Inspection on 09/04/08 for Douglas Bank Nursing Home

This inspection was carried out on 9th April 2008.

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

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

Other inspections for this house

Douglas Bank Nursing Home 18/10/07

Douglas Bank Nursing Home 14/09/06

Douglas Bank Nursing Home 22/03/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Douglas Bank Nursing Home Lees Lane Appley Bridge Wigan Lancashire WN8 0SZ Lead Inspector Vivienne Morris Unannounced Inspection 9th April 2008 09:00 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.V359216.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.V359216.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 Care Home with Nursing 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.V359216.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 18th October 2007 Brief Description of the Service: Douglas Bank Nursing Home provides personal and nursing care for up to 40 elderly people, including up to ten people requiring dementia care, who live in a dedicated wing of the home. Douglas Bank 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 9th April 2008 ranged from £366 to £544 per week. Additional charges were being incurred for hairdressing, chiropody, newspapers and magazines. Douglas Bank Nursing Home DS0000065686.V359216.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. An unannounced site visit was conducted to this service over one day in April 2008, which formed part of the key inspection process. During the course of the site visit, discussions took place with those living at the home, as well as relatives and staff. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas were seen. Comment cards were received from seven 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. The self-assessment was completed and submitted, as requested by the previous manager, who had left the home very recently. Therefore, statements, which have been taken from the assessment and which, are included in this report have been made by the previous registered manager. We observed the activity within the home and ‘tracked’ the care of three people during the site visit, not to the exclusion of other residents. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The Commission for Social Care Inspection had not received any concerns, complaints or allegations about this service since the last inspection. What the service does well: People were provided with current information about the service before admission to enable them to make an informed choice about moving into the home. One plan of care contained a lot of detailed information, so that staff could form a picture of this person’s needs and therefore provide the care required. A variety of external people were involved in the care of the people living at Douglas Bank. Douglas Bank Nursing Home DS0000065686.V359216.R01.S.doc Version 5.2 Page 6 Those spoken to provided a lot of positive comments, covering a wide range of aspects of life at Douglas Bank, some of which included, My mum has settled here and I feel that she is being well cared for”, “There is always something going on. We don’t get time to get bored” and “The food is excellent. I can’t fault it”. 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. Staff had a good understanding of the principals of care and promoting privacy and dignity. 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. When asked what the service does well, the registered manager told us, ‘we encourage residents to become involved in activities. We have an Activities co-ordinator who organises a host of activities both within and outside the home. We ask all families to complete a Life History detailing important events hobbies and interests. This helps to tailor some activities to individual preferences as well as group activities.’ 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. When asked what the service does well, the registered manager wrote on the self-assessment, ‘We try to encourage regular meetings with residents, relatives and Staff to discuss all areas of the Home.’ The environment was relaxed and the routines of home were well managed. It was evident that people living at Douglas Bank were happy and contented. The Douglas Bank Nursing Home DS0000065686.V359216.R01.S.doc Version 5.2 Page 7 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. Complaints were well-managed and robust policies and procedures adequately safeguarded people living at the home against abusive situations. 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 infection. People working at the home had been appropriately trained and were competent to do their jobs. The induction and training of staff was good and an acceptable percentage of care staff were appropriately trained to maintain the standards of care delivered. 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? What they could do better: The assessment of people’s needs could be better to ensure that everyone is thoroughly assessed before admission, so that the home is confident that individual needs can be fully met by the staff team. The prospective resident or their relative could be given the opportunity to be involved in the preadmission assessment process so that they have some input into the planning of their care. Douglas Bank Nursing Home DS0000065686.V359216.R01.S.doc Version 5.2 Page 8 The care planning process could be better by incorporating all the assessed needs of people and how these needs are to be met to ensure that appropriate care is being delivered. The resident or their relative could have been given the opportunity to be involved in the care planning process, if they so wished, so that they could have some input into the care being provided. Any unnecessary risks to the health or safety of residents could have been managed better within a risk management framework, to ensure that people are always protected from potential risks. The care records sometimes provided conflicting information for staff. This could be avoided to ensure that consistent care is provided. All hand written annotations on Medication Administration Record could be signed, witnessed and countersigned to ensure transcriptions are accurately recorded. When asked what the service could do better, the registered manager wrote on the home’s self - assessment, ‘Continue to introduce new activities. Increase one to one activities. Continue to invest in the home to improve facilities. Continue to encourage comments and suggestions from residents, relatives and staff.’ Some minor maintenance work, redecoration and refurbishment were required so that the premises were consistently safe for people to live in and so that a comfortable environment was provided for everyone living at the home. The recruitment practices needed to be improved, as they did not demonstrate that people living at the home were adequately protected. The home could not demonstrate that references held on two overseas staff member’s file were authentic and therefore, although checks had been conducted and relevant documents obtained, the recruitment process could have been better. Although the monitoring of the quality of service provided had improved since the last inspection, it could still be better by obtaining the views of other people involved in the care of those living at the home, to see how Douglas Bank is meeting it’s goals for residents. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Douglas Bank Nursing Home DS0000065686.V359216.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.V359216.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): 1 and 3. Standard 6 is not applicable to this service. Quality in this outcome area is adequate. 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. However, the preadmission process was not thorough enough to ensure that the staff team were able to meet everyone’s individual needs. EVIDENCE: Standard 1 was assessed on this occasion, due to the very recent change of manager of the home. We saw that the service users’ guide was easily accessible for people and that it had been updated to include the current management arrangements of the home. However, the range of fees should also be included, so that people are aware of the charges to expect for their care, should they wish to live at Douglas Bank Nursing Home. Douglas Bank Nursing Home DS0000065686.V359216.R01.S.doc Version 5.2 Page 11 The statement of purpose had also been updated in accordance with the National Minimum Standards and the Care Home Regulations, so that people were given up to date information about the home. When asked what the service does well, the manager wrote on the selfassessment, ‘we have an open door policy for all prospective residents, who are able to visit the home at any time. We provide comprehensive information to prospective residents, which include a breakdown of fees. We encourage prospective residents to visit the home prior to admission and our contract of residence allows people to stay at the home for a trial period of time. Prospective residents are assessed prior to admission to confirm we can meet their assessed needs. We provide all residents with a service users’ guide, which contains a copy of the homes complaints policy. We also ensure a full person centred care plan is implemented from the first day and evaluated and reviewed at least once a month throughout the resident’s stay.’ The self – assessment read, ‘Our mixed ethnicity workforce gives us the opportunity to cater for a wider group of residents, provided the area has a need for this service’. This shows that everyone wishing to move into Douglas Bank Nursing Home is provided with the same opportunities. We looked at the care records of three people living at the home. The needs of two of these people had been assessed before they were admitted, but no assessments were available for the third resident and therefore the home had not determined if the staff team were able to meet this persons needs before they moved into Douglas Bank. There was no evidence available to show that the residents or their relatives had been given the opportunity to be involved in the assessment of needs before they were admitted to the home, so that they could have some input into planning their care. When asked what the service could do better, the registered manager stated on the self-assessment, ‘We could update our service users’ guide to include comments from residents who have lived at the home so that prospective residents have some insight into living here.’ ‘We could also review our pre-admission assessments to make amendments to fully address the requirements of the mental capacity act.’ Two residents sent in comment cards and both indicated that they were given enough information before they moved into the home to help them to decide if it was the right place for them. Residents and their relatives, who were spoken with said that they were more than happy with the services provided. One resident wrote on the comment card, ‘I am very happy living here’. Douglas Bank Nursing Home DS0000065686.V359216.