CARE HOMES FOR OLDER PEOPLE
Dove`s Nest Nursing Home 17/19 Windsor Road Clayton Bridge Manchester M40 1QQ Lead Inspector
Val Bell Unannounced Inspection 10:00 14th and 20 August 2007
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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 Dove`s Nest Nursing Home DS0000021641.V342067.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. Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Dove`s Nest Nursing Home Address 17/19 Windsor Road Clayton Bridge Manchester M40 1QQ 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) 0161 681 7410 0161 681 3612 laura@dovesnest.co.uk Dove`s Nest Limited Ms Jane Rawsthorne Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (29), Physical disability (2) of places Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Nursing or personal care may be provided for a maximum of 31 service users of either sex aged 60 years or over. Two named service users are currently accommodated and receiving nursing care by reason of physical disability. Should these service users no longer require the accommodation offered by Dove`s Nest the service user category will revert to OP (old age). At any one time one younger adult aged 18 - 60 years can in addition be accommodated for nursing care / personal care, by reason of physical disability for respite care for a period of no longer than 3 weeks. Registration is subject to compliance with the minimum nursing staffing levels indicated in the Notice previously served in accordance with Section 13 of the Care Standards Act 2000 and dated 11th March 2005. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing for the service users assessed as requiring personal care only must comply at all times with the minimum levels set out in the Residential Forum guidelines ` Care Staffing in Care Homes for Older People`. 26th February 2007 3. 4. 5. 6. Date of last inspection Brief Description of the Service: Dove’s Nest is a nursing home providing 24-hour accommodation for up to 31 older persons. The home is owned by Doves Nest Limited. The Responsible Individual is Ms Helen Claffey. The home is situated in the North of the City of Manchester. Local facilities and bus routes are within easy walking distance. Parking to the side of the property is available. The building is an extended and converted detached house set in its own grounds. Accommodation is provided on two floors, served by a passenger lift and the home is accessible to wheelchair users. Bedroom accommodation is on the ground and first floor. The third floor provides office space. There are 21 single and 5 double rooms. All rooms,
Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 5 with the exception of one single room, are provided with a hand washbasin. There are no en-suite facilities available. The double rooms have strategies in place for the maintenance of privacy. There are 3 lounges, a hair dressing room and conservatory/dining room, which is designated as a smoking area. The conservatory has patio doors leading out on to a small patio area, overlooking a wooded garden area, which enables service users to sit outside in warm weather. A separate house situated within the grounds of the home is currently being converted into an administration and training centre. The work is nearing completion and part of the building is in use. Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This report is based on information gathered by the Commission for Social Care Inspection (CSCI) since the last inspection on 26th February 2007. Site visits to the home form part of the overall inspection process and the lead inspector conducted a visit during daytime hours on Tuesday 14th and Monday 20th August 2007. The opportunity was taken to look at the core standards of the National Minimum Standards (NMS). This inspection will also be used to decide how often the home needs to be visited to make sure that the required standards are being met. During the visit, time was spent talking to six people living in the home and discussions were held with the provider, two nurses and the registered home manager. Telephone conversations were held with the relatives of two residents and one resident completed and returned a satisfaction survey to the Commission. Relevant documents, systems and procedures were assessed and a tour of the home was undertaken. What the service does well: What has improved since the last inspection?
Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 7 Since the last inspection improvements had been made by introducing a record for the disposal of medication and by supplying residents with a contract that outlined their conditions of residency. Appropriate written references had been obtained for staff recently recruited. The manager said that residents wishing to make private telephone calls could use the facilities in the office and that locks were being fitted to bedroom doors as part of the refurbishment programme. 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. Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People making enquiries about this home can be confident that their personal and healthcare needs will be assessed prior to making a decision on whether the home is the right place for them to live. EVIDENCE: The requirement made at the last inspection to provide residents with contracts had been addressed. Local authority assessments of need had been obtained for the six people that were case-tracked during this inspection. The manager stated that in-house pre-admission assessments of need had been undertaken although these could not be located. It was recommended that the in-house assessments of need are held in residents’ files and that these documents are kept under regular review. Two residents’ relatives confirmed that they had been involved in the pre-admission assessments and were consulted about any changes in the residents’ wellbeing. The home did not offer an intermediate care service.
Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 10 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 good. This judgement has been made using available evidence including a visit to this service. People living in the home have their personal and healthcare needs met in a safe way. EVIDENCE: The care plans belonging to six people living in the home were examined. Care plans had been developed from information supplied by local authority assessments of need. The manager said that in-house assessments of need had been carried out prior to admission, although these were not made available to the inspector during the visit. The daily records in relation to meeting individuals’ personal and healthcare needs were generally very good, particularly in relation to follow-up action agreed with various healthcare professionals, such as the tissue viability nurse. The six care plans had been subject to review on a monthly basis. Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 11 Risks associated with falls, poor appetite, moving and handling needs and the use of bed rails etc. had been assessed and instructions for staff on how to maintain residents’ safety had been documented. Minor shortfalls were found in the way some information was recorded. Blood sugar monitoring and weight records were not consistently signed and dated and hoist risk assessments should state the type of hoist and sling to be used. One care plan belonged to a resident who was of West Indian origin. There were no instructions relating to this person’s specific skin and hair care needs. Staff on duty confirmed that this resident’s skin and hair care needs were being met, but agreed that it had not been written down. Conversations with two residents and their relatives confirmed that they had been consulted on the care to be provided. Improvements should be made by recording the action agreed during these consultations. Medication was supplied by a local pharmacy using the dosette system of administration. The medication records for the six residents case-tracked appeared to be accurate and up to date. However, this could not be verified as the current weeks delivery had not been signed for as correct and the previous months records could not be located during the visit. The manager explained that a member of night staff had checked the medication but due to the late arrival of the medication record sheets from the pharmacy it had not been possible to sign the sheets. This member of staff should have kept a temporary signed record to confirm that the check had taken place. Records were in place for medication disposed of and the manager confirmed that medication was held for a minimum of seven days after the death of a resident. Controlled drugs administered to one of the residents had been signed for by two members of staff. However, a second signature had not been obtained on the morning of the inspector’s visit. During the visit staff were observed to interact well with residents. It was evident that staff had taken care to ensure that residents were well presented with attention paid to their attire, hair and accessories, such as jewellery. Six residents confirmed that their needs were met in a dignified way and that staff treated them with respect at all times. One shortfall was noted during lunchtime when one member of staff was overheard several times referring to a resident as a ‘good girl’, which is demeaning to older people. This was discussed with the provider who said she was aware that this member of staff used such language and was taking steps to reinforce the correct manner in which older people should be addressed. Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 12 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 good. This judgement has been made using available evidence including a visit to this service. Group activities provide some interest and stimulation for residents, although this could be improved by focussing on individual needs in a person-centred way. EVIDENCE: The home provides a weekly timetable of activities for residents such as films, bingo, exercise classes, sing-a-longs, arts and crafts, dominoes and manicures. A record is held of residents that attend the activity sessions but there was no written evidence of the outcomes experienced by individuals. The activities are mainly group orientated and there was little evidence that the diverse needs and interests of individual residents had been assessed. Improvements must be made by undertaking social needs assessments with individual residents, to ensure that a person-centred service is developed. Of the six care plans examined only one recorded the person’s nationality and religion. The inspector was told that one of the residents was Polish yet the assessment of need provided by the local authority stated the person’s nationality to be Ukrainian. This information is important and must be accurately recorded to reflect the diverse needs and personal autonomy of
Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 13 people living in the home. Furthermore, although residents spoken to confirmed that their relatives visit regularly, there was no written evidence of this in the daily notes, which focussed mainly on residents’ health and personal care needs. The manager said that care staff would be much more involved in developing personal life histories with residents and in recording the outcomes of their daily life experiences. The inspector joined residents in the lounge for the midday meal as the dining room had been decommissioned due to current building work in progress. Despite the upheaval a relaxed atmosphere was maintained at all times. Several choices of a hot meal, a salad or sandwiches were available. Meals were nutritious in content and attractively presented. Staff maintained an attentive and unobtrusive presence during the meal and provided assistance to residents where needed. Three residents said that their special requests at breakfast time were provided and that, ‘if you ask, you can always have alternatives.’ They said that the food was very good and staff looked after them very well. Records for the safe handling, storage and preparation of food were up to date. Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 14 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, 17 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are listened to, their concerns are taken seriously and they are afforded protection from harm by the policies and procedures in place. EVIDENCE: Policies and procedures were in place to deal with complaints and residents had been issued with information on how to make a complaint. Three service users said that they knew who to talk to if they had any concerns. One resident said, “You don’t need to make a complaint because staff sort things out if you let them know you have a problem.” No complaints had been made in the previous twelve months. Two care plans recorded that the residents were assessed as not having the capacity to make decisions that affected their future care. It was recommended that the manager undertake training to implement the requirements in relation to decision-making specified by the Mental Capacity Act. Manchester’s multi-disciplinary policy and procedures for safeguarding adults from abuse were in place at the home and staff had received training in how to recognise and deal with allegations or suspicions of abuse. Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 15 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 home’s development and maintenance programme ensures that residents continue to be provided with a safe, comfortable and pleasant living environment. EVIDENCE: A tour of the home’s communal and private space was undertaken to assess health and safety and the environmental standards provided. Despite the upheaval of extensive building work in progress the staff had worked hard to maintain continuity of care and a homely and safe environment for people living and working in the home. Good communication with the builders had resulted in the stoppage of building work at key times during the day, such as mealtimes to respect the residents’ privacy and comfort. The home was found to be clean and hygienic and no unpleasant odours were present. Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 16 The manager said that residents wishing to make private telephone calls could use the facilities in the office and that locks were being fitted to bedroom doors as part of the refurbishment programme. Procedures were in place for the control of infection and the laundry area was sited away from food preparation areas. The home had been suitably adapted to accommodate residents’ assessed physical needs and this maximised their independence and quality of life. Further work was planned to provide a multifunction bathing system in the newly converted ‘wet-room.’ The home’s redecoration programme was ongoing at the time of this visit. Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 17 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. A robust induction and training programme along with the careful recruitment of staff ensures that staff have the desired qualities, knowledge and skills to meet the assessed needs of people living in the home. EVIDENCE: At the time of this visit sufficient qualified and support staff had been deployed to meet the assessed needs of people living in the home. Six residents said that they felt safe living in the home and they confirmed that staff were responsive to their requests for assistance. The majority of care staff had achieved either a level 2 or 3 National Vocational Qualification in care. Examination of recruitment records for newly appointed staff provided evidence that the required pre-employment checks had been undertaken. Once appointed, staff undertake an induction programme in line with the Skills for Care Induction Standards, during which time they are assigned a mentor. Their performance is reviewed at the end of the induction period and they are then assigned performance goals for the coming twelve months. Supervision is provided every two months and staff appraisals take place annually. The manager stated that she intended to provide training to the qualified nursing staff and senior care staff in how to conduct supervisions.
Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 18 Training provided in the previous twelve months includes mandatory health and safety, recognising abuse and safeguarding adults, medication administration and various courses relevant to the conditions associated with older age. Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 19 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 views of residents and their representatives are listened to and action is taken in their best interests to make improvements to the service provided. EVIDENCE: The registered manager is a qualified nurse and has extensive knowledge in the care of older people having worked at the home for the previous twentythree years. There are clear lines of accountability and the ethos and management of the home creates an open and positive atmosphere. The home achieved the Investors in People Award in December 2006 and quality audits are a feature of life in the home. Good communication is facilitated by the manager who meets with senior staff every week and residents meeting four times per year. In addition to this, residents and their
Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 20 relatives are issued with regular satisfaction surveys. Responses to the surveys inform the business plan and future development of the home. Residents’ personal finances are managed either by their relatives or the local authority client affairs department. A sample of health and safety records was examined and found to be accurate and up to date. The manager stated that there had been a recent outbreak of scabies in the home, although this had not been notified to the Commission as required under Regulation 37 of The Care Homes Regulations 2001. Following the outbreak infection control training had been provided to all staff working in the home. Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP12 Regulation 12 (4) 16 (2) (m) Requirement Social needs assessments must be undertaken with individual residents to reflect their spiritual, racial, cultural, social and personal relationship needs. The registered person must notify the Commission of incidents that affect the welfare of people living in the home. Timescale for action 14/11/07 2. OP38 37 14/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations In-house assessments of need should be held in residents’ files and these documents should be kept under regular review. The plan of care should be drawn up with the involvement of the resident in a style accessible to the resident. Agreements reached through consultation with residents
DS0000021641.V342067.R01.S.doc Version 5.2 Page 23 2. OP7 Dove`s Nest Nursing Home and their relatives should be recorded and signed wherever possible. 3. OP8 Records should be signed and dated and should contain sufficient information to provide evidence that residents’ personal and healthcare needs are being met. Staff should keep a signed record to provide evidence that they have checked the accuracy of medication received into the home and the administration of controlled drugs should be witnessed by a second person. The manager should undertake training to ensure that the requirements of the Mental Capacity Act are met in relation to recording decisions made on behalf of people that lack capacity. 4. OP9 5. OP17 Dove`s Nest Nursing Home DS0000021641.V342067.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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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