reduce any Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 13 potential harm to people. The statement of purpose showed that people were able to retain the freedom to take personal risks, so that they could continue to participate in daily activities. We were told that, ‘the home provides residents with choices appropriate to them individually and the home allows them to make their own 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’. Nine of the comment cards received from residents indicated that they were able to decide what they wanted to do at all times of the day. The remaining six said that they were not always able to do what they want to do. One person added, ‘we need more variety. I would like to go for a pint’ and another wrote, ‘I would like to make my own decisions, such as to go for a walk’. In general comment cards indicated that staff listened to residents and acted on what they said. The care records of two people living at the home were thoroughly examined and their care was ‘tracked’. The two plans of care varied greatly in detail and quality. One of the care plans provided clear, detailed guidance for staff about how individual needs could be met and how this person could be supported to make decisions within their daily life. Information obtained about this resident had been transferred onto the person centred care plan. The plan of care for this individual outlined any limitations that needed to be implemented for the safety of the individual and others. However, although a key worker had been identified to support this resident there was no evidence that the care plan had been reviewed every month or that the resident or their relative had been given the opportunity to be involved in the care planning process, enabling them to have some input into the care delivered. The plan of care for the other resident was inadequate as it did not identify many of his assessed needs, particularly in relation to personal care and his mental health needs and therefore guidance was not provided for staff as to how care was to be delivered for this individual. Although this person’s rights were being upheld, the care planning process did not clearly demonstrate how he was being supported. The provider has since provided us with a clear picture of this person’s needs in the form of a detailed care plan. 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, Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 14 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 plan of care for one individual included detail about their social care needs and leisure activities with details of how they 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. 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. Simeon House Nursing Home DS0000065154.V365078.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): 13, 15, 16 and 17. Standard 12 is not applicable to this service. 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. From this information an individual tailored programme of activities was developed for each person living at the home, although these were not always being followed in day-to-day practice and were not always included in the planning of care to show how people were to be supported in maintaining their individual interests and activities. We were told that the home is moving towards the key workers taking responsibility of the care of their allocated residents, using a holistic approach Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 16 so that all their needs will be appropriately met and recorded within the plans of care. We saw residents walking in the garden area, sitting on the patio and going out into the community accompanied or unaccompanied, which showed that those able to do so made some decisions about how to spend their day. Some residents told us about a show that they had been to see recently, which they said was enjoyable. 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. 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 us that an activities co-ordinator would be appointed soon, 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. Fifteen 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. 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. Relatives spoken to said that they were always made welcome to the home and were able to visit residents in private, which we observed at the time of the site visit. 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 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 were protected. The policies of the home demonstrated that meal planning and nutritional requirements were fully considered when assessing individual needs and that Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 17 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. We spoke to the chef who told us that there were four meal choices each lunchtime, which was confirmed by examining the four weekly menus, which had been developed in accordance with people’s preferences. A record was seen to show that people living at the home were offered all four choices and that an alternative to the menu could be provided if people did not like the choices on the menu. The chef was very aware of special diets required and it was pleasing to see that all fresh produce was served, so that people were provided with a nutritious, well balanced diet. One resident confirmed that specialised foods are bought in for him so that his cultural dietary needs are met which is commendable. We noticed that there was a lack of space to keep food warm, such as a hot cupboard. We were told that this was in hand and will be addressed when the kitchen is refurbished in the near future. 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, “I like the food here, there is always a lot of choice” and, “the food is lovely”. On the day of our site visit people ate their lunch in the lounge areas of the home as the dining room was in the final stages of being completely redesigned and refurbished. By teatime this had been completed and those living at the home showed excitement about dining in their new surroundings. The dining room had been refurbished to a high standard and was tastefully furnished and decorated, which is commendable. One resident said, “I am very happy living here. I don’t want to move” and another, when asked what she did during the day told us, “I watch TV. I like the soaps and I enjoy colouring”. One person living at the home told us that she enjoyed going shopping and choosing her own things. Simeon House Nursing Home DS0000065154.V365078.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 adequate. This judgement has been made using available evidence including a visit to this service. People did not always receive appropriate personal and health care support and the management of medications did not consistently protect those living at the home. EVIDENCE: The home’s self-assessment submitted to the Commission 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. One care plan was a very well written, person centred document, providing detailed guidance for staff, so that they were fully aware of how personal and health care support should be provided to this individual. Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 19 The second care plan examined lacked detail and did not incorporate all the assessed needs of the individual so that staff were aware of how his needs were to be met. This resident had drawn up a list of issues that he would like addressing in relation to his care, but the plan of care did not incorporate any of his requests and his individual activity programme stated ‘refer to care plan’, but a care plan had not been developed about this person’s social care needs. However, people spoken to felt that they were respected and that their privacy and dignity was always promoted. 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. 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. Thirteen residents who sent in comment cards responded by saying that staff always treat them well, the other two said that they usually treat them well. One resident wrote, ‘we get looked after here’, and another simply wrote, ‘they (the staff) are superb’. 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. Comment cards were received from three staff members who indicated that they are usually given up to date information about the needs of the people in their care. 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. Qualified nurses administered all medicines, except those that people managed themselves. It was of concern that where people managed their own medicines or medicines were supplied to be taken when people were away from the home, written risk assessments had not always been completed and, any agreed support was not recorded. It is important that arrangements are Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 20 recorded to help ensure people always receive any support they may need to safely manage their medicines. As previously seen there was a lack of guidance about the use of medicines prescribed ‘when required’ that would help ensure consistency in the use of these medicines. As seen at previous visits, checks of medicines records and stocks showed that it was not always possible to track the safe handling of medicines at the home. It was of concern that we saw one example, where 15 tablets recorded as received into the home could not be accounted for (missing). Another medicines administration record wrongly recorded a medicine had been ‘stopped’ when the person’s clinical notes recorded that it was currently prescribed, and its’ use would be reviewed later in July as doses were being ‘refused’. Records for another person wrongly showed that two 5mg tablets had been given; stock checks showed that on occasions one 10mg tablet must have been given instead. To reduce the risk of mistakes it is important the records accurately reflect what was actually given. Additionally, unnecessarily having two strengths of the same medicine in the medicines trolley increases the risk that mistakes may be made. We also saw that although the receipt of the main monthly medicines delivery was recorded, records were sometimes missed when medicines were delivered at other times. And, where medication was ‘brought forward’ for use the next month, the quantities were not recorded making it difficult or impossible to track the safe handling of these medicines. The clarity and accuracy of the medication records needs to improve to reduce the risk of making mistakes when administering peoples’ medicines. We saw that several people were prescribed ‘Movicol’ but only one person had a box of this medicine. Prescribed medicines should be safely administered from people’s own supplies, and a stock should be available for each person prescribed the same medicine. ‘Sharing’ medicines again makes it difficult or impossible to track their safe handling. There was some unwanted medication in the medicines fridge that should have been sent for safe disposal. Some people had several supplies of the same medicine in the medicines trolley, in one case there were three bottles of the same tablet and the label on one bottle had faded to the point where it was barely legible. It was of concern that we were unable to find a box of one person’s tablets, but then found an unused and unlabelled ‘strip’ in the bottom of the trolley. All medicines should be safely stored in their original pharmacy labelled container. Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 21 The manager explained that they had just completed an initial audit of medicines handling and that the outcomes would be shared with qualified nursing staff. This is important to help ensure any areas for improvement are identified and addressed. A revised medicines policy had still not been implemented, this needs to be addressed to ensure there is clear guidance for staff about the safe handling of medicines at Simeon House. Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 22 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 complaints were well managed. EVIDENCE: The self-assessment submitted by the home showed that policies and procedures were in place in relation to complaints and concerns. Of the fifteen comment cards received from residents, eleven said that they would know how to make a complaint and the other four said that they would not know how to complain. However, a clear complaints procedure was seen, 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. All three staff members who submitted comment cards said that they would know what to do if a resident, relative or advocate had concerns about the home. A system was in place for the recording of complaints received by the home, so that issues could be monitored and audited. Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 23 The Commission for Social Care Inspection had not received any complaints about this service since the last inspection. The home’s self-assessment showed that a variety of policies and procedures were in place in relation to safeguarding adults. These were seen at the time of our visit to the home and included appropriate ‘whistle blowing’ guidance for staff to ensure that they were aware of the correct procedures to follow should they have any concerns about possible abuse of people in their care. Staff had been provided with training in relation to safeguarding 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.V365078.R01.S.doc Version 5.2 Page 24 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 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 well maintained or homely for those living at Simeon House. EVIDENCE: 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. It was pleasing to see that the general cleanliness of the home had improved significantly since the last inspection, providing people with a more hygienic Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 25 environment in which to live. The home, in general was more pleasant smelling than during our last visit, which provided people with a better environment. Ten of the comment cards received from residents indicated that the home was always fresh and clean. The other five indicated that it was usually or sometimes