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Inspection on 24/06/08 for Daneside Court Nursing Home

Also see our care home review for Daneside Court Nursing Home for more information

This inspection was carried out on 24th June 2008.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People considering moving into Daneside Court are given plenty of information about the home and the services it provides. An assessment of needs is carried out so that they can be confident that staff at the home have the knowledge and the skills to meet their needs. Everyone we spoke with were complimentary about the staff at the home. Comments such as `the staff are marvellous` `the staff are great` were made. Visiting professionals said they thought people received good care. No concerns were raised.Relatives spoken with were also complimentary about the staff and the care provided. One relative said `it impressed me that there were no bad odours when we visited the home` Staff respect the privacy and dignity of residents. Good relationships existed amongst the staff and the people living in the home. There are enough activities provided to keep people active and stimulated. A good balanced diet is offered so maintaining the health of the people living in the home. There are good recruitment procedures, which means that only people suitable to work in care are employed.

What has improved since the last inspection?

Several areas of the home have been redecorated providing a more pleasant place for people to live in. Improvements have been made to the garden so people living in the home can sit out and enjoy the better weather. The rear fence has been secured thus enhancing security. A new parker bath and more moving and handling equipment have been purchased so that the needs of people living in the home can be met. Staff have had training in safeguarding adults so are aware of the action to be taken should an allegation of abuse or poor practice be made. This means that people living in the home are protected from injury or harm.

What the care home could do better:

Although everyone has a care plan in place, these do not always identify individual needs. Qualified nursing staff should oversee the care plans belonging to people requiring nursing care to ensure that their health is monitored and appropriate action taken as necessary. Care plans should be evaluated monthly and updated should there be any change. The operations manager told us that plans were in place to introduce training on person centred care planning to make sure that the care plans reflect people`s individual needs. Although the meals provided are good, more choice should be offered to people who have a pureed diet. The cleanliness and storage of items on the upstairs floor needs to be improved. Several areas upstairs were noted to be in need of cleaning. Itemsspilt on floors should be mopped up immediately to prevent risks to the health and safety of people living in the home and staff. Kitchen areas should be kept clean to prevent outbreaks of infection and fridge temperatures should be monitored. Items such as peoples clothing, soft furnishings, ladders and bed covers should not be stored in bathroom areas. This issue has been discussed at the previous inspection but has not been addressed. Staffing levels need to be reviewed and in some instances increased to make sure that the needs of all people living in the home are met. This is an outstanding requirement from the last inspection. After the inspection the manager told us that she had increased the staffing levels from 2 to 3 staff working downstairs at night so that people living in the home do not have to wait a long time before getting assistance. The implementation of the quality assurance system needs to be improved to ensure that the home is run in the best interests of the people living there.

CARE HOMES FOR OLDER PEOPLE Daneside Court Nursing Home Chester Way Northwich Cheshire CW9 5JA Lead Inspector Helena Dennett Unannounced Inspection 24th June 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Daneside Court Nursing Home Address Chester Way Northwich Cheshire CW9 5JA 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) 01606 40700 01606 40621 www.schealthcare.co.uk Southern Cross Healthcare Services Ltd Manager post vacant Care Home 64 Category(ies) of Old age, not falling within any other category registration, with number (64) of places Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home with Nursing - code N, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: - Old age not falling within any other category Code OP. The maximum number of people who can be accommodated is: 64 Date of last inspection 6th November 2007 Brief Description of the Service: Daneside Court is a purpose built care home, built in the 1990s, which provides both personal and nursing care for up to 64 older people. It is owned by Southern Cross Healthcare, a company, which operates care homes throughout the country. The home provides single room accommodation on the ground and first floors. There are four lounges for residents to use. There is access into the garden, which has seating and tables. The home is situated in the centre of Northwich within walking distance of local shopping facilities, public houses, bus stops and open park areas. It is well established within the local community. The current range of fees is from £367.54 - £654.72 per week. Additional charges are made for the hairdresser, chiropodist, outings, bingo and newspapers. Daneside Court Nursing Home DS0000018768.V363603.