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 health and personal care needs of people were not always being met, but the privacy and dignity of those living at the home was consistently respected. The management of medications was, in general satisfactory. EVIDENCE: The three plans of care examined varied in quality and detail. One of the care records provided a lot of information, giving staff clear guidance as to how the resident’s needs were to be met. The other two could have been more detailed in relation to the individual needs of people living at the home. One plan of care had been implemented some time after the person was admitted to the home, which did not provide staff with clear guidance of this individual’s needs from the time they moved into Douglas Bank. Although a range of risk assessments had been conducted, some identified hazards were not being covered within a risk management framework, particularly in relation to people being at risk of falling and people at risk of Douglas Bank Nursing Home DS0000065686.V359216.R01.S.doc Version 5.2 Page 13 leaving the building. Therefore, those living at the home were not always protected from potential hazards. The care records examined provided some conflicting information about the needs of people living at the home, which did not always provide staff with consistently up to date details about the people they were looking after, so that they could deliver the care required by each individual. There was no evidence that residents or their relatives had been given the opportunity to be involved in planning the care required, so that they could have some input into what they needed and wanted, whilst living at the home. However, 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 did not always include the identified risks and needs of people living at the home, particularly in relation to nutrition and pressure care. An assessment for one resident identified them as having a reduced appetite and being at very high risk of malnutrition. It also showed that dietary supplements were to be given. However, the plan of care did not record a problem with nutrition and therefore staff were not provided with clear guidance as to how this person’s nutritional needs were to be managed. The assessment in relation to pressure care for this resident demonstrated that they were at very high risk of developing pressure wounds and although the care plan recorded, ‘staff to monitor skin viability on each intervention’, it did not indicate what pressure relief was to be delivered and what pressure relieving equipment was to be provided, despite the resident being immobile and needing the assistance of two people to stand. However, we saw that appropriate 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. There was a lot of evidence available to show that other professionals were involved in the care of people living at the home, so that external advice had been sought about any health care needs. 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 girls look after me very well. They are all very nice, you know. They knock on my bedroom door before coming in”. 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 seem to be kind and caring towards the residents. The activities lady is marvellous. She is very caring”. The relative who returned a comment card stated that they receive enough information to help them to make decisions about their relative’s care. Douglas Bank Nursing Home DS0000065686.V359216.R01.S.doc Version 5.2 Page 14 The policies and procedures in relation to medications were, in general, 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 errors and 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, hand written entries on Medication Administration Records had not always been signed, witnessed and countersigned to ensure that the transcriptions had been accurately recorded. One staff member wrote on the comment card, when asked what the service does well, ‘Provides a welcoming, comfortable place for people to live’. When asked how the service had improved in the last twelve months, we were told, ‘our care plans are more focused on person centred care with more details on social aspects of life, choices and preferences. We have included a “Life History” document for all residents, which give an individual account of their life and interests’. We saw the life history documents, which were very informative and which were considered to be good practice. We were told that palliative care training had been increased and that the home had introduced a recognised system for end of life care, to ensure that residents and their families were supported during the final days of life. One resident indicated on the comment card that they always receive the care and support they need and the other stated that they usually did. Both residents indicated that they always received the medical support that they needed. The relative who sent in a comment card indicated that the care home always met the needs of their relative and that they were always kept up to date with important issues affecting their loved one. Two staff members indicated on the comment cards that they are always given up to date information about the needs of the people who they support and care for, the other two staff members stated that they are usually given this information. Three staff members stated on the comment cards that the ways in which information was passed between staff about people who use the service usually works well and one person indicated that it sometimes works well. One staff member, when asked what the service does well, wrote, ‘The home provides individual care for residents’. Douglas Bank Nursing Home DS0000065686.V359216.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: An Activities Co-ordinator is employed at Douglas Bank Nursing Home, who has been organising a host of activities, both within and outside the home for many years. It was noted 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. 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 Douglas Bank Nursing Home DS0000065686.V359216.R01.S.doc Version 5.2 Page 16 if they wished to participate or not. 