CARE HOMES FOR OLDER PEOPLE
Douglas Bank Nursing Home Lees Lane Appley Bridge Wigan Lancashire WN8 0SZ Lead Inspector
Vivienne Morris Unannounced Inspection 09:30 18 October 2007
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18/10/07 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 Douglas Bank Nursing Home DS0000065686.V345191.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. Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Douglas Bank Nursing Home Address Lees Lane Appley Bridge Wigan Lancashire WN8 0SZ 01257 255823 01255 255467 douglasbanknh@tiscali.co.uk 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) Tudor Bank Ltd Christopher Pearson Care Home 40 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (30) of places Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care home only: Code N, to people of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE (maximum number of places 10) The maximum number of people who can be accommodated is: 40. Date of last inspection 14th September 2006 Brief Description of the Service: Douglas Bank Nursing Home provides personal and nursing care for up to 40 elderly people, including a dedicated unit for up to ten people requiring dementia care. The home is situated on the outskirts of the rural village of Apply Bridge, although there is easy access by road and rail. The home is surrounded by scenic countryside, overlooking the picturesque village itself. Private accommodation is provided on two floors, served by a passenger lift and comprises of 32 single rooms and 4 shared rooms, the majority of which have en-suites. There are a range of bathrooms and toilets situated throughout the home. Two large lounge areas are available as well as a conservatory and separate dining area. People living at Douglas Bank are able to spend the day in the area of the home, which they choose and they can eat their meals within the privacy of their own rooms, if they wish. A variety of leisure activities are available for those wishing to take part and families are welcome to join in. The fees charged for the service as at 18TH October ranged from £342 to £522 per week. Additional charges were being incurred for hairdressing, chiropody, newspapers and magazines. Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced site visit, which formed part of a key inspection, was conducted over one day in October 2007. During the course of the visit to this service, discussions took place with those living at the home, as well as relatives and staff. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas were seen. Comment cards were received from nine people involved with the service and their feedback is reflected throughout this report. Every year the provider completes a self-assessment, which gives information to the Commission about how the home is meeting outcomes for people using the service and how the quality of service provided is monitored. Some of this information forms part of this inspection report. The inspector ‘tracked’ the care of three people living at the home, not to the exclusion of other residents. The total key inspection process focused on the outcomes for people living at Douglas Bank Nursing Home. The Commission for Social Care Inspection had received one complaint about this service since the last inspection, which was referred back to the provider for investigation under the home’s complaints procedure. What the service does well:
The preadmission process was thorough enough to ensure that the needs of people had been adequately assessed before they moved into Douglas Bank to ensure that the staff team were able to meet individual needs. People were provided with current information about the service before admission to enable them to make an informed choice about moving into the home. Information written on the plans of care, covered a wide variety of aspects of care, which was detailed, providing staff with clear guidance about how these needs were to be met. The plans had been developed with the resident or their relative and had been reviewed each month, showing that people living at the home had some input into the care that they received. A variety of external people were involved in the care of the people living at Douglas Bank and when asked on the comment card, what the service does well, one General Practitioner wrote, Well trained nursing staff and carers”. All relatives provided a lot of positive comments, covering a wide range of aspects of life at Douglas Bank, some of which included, Good care and attention to my relative’s needs. An excellent activity programme, Good meals. Visitors are welcome and involved, Friendliness of staff, Excellent organised events, Sound communication, My relative is well cared for and I feel activities help motivate the residents. Catering and meal choice is
Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 6 excellent and People are respected and their dignity is protected in a cheerful atmosphere. When asked what the home does well, the registered manager told us that detailed assessments and care plans are developed from the information given by residents and their relatives and that all staff have a good understanding of the principals of care and promoting privacy and dignity. The staff team respected people living at the home, ensuring that their privacy and dignity was consistently upheld. The leisure interests and hobbies of those living at the home had been taken into consideration so that they were supported to maintain their individual interests. An experienced member of staff provided a variety of activities in order to promote stimulation and motivation. Nutritious, well-balanced meals were served for residents, in pleasant dining areas and snacks were available at all times. However, people were able to eat their meals within the privacy of their bedrooms, if they preferred. Those spoken to enjoyed the food served and the choices available. People living at the home were supported to remain independent for as long as possible and they were encouraged to maintain contact with their family and friends so that they continued to have links with the outside community. Residents’ finances were adequately protected by the home’s policies and procedures, clear record keeping and audited practices. The provision of activities and leisure interests was excellent. We were told that there was always something going on and we noticed a full activity programme, designed to meet individual and group needs. People living at the home were provided with 1:1 activities, where required and those spoken to thoroughly enjoyed living at the home. Visiting was flexible and it was evident that people visiting the home were made to feel welcome and they were encouraged to be involved both in the care of their relative and in the activities provided. It was confirmed that if people wished to appoint an independent advocate to act on their behalf, then the home would support them to do so. Complaints were well-managed and robust policies and procedures adequately safeguarded people living at the home against abusive situations. Staff felt that the manager was approachable and supportive. The home was clean, tidy and pleasant smelling, providing a comfortable environment for the people living at Douglas Bank. Robust infection control policies and procedures had been adopted by the home so that people were adequately protected from Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 7 infection. People working at the home had been appropriately trained and were competent to do their jobs. Douglas Bank was being well managed and the systems and equipment within the home had been checked and serviced at regular intervals, ensuring that they were safe for use so that residents and staff were adequately protected. What has improved since the last inspection?
When asked how the home had improved in the last twelve months, the registered manager said that the menus had changed and meal times were better. The activity programme had been reviewed in accordance with people’s individual and group preferences. He also told us that links had been improved with professional support bodies. The general routines at meal times were better. People were supported to eat their meals, where necessary, in a discreet manner and the whole dining experience for people living at the home was less rushed and more relaxed, which was pleasing to see. When asked how the service had improved in the last twelve months, the registered manager told us that, the statement of purpose and preadmissions assessments had been reviewed, committed full time qualified nurses had been recruited and the care planning process had improved. Some improvements to the environment had been made in the last twelve months including, redecoration and refurbishment of some communal areas, garden maintenance.and a coded lock to front door. A dedicated ten bedded dementia care unit has been registered with the Commission since the last inspection. Some areas of the home had been redecorated and Douglas Bank provided a comfortable and friendly environment for people to live in. Residents were able to bring their own possessions to the home, if they wished in order to promote a homely atmosphere. The environment was less chaotic and more relaxed at this visit to Douglas Bank. The routines of home were better managed and it was evident that people living there were happy and contented. The needs of people were being met at this visit and the staffing levels were being calculated in accordance with the assessed needs of people living at the home. When asked what improvements had been made since the last inspection, the registered manager told us that the home had secured training sources for palliative care and dementia care and that an audit of training needs for staff had been developed. Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 8 The amount of training provided for staff had improved since the last inspection and at the time of this visit a good percentage of care staff were appropriately trained to maintain the standards of care delivered. 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. The summary of this inspection report can be made available in other formats on request. Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 9 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 Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 10 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. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were provided with sufficient information about the service to allow them to make an informed choice about moving into the home, and the preadmission process was thorough enough to ensure that the staff team were able to meet individual needs. EVIDENCE: The statement of purpose had been updated since the previous inspection to reflect the recent changes in registration, so that up to ten people requiring dementia care could be accommodated Two comment cards were received from people living at the home, which showed that they had been given enough information before they moved into the Douglas Bank. One of them added, “the staff are very informative”. The registered manager told us that the home tried to make potential residents and their relatives welcome and at ease whilst they were looking around the home. He wrote, “We give comprehensive information regarding
Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 11 all aspects of coming into care and the facilities available. People are encouraged to bring other members of their family to look round and to stay for lunch or afternoon tea if they would like to. Each potential resident has a detailed pre-admission needs assessments carried out to enable us to start developing a personalised care plan. All residents come on a 28 day trial period”. The care of two people living at Douglas Bank was ‘tracked’ at the time of the site visit. Their records showed that a lot of information had been gathered about what people needed before they were admitted, so that the home was sure that individual assessed needs could be met by the staff team. One resident spoken to confirmed that a visit to the home had taken place before admission so that an informed choice about moving into Douglas Bank Nursing Home could be made. The information obtained before admission had been used to write the basic care plan so that all assessed needs were taken into consideration. Staff spoken to were fully aware of the individual needs of those living at the home and were able to discuss what they did for individual residents. Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 12 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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning process was thorough and the privacy and dignity of people was protected, but the nutritional care needs of people living at the home were not consistently met in day-to-day practice and the management of medications needed to be improved. EVIDENCE: The plans of care were developed with the resident or their relative from the information gathered before admission to the home. However, although some aspects of care were very detailed, the care plans did not always reflect all the needs of people and were not consitently being followed in day-to-day practice. In some instances needs had been identified, but how these needs were to be managed was not clearly recorded to ensure that appropriate care was being delivered. Comment cards were received from six relatives. Four said that residents’ needs were always met and two said that they usually were. One relative
Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 13 simply added, very caring and another wrote, Douglas Bank is the next best thing to home. All six relatives felt that, in general, they were always kept up to date with important issues affecting the residents. The various documents which made up the care file for one person provided staff with some conflicting information in relation to nutritional needs. Therefore, a clear picure of this person’s assessed needs was not evident. Although a variety of risk assessments had been conducted, so that hazards were identified, the assessment in relation to nutrition showed a high risk of this person loosing weight and records showed that they had lost a significant amount over a three month period. However, no dietetic advise had been sought as indicted as a course of action on the nutritional assessment. Therefore instructions were not being followed in day-to-day practice. The plan of care did not indicate that dietary supplements were being given in order to aid nutrition. The nutritional risk assessment for another resident had not been reviewed for a period of seven months, despite showing a reduction in appetite, following which a significant weight loss was evident in a short period of time. This person had not been weighed for two months, although the daily records showed a poor dietary intake on a regular basis. However, although a consultant had been requested to visit, the plan of care did not indicate that there were any concerns about this person’s dietary intake, which demonstrated that their needs in relation to nutrition were not being consistently monitored. Comment cards received from two residents indicated that they always received the care, support and medical attention needed. One added, All aspects of my care are excellent and the other commented, “If ever I am under the weather the nursing staff always know and they have my doctor visit me if they think I need medical attention”. Comments received from relatives on the comment cards included, The home is very good and as I visit most days I get an almost daily update of status. I am advised of my relatives medical condition. I am always advised of medication changes following a GP visit, Information is always conveyed promptly and, “I find the staff extremely caring and gentle. As I live very local I tend to visit all times of the day and always find my relative well tended, dressed, good hygiene and tidy hair and makeup The General Practitioner, who sent in a comment card provided the Commission with some positive feedback, indicating that, when necessary, the the home always sought medical advice for his patients and that their health care needs were being met by an appropriately skilled and experienced workforce. Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 14 Staff spoken to were familiar with the care planning process and were fully aware of individual assessed needs and how to access further information, should they require it. The plans of care examined demonstrated that appropriate care and equipment was being provided for those requiring pressure relief in order to promote good skin care and to reduce the possibility of pressure wounds developing. One resident spoken with said, “The staff really do care. They are a lovely bunch”, and another commented, “I am very happy with the care provided. It is second to none”. A relative told us, “The staff are impeccable, and they are just fantastic”. The policies and procedures in relation to medications were in line with the Royal Pharmaceutical Society of Great Britain guidelines to cover all aspects of medicines management. The handling of controlled drugs and waste medication was in accordance with current legislation so that those living at the home were protected from drug misuse. The home had implemented systems in order to monitor the management of medications so that any errors or potential risks could be easily identified. However, the overall management of medications needed to be tightened up to ensure that people were adequately safeguarded from drug misuse or drug errors. The criteria for the administration of when required and variable dose medication had not been clearly defined and recorded for all service users prescribed such items so that their administration could be monitored. The receipt of medications into the home had not always been recorded on the Medication Administration Records. Hand written annotations on Medication Administration Record charts had not consistently been signed, witnessed and countersigned, to reduce the possibility of drug errors. The plans of care examined demonstrated that the privacy and dignity of those living at the home was an important aspect of care provision. The statement of purpose showed that the home ensured that the privacy and dignity of people was upheld at all times and the residents spoken to confirmed this information. One stated, “The staff treat me very well. They respect my privacy and knock on my bedroom door before entering”. Staff were seen to be treating residents with respect and were heard talking to them in a kind manner. One relative said, “All the staff are very caring and they respect people as individuals” and another commented, “The staff are very thoughtful and anticipate needs well”. Douglas Bank Nursing Home DS0000065686.V345191.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 and 15. Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. Routines within the home were flexible and the lifestyle experienced by people living there satisfied their leisure interests, religious needs and hobbies. Meals were well managed and people were helped to exercise choice and control over their lives. EVIDENCE: The registered manager told us that an Activities Co-ordinator was employed, who organised a host of activites both within and outside the home. He said that all the residents and their families were asked to complete a life history, detailing important life events, hobbies and interests, which helped the home to tailor some activities to individual preferences as well as providing group activities. He said that there was a choice of menu was available each meal time and residents could go to the dining room or eat in their own rooms if they choose. Personal and social relationships were encouraged and religious needs were met. One resident said, “You couldn’t find a better place than this to live”. One resident wrote on the comment card, A variety of activities are always available. The organiser is hard working, very pleasant and goes to great lengths to cater for all our needs. Families are encouraged to be involved in
Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 16 activities and another commented, “The activities programme is wonderful, with always plentyn of varied activities eg dominoes, bingo, quizzes, craft work and keep fit. Also outside groups vome to the home to do a performance for us”. Comment cards received from two residents showed that staff always listened and acted upon what residents said. Comment cards received fom relatives, in general, showed that the home helped people living there to keep in touch with relatives and that residents were supported to live the life they choose. One relative wrote on the comment card, Activities for residents are excellent. The activities co-ordinator does a wonderful job with residents, and another said, “My relatives views are always given respectful consideration”. It was established that the activities co-ordinator had been employed for many years and was a very dedicated member of staff, who arranged a variety of activities on a daily basis, in order to stimulate and entertain those living at the home. We saw the activities co-ordinator helping some people with flower arranging, including one lady who was very interested in this activity before she went to live at Douglas Bank. Some people were reading newspapers and one person told us that they enjoyed reading and showed us their good supply of books. One relative addressed the activities co-ordinator by name and said, “She is wonderful” and another stated, “She is fantastic. She is very dedicated”. One resident said, “The activities lady is super. She really is very good at her job” Evidence was available to show that ministers of different denominations