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 people using this service experience adequate quality outcomes. This site visit, which was part of the key unannounced inspection, took place over 12.5 hours. We visited the home over two days and provided feedback on our findings to the manager and the operation manager at the end of the second day. Before the visit the manager was invited to provide information about the home as part of this inspection process. The views of residents and relatives were also sought and their comments are incorporated into this report. During the visit we spoke with people who live at the home, relatives, staff, the manager and the operations manager. We also spoke to three visiting professionals. Their comments are also incorporated into the report. The care records for four people who live at the home were examined as part of the inspection, in respect of the care they receive. Records of medication care plans, and training were also examined. After the last inspection we met with the operations manager and the manager to discuss our findings. They told us that all requirements would be addressed and that improvements would be made. Although some requirements have been met others remain outstanding. What the service does well: People considering moving into Daneside Court are given plenty of information about the home and the services it provides. An assessment of needs is carried out so that they can be confident that staff at the home have the knowledge and the skills to meet their needs. Everyone we spoke with were complimentary about the staff at the home. Comments such as ‘the staff are marvellous’ ‘the staff are great’ were made. Visiting professionals said they thought people received good care. No concerns were raised. Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 6 Relatives spoken with were also complimentary about the staff and the care provided. One relative said ‘it impressed me that there were no bad odours when we visited the home’ Staff respect the privacy and dignity of residents. Good relationships existed amongst the staff and the people living in the home. There are enough activities provided to keep people active and stimulated. A good balanced diet is offered so maintaining the health of the people living in the home. There are good recruitment procedures, which means that only people suitable to work in care are employed. What has improved since the last inspection? What they could do better: Although everyone has a care plan in place, these do not always identify individual needs. Qualified nursing staff should oversee the care plans belonging to people requiring nursing care to ensure that their health is monitored and appropriate action taken as necessary. Care plans should be evaluated monthly and updated should there be any change. The operations manager told us that plans were in place to introduce training on person centred care planning to make sure that the care plans reflect people’s individual needs. Although the meals provided are good, more choice should be offered to people who have a pureed diet. The cleanliness and storage of items on the upstairs floor needs to be improved. Several areas upstairs were noted to be in need of cleaning. Items Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 7 spilt on floors should be mopped up immediately to prevent risks to the health and safety of people living in the home and staff. Kitchen areas should be kept clean to prevent outbreaks of infection and fridge temperatures should be monitored. Items such as peoples clothing, soft furnishings, ladders and bed covers should not be stored in bathroom areas. This issue has been discussed at the previous inspection but has not been addressed. Staffing levels need to be reviewed and in some instances increased to make sure that the needs of all people living in the home are met. This is an outstanding requirement from the last inspection. After the inspection the manager told us that she had increased the staffing levels from 2 to 3 staff working downstairs at night so that people living in the home do not have to wait a long time before getting assistance. The implementation of the quality assurance system needs to be improved to ensure that the home is run in the best interests of the people living there. 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. Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering moving into the home are given information and have their needs assessed before admission so they can be confident that the home can cater for their needs. EVIDENCE: Information on the home and the services it provides is available in the main hall. This outlines the facilities that are on offer at Daneside Court. We spoke to one person and her relative who had recently moved into the home. They had been given a list of homes to visit by social services. They arrived unannounced and were shown around the home by a senior member of staff. They said they were impressed with the friendliness of the staff and their willingness to answer questions. They also told us that the manager Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 10 visited the person in hospital before arranging her admission. During this visit they were given a lot of information about the home including a copy of the complaints procedure. Both the relatives and the person living in the home found this positive experience. We looked at the care files for four people living in the home. Three of the files contained a pre admission assessment, which recorded the person’s needs, and any specialised equipment needed when they come into the home. The fourth file contained detailed hospital and social workers assessment as the person had travelled a long distance to live in the home. This means that staff can be prepared and have any equipment that is needed ready for the person when they arrive at the home. Intermediate care is not provided at Daneside Court so standard 6 does not apply. Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is some variable practice in the planning and delivery of care, which means that some people receiving the service cannot be sure that their heath and personal needs will always be met. EVIDENCE: The records of four people living in the home were looked at during the site visit. All of the records contained an assessment document, which formed the basis of the care plan that outlines the care to be given to the person. Risk assessments were also completed. Some of the risk assessments had been completed incorrectly which could mean that the care provided does not meet the persons needs. Care plans were in place in all the files that were looked at. Some of these contained general information and did not always address individual needs For example: The care plan for a person who had a visual impairment was looked at. Although the plans outlined general care there was no specific Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 12 instructions on how the visual impairment affected the persons daily life or how staff could