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, calm 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. On the day of the site visit, those living at the home were enjoying a ‘pamper day’ and were looking forward to the return of the owl trainer the following day. Those spoken to talk about the enjoyable summer barge trips that were arranged and how much they liked the varied activities programme. 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 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. One resident was proud to show us some old photographs displayed on his bedroom wall of his youth, where he lived as a boy and his young working life. Both residents who sent in comment cards said that there were always suitable activities provided and that they usually liked the meals at the home. The relative who submitted a comment card wrote, when asked what the service does well, ‘the activities co-ordinator is invaluable. Nursing staff are sympathetic, approachable and efficient. All staff care about the residents.’ One resident confirmed that independence was promoted as far as possible and it was established that people were supported to be as comfortable as possible, whilst living at the home. A choice of menu was available each mealtime, providing a wide variety of well – balanced meals. Residents could go to the dining room or eat in their own rooms if they preferred. Personal and social relationships were encouraged and religious needs were met. One resident said, “The food is marvellous. I have put two stones on since I came here a year ago ”. The meals served looked, in general, well-presented and wholesome, providing residents with a nutritious and well balanced diet. However, although the different tastes were served separately for those requiring a soft diet, one Douglas Bank Nursing Home DS0000065686.V359216.R01.S.doc Version 5.2 Page 17 member of staff was seen to mix all the flavours together before assisting one person with their meal, which did not look appetising for the resident. The dining tables were pleasantly decorated and condiments were available, so that people could help themselves. 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. Those eating in the dining room were given a choice of music to listen to whilst they were having their meal, which was considered to be good practice. Cold and hot beverages were served during lunch, including an alcoholic drink, if people wanted one. Residents were routinely offered more to eat if they wanted and staff chatted to them in an unrushed environment about their individual interests, whilst they ate at their own pace and enjoyed a relaxed lunch time. Following the main course the sweet trolley was taken round so that people could see the wide range of desserts and choose which they wanted, which was considered to be good practice. The management of meals was, in general good, which was pleasing to see. Several 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. One relative said, “The staff make me feel very welcome to the home. Everyone is very nice.” When asked what improvements had been made in the last twelve months the registered manager told us, ‘we continue to increase the activities on offer. We have made changes to the menus to incorporate suggestions from residents. We are looking at activities suited to residents with varying levels of cognitive impairment’. One staff member, when asked what the service does well, wrote on the comment card, ‘Offers good support and activities for residents’. Another staff member commented, when asked what the service could do better, ‘Introduce new activities and more 1:1 activities’. When asked what the service does well, the registered manager wrote on the self-assessment, ‘We try to encourage regular meetings with residents, relatives and Staff to discuss all areas of the Home.’ Douglas Bank Nursing Home DS0000065686.V359216.R01.S.doc Version 5.2 Page 18 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 service users’ guide stated, “ Every resident has the right to be respected, listened to and to be involved in decisions that affect their lives”. When asked if there were any plans for the future, the registered manager wrote on the home’s self-assessment, ‘We will need to liaise closely with Local authorities regarding the Mental Capacity Act in particular with the need for Independent Mental Capacity Advocates.’ Douglas Bank Nursing Home DS0000065686.V359216.R01.S.doc Version 5.2 Page 19 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 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. Both residents who submitted comment cards said that they would know how to make a complaint and that the staff listen and act on what they say. 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 know what to do should they have any concerns about the treatment of someone living at the home. When asked what the service does well, we were told, ‘The Home has a clear and accessible complaints procedure, giving details of who will deal with the Douglas Bank Nursing Home DS0000065686.V359216.R01.S.doc Version 5.2 Page 20 complaint, the time scale for a response, details of the local Commission for Social Care Inspection office and how a complaint will be dealt with. All staff have received training in relation to safeguarding adults and procedures are in place to respond to any suspicion of abuse or neglect.’ When asked what they could do better, we were told, ‘The Mental Capacity act gives the need for the home to be using Independent Mental Capacity Advocates. To fully comply with the National Minimum standards we need to look at our residents and those whom lack capacity and have no relatives or friends to consult. Then we need to consider the use of an Independent Mental Capacity Advocate.’ When asked what improvements had been made in the last twelve months the registered manager wrote on the home’s self-assessment, ‘We have addressed issues raised by those within the home and by our inspection report. Our policies have been reviewed and updated in line with new initiatives. We are organising training on the Mental Capacity Act. Resident questionnaires show a high level of satisfaction. We have not received any complaints in the last 12months.’ The Commission has not received any concerns, complaints or allegations about this service since the last inspection. All four staff members indicated on the comment cards that they would know what to do should a resident, relative, advocate or friend have any concerns about the home. Douglas Bank Nursing Home DS0000065686.V359216.R01.S.doc Version 5.2 Page 21 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 pleasant smelling. 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 provides a safe and secure environment for residents to live in and this was confirmed by our tour of the premises and examination of the equipment service certificates. The home was clean, tidy and pleasant smelling, thereby reducing the risk of infection. Detailed infection control policies were in place and staff records showed that those working at the home had been provided with infection control training, so that they were aware of measures to implement in order to Douglas Bank Nursing Home DS0000065686.V359216.R01.S.doc Version 5.2 Page 22 reduce the risk of infection. Both residents who sent in comment cards stated that the home is usually fresh and clean. Clinical waste was being disposed of in the correct manner, ensuring that people in the home were adequately protected. One person said that the laundry service was satisfactory and that the home was always kept clean. The bedrooms seen were personalised with residents’ belongings, providing a homely environment for those living at the home. People spoken with told us that they were very happy with their bedrooms When asked what the service could do better the registered manager told us, ‘we are aware that the dependency levels of our residents are increasing. We therefore need to be assessing the need to have more adapted and specialised equipment.’ We were also told that a number of rooms have been redecorated since the last inspection and that the tables and chairs in the dinning area have been replaced, the heating system replaced and blinds have been fitted in the conservatory, which has improved the environment for those living at Douglas Bank. At the time of our visit, there were no residents spending their time in the conservatory. However, this area of the home was noted to be cool, the recorded temperature being 56°C, which did not provide people living at the home the opportunity to sit in the conservatory, if they wished to do so. We noted that the disabled toilet on the ground floor was in need of upgrading and decorating, so that this facility is better maintained for the people using it. Although it was evident that there was an ongoing programme of decoration and refurbishment, we noted that some of the bedrooms were ‘tired’ looking and in need of brightening up. The manager of the home was aware of this and said that these bedrooms would be refurbished in the near future in order to enhance the environment for the people living in them. Douglas Bank Nursing Home DS0000065686.V359216.R01.S.doc Version 5.2 Page 23 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: When asked what the service does well the registered manager wrote on the self-assessment, ‘ Recruitment policies ensure that new employees have appropriate checks and two written references before they are employed. We operate an equal opportunities policy and recruit from all cultures and backgrounds. All staff receive a job description, employee handbook and contract of employment. Staff go through an in-depth induction programme with up-dates and continuous training. We have a high percentage of staff qualified to NVQ level 2 and above.’ Records seen 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 29 people living at Douglas Bank and all Douglas Bank Nursing Home DS0000065686.V359216.R01.S.doc Version 5.2 Page 24 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. 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. 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 two people working at the home were examined. We found that, in general, the service had a satisfactory recruitment procedure. However, the files examined showed that both staff members had been employed from overseas and although all checks had been conducted, these staff members had been appointed through a recruitment agency. There were no application forms on file and it was not evident that the references obtained were authentic, as they were addressed to ‘whomsoever it may concern’, which suggests that the recruitment agency had accepted references brought by the employee themselves. All four staff members who submitted comment cards said that the home carried out appropriate checks on them before they started work and that their induction period covered, in general everything that they needed to know to do the job. All four said that they are given training which helps them understand and meet the individual needs of people in their care and which keeps them up to date with new ways of working. They also confirmed that their manager met with them often to give them support and to discuss how they were working and they felt that there were usually enough staff on duty to meet the individual needs of all the people who use the service. The relative who sent us a comment card indicated that the care staff usually have the right skills and experience to look after people properly and the selfassessment showed that there was a stable workforce with a very low turn over of staff, which promoted continuity of care. Douglas Bank Nursing Home DS0000065686.V359216.