Inspection on 03/09/07 for Donness Nursing Home

This inspection was carried out on 3rd September 2007.

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

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

Other inspections for this house

Donness Nursing Home 14/07/09

Donness Nursing Home 20/08/08

Donness Nursing Home 13/07/06

Donness Nursing Home 14/09/05

Donness Nursing Home 07/04/05

Donness Nursing Home 15/11/04

Donness Nursing Home 05/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Donness Nursing Home 42 Atlantic Way Westward Ho ! Bideford Devon EX39 1JD Lead Inspector Victoria Stewart Key Unannounced Inspection 09:40 3 September 2007 rd 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 Donness Nursing Home DS0000026712.V337763.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. Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Donness Nursing Home Address 42 Atlantic Way Westward Ho ! Bideford Devon EX39 1JD 01237 474459 01237 479349 pydon@supanet.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Yvonne Lesley Thelma Newton Mr Paul Christopher Newton, Mrs Esther Waldron Mrs Yvonne Lesley Thelma Newton Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To include a maximum of up to 4 unnamed residents with a learning disability need who are under the age of 65 years The maximum number of persons accommodated at the home will remain at 34. Date of last inspection Brief Description of the Service: Donness is a detached, three storey property situated in the Westward Ho! area of Bideford which has been extended in recent years. It provides services for 34 people over the age of 65 years, with either personal or nursing care needs. It occupies an elevated position and offers far ranging views to the nearby coastline. There is a selection of communal areas on different floors of the building - this includes two dining rooms, three sitting rooms and a visitors lounge/quiet room. Private rooms comprise of four double rooms and twentysix single rooms, many of which have en-suite facilities. All areas of the home can be accessed by one of the two passenger lifts. There is a large sun balcony with lovely sea views. This provides the outdoor space for people to sit. Some private rooms also have a small balcony. A direct bus route to and from Bideford is available. The cost of care at the time of the inspection was £496 to £535 per week. Chiropody, toiletries, newspapers/magazines, personal items, clothing and hairdressing are additional costs which are not included in the fees. The latest CSCI report is held in the manager’s office of the home and would be available upon request. Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A total of 10.5 hours were spent at the home and two inspectors completed the inspection over two days. At the time of the visit, there were 29 people living at the home with five vacancies. Several weeks before the inspection took place an Annual Quality Assurance Assessment (AQAA) document, which contains general information about the home and the people living there, was completed by the registered manager/owner of the home and returned to the CSCI. From this information, survey forms were then sent out to residents, relatives and health/social care professionals. Responses were received from 3 residents, 7 relatives and 3 health/social care professionals. We also spoke with a further 6 relatives and 12 members of staff during our visit to the home. Donness provides nursing care for people with old age and the majority of those people presently living at the home do not have the capacity to communicate fully or understand the inspection process. Several of the residents may also have a learning disability need. Therefore we spent a considerable amount of time observing the care and attention given to these people by staff. We also looked closely at the care given to four specific people living at the home, looked at a selection of records (including residents’ files, staff files, medication records, staff training records, quality assurance records, health and safety records) and undertook a tour of the premises. All of this evidence has been used and included in this report to help form the judgements and findings of this inspection. On the first day of inspection, the manager/owner was on annual leave and a registered nurse was in charge of the home. The manager was present on the second day of inspection. The outcome of the inspection was discussed with both the registered nurse on the first day and the manager on the second day of inspection before we left the home. What the service does well: Prospective residents receive an information booklet which contains lots of useful information about what the home offers. If they then decide they want to live at Donness, an assessment is undertaken to ensure that the home can fully meet their needs. The home ensures that residents have some choice in their day-to-day living and they are able to participate in a range of suitable recreational activities and interests. Visitors are welcome at any time and the home has a warm, open and homely atmosphere. Staff are friendly, work very hard and receive the training that is necessary for them to do their jobs properly. Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 6 The home has a good procedure in place to deal with complaints and no complaints have been received by the home or the CSCI since the last inspection. The home is well managed by a ‘hands-on’ manager who has been both the owner and manager of the home for many years. She is a qualified general nurse and has a management qualification. The home is very clean and kept in a nice, attractive condition. Private rooms are individual and are personalised. People are encouraged to bring in their personal and sentimental items. Quality assurance systems are in place and once a year a survey is sent out by the home to monitor the service and facilities it is providing. What has improved since the last inspection? What they could do better: 5 requirements have been made as a result of this inspection. 