CARE HOMES FOR OLDER PEOPLE
Donness Nursing Home 42 Atlantic Way Westward Ho! Bideford EX39 1JD Lead Inspector
Dee McEvoy Annual Inspection 14 September 2005
th 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 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 D54-D06 S26712 Donness V241722 090905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Donness Nursing Home Address 42 Atlantic Way, Westward Ho! Bideford, EX39 1JD 01237 474459 01237 479349 Telephone number Fax number Email 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 L T Newton Care Home 34 Category(ies) of OP Old Age (34) registration, with number of places Donness Nursing Home D54-D06 S26712 Donness V241722 090905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Three named service users are in the LD(E) category 2. When the three named service users in the LD(E) category leave the home the provider will notify the commission in writing and the registration will then revert back to its original OP registration. 3. The home is staffed in line with National Minimum Standards guidelines and the signed agreement of 6th October 2003. 4. That Building Control and Fire Department approval of the building alterations is received by June 2004 - 2 months after the planned completion date of 31st March 2004. 5. To ensure that staffing levels are adequate and that other service users care will not be prejudiced by the admission. Date of last inspection 6th April 2005 Brief Description of the Service: Donness Nursing Home is situated in Westward Ho! Bideford. It is registered to provide nursing care for 34 service users who are over 65 years of age. Donness is a detached, three storey property occupying an elevated position and offering uninterrupted views to the nearby coastline. The accommodation comprises of four double rooms, and twenty-six single rooms, many with ensuite facilities. There are a variety of communal areas, which include two dining rooms, three sitting rooms and a visitor’s lounge. Two lifts provide access between three levels within the home. Level access is provided throughout. There is a large sun balcony with lovely views, which extends from the sitting room to the front of the building. A direct bus route to and from Bideford is available. Donness Nursing Home D54-D06 S26712 Donness V241722 090905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second inspection of the current year and was undertaken over the course of one day. Not all of the standards were inspected on this occasion or not all were inspected fully. The inspector met with the majority of residents and interviewed six. Seven members of staff on duty were also interviewed. One comment card was received from a resident and 4 from relatives. Comments were generally very positive about the home and the service provided. The inspector toured the premises and a number of records were inspected including the pre-inspection questionnaire, care plans, training, financial and accident records, and staff recruitment files. The registered provider was available for part of this unannounced inspection. What the service does well: What has improved since the last inspection?
The content of initial assessments has improved and is generally detailed in care plans. Donness Nursing Home D54-D06 S26712 Donness V241722 090905 Stage 4.doc Version 1.40 Page 6 Continued refurbishment within the home provides a safe and homely environment. The dining room on the first floor has been re-organised to offer a pleasant space for residents and the ground surrounding the home has been landscaped and planted. Staff training has been addressed since the last inspection; staff have received manual handling, food hygiene and fire safety updates to ensure the safety and well-being of residents is maintained. The disposal of clinical waste has been dealt with appropriately reducing any risk to residents or staff. What they could do better: 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. Donness Nursing Home D54-D06 S26712 Donness V241722 090905 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Donness Nursing Home D54-D06 S26712 Donness V241722 090905 Stage 4.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Improvements have been made to the admissions process ensuring that resident’s needs are assessed prior to moving into the home. EVIDENCE: Four residents’ assessments were inspected. The home’s assessment process and documentation is good and ensures that there is a proper assessment prior to people moving into the home. Where possible a registered nurse, usually the provider, will visit people before admission. One visitor said that the recent admission of their relative had been managed well by the home, “Staff are very kind and helped my relative to settle in.” Donness Nursing Home D54-D06 S26712 Donness V241722 090905 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 9, 10 Residents’ health needs are generally well met, however, there is a risk that staff will not meet needs if changes are not identified or planned for with regular reviews. Medication administration at the home is in the main well managed, promoting good health. Staff treat residents with dignity and respect. EVIDENCE: Care plans are set out in a good format and detail within care plans had improved since the last inspection. Four residents were case tracked; two residents had wounds. Some aspects of wound care were in the daily notes but specific care plans for tissue viability had not been completed. Evaluations and reviews were brief in places, not showing whether wound care had been appropriate or successful in meeting residents’ needs. One care plan did not include management of an infection, but staff were aware of procedures to follow to ensure safe practice. One manual handling assessment did not reflect the residents’ current needs. Care plans contained good detail of residents’ preferences, for example, dietary likes and dislikes and times for getting up and going to bed. Donness Nursing Home D54-D06 S26712 Donness V241722 090905 Stage 4.doc Version 1.40 Page 10 Residents and relatives were generally happy with the overall care provided, one relative said, “We are happy with everything here.” Staff spoken with had a good understanding of the health and personal care needs of each resident. A comprehensive risk assessment tool is used to identify and reduce risks however some areas of risk were not assessed; one resident had had a number of falls but an assessment had not been completed to identify how to reduce risk and manage falls. Trained nurses administer medicines within the home. The system for the administration of medicines is clear with comprehensive arrangements in place. Staff are clear about medication procedures. One shared room, which caused concern at the last inspection due to a lack of privacy, has had a dividing curtain replaced to improve privacy for the residents. Throughout the inspection staff were seen to address and assist residents in a courteous and friendly manner. Donness Nursing Home D54-D06 S26712 Donness V241722 090905 Stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 & 15 Social activities are well managed providing daily variation and interest for most people. Staff promote residents’ welfare with appropriate attitudes towards them. Residents enjoy meals, which are nutritious and appealing, taking into account, the likes and dislikes of individuals. EVIDENCE: An enthusiastic activities co-ordinator provides a variety of group and individual activities including arts and crafts, games and gentle exercise sessions three mornings a week; External entertainers also visit the home. Several service users were engaged with the activities co-ordinator on the morning of the inspection. Staff try to encourage individual choice and preference wherever possible; personal profiles are a valuable source of information, ensuring that preferences are recorded. During the inspection residents were seen to be engaged in various activities in different parts of the home. Residents are free to bring personal possessions with them and the bedrooms inspected were personalised. The home has an experienced cook, who is aware of the likes and dislikes of individual residents. Since the last inspection the kitchen has been refitted, the cook said, “I have everything at hand”. The inspector had lunch with several
Donness Nursing Home D54-D06 S26712 Donness V241722 090905 Stage 4.doc Version 1.40 Page 12 residents; there was a convivial atmosphere and staff were at hand to assist where necessary. Residents were positive about the quality and quantity of food provided, one said, “The food is lovely”, another said, “The food is very good, home cooking”. No menus were available but alternatives to the main meal were provided where needed. Residents were not concerned about the lack of menus, one said, “I like the surprise”. The development of weekly menus was discussed with the cook. Donness Nursing Home D54-D06 S26712 Donness V241722 090905 Stage 4.doc Version 1.40 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Residents are protected from the risk of abuse or harm by well-informed staff. EVIDENCE: All staff spoken to were aware of the issues relating to adult protection; staff were aware of their responsibility to report any suspicions and worries. Adult protection is covered during induction and further training is planned for later this year. The home has dealt with one concern in a robust and multidisciplinary way. All residents spoken with felt safe within the home and had confidence in the staff. Donness Nursing Home D54-D06 S26712 Donness V241722 090905 Stage 4.