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): 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. A new manager had been appointed at Douglas Bank, who had been in post for only three days. Therefore, Standard 31 was not fully assessed on this occasion. However, it was evident that the home was continuing to ensure that Douglas Bank Nursing Home DS0000065686.V359216.R01.S.doc Version 5.2 Page 26 the health, safety and welfare of those living there was promoted and protected. 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. Internal inspections were being conducted every month, following which’ a report was formulated and forwarded to the Commission as well as being retained at Douglas Bank Nursing Home. 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. The personal allowances for residents had been thoroughly 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. When asked what the service does well the registered manager told us, ‘All staff receive induction training, supervision and annual appraisals. Through residents, staff and management meetings we continually appraise the care we offer. The service is also monitored through the quality assurance audit system.’ When asked what the service could do better the self-assessment read, ‘we could look at ways to apply new government initiatives. We could monitor and control financial budgets and examines ways to better manage home budgets. Douglas Bank Nursing Home DS0000065686.V359216.R01.S.doc Version 5.2 Page 27 We could investigate new areas of supply, to reduce costs and improve quality of service and look at specific areas within the home where we can improve.’ The information given to us by the home told us that in the last twelve months improvements have been made by updating the questionnaires in order to gain a more advanced understanding of how the service is meeting the needs of the residents. One staff member wrote on the comment card, when asked what the service does well, ‘Provides a safe and comfortable environment for residents and supports relatives well’ and another told us, ‘The service provides good care and support for residents and it supports staff well.’ Douglas Bank Nursing Home DS0000065686.V359216.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 2 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 3 Douglas Bank Nursing Home DS0000065686.V359216.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 OP3 Regulation 14(1)(a) (b)(c) Requirement The registered person must not provide accommodation to people whose needs have not been assessed by a suitably qualified or trained person. The registered person must obtain a copy of the assessment and the prospective resident or their relative must have been given the opportunity to be involved in the pre-admission assessment process. The plans of care must incorporate all the assessed needs of people and how these needs are to be met to ensure that appropriate care is being delivered. (Timescale of 01/02/07 and 30/11/07 not met). The resident or their relative must be given the opportunity to be involved in the care planning process, if they so wish, so that they can have some input into the care being provided. Any unnecessary risks to the health or safety of residents must be identified and so far as possible eliminated. DS0000065686.V359216.R01.S.doc Timescale for action 30/04/08 2. OP7 15(1) 30/04/08 3. OP7 15(1) 30/06/08 4. OP8 13(4)(c) 30/04/08 Douglas Bank Nursing Home Version 5.2 Page 30 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 OP1 OP7 OP8 OP8 Good Practice Recommendations The range of fees should be included in the service users’ guide so that people are aware of what charges to expect should they go to live at the home. The care records should not provide any conflicting information for staff, so that those living at the home are provided with appropriate care. The registered person should review the management of nutritional care and pressure care to ensure that clear strategies are in place in order to improve the standards for those needing additional pressure relief and nutritional support. All hand written annotations on Medication Administration Record charts should be signed, witnessed and countersigned. Soft diets should look appetising and the different tastes of food should be served separately so that everyone is given the same opportunity to enjoy their meals. Consideration should be given to upgrading and decorating the disabled toilet on the ground floor, so that this facility is better maintained for the people using it. The temperature of the atmosphere in the conservatory should be increased, so that people have the opportunity to spend some time in this area of the home, if they so wish. The programme of redecoration and refurbishment should continue because some areas of the home are now looking ‘tired and ‘worn’ and in need of brightening up for the people living at Douglas Bank. 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 that robust recruitment practices are in place. DS0000065686.V359216.R01.S.doc Version 5.2 Page 31 4. 5. 6. OP9 OP15 OP19 7. OP29 Douglas Bank Nursing Home 8. OP33 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. Douglas Bank Nursing Home DS0000065686.V359216.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Douglas Bank Nursing Home DS0000065686.V359216.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. 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