3 of these requirements are with regard to staff recruitment, record keeping and health and safety. The other 2 requirements were identified at the last inspection, have not been met and carried forward to this inspection report. These are with regard to medication and privacy and dignity practices. 7 recommendations (which are seen as good practice) have also been made. 5 of these relate to care planning, resident/relative meetings, laundry (x2) and staff supervision. 2 recommendations relating to medication and food have also been brought forward from the last inspection report. The home needs to decide which type of resident care plans it is going to use and then develop these to include all the information necessary for planning an individual resident’s care. Whilst some aspects of medication have improved since the last inspection, further improvements are still needed to ensure the safety of people’s wellbeing. The home needs to look at people’s privacy and dignity and improve on the areas highlighted in the report. Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 7 Residents enjoy basic home cooking, but the home needs to offer residents more choice in what they have and vary the type and size of meals offered to suit individuals’ likes and dislikes. Improvements are needed in the laundry to ensure that residents’ personal clothing is washed and dried properly and simple repairs routinely done such as sewing buttons back on. The home must ensure that all new employees who are recruited go through a robust recruitment procedure and that all the necessary pre-employment checks are undertaken to protect people living at the home. The numbers of staff necessary to look after residents properly are not always being met. These numbers were reviewed and agreed between the home and CSCI when the new extension was built a couple of years ago. This must be adhered to. Staff should receive regular one to one supervision in order to review their practice and learning needs. The home sends out a formal quality assurance survey once a year. In view of the number of people living at the home who are unable to comment on the care they receive, we have recommended that relatives, friends, health/social care professionals and other stakeholders are included in this survey. Further informal meetings between this period would help the home monitor its service and facilities. All records pertaining to the residents and staff must be held on the premises and be available for inspection at all times. All equipment must be serviced and maintained as per the manufacturer’s guidelines. 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. Donness Nursing Home DS0000026712.V337763.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 Donness Nursing Home DS0000026712.V337763.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): 1,3,4 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 Donness can be assured that they will receive full information about the home. Those choosing to live there will receive an assessment before they move in to make sure that the home can fully meet their individual needs. EVIDENCE: Surveys received from people living at the home showed that three out of four had received enough information about this home before deciding to live there. One person could not remember. Five surveys received from relatives showed that they had also received enough information about the home and two had not. The home has a Statement of Purpose (SOP) which had recently been updated in July 2007. This helps people to understand what the home offers and whether it is suitable for their individual needs. The AQAA states that a brochure is given to all prospective residents which includes the SOP, a Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 10 contract of terms and conditions, fees payable and other useful information to help people decide whether the home is right for them. We looked at the SOP with the manager. It was agreed that this needs some further amending to explain more clearly to people what type of resident Donness is registered to care for. The AQAA states that shared care assessments are obtained from health and social care professionals prior to admission to the home. These are obtained to ensure the home can meet all the prospective person’s needs in full. The home states that this can sometimes be difficult for them as the information provided is “scanty” and “not current with the changes in the client’s needs” (although the home acknowledges there have been some recent improvements made). The manager of the home also visits prospective residents prior to admission to the home. The AQAA states that information is gathered from those providing the care at that time, with the person, their relatives and other relevant professionals. We looked at four people’s care files and these showed that some information is gathered before people move into the home. We were told that these assessments are completed on people who live in the local area – in their own homes, in other care homes or in hospital. People who live out of the North Devon county area are not routinely visited. Donness Nursing Home DS0000026712.V337763.