fresh and clean. Two residents spoken to told us that they were happy with their bedrooms and that they were comfortable living at Simeon House. It was also nice to see that major refurbishment work had commenced. A new carpet had been fitted in the upstairs corridor and the dining room had been restructured and completely refurbished to a high standard, providing a bright and very pleasant area for people to eat their meals. The new dining furniture was delivered on the day of our visit to the service, which was of good quality and people living at the home were looking forward to eating their meals in their new surroundings. However, in the remainder of the home many of the furnishings were old and worn and in need of replacement. Some areas 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 manager told us that a programme of refurbishment was in place and plans were to gradually update the environment so that it would be of a high standard throughout for people living at the home. We were told that the lounge areas were the next to be upgraded, so that more comfortable areas could be provided for people to spend their leisure time. We recommend that plans discussed are maintained so that the environment throughout is brought up to a good standard for people living at the home. The home was awaiting the delivery of a smoking shelter to be erected outside, as the environment was a ‘no smoking’ zone. Residents were seen sitting in the pleasant grounds of the home having a cigarette. However, there was some evidence that people were still smoking within the home, which was against the policies of the home and therefore could present a fire risk. 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. Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 26 Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 27 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 adequate. This judgement has been made using available evidence including a visit to this service. The recruitment procedures adopted by Simeon House did not consistently protect the people living there and not all the staff team were sufficiently trained to ensure that the individual needs of people were being appropriately met. EVIDENCE: Registered nurses working at Simeon House held appropriate qualifications to enable them to be competent to look after the people in their care. Care staff spoken to demonstrated that they were fully aware of people’s needs and that they were able to provide the care required. Staff were seen to be accessible to those living at the home and residents appeared relaxed when talking to them, saying that they felt comfortable discussing anything with the staff, as they were all very approachable and friendly. Staff spoken to were interested in the people in their care and showed a commitment to the service. Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 28 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. The home’s self-assessment showed that a variety of training programmes were provided for staff and that they received a recognised training programme, leading to a National Vocational Qualification (NVQ). However, staff spoken to felt that the provision of training had decreased recently and the management confirmed this, although they were in the process of implementing a more structured programme so that staff would be brought up to date with courses that had lapsed. We spoke to a new member of staff who said that she had done some fire training since she started, but not much else. However, she had only been employed for two weeks and so it was still early days. She told us that she ‘shadowed’ someone for two days when she started, but that there was no formal induction recorded and signed off. A long-standing member of staff said that there wasn’t much training going on at present, but that she had been told that a structured training programme would soon be implemented. The personnel records of one person who had been employed in April this year did not contain any training certificates and the records of another person employed in December 2006 only contained a certificate for POVA training, completed in August 2007. Comment cards received from three staff members in relation to induction varied. One felt that the induction period covered everything they needed to know and another felt it mostly did. However, the third member of staff said that they did not get an induction period when they started to work at the home. Two of the three staff members who submitted comment cards said that they were being given training relevant to their roles, which helped them understand and meet individual needs of residents, but were not always kept up to date with new ways of working. However, one member of staff said that they were not given training relevant to their role and wrote on the comment card, ‘so far no training has been offered or given and I have been here three months now’. Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 29 Two of the three staff members indicated that their manager sometimes meets with them to give support and discuss how they are working. The third staff member said that their line manager met with them often. The home’s self-assessment showed that policies and procedures were in place in relation to the recruitment of staff and that staff employed by the home routinely had a Criminal Records Bureau (CRB) disclosure conducted and that all qualified nurses were registered with the Nursing and Midwifery Council (NMC). The records of two staff members were examined at the time of the site visit, which demonstrated that thorough checks had not always 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. However, for one person working at the home only one reference was on file and this staff member had not had a CRB disclosure conducted or a POVA first obtained. When asked what the home could do better, the home’s self-assessment stated, ‘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’. Some new documentation was shown to us in relation to competence assessments for staff and induction programmes. We look forward to seeing these in place at our next visit to the service. 