visited the home, so that people’s religious needs could be met. We saw those living at the home being offered a variety of choices throughout the day and being reminded of the activities available, to allow them to decide if they wished to participate or not. Craft work completed by the people living at the home was displayed, creating a homely environment. People living at the home looked cheerful and happy in their surroundings. They were comfortable with the staff and there was a relaxed, jovial atmosphere, which was pleasing to see. All residents spoken to confirmed that there was plenty going on and that they did not have the time to get bored. We were told that outside entertainers visited regularly and notices were displayed of, ‘dates for your diary’, which incorporated a wide range of activities and entertainment, including a full Christmas programme with fesive activities. One of the activities on the day of the site visit was called ‘sunny smile’ and a resident photograph enthusiast was delighted to have been nominated as the photographer for the event. The activities organiser demonstrated that both group and individual activities were provided so that no one was isolated regardless of their abilities or disabilities, which showed that the provision of activities was in line with Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 17 equality and diversity guidelines. Resident’s leisure interests, preferences and hobbies were recorded in individual care records and any events were displayed throughout the home. Those spoken to thoroughly enjoyed the activities available and were happy living at the home. Both residents who sent in comment cards said they always liked the meals at the home. One added, A good choice of food. Well presented. Tables well set with napkins and flowers. A great effort is made with meals for special occasions and the other wrote, “The meals are first class. Always plenty of choice and good portion sizes”. One resident confirmed that independence was promoted as far as possible and it was established people were supported to be as comfortable as possible, whilst living at the home. Residents spoken to confirm that they enjoyed their meals and were able to dine within the communal areas of the home or within the privacy of their own bedroom, if they wanted. The meals served looked well presented and wholesome, providing residents with a nutritious and well balanced diet. The dining tables were pleasantly decorated and condiments were available, so that people could help themselves. The menu provided a varied choice of meals and people were seen eating their chosen selection of food. Staff were observed assisting people with their meals, as was needed, in a discreet manner, but chatting with them about everyday activities and providing encouragement along the way. The management of meals was good, which was pleasing to see. Many visitors were spoken with; who all confirmed that the home worked to open visiting arrangements and residents knew that they could entertain their family and friends in their own rooms if they wished. If they preferred they were also able to use community areas of the home to talk to visitors and relatives and friends were encouraged to participate in the various events taking place in the home. People were observed visiting residents in their bedrooms and also in the communal areas of the home. Visitors spoken to felt that they were made extremely welcome to the home, being offered beverages and snacks and one said, “My relative sees this as her home. The people living here and working here are like an extended family to her”. Information was available around the home about the use of advocates and a relevant policy was in place, showing that people would have the option of accessing an independent person to act on their behalf, should they so wish. The home supported one person to access an independent advocate, to help them to resolve some concerns and the service users guide stated, “ Every resident has the right to be respected, listened to and to be involved in decisions that affect their lives”. Douglas Bank Nursing Home DS0000065686.V345191.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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints were managed well and people living at the home were safeguarded against abusive situations. EVIDENCE: The registered manager said that all residents and relatives were aware of the complaints procedure and that they were encouraged to speak to the managers if they had any concerns. All six comment cards received from relatives said that they would know how to make a complaint and five said that the home had always responded appropriately if they had raised any concerns and one wrote, Concerns are dealt with promptly and professionally”, and another stated, On three occassions I have felt my concerns were met rapidly and thoroughly. Comment cards received from two residents said that they would know how to make a complaint and who to speak to if they were not happy. There was a detailed complaints procedure in place, which was examined at the last inspection and was found to be satisfactory. Complaints received by the home were adequately managed. The complaints procedure was widely distributed, and had a high profile within the service, so that people were fully aware of how to make a complaint, should they wish to do so. A system was in place for the recording of complaints, which was seen to be satisfactory.
Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 19 Robust procedures were in place in order to safeguard those living in the home from abusive situations. The procedures were in line with the Department of Health guidance No secrets and incorporated a whistle blowing policy so that staff were aware of their responsibility in reporting any concerns. Records showed that training had been provided for staff in relation to safeguarding adults and those spoken to knew what to do should they suspect that someone in their care was being abused. Douglas Bank Nursing Home DS0000065686.V345191.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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment was homely and in general clean and tidy, although there was an unpleasant smell in some areas of the home. The premises were maintained to a reasonable standard, providing a comfortable place for people to live in. EVIDENCE: The registered person told us that the home is well designed to cater for the needs of the resident group accommodated and that all residents have access to safe and comfortable indoor and outdoor communial areas. He wrote on the home’s self assessment that the lighting and furnishings are domestic in character and that assisted baths and adequate toilet facilities are available. He also told us that some areas of the home had been redecorated and that residents are encouraged to bring in personal items, if they wish to make their room homely. Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 21 Comment cards received from two residents indicated that the home was always fresh and clean. One wrote, Excellent hygiene standards. Everywhere in the home is spotlessly clean at all times. Bed linen is changed regularly. Rooms are always fresh and well ventilated” and the other commented, “There is never any smell as the home is cleaned frequently throughout the day”. A tour of the premises took place at the time of the site visit, when we found that, in general, Douglas Bank was clean and tidy. However, there was a slight odour in two of the bedrooms, which did not provide the people occupying these rooms with a pleasant environment in which to live. The bedrooms were personalised with residents’ belongings, providing a homely atmosphere for those living at the home. The pipes in one of the en-suite bathrooms were in need of boxing in, as they were exposed following some maintenance work. The flooring and wall tiles in this area also needed to be finished off in order to provide a pleasant bathroom for the person living in this room. A number of bedroom doors needed to be adjusted, as they ‘slammed’ shut, which was a potential hazard for the people living at the home and which created a degree of disturbance for the residents. People spoken with told us that they were very happy with their bedrooms and that they enjoyed watching the birds feeding outside their bedroom windows. One resident said, “My room is kept lovely and clean. It is very comfortable”. The laundry department was fit for purpose and detailed policies and procedures were in place in relation to infection control and appropriate training had been provided for staff. Clinical waste was being disposed of in the correct manner, ensuring that people in the home were adequately protected. One person said that there was no problem with laundry and was happy with standard of cleanliness. Douglas Bank Nursing Home DS0000065686.V345191.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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The number, skill mix and experience of staff met the needs of those living at the home. People working at Douglas Bank had been appropriately trained and were competent to do their jobs. Residents were not always protected by the recruitment practices of the home. EVIDENCE: The registered person told us that the home had a good skill mix of trained staff and that the recruitment procedures were consistently followed in day-today practice. Information provided by the home showed that all new employees were guided through an induction period, followed by an ongoing staff development programme and that 55 of care staff had achieved a recognised qualification in care. The staff rota was examined showing which staff were on duty at any one time. On the day of the site visit there were 31 people living at Douglas Bank and all those spoken to felt that their needs were being appropriately met be the staff team. The staffing levels were being calculated in accordance with the dependency needs of people living at the home, ensuring that enough staff were always on duty to deliver the care required. All the comments we received were very positive, showing that people were happy with the service provided.
Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 23 A variety of training courses had been provided for staff and those working at the home told us that they had received a period of induction. However, this was not always formally recorded, particularly when registered nurses were employed. The registered manager told us that they were in the process of starting the Skills for Care induction course, so that in depth, formal induction would be provided for all care staff. People working at the home were appropriately trained and competent to do their jobs. Those spoken to said that there was plenty of training provided to ensure that their skills were maintained. It was pleasing to see that some staff members had completed training specific to dementia care since the opening of the dementia care unit. Records showed that all staff had completed a range of mandatory courses to ensure that they were appropriately trained. The personnel records of three people working at the home were examined. We found that, in general, the service had a satisfactory recruitment procedure. However, the file of one staff member showed that they had been employed from overseas and although all checks had been conducted, this staff member had been appointed through a recruitment agency. It was not evident that the two references on file were authentic. Both references were addressed “To whomsoever it may concern”, which suggests that the recruitment agency had accepted two references obtained by the employee themselves. Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 24 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, and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home consistently focused on the outcomes for people living at Douglas Bank. EVIDENCE: The information given to us by the home showed that they had developed an open, positive and inclusive atmosphere within the home and that a system had been introduced to monitor the quality of service provided. Staff spoken to felt supported by the manager of Douglas Bank, who has been appointed by the home and registered with the Commission since the last inspection. They said that he is very approachable and will listen to any concerns, which they may have. On speaking with the manager, it was evident that he had identified some areas needing improvement, which he had prioritised so that the most important issues could be addressed first.
Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 25 We were also told that several meetings had been held for residents, their relatives and staff so far this year and minutes had been recorded, so that any new information could be passed on to all concerned and those present were given the opportunity to raise any issues which they wished to discuss. The manager was in the process of setting up a residents’ and relatives’ forum, so that people could get together and discuss any issues, which they may have or talk about any topics of interest. A variety of audits had been conducted, which had been reviewed at regular intervals in order to ensure that the quality of service was being periodically monitored. Customer satisfaction surveys had been conducted for residents and their relatives in order to obtain people’s views about the quality of service provided, the results of which were available for people to see. The system in place for monitoring the quality of service provided should now be extended to allow stakeholders within the community the opportunity to provide their views about how the home is achieving goals for residents. Clear, easy to follow records were retained for small amounts of money, held on behalf of some residents. These records were periodically audited, which was found to be good practice so that the potential for financial errors or financial abuse was reduced. Personal allowances were retained safely and receipts were obtained for any expenditure, including hairdressing and chiropody, so that a clear audit trail was evident. Clear records showed that systems and equipment in the home were serviced at regular intervals to ensure that they were safe for use. A contractors’ policy was seen, which was good practice, demonstrating that any contractors working in the home had signed the policy indicating that they had been made aware of the homes safety guidance and fire procedure. Accidents were recorded appropriately, in line with the data protection act 1998, so that confidentiality was maintained at all times. A variety of internal checks had been conducted on a regular basis, showing that systems and equipment were monitored to ensure the safety of both residents and staff. A lot of relevant training had been provided to ensure that staff had received sufficient guidance to enable them to do the job expected of them. Detailed policies and procedures were in place in relation to Health and Safety. Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 26 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 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 27 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 15(1) Requirement Timescale for action 30/11/07 2. OP8 13(1)(b) 3. OP19 13 4(b) The plans of care must incorporate all the assessed needs of people to ensure that appropriate care is being delivered, including nutritional needs. (Timescale of 01/02/07 not met) The nutritional needs of people 30/11/07 living at the home must be monitored and specialist advice sought, when necessary. (Timescale of 01/02/07 not met) Any unnecessary risks to the 30/11/07 health and safety of residents must be, as so far as possible, eliminated, including ensuring that bedroom doors are adjusted to prevent them ‘slamming’ shut. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 28 1. OP8 Any instructions on the risk assessments should be followed in day-to-day practice. The registered person should review the management of nutritional care to ensure that conflicting information is not provided and that clear strategies are in place in order to improve the standards for those needing additional nutritional support. Criteria for the administration of when required and variable dose medication should be clearly defined and recorded for all service users prescribed such items. All hand written annotations on Medication Administration Record charts should be signed, witnessed and countersigned. Medications received into the home should be recorded on the Medication Administration Records. 2. OP9 3. OP19 Systems should be implemented to ensure that the home is pleasant smelling throughout. The exposed pipes in one of the en-suite bathrooms should be covered and the flooring and wall tiles in this area should also be finished off in order to provide a pleasant bathroom for the person living in this room. Systems should be put in place to make sure that the home is confident that all staff references are authentic. References should be obtained from the referee directly and not brought to the service by the person being appointed, to ensure robust recruitment practices are in place. Records should be kept of induction provided for all new employees so that the home can show people working there have been given relevant information about the service before they start to work alone with residents. The registered manager should implement strategies for enabling stakeholders within the community to affect the way in which the service is delivered and to determine their views on how the home is achieving goals for residents. 4. OP29 5. OP30 6. OP33 Douglas Bank Nursing Home DS0000065686.V345191.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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