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. Residents’ health and personal care needs are generally met but the efficiency of this can be dependent upon staffing numbers. The home needs to make a decision on which system of care planning to use and develop this further to ensure that care and support is consistent and person centred. Staff consider residents’ privacy and dignity but further review in this area will be of residents’ benefit. Medications are well managed but some improvements are required in record keeping to ensure that residents’ are not put at unnecessary risk of harm. EVIDENCE: Surveys received from people living at the home showed that they were happy with the care and support provided. Seven relatives responded to surveys and we spoke with a further six. All confirmed that they were very happy with the care provided at the home and very positive comments were received such as “the staff are excellent, nothing is too much trouble”, “I think it is a first class home” and “they are very kind to their residents and show great patience with them”. However, these relatives also considered that the home was short of Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 12 staff on occasions, which sometimes meant that staff were slow in responding to residents’ needs for example answering call bells. Comments included “staff good but short staffed – really busy” and “think home is short staffed occasionally”. Staff also commented on the staff numbers and these comments are included elsewhere in the report (see Standard 27). We noticed that on the first day of inspection, the home was short of staff as one member of care staff had called in sick and no replacement had been employed. This meant that the home was running under the staffing levels agreed with CSCI. We saw several examples of the effect this had on resident care including residents waiting for long periods before being transferred from wheelchairs into lounge chairs, residents’ slipping out of wheelchairs (but fastened in tightly with lap straps) and no staff around, one resident wandering around the home with no trousers on, residents’ clothing not fastened properly with buttons missing, heavy facial hair on one female resident, three residents being fed at the same time, three care staff needed by residents on the upper floor at the same time, residents wearing clothing stained with food and residents having to wait to be assisted to get up by staff and it almost being lunchtime when this was done (refer individual standards). Both inspectors felt these issues arose due to the staff being pressurised and rushed. We saw that the staff employed on this shift were indeed working very hard and doing their best to meet residents’ needs, but all staff commented on how difficult this was and felt it could be unsafe. They also said that they had become used to shortages of staff but were not happy about it. They told us the manager had been informed of their concerns. On the second day of inspection, three care staff were again on duty (including two agency staff). However, on this occasion we arrived later in the day than the first inspection and most of the residents were up. We saw that the home was less rushed, more organised and residents better looked after. We looked at the care files of four residents. These all contained care plans. Some files contained two different types of care plans. The manager told us that she was considering changing over to the new care plan system (which was American in origin and obtained from the internet). We considered this format to be comprehensive but very complex and not easy to understand. It also appeared to focus on medical care rather than social care. Two members of qualified nursing staff confirmed that they had received no training in this system of care planning and were unsure about how to apply it at the time of inspection. This has led to this new care plan model (when used for certain residents) not being completed either appropriately or fully. One health care professional also expressed concern to the CSCI that he/she felt that these new care plans were not being completed properly and not appropriate for the people who live there. We looked at the ‘old style’ of care plan used in some of the care files. Whilst these are straightforward and easy to understand, we thought they could be further developed to be more person centred. These showed that they had been drawn up with information obtained from the assessment process. Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 13 Wording on some of the care plans showed that resident’s, or others acting on their behalf, had been involved in their initial compilation as their preferences had been recorded, such as likes and dislikes of food and preferred time to bathe. Reference to the home’s ‘bath list’ confirmed that bathing times correlated with what was written on the care plan. Relatives commented that they were not involved in the reviewing of their relative’s care planning and no record of their involvement was written in the care records. Comments included “not involved with xxx‘s care” and “would find meetings useful to discuss issues”. Staff said that relatives were not involved in the formal review of residents’ care but thought it would be a good idea if introduced. On the second day of inspection the manager told us that when a formal review is carried out by a health or social care professional, then letters inviting them to attend are sent out but the offer is not often taken up. We were told that this had been done for the last three residents in the home to be formally reviewed. Care files contained suitable risk assessments such as manual handling and tissue viability and other useful information such as the best way to communicate with individuals. This is very relevant due to the high number of residents who have difficulty in communicating or are unable to communicate verbally at all. Care files showed that residents receive regular support from healthcare professionals. Two General Practioners stated in their surveys that the home always communicates clearly with them and that staff understand the needs of residents. One health care professional confirmed in his/her survey that specialist advice is always sought and that all care needs are met by the service and also commented that Donness is “friendly, caring, good atmosphere and very professional”. Residents felt that they “always” or “usually” get the medical support they need. We looked at the management of residents’ medication. Two people living at the home were managing their own medication, one giving their own eye drops and one using their own nebuliser. These people had been assessed