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. The three staff members 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.V365078.R01.S.doc Version 5.2 Page 30 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): 37, 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, in general, protected but the monitoring of the quality of service provided could have been better. EVIDENCE: A manager was not in place at the home who is registered with the Commission for Social Care Inspection. This is a long-standing situation and must be addressed as a matter of urgency. We were told that Gill Lawrence will be submitting an application to be registered as manager of Simeon House Nursing Home, as well as manager of it’s sister home, The Hamptons, which is on the same site and registered with the Health Care Commission. There was some evidence available to show that the quality of service was being monitored to a certain degree, but this could have been much better by Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 31 obtaining the views of people with an interest in the service; by holding regular meetings for residents and their relatives with minutes kept; by using an external auditing system; by implementing an annual development programme; by increasing the range of internal audits; by implementing a structured programme of routine maintenance and by developing a training matrix for staff. Minutes of staff meetings had been recorded and were available to those concerned, so that a record of discussions, which took place were retained. Views of residents, relatives and stakeholders in the community had not been formally sought for some time about how the home was achieving goals for the people living at Simeon House. There was evidence available to show that the provider conducts regular visits to the home and records his findings in accordance with regulation 26 of the Care Homes Regulations 2001, so that he is able to address any issues raised. A health and safety report had been conducted by the directors of the company during May 2008, which showed action that was being taken to ensure that people were safe living at the home. The fire risk assessment had recently been reviewed to ensure that it was up to date. The infection control policies were satisfactory and we noted that hazardous waste was being disposed of appropriately. The home routinely conducted and recorded a wide range of internal checks on systems and equipment to ensure that it was safe for use. We checked a random selection of certificates, which showed that, in general, equipment and systems in the home had been appropriately serviced to ensure that they were safe for use. However, the electrical installation certificate of maintenance could not be located at the time of our visit, so it could not be determined if this system had been serviced. 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 updated recently, to ensure that current information was being provided for staff. Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 32 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 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 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 N/A 13 2 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 1 X 2 X X 2 X Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 33 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) Requirement The plans of care must clearly identify all the assessed needs of people living at the home in relation to heath, personal and social care needs and clear guidance must be recorded to show how these needs are to be fully met. People living at the home, or their relative, must be given the opportunity to be involved in the planning of their care. Timescale of 31/01/08 not met. 3. YA19 15 (1) The health care needs of people must be recorded within the plan of care so that staff are provided with clear guidance about how people’s needs are to be met, including needs associated with mental health. To support the safe administration of medication there must be a complete and accurate list of currently prescribed medication and the DS0000065154.V365078.R01.S.doc Timescale for action 31/08/08 2. YA6 15(1)(2) 31/08/08 31/08/08 4. YA20 13(2) 11/08/08 Simeon House Nursing Home Version 5.2 Page 34 time and date of administration for each person. Records must be kept of all medicines received into the home. [Record Keeping was an element of a previous requirement. Previous Timescale15/02/07, 31/01/08, 06/03/08 and 16/06/08 not met] 5. YA20 13(4)(c) To help ensure people receive any support they may need when self-administering medicines and that any ‘leave’ medicines are safely supplied written risk assessments must be completed and the agreed arrangements recorded. All parts of the home must be kept reasonably decorated, so that people living there are provided with pleasant surroundings in which to live. 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. Timescale of 30/06/08 not fully met 8. YA24 16(2)(c) Adequate furniture, bedding and other furnishings, including floor coverings must be provided in rooms occupied by residents so that they can live in a comfortable environment. Timescale of 30/06/08 not fully met. Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 35 11/08/08 6. YA24 23(2)(d) 31/01/09 7. YA24 23(2)(b) 31/01/09 31/01/09 9. YA34 19(1) 5(d) 10. YA37 8 (1) 11. YA42 23(2)(c) A thorough recruitment procedure must be adopted by the home so that people living there are adequately protected. This includes a check of the Protection of Vulnerable Adults register, obtaining a Criminal Records Bureau disclosure and seeking two written references before people start to work at the home. A person applying to be the registered manager of Simeon House must submit an application to the Commission as a matter of urgency. The electrical installation must be serviced in accordance with the contractor’s recommendations. Once this has been completed please forward a copy of the certificate to the Commission. 31/07/08 15/08/08 31/08/08 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 YA6 Good Practice Recommendations The care plans should be reviewed with the service user or their relative at least every six months or when changes in needs dictate. 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. Any social care programmes implemented should be followed in day-to-day practice or changed to meet the social care needs of people living at the home. It is recommended that an activities coordinator be DS0000065154.V365078.R01.S.doc Version 5.2 Page 36 2. YA9 3. YA13 4. YA13 Simeon House Nursing Home employed so that a more structured approach to the provision of activities can be established. 5. 6. YA18 YA20 Care records should be accurate and people’s wishes should be consistently respected in day-to-day practice. The medication policy should be reviewed and implemented to provide clear guidance to staff in the handling of medication at Simeon House. Any unwanted medicines should be promptly segregated from those still in use and sent for safe disposal. To reduce the risk of mistakes and make it easier to keep track of medicines in the home, only one supply (box) of each person’s medicines should be kept in the medicines trolley. The oldest supplies should be used first. 7 YA24 A copy of the refurbishment programme 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. 9. YA39 The monitoring of the quality of service provided should be further extended: • By obtaining the views of people with an interest in the service; • By holding regular meetings for residents and their relatives with minutes kept; • By using an external auditing system; • By implementing an annual development programme; • By increasing the range of internal audits; • By implementing a structured programme of routine maintenance and • By developing a training matrix for staff. 8. YA35 Simeon House Nursing Home DS0000065154.V365078.R01.S.doc Version 5.2 Page 37 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. 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