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 25 Residents live in a safe and comfortable environment. EVIDENCE: Thermostatic valves have been fitted to ensure safe water temperatures; on the day of the inspection hot water temperatures from the hand basins and baths in communal bathrooms were satisfactory. One bathroom, used only by staff, did have water that exceeded 50oC. The provider did not consider this a risk to any resident, as they do not use this bathroom. Donness Nursing Home D54-D06 S26712 Donness V241722 090905 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28, 29 & 30 The numbers and skill mix of staff are sufficient to meet residents’ needs. Recruitment procedures have improved ensuring residents are protected. EVIDENCE: A friendly and caring staff team supports residents. Residents spoken to said that the staff were kind and caring and always there to help. During the visit staff were observed spending time with residents and call bells were answered quickly. Staffing levels have improved at night since the last inspection but will need to be monitored and increased when necessary. Designated domestic, laundry and kitchen staff are employed to ensure that standards relating to meals and cleanliness are maintained. Additional staff are available at peak times, such as mealtimes, to ensure residents’ needs are met. Staff receive induction and ongoing training. Several training opportunities have been provided for staff since the last inspection including, communication, manual handling and skin care. Dementia training is planned for November. It was difficult to evaluate current training records and attention is needed to ensure accurate records of induction and other training are kept. Four members of staff hold NVQ 2 and a number of other staff are working towards NVQ level 2. The recruitment procedure has improved since last inspected. The recruitment files of three newly appointed staff were examined. Each contained the necessary records to ensure the protection of residents. Donness Nursing Home D54-D06 S26712 Donness V241722 090905 Stage 4.doc Version 1.40 Page 16 Donness Nursing Home D54-D06 S26712 Donness V241722 090905 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 36 & 38 There are no quality assurance systems in place at present to ensure that residents influence the way the home is run. The health and safety of residents is protected by the improved systems in place since the last inspection. EVIDENCE: An annual quality assurance audit has not been undertaken since March 2004, to ensure that the quality of care provided is reviewed and improved where necessary. The inspector was told that this would be carried out. Where residents lack capacity family members generally manage their finances. In the case of four residents the provider manages their finances. These residents have individual bank accounts, but records were not available. Day to day monies are held by the home. Records and receipts were examined for four residents; totals and monies were balanced. The majority of residents do not sign transactions as they lack capacity, however two signatures are obtained for each transaction [either staff or relatives].
Donness Nursing Home D54-D06 S26712 Donness V241722 090905 Stage 4.doc Version 1.40 Page 18 Staff continue to be supervised on an informal basis, as yet there is no formal supervision system in place. Staff spoken with said they felt well supported in their role and could approach senior staff members at any time. Staff told the inspector the manager’s door was “always open”. Several improvements were seen since the last inspection with regards to health and safety issues. All staff have received fire safety, manual handling and food hygiene training. A fire officer was visiting the home on the day of the inspection and was satisfied with the safety standards. A fire risk assessment has now been completed, which includes the new building. The arrangements for the disposal of clinical waste have been improved and no longer pose a risk to residents and staff. Donness Nursing Home D54-D06 S26712 Donness V241722 090905 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3
COMPLAINTS AND PROTECTION x x x x x x 3 x STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x 1 x 3 2 x 3 Donness Nursing Home D54-D06 S26712 Donness V241722 090905 Stage 4.doc Version 1.40 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 (2) (b) 17(1)(a) Sched.3 (m) & 14 (2) Requirement Timescale for action 31/10/05 2. 7 3. 33 The registered person shall keep the service users plan under review. You must record details of any plan relating to a resident in respect of nursing & specialist health care and detail in evaluations/reviews residents changing needs. (This is especially with regard to wound care, the management of infections and manual handling plans) 13 (3) ( c) Unnecessary risks to the health or safety of residents are identified and so far as possible eliminated. (With particular reference to falls.) 24 The registered person shall establish and maintain a system for reviewing and improving the quality of care including nursing care. You must supply to CSCI a copy of the report and make it available to residents. 31/10/05 4/1/06 Donness Nursing Home D54-D06 S26712 Donness V241722 090905 Stage 4.doc Version 1.40 Page 21 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. 3. Refer to Standard 15 30 36 Good Practice Recommendations It is recommended that a menu is developed, which is changed regularly, with the involvement of residents. It is recommended that clear and accurate training records are kept for all staff. Formal supervision is to be developed for all staff and provided at least six times a year. Donness Nursing Home D54-D06 S26712 Donness V241722 090905 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Suite 1, Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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