as able to do this safely but this had not been reviewed for some time. We looked at the Medication Administration Record (MAR) and saw when some dosages of medication had been amended/altered, the reasons why, when or on who’s directions this had happened were not documented. We had difficulty in understanding what changes in medication had been written on the MAR chart and decipher the handwriting. It was also not possible to determine from the MAR chart if medicines prescribed for external use, such as creams, had been used as prescribed. Several records showed various gaps in the application of creams with no explanation as to why they had not been used as prescribed. Staff confirmed that these are being used but not recorded. We discussed how to manage these types of medicines more safely and appropriately and record their application. We also saw that some entries on the MAR chart had been removed with ‘Tippex’, which is not acceptable. Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 14 The home has a designated drugs fridge to store unopened medication in, such as insulin. This type of medicine needs to be kept at a constant temperature to ensure the medication works properly. The temperature recording of the fridge was not undertaken and there was no thermometer available. The home uses controlled drugs, which are managed satisfactorily, and a random check was undertaken. The AQAA states that the home has addressed peoples’ privacy and dignity and has introduced new practices such as, name addressing, confidentiality, choice etc. We saw that care plans also made reference to residents having choices, for example what time they wanted to get up, preferred time of day for bathing and likes and dislikes regarding food. Relatives commented that residents are treated as individuals and comments included “xxx likes to do things at set times and staff accommodate these” and “xxx can get up when he wants, sometimes likes a lie in and staff let him. Has no regular patterns to his day, his choice”. We saw that residents were treated with respect and dignity from staff. However, we felt that residents’ privacy and dignity was not always afforded, for example at mealtimes, one bathroom having a clear glass window (as oppose to an opaque one), residents wearing food stained clothing and one communal bowl and flannel to wash peoples’ faces and hands after eating. We were told that this was atypical and the result of an unexpected staff shortage on the day of the inspection (refer Standard 27). We read entries on the care plans of residents’ which reflected an emphasis on their need for dignity and instructed staff how to maintain this. The home also has a designated room where residents can see their friends or visitors in private. One relative commented that they particular liked this facility, as they are a large family and can all fit in. They also feel they can bring children and enjoy fun at the home without disturbing others. Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 15 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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The open, friendly atmosphere helps both residents and relatives feel welcome and at home. Residents’ benefit from a diet that is adequate but aspects of provision, choice and variety need some consideration. Residents’ enjoy taking part in varied social activities. EVIDENCE: The home supplies residents with an ‘Information For Residents’ booklet. This states that relatives and friends are welcome to visit them at Donness and can also take residents out if they so wish. This also refers to residents informing the staff if there are any hobbies they wish to pursue. During the course of the inspection we saw that many relatives were visiting residents. Some visited on a very regular basis and at least one relative visited every day to assist their relative to eat at lunchtime. All relatives confirmed that they can visit the home at any time and are always made to feel welcome in a friendly atmosphere. All said that they are contacted by the home if there is a change in their relative’s health. One commented, “like home, drop in anytime and made to feel welcome” and another “staff inform me if xxx has a bad day and they are calling Dr”. Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 16 Surveys received from people living at the home showed that one person ‘always’ took part in activities, one person ‘sometimes’ did and two did not reply. One commented “there are activities twice a week. With music and songs with simple exercise and fun games”. Relatives confirmed that they thought there were enough activities in the home. One relative commented that their family sometimes take part in the activities with the people living at the home. The home offers people living there a variety of activities which are scheduled for different days of the week. The AQAA showed the activities offered to residents each week such as exercise to music, arts and crafts and singing and music lead by an entertainer. People’s spiritual needs are also met with visiting members of the Church. Wherever possible residents or their families take responsibility for their finances and valuables. In order that residents feel ‘at home’ they are encouraged to bring with them items of sentimental value, such as pictures, ornaments and in some instances, items of furniture. These are used to personalise bedrooms and thereby give residents a sense of ownership of their rooms and immediate environment. During the inspection we saw residents having both their breakfast and their lunch. We saw those having breakfast being assisted by ‘hospitality’ staff. However, some residents were still eating their breakfast after 11.30am due to the short staffing. This meant that lunch was served to these residents in a very short time after and they may not have been yet hungry. At lunchtime, whilst some staff were able to assist residents with eating, we saw that one member of staff was