assist them to overcome this. In one persons care plan the risks associated with the persons swallowing difficulties and the need to ensure that they have thickened fluids were not fully addressed in the care plan to make sure that all staff and family were aware of the risk. Some of the care plans had not been evaluated since May 2008. This means that changes to a persons care might not be noted or the care plan updated to reflect that change. The home operates a system whereby a named person is responsible for writing the care plans and overseeing a person’s care. We noticed that a senior carer was responsible for the care plans for one person who had complex nursing and medical needs. The care plan for this person did not fully address all of their nursing needs and the evaluation did not take into account all of the issues associated with the person’s condition. A senior carer would not have the knowledge or skills to write a nursing care plan or to evaluate nursing care. This means that the persons health may not monitored as closely as it should be or that early signs of health deterioration may not be recognised. There was evidence that specialist health care professionals such as the dietician and the tissue viability nurse visit as required. In one persons notes instructions from the tissue viability nurse were not incorporated into her care plan. However, there was evidence that staff were using the correct dressings but it was difficult to ascertain whether the other checks that the tissue viability nurse advised had been carried out. Two opticians were in the home on the day of the site visit assessing several people’s sight and providing advice and information to help staff address their needs. We spoke to several people living in the home. They told us they were very happy with the care provided. One person said ‘ the staff are marvellous here. I have just been to hospital and the doctors are very pleased with my wounds as they are healing well’ Another person told us; ‘ the staff are great. I can please myself. You can get as many baths and showers as you want and staff treat you very well’ One relative told us: ‘ since my relative has come into Daneside Court she has come on really well. I am very happy with the home’ We spoke with two visiting professionals. They told us that they visit the home regularly and that ‘it is one of the best in the area’. They thought the people Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 13 living in the home are well cared for and that the staff are friendly and approachable. They said that staff are always available when they bring a person back from hospital so ensuring they are not left lying on a stretcher for any length of time. Staff spoken with had a good understanding of the people they were supporting and of their individual needs. Some problems were found with the management of medicines on the ground floor. Three people requiring nursing care were accommodated on the ground floor. On looking at the Medicine Administration Record (MAR) record sheets we noticed that at times the senior carer takes responsibility for the administration of medicines for these people. When questioned staff were not clear what some of the medicines were or their associated side effects. This would make it difficult for them to monitor the person’s condition and whether their medication was effective. The National Minimum Standards advise that medicines for people receiving nursing care are given by a medical practitioner or registered nurse. The operations manager addressed this issue during the site visit and told us that in future only registered nurses will give out medicines to people requiring nursing care. The privacy and dignity of people was promoted and maintained during the site visit. Staff appeared to know the people living in the home well and a good rapport seemed to exist. People living in the home told us that staff treated them well. Members of staff were seen knocking on doors before entering bedrooms. Bathroom and bedroom doors were shut before any personal care was carried out. Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There is a good range of activities available to make sure that people living in the home are kept active and stimulated. People can generally exercise choice and control over their lives. EVIDENCE: There are plenty of planned activities carried out in the home. A full time activity co-ordinator is employed. A weekly activities sheet is put on the notice board in the main reception area and is also on a notice board upstairs. Information received before the inspection indicates that the activity coordinator works one evening a week and some weekends so that people are kept occupied at different times in the day. We spoke with several people living in the home. All of them said they could suit themselves and decide what they wanted to take part in. Two people told us they enjoyed the bingo sessions; others said they enjoy trips out and were looking forward to going to the zoo. One person told us she used to enjoy going for long walks in a morning but since she had lost her mobility she missed this exercise. She went on to say that members of staff take her out in Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 15 her wheelchair into Northwich town centre and the park and that she looked forward to these outings. The following comments were made on survey forms returned before the site visit: ‘Staff are very good. I like playing dominos. I go out most days. The food is lovely and there is plenty of it. ‘ ‘I take part in bingo, dominos; carpet bowls arts and crafts and the alpha group. I like company.’ People living in the home are enabled to follow their religion as they wish. A lay preacher visits the home regularly and Holy Communion is served fortnightly. Members of the Roman Catholic Church also visit. Visitors can meet with their relatives in private and at any reasonable time. Southern Cross Healthcare operate a system whereby the menus are inputted into the computer and cross checked to make sure that they are varied and nutritionally balanced. This means that people living in the home can be confident they are getting a healthy and varied diet. Staff told us that people are given a choice of main meal at lunchtime and alternatives can be arranged if they don’t like what is on offer. One person living in the home that has a pureed diet and has a visual impairment said they are not always informed what the main meal is. Kitchen staff told us that usually the pureed diet consists of the main meal of the day and that a choice is not usually given. Staff should make sure that everyone is offered a choice of main meal. The home has introduced a ‘nite bite’ system so that people living in the home can access food at any time if they are hungry. Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are protected by the implementation of the homes policies on complaints and abuse. EVIDENCE: The complaints procedure is displayed in the home. This has information on the action to take should anyone have a complaint or concern. The manager of the home keeps a record of complaints received. These detailed the action taken by staff to ensure that people receive good care. We received one complaint from someone who did not wish to give his or her name. They raised concerns about staff actions and the fact that sometimes the home is short of staff. We sent the complaint to the provider to investigate. A response was returned to us. The provider did not find enough evidence to substantiate the complaint and told us he had checked the staffing rotas and had judged that there are enough staff to meet the needs of the people in the home. Please look under staffing standards for further information on the findings on this visit. He also told us that he had sent surveys out to all people living in the home and their relatives to ascertain whether the manager is approachable and whether the activities in the home are suitable for peoples needs. The results Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 17 of these surveys could not be found during the site visit. Please see under the management standards. People living in the home told us they knew how to complain and would approach the manager or the person in charge in the first instance. All of them said they found staff friendly and approachable and all said they were very happy with the care provided. Members of staff spoken with knew what to do if they witnessed any incident or occurrence. All of them knew the whistle blowing policy and said they would use it if they needed to. They told us they had received training on abuse. Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22 & 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although the environment is well-maintained problems with cleanliness and storage could leave people living in the home at risk. EVIDENCE: The home is situated near the centre of Northwich. It shares its entrance with Daneside Mews. Both homes share the laundry and kitchen facility. Since the last inspection Daneside Court has improved the garden areas and people living in the home can now sit outside in the better weather. The rear of the home has been secured so that members of the public can no longer use it as a shortcut through to the town centre. This site visit started at 0920hrs. We visited the upstairs floor first and walked around the unit, visiting unoccupied bathrooms, sluice and kitchenette areas. Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 19 The cleanliness of some of the areas upstairs needs to be improved. Infection control procedures also need to be improved to ensure that people living in the home are not placed at risk. For example: In the bathroom upstairs near to the nurses’ station a laundry bag with dirty washing was placed on the floor. This remained there until early afternoon. A clinical waste bag was also on the floor - this was removed and put in its container during the morning. A spillage had occurred onto the floor in the sluice area. This was dry so had been there for some time. When questioned staff did not know what the spillage was. The cupboards in the small kitchenette were dirty and in need of cleaning. The fridge and freezers upstairs were dirty and required cleaning. There was no evidence that fridge temperatures had been taken and monitored. Some of the bathrooms were used as storage areas. For example: In the bathroom opposite the nurses station a pair of stepladders were stored, a bed cover was left on the floor and an easy chair and cushion also stored in the bathroom. All of these pose a risk to people living in the home, as they could be a fire risk, infection control risk and a health and safety risk. Several clothes belonging to people living in the home were stored in another bathroom on hangers. It was not clear why these had been left there, as they should have been returned to the individual’s room or back to the laundry for staff to find out who owned them. People living in the home said their bedrooms were kept clean and tidy. They are encouraged to bring in personal items from home. Information received before the inspection states that the home has been refurbished since the last inspection. A new parker bath has been purchased and more moving and handling equipment obtained so that the needs of the people living in the home can be met. Downstairs was found to be clean and tidy with no issues noted. Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 7 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There are not always enough staff working in the home so people living in the home may have to wait to receive the care they need. Recruitment procedures are thorough enough to make sure that staff are suitable to work in the home. EVIDENCE: At the last inspection we found there were not always enough staff working in the home to make sure that people’s needs are met. We met with the operation manager and the home manager and they told us that more staff would be provided in particular in the evening on the downstairs floor to make sure that peoples need are met at all times. In February 2008 social services raised concerns that at time there are not enough staff to meet peoples needs. A complaint was also received from someone who did not wish to give their name regarding the lack of staff at times in the home. The dependency level of people accommodated downstairs has increased since the last inspection. There are now three people requiring nursing care living there. This means that a qualified nurse should oversee their care and monitor their health. We looked at the duty rota for the month of May/June. There was evidence that at times two people were working from 8pm – 8am downstairs. This Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 21 means that if one person is giving out medicines, there is only one person left to answer call bells and attend to people during that time. This issue was raised at the last inspection but has not been addressed. We spoke with some people who were accommodated on the ground floor. One person told us that they felt there was not enough staff working late evening and at night. The following comment was made on a survey form that was returned to us before the site visit: ‘Sometimes I go to find my relative very distressed with no one in attention. Need to increase the ratio of staff to patients.’ After the inspection the manager told us that she has increased the staffing levels on the downstairs floor from 2 to 3 staff to ensure that the needs of the people accommodated there are met. There is a good recruitment policy in place. There was evidence that references and Criminal Record Bureau disclosure checks are done before anyone is employed to work in the home. Although the PIN numbers of nurses is recorded on the application form there was no record that these had been checked with the nurses governing body to make sure that they were still registered. The manager told us she had carried out these checks, however she could not find them. Staff told us they are supported in their training. Records of training are kept. There was evidence that staff have attended fire drills, food hygiene training and training on how to deal with challenging behaviour. Some staff have attended a moving and handling trainers course so can provide moving and handling training in –house. However all staff have not had up to date moving and handling training and so people living in the home could be place at risk of harm. This should be addressed. Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The quality systems in the home are not good enough to make sure that the views of people living there influence the running of the home so cannot be confident that the home is run in their best interests. EVIDENCE: The manager of the home has been in post since August 2007. She is a Registered General Nurse and held the post of a deputy manager at a different home before this appointment. An application to become registered has not been received to date. The manager told us that she has got the forms but will need to get the necessary checks and information before these can be submitted for our consideration. Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 23 There is a quality assurance system in place. The administrator sends out satisfaction surveys regularly and these are returned to head office. The manager said that they are only informed if there are issues to be actioned or compliments. Following a complaint earlier this year the operations manager told us that he had sent surveys out to all the relatives so that he could monitor the quality of care provided to people living in the home. None of these questionnaires had been returned to the home. It is not clear whether they had been returned to head office and the manager of the home not informed of the outcome of the surveys. The operations manager visits the home unannounced on a monthly basis and writes a report on the quality of the service provided. A copy of the report is left with the manager. In addition a more in depth audit is carried out and a copy sent to head office. We looked at the audit for May. One of the issues highlighted in this audit had not been addressed and was still outstanding. Staff at the home manage some of the residents money. A separate account is kept in Southern Cross Health Care’s name and transactions are carefully monitored. Residents can have an update on their account on request. Receipts are kept whenever possible and two signatures are also obtained for all transactions. The maintenance man confirmed that all essential equipment is maintained in accordance with manufacturers instructions. A sample of certificates was seen and these were satisfactory. As mentioned under the staffing and environmental standards some health and safety issues were identified which could put people living in the home at risk so need to be addressed. Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 2 Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 17 (3) (a) Requirement Timescale for action 30/08/08 2 3 OP22 OP27 23 (2) (i) 18 (1) (a) 4 OP31 9 Care plans must be specific to the individual and kept up to date, reflecting residents’ current needs so that the most appropriate care is provided to residents. (Timescale 15/12/07 not met.) Bathrooms must not be used as 31/07/08 storage areas for equipment or soft furnishings. Adequate numbers of staff must 24/07/08 be provided so that residents are not waiting long periods of time before they can get assistance. (Timescale 06/12/07 not met) An application to become 30/09/08 registered with CSCI must be submitted by the manager. This is to ensure that the home is run by a person who is fit to be in charge of the home. Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP15 OP26 Good Practice Recommendations Staff should make sure that people having a pureed diet are given a choice of meals. The manager and senior staff should monitor the cleanliness of the upstairs floor. Infection control procedures should be adhered to so that people living in the home are not placed at risk. The skill mix of staff working on the downstairs floor should be reviewed to ensure that there are enough suitably qualified staff with the knowledge and skills to care for the people requiring nursing care. Residents views should be sought and acted on whenever possible to ensure that the home is run in their best interests. All members of staff should be trained in moving and handling techniques and are provided with annual updates. This is to ensure that people living in the home or staff are not placed at risk of harm or injury. 3. OP27 4. OP33 5. OP38 Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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 Daneside Court Nursing Home DS0000018768.V363603.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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