feeding three residents at the same time. This was undignified. Staff time, which could have been used assisting residents, was taken up washing pots and utensils due to a lack of dishwashing facilities. Residents did appear to enjoy their food and three confirmed this in their surveys. However, we saw that the menu did not show any choice of main meal and there was sometimes a duplication of food available during the week. An example of this was cottage pie being served twice and, according to menus seen, being served on seven out of eight Saturdays. The AQAA states that the menus are planned to take into account residents’ likes and dislikes and the fact that most of the residents lack the capacity of choosing from a menu. The cook explained that she chooses the meals on a weekly basis and does so from the food that she has available in the home at that time. The menus did not always record the vegetables served or demonstrate what dessert was on offer. The menus are not displayed in the home and so residents are unaware what is for lunch and supper meals. Food served is basic home cooking and on the first day of inspection was a simple pork casserole with vegetables and on the second day of inspection turkey pie with vegetables. Staff said that if a resident did not like the meal on offer at lunchtime, a sandwich would be offered as an alternative. Residents who Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 17 required it were seen to have their food liquidised. In the kitchen there was a list of what some residents likes or disliked - however not all the preferences or dislikes listed on resident’s files had been transferred to this list which might mean that some residents are being given food they do not like. We saw a list in the kitchen, which stated that eleven residents’ meals were served on small side plates, as oppose to normal sized dinner plates. Although the cook assured us that the same amount of food was placed on both plates, we considered it unhelpful for those residents who have difficulty in feeding themselves as the food was put right to the edge of the plates. We saw from care files that one or two residents have requested a smaller portion of food but could find no reason why small plates are used for the rest of the residents. One health care professional commented that he/she felt that the small plates (and smaller portions) used were not acceptable. The AQAA states that residents’ special occasions are celebrated and family and friends are invited to join in. One relative confirmed this and was looking forward to the birthday party which had been planned by the home, complete with a birthday cake. Some care staff, but not all, have undertaken training in basic food hygiene. The manager told us that this training would be happening in the near future. Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 18 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. The home has a good complaints procedure but must ensure this is used when concerns of any type are raised. Residents’ are protected from staff who have a good knowledge of adult protection issues. EVIDENCE: The AQAA states that there is a robust system in place to ensure that all complaints are taken seriously. We saw that the complaints procedure is displayed in the home and in the brochure package and is appropriate. Resident surveys stated that they knew how to make a complaint and one commented “there are no complaints to make up to now”. All relatives also stated they knew how to make a complaint and commented that they had no complaints about the home including “absolutely 100 happy with the home, “no complaints about the home” and “nicest home around”. The home does not hold currently hold a complaints file as no recent complaints have been made. We discussed this with the manager and suggested a file should be make available with forms readily accessible for people to complete if requested. Whilst the CSCI had received no formal complaints since the last inspection, and none had been recorded by the home, a concern was raised by one social care professional recently and this had been investigated by the home. Staff surveys and conversations showed that the majority of staff are aware of adult protection procedures. The AQAA and staff training files confirmed that Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 19 Protection of Vulnerable Adult training took place in April 2007. All staff have training on this subject during their induction and watch a training video prior to them undertaking the formal training. Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 20 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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a clean and homely environment, but improvements are needed in the management of personal laundry. EVIDENCE: Several improvements have been made to the home since the last key inspection including redecorating, refurbishing and recarpetting. Both resident and relative surveys stated that the home “always maintains a good standard of cleanliness and hygiene”, “the home’s kept very clean and it’s quite a pleasant place to reside” and “home is clean”. We had a tour of the premises including private rooms, communal areas, laundry and the kitchen. We saw that Donness was extremely clean with two cleaners on duty. Cleaning rotas include daily, weekly and monthly cleaning duties. The home has two passenger lifts which enable residents and relatives to access all areas. The home has been issued a “green light” from the Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 21 Environmental Health Officer, which indicates their attention to cleanliness and correct procedures used in the kitchen area. The laundry area is quite small and compact for the number of people living in the home and amount of laundry generated. We were told that the home uses a system of ‘blue bins’ for transferring dirty laundry from each floor to the laundry room. However, some staff say that no other system is being used for contaminated laundry, for example soiled bed linen. This soiled laundry is placed in the bins with the rest of the ‘normal’ washing. The manager told us that there are red dissolvable bags to be used for this purpose in the home, but staff said this is not routinely used and were unaware they existed. We saw from training records that staff have received recent training in infection control procedure. We saw that laundry was being washed at the correct temperatures to ensure it is cleaned properly. Two relatives stated that no repairs are done in the home to personal clothing, for example sewing buttons back on. The quality assurance questionnaire sent out by the home contained several comments from different people about the laundry provision, for example clothes being lost, clothes being crumpled, clothes being shrunk and clothes not ironed properly. One relative commented that her relative had been given the wrong clothes to wear. Staff commented that no member of staff routinely undertakes the repairs of residents’ clothing and also not all clothes are marked and so are not always given back to the right people. We did see some buttons missing on residents’ clothes during the inspection. We discussed these issues with the manager. One relative commented that they had bought three aprons for their relative to use at mealtime but these had all been lost which meant that their relative now frequently has food stains on their clothing. Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 22 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): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff on duty are not always sufficient to fully meet the needs of the people living at this home. People living at the home have not always been protected the home’s poor recruitment procedure. New staff undergo a good induction training. EVIDENCE: Staff, relatives and one health care professional said that they considered the home was short of staff on occasions. On the first day of inspection one registered nurse, and three care assistants were on duty (plus the cook, cleaning staff and hospitality staff) on the morning shift. The home should have had four care assistants on duty. Staff commented that the overall level of care staff had been reduced recently (about three months ago) from five care staff to four care staff on a morning shift. On the afternoon shift one registered nurse and three care staff were on duty - staff reported this could sometimes be reduced to two care staff. On the night shift one registered nurse and two care staff were on duty - again staff reported that this could sometimes be just one member of care staff. One health care professional had voiced her concerns to the CSCI at the lack of staff on night duty when he/she felt it was under staffed when only two staff were on duty. This means that residents may not be having their needs met properly or promptly. There were 29 people living in the home. On the second day of inspection one registered nurse (the owner/manager) and three care assistants were on duty (including two agency staff). The manager told us that this was the first time agency Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 23 staff had been used for a very long time and was unusual. Staff expressed concern that when planned staff absences such as holiday or long term sickness, occur no agency staff are booked but permanent staff cover by working extra shifts when they can. The staff rota confirmed the staff’s comments and showed a shortfall in staff on occasions both during the day and during the night. Staff reported that they do want to cover absences on occasions, but when none of them can do it, they felt agency staff should be used. The short staffing has resulted in very low morale of staff who appear tired and worn out. Unanimous comments included “home needs more staff”, “staffing levels are low”, “home is short staffed”, “home should employ more staff”, “very tired and stressed out”, “staffing levels are bad” and “staff short, very tired”. Staff also felt that this compromised the time spent with residents and comments included “horrible, haven’t got time to talk to residents”, “would like to spend more time with residents – rushing about” and “would like to spend more time with residents – not much chance!” Staff also reported that they had lost some faith in the management due to the short staffing and felt that they are not listened to. The home has a core of staff who have worked at the home for some time and are committed individuals who care about the residents. The AQAA states that the home considered it has a “low staff turnover” but contradicts this statement by indicating that twelve members of staff have left the home in the last twelve months, which we considered to be a high staff turnover. Staff felt that people were employed to fill vacancies rather than getting the right person for the job. One member of staff spoken with during the inspection was leaving to work at another home. The manager acknowledges there is a shortfall in staff numbers and is in the process of trying to recruit permanent staff. She told us that 5 members of staff have recently undertaken maternity leave and this has left a temporary shortfall in the staff numbers to fill. The AQAA was written when 27 people were living at the home. It states that all 27 of these people required help with washing and bathing and 23 required help to use the toilet. It also shows that 14 residents needed the help of two or more staff to provide care. There were two more people living at the home on the day of inspection making a total of 29. The registered nurse confirmed that many of these people needed the help of two members of staff and felt that out of the 29 residents, 18 of those needed the help of two staff at all times, with only 11 requiring just one staff member’s help. The AQAA indicates that 12 residents require the help of two members of staff during the night. This means that if the home runs short staffed with only two members of staff are on duty and they are tending to one resident in their private room, there is no member of staff to supervise the rest of the people in the home, which poses unnecessary risk to residents. It was agreed with the CSCI that three members of staff must be on duty at night, including one registered Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 24 nurse and two care staff. The CSCI has had previous discussions with the management about the numbers of staff needed during the night. The afternoon staff come on duty at 12pm to assist residents at mealtimes and the care staff is then effectively doubled for a couple of hours. The AQAA states that 8 people need help or supervision to eat their meals and staff felt that 3 out of these 8 need to be given full assistance. The AQAA states that the home has 13 out of 15 staff who either have or are working towards NVQ Level 2 or above. This is a recognised qualification in social care. Relatives and health and social care professionals were very complimentary of the staff employed at the home and comments included “happy with staff” and “staff are brilliant!” We looked at the files of three care staff and a non-care staff member of staff. Three files showed that most of the right checks were in place before they started work with the exception of Protection of Vulnerable Adults (PoVA) and Criminal Records Bureau (CRB) checks. Some of these members of staff had begun work at the home some time before either a PoVA or CRB had been received by the home and therefore put residents’ at risk of potential harm. Currently all staff at the home have now been checked to see whether their names have been placed on the PoVA register. It was explained to the registered manager that staff could only commence employment when confirmation that their names are not included on the Protection of Vulnerable (PoVA) Register. The non-care staff member did not have any items of identification on his/her file, no police check, although there was a declaration by the staff member that they did not have any police convictions. There were however two appropriate records to confirm identity on the file. Staff reported that training had improved since the last inspection and that this was on going. Training records showed that this included fire, manual handling, health and safety, protection of vulnerable adults, first aid, continence and infection control. New staff in the home undertake the recognised “Skills for Care” induction training, which they felt, was very useful and comprehensive. We looked at two staff records of this training which had almost been completed. Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 25 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): 31,33,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is good, open communication between staff, residents and management. Residents can be confident that their monies are handled safely, but some improvements to the health and safety are required to ensure that people living at the home are safe and protected. EVIDENCE: The registered manager is also the joint owner of the home. She is a qualified general nurse with a formal qualification in management - the Registered Manager’s Award. The AQAA states that the manager is involved in the dayto-day running of the home and works alongside her staff. Staff, relatives and residents confirmed they have respect for her and that the atmosphere is open and welcoming. Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 26 On the first day of inspection, the manager was on annual leave and the staff on duty did not have access to all records relating to residents and staff including staff recruitment files, residents’ contracts, finances and monies. We were told that some of these records are indeed not held in the home but in the owner’s private home. The home carried out an annual questionnaire to obtain residents and visitors/relatives views of the service. We looked at these and found lots of positive feedback and excellent comments, which the exception of the laundry service which has been discussed earlier (see Standard 26). These questionnaires were sent out in April 2007 but it is obvious from comments within this report that the issues with the laundry have not yet been resolved. The AQAA states, “resident meetings are planned (but not well attended)”. However, staff, relatives and residents confirmed that these have not recently taken place. The manager told us that she had tried them in the past with little success so does not now hold them. Relatives thought they were a good idea and some commented they would like to be more involved in the running of the home. We discussed the usefulness of these meetings and the manager thought she might re-introduce them. Staff told us that their meetings do take place every couple of months. However some staff felt that they are a “waste of time” as “nothing ever changes”. Qualified nursing staff also said they thought a trained staff meeting would be very useful to discuss relevant nursing/care issues, discuss individual situations and discuss training needs/supervision but are not given this opportunity, for example discussing the new care plans. It was felt that this would help them feel part of the running/managing/organising of the home. All staff do have a handover at each change of shift but this is a brief meeting which details any change in a resident’s condition. The AQAA states that records of monies are held for residents with two signatures recorded. We checked a sample check of three resident’s monies and these were all satisfactory, although some did not have the two signatures required. The AQAA confirms that all service contracts and maintenance of equipment is carried out to manufacturers and health and safety guidelines. We looked at a random selection of these records and discussed them with the manager. These confirmed that there was appropriate testing of portable electrical appliances, that gas installations within the home were safe, and that the call bell system had been checked. The records relating to the servicing of the hoist, passenger lifts and the safety of electrical installations could not be found. The manager stated that she was certain that these had been carried out but could not find the records. We agreed that she would send confirmation of these certificates to the CSCI before this report was issued. However, these have not been received. The accident book was looked at and Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 27 records are held on individual resident’s files. The manager told us she looks at these regularly to note any trends in accidents. Records show that fire safety equipment is serviced and also checked regularly. The AQAA states that staff have received training such as moving and handling, health and safety, first aid, fire safety training, Protection of Vulnerable Adults and continence. Training records showed that these took place and further training is planned. The AQAA also stated that training on supervision procedures was due to take place but staff told us that this had been cancelled due to the trainer. This is to be planned for later in the year. Staff, especially trained staff, felt that formal supervision was a good idea and would like it to be introduced. We were told that informal supervision of care staff takes place but this is on an ‘ad hoc’ basis, if the qualified nurse happens to be present. Care staff stated that they would also like formal supervision, as a forum to discuss any issues they may have and develop their individual training needs. Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 28 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 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 2 2 Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 29 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 OP9 Regulation 13 (2) Requirement All medication requiring refrigeration must be stored within the temperature range as directed by the manufacturer and this temperature must be monitored. This will ensure that medication is being stored correctly. Previous timescale of 31/08/06 not met. The manager must review the privacy and dignity practices given to residents in respect of personal care, personal clothing and mealtimes. This will ensure that residents are treated with respect. Previous timescale of 13/10/06 not met. The home must have the right numbers of qualified, competent and experienced staff working at the home at all times, which takes into account the different dependency levels of the residents. This is to ensure that the people who live there will have their care needs met fully and in the correct manner. DS0000026712.V337763.R01.S.doc Timescale for action 03/10/07 2. OP10 12 (4) a 03/11/07 3. OP27 18 (1) a 13/09/07 Donness Nursing Home Version 5.2 Page 30 4. OP29 19 (1) (a)(b)(c) Schedule 2 1-7 5. OP37 17 (1) (a)(b), (2), (3) (a)(b) Schedule 3 and Schedule 4 13 (4) (c) 6. OP38 No member of staff must be 03/09/07 employed to work at the home without first obtaining all the necessary information required, in this case a PoVA and CRB check. This will ensure that residents are not put at unnecessary risk of harm. All records listed relating to 03/10/07 residents and staff must be up to date, held in the home at all times and be available upon request. This is to ensure that all authorised parties can review the health, safety and welfare of residents living in the home. All equipment in the home must 03/12/07 be maintained and serviced in accordance with the manufacturer’s guidelines and records kept. This is to ensure proper attention to the health and safety of residents and staff. 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 OP7 Good Practice Recommendations It is recommended that the home decides which type of resident care planning system it is going to use and maintains this appropriately. This is to ensure that all residents have a current and up to date plan of all their individual care needs. It is recommended that consideration be given to having resident and relative meetings. This is to ensure that residents and relatives are more involved with their care practice is an informal process for DS0000026712.V337763.R01.S.doc Version 5.2 Page 31 2. OP7 Donness Nursing Home 3. OP9 4. OP10 5. OP15 6. OP27 7. OP36 the home to review its services and facilities. It is recommended that when an entry is hand written on to the Medicines Administration Record chart that this is signed and dated by the person making the entry and that it is then checked and countersigned by a second person. This is to ensure safety to all residents. Brought forward for last inspection report of 13/07/06 It is recommended that the way washing is taken and dealt with in the laundry be reviewed. This is to ensure that all linen (normal and soiled) is being washed properly in the laundry, at the right temperatures and prevents any infection risk. It is recommended that food choice, presentation and variety is reviewed and amended with resident involvement in the process. This is to ensure that residents are eating the correct portions and choice of food for their individual tastes. Brought forward for last inspection report of 13/07/06 It is recommended that the laundry service is reviewed to ensure that personal clothing is washed and dried properly and that any repairs to resident’s personal clothing are undertaken. This is to ensure that residents maintain their dignity and appearance. It is recommended that all staff receive regular one to one supervision. This is to ensure that staff have their care practice formally reviewed and their training and development needs are identified and planned. Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Donness Nursing Home DS0000026712.V337763.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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