Inspection on 03/01/08 for Dunwood Manor Nursing Home

This inspection was carried out on 3rd January 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Dunwood Manor Nursing Home 06/02/07

Dunwood Manor Nursing Home 07/09/05

Dunwood Manor Nursing Home 26/04/05

Dunwood Manor Nursing Home 23/11/04

Dunwood Manor Nursing Home 19/08/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Dunwood Manor Nursing Home Dunwood Manor Nursing Centre Sherfield English Romsey Hampshire SO51 6FD Lead Inspector Tim Inkson 3 rd Unannounced Inspection January 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 Dunwood Manor Nursing Home DS0000011422.V355448.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. Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dunwood Manor Nursing Home Address Dunwood Manor Nursing Centre Sherfield English Romsey Hampshire SO51 6FD 01794 513033 01794 519700 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) www.sentinel-healthcare.co.uk Sentinel Health Care Limited Post Vacant Care Home 55 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (55), of places Physical disability (25), Physical disability over 65 years of age (55), Terminally ill (25), Terminally ill over 65 years of age (55) Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th February 2007 Brief Description of the Service: Dunwood Manor is a large Victorian country house and was converted for use as a nursing home. Sentinel Healthcare Ltd owns the service with four other homes in Hampshire. It is set in extensive grounds with panoramic views of the surrounding countryside. It is located in the rural community of Sherfield English and the nearest town is Romsey. The building has 2 storeys and has been improved and refurbished over time. Dunwood Manor is registered to accommodate 55 service users who require nursing care. It has 34 single and 9 double bedrooms, and 19 bedrooms benefit from en-suite facilities. The communal facilities comprise 3 lounges and a separate dining room. There is also a hydrotherapy pool in the grounds of the home and this is available at an extra cost to all the service users. People wishing to live in the home or for whom arrangements are made to do so by relatives or other representatives were given written information about it and are invited to visit. A copy of a report of the most recent inspection of the home carried out by the Commission for Social Care Inspection (“the Commission”) is made readily available in the home with a copy of the home’s Service Users Guide. The company that owns the home also has details about it on its website. At the time of the site visit on 3rd January 2008 the home’s fees ranged from £550-£950 per week. This did not include the cost of toiletries, hairdressing and podiatry. Dunwood Manor Nursing Home DS0000011422.V355448.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 3 star. This means the people who use this service experience excellent quality outcomes. This site visit was part of the process of a key inspection of the home and it was unannounced and took place on 3rd January 20087, starting at 08:50 and finishing at 17:30 hours. During the visit accommodation was viewed including bedrooms, communal/shared areas and other facilities. Documents and records were examined and staff working practice was observed where this was possible without being intrusive. People living in the home, visitors, staff and a health professional were spoken to in order to obtain their perceptions of the service that the home provided. At the time of the inspection the home was accommodating 49 people. Of these 17 were male and 32 were female and their ages ranged from 27 to 100 years. No individual was from minority ethnic groups. The home’s proposed manager and the director of care employed by the company/organisation that owned the home were present during the site visit and were available to provide assistance and information when required. People both living and working, relatives and advocates of people living in the home and health care professionals were canvassed for their views about the home using questionnaires before the site visit took place. The responses were taken into consideration when producing this report. Other matters that influenced this report included. An Annual Quality Assurance Assessment completed by the home’s proposed manager in which she set out how she believed the home met and planned to exceed the National Minimum Standards (NMS) for Care Homes for Older People and evidence to support this. A “Dataset” containing information about the home’s staff team, and some of its managements systems and procedures. Information that the Commission for Social Care inspection had received since the last fieldwork visit made to the home on 6th February 2007, such as, complaints and statutory notices about incidents/accidents that had occurred. It was apparent that during the 11 months since the last key inspection of the home that was completed in February 2007 that the company that owned it continued to strive to improve the standard of the service that it provided. Further changes to the environment had been carried out, new policies and procedures had been implemented and documentation included in the homes system for recording important information. The opportunities for people living in the home to participate in organised activities including using amenities in the local community had been increased due to the employment by the company/organisation that owned the home of a permanent driver for a Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 6 minibus used by the home and the purchase of an another vehicle that could convey one wheelchair user. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 7 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. Dunwood Manor Nursing Home DS0000011422.V355448.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 Dunwood Manor Nursing Home DS0000011422.V355448.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): 3 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 and their relatives/representatives were confident that the home could meet their needs. This was because the help that individuals required was identified before they moved in to ensure that the level of support and care they required could be provided. EVIDENCE: A sample of the records of 4 residents was examined including those concerned with the actions that the home took to identify the help and assistance that people needed. The homes AQQA included the following statements about how information was obtained about the needs of people who either wished to move into the home or for whom such arrangements were made: “Each service user has an individualised pre-admission assessment to ascertain whether the home can meet their needs and questions and queries about the home invited. Each service user is given the opportunity to visit the home and spend some time within the home before a decision is made. Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 10 The home offers a three months settling in period and then both parties are able to reassess the placement. The care home ensures an individualised package of care is planned, implemented and evaluated from pre-admission through out the service users stay”. As on the last key inspection of the home on 6th February 2007 there was also evidence on this occasion from the documents examined and also discussion where possible with people living in the home and or their relatives that the admissions to the home of the individuals concerned had all been planned with staff with the appropriate knowledge and skills. The home’s proposed manager said: • “I go out and see them before they come in. The majority of people are in hospital, but I have seen some people in their own homes”. Where a person had moved into the home through arrangements made by the adults services department of a local authority the home obtained written information about the needs of the individual concerned from the relevant care manager involved with that person. The home’s pre-admission assessments were complemented by more thorough and comprehensive assessments of a resident’s needs when they actually moved into the home. Comments from individuals spoken to about the process referred to above included: • “I remember her coming to visit me when I was in hospital”. There was documentary evidence that assessments of residents needs were reviewed at least monthly and revised as necessary when an individual’s circumstances had changed. The home does not provide intermediate care Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People’s health, personal and social care needs were met. The home had plans of care that individuals, or someone close to them, had been involved in making. People unable to manage their own medication were supported by the home to manage it in a safe way. Individuals’ right to privacy was respected and the support they got from staff was given in a way that maintained their dignity. EVIDENCE: The care plans were examined of the same sample of 4 residents as in the section above i.e. “Choice of Home”. Among the sample were individuals who among other things were: • Receiving treatment to a wound caused by an injury/trauma • Fitted with catheters • Receiving their nutrition through peg feeds The documents examined were comprehensive and the plans were based on the assessments that the home carried out in order to identify what help the individuals needed. Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 12 Assessments included a range of potential risks to residents e.g. pressure sores; falls; moving and handling; malnutrition; etc. Where a pressure sore assessment indicated that an individual was at risk it was noted that the corresponding plan of care identified how this would be addressed e.g. the use a pressure relieving aid e.g. air-bed, and/or turning regime. The plans examined also set out the actions staff had to take and what specialist equipment was needed to provide the support and assistance each person required. There were specific plans for the management of catheters, peg feeding and also about the capacity to make decisions where these particular matters were relevant. These specific plans had been introduced or/and amended and improved since the last key inspection. There were also clear night care plans in place that included more detail than had been available on previous inspections. Where the care plans examined referred to the use of equipment or how a specific need was to be met this was observed to be available, provided or in place e.g. Zimmer frame; assistance with feeding. Moving and handling care plans described the specific equipment needed to transfer a person e.g. hoist and sling, slide sheet, or “Standaid”. These were all seen to be readily available. There was evidence from documentation and discussion with individuals and their representatives that wherever possible they and/or their representatives had been involved in developing the plans and had agreed with the contents. They also indicated that they were involved in regular reviews of the plans. The plans of care were kept in the bedrooms of the person concerned and included brief individual summaries of the help that the individual needed and where relevant how they communicated e.g. “will use non-verbal signs”. This enabled staff who were unfamiliar with the person concerned to quickly obtain information about the most important aspects of the care the person required. Records indicated that risk assessments and care plans were reviewed at least monthly and daily notes referred to the actions taken by staff to provide the needs set out in those plans. Staff spoken to knew the needs of the individuals whose records were sampled and they were able to describe the contents of the care plans. Comments from people living in the home and relatives/representatives about the abilities of staff the care and support that they provided included: • “They treat me like a princess, they are so kind. I would not want to go anywhere else …”. Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 13 • “I have been here 12 months. I am looked after very well. The nurses are very nice. Nothing is too much trouble for them”. Responses in questionnaires returned by people living in the home indicated that 60 believed that they always received the care and support that they needed and 20 usually. Responses in questionnaires returned by relatives/representatives of people living in the home indicated that 100 believed that the home either always or usually met the needs of the their friend/relative. Comments from this group of people included the following: • • • • “This is an excellent service for a handicapped person like my brother”. “My sister is always well cared for and clean. They try to find food that she likes and they feed her well”. “Dad is treated in a dignified way and my questions or requests are always dealt with quickly and competently”. “They look after Y’s diabetic needs well”. Care plans examined were not simply task focussed. They were person centred and addressed and included many references to the fundamental principles that underpin social and health care such as independence, privacy, dignity and choice. Entries in plans illustrating this included the following: • • • • “Needs full assistance but is able to make a decision about what she wants to wear”. “Likes to go to bed about 10:00 p.m.”. “Involve P in all decisions about every day life”. “Likes to shower or bath at least twice a week … maintain dignity at all times”. The records examined indicated that a range of healthcare professionals visited the home and that arrangements were made for treatment for service users when it was necessary. Individuals and relatives said that people received treatment from among others, doctors, podiatrists and opticians. Responses in questionnaires returned by people living in the home indicated that 85 thought that they either always or usually received the medical support that they required. Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 14 The relative of one person living in the home said: • “On at least two occasions my daughter has been very ill and staff swung into action straight away and they arranged for her to be transferred to hospital”. Two local surgeries with patients accommodated at the home held surgeries at the home at least weekly. The views of health care professionals about their relationship with the home and the competence and attitude of the staff in questionnaires returned to us and comments arising from discussion during the site visit were all positive. A visiting health care professional said: “I see everyone in their rooms, or the home’s treatment room. The staff will always help me if I need it. They are very supportive. I try to see everyone here at least every 6 to 8 weeks. A relative of my wife is a resident here and my wife is very happy with her treatment”. There was documentary evidence that when an individual had a wound/pressure sore that specific plans were implemented to manage the wound and monitor progress with healing. The director of care employed by the company that owned the home carried out regular audits of wounds being managed in the home. Specific plans were implemented when weight loss or eating difficulties had been identified as a problem for an individual and records were kept of their food and fluid intake and if the difficulty persisted advice and support was sought from the doctor of the person concerned. The home also obtained advice from speech and language therapist when this was required if someone had swallowing difficulties. The home’s proposed manager said that where specialist help or advice was needed this was obtained from among others: community psychiatric nurses; stoma nurses; nurses specialising in Huntingdon’s Chorea and Parkinson’s disease. The company that owned the home had a hydrotherapy pool in the grounds in which the home was situated and if prescribed for them individuals could benefit from treatment provided by remedial therapists employed by the company. It was apparent from training records seen and discussion that nursing and where appropriate health care assistants in the home had attended training in a range of clinical subjects/areas such as venapuncture, catheter care, male catheterisation and wound care. The home had written policies and procedures concerned with the management and administration of medication. Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 15 Medication was kept in locked and secured medicine trolleys, cupboards and where required in a medical refrigerator. Controlled drugs were stored securely and appropriately. A sample audit of controlled drugs indicated that the records were accurate and up to date. The home’s system for giving out medication was based on doing so from original containers. The only staff in the home that gave it out and who were responsible for the management of medication on a day-to-day basis were registered nurses. During the site visit staff were observed giving out medication. An individual who had very recently obtained his registration to practice/work as a registered nurse in the United Kingdom was having his competence to manage medication being assessed by an experienced and senior member of the home’s nursing team. Records were kept of the receipt into the home, giving out (i.e. dispensing) of medicines and the appropriate destruction or return of unused or unwanted medication. All records seen at the time of the site visit were accurate, complete and up to date. Good practice noted during the fieldwork visit included: • • • • • Ready availability of recent reference material/information about medication Sample copies of the signatures of the Registered General Nurses that dispensed medication Some sedative medication was treated as if it was a controlled drug The dating of some medicine containers when they were opened. Protocols and related documentation/records about crushing medication when necessary and also the giving of medicines covertly The home had a policy and procedure promoting the rights of individuals to look after their own medication. At the time of the fieldwork visit however no person was managing all of his or her own medication. The importance of offering people the opportunity to do so based on an assessment of their ability/competence and recording the outcome of the assessment was part of a general discussion with the home’s proposed manager and the director of care about the implications of Mental Capacity Act 2005 and individuals rights. People spoken to during the site visit confirmed that staff promoted their privacy and dignity and were polite and respectful. All shared bedrooms that were viewed were provided with screens to help with ensuring that the privacy of its occupants could be maintained. The number of single rooms in the home had been increased since the last key inspection of the home had been completed on 6th February 2007 from 34 to 37. Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 16 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. People living in the home were able to choose their own life style, social activities and maintain contact with families and fiends. Social, cultural and recreational activities generally met individuals’ expectations. The food provided was healthy, varied and nutritious and according to the choices and preferences of those living in the home. EVIDENCE: The home employed activities organisers and people spoken to said that they enjoyed the opportunity to participate in a range of organised activities. “I don’t do a lot as I am a lazy lump. Some went out to Romsey this morning. We go to the theatre. They can take us in wheelchairs”. Responses in questionnaires returned to us by people living in the home indicated that 20 of the respondents did not want to join in organised activities and of the rest 50 thought that there were always or usually activities arranged that they could take part in and 30 sometimes. On the day of the site visit a small group had gone out in a minibus owned by the company that owned the home to go shopping and visit a local garden centre. Individuals spoken to who were bedfast and who were unable to join in Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 17 activities indicated that activities organisers and staff spent time with them on an individual basis. There was an activities room in the home provided with soft furnishings and equipment that could provide sensory stimulation such as, lights and bubbles. This was used with individuals with communication and learning difficulties or cognitive impairments who were unable to participate meaningfully in other organised group activities. One relative commented: • “They try to stimulate him to try things even though he is unable to do much” There were materials in the home that were used to promote activities e.g. board games, art and craft material, books from a visiting library, CDS and DVDs and videos. Photographs and displays in the home illustrated the special events/occasions that had taken place e.g. visits to: Southampton Football Club matches and local places of interest and social events such as Christmas celebrations. The home’s AQAA also included information about the activities that the home arranged indicating that theme days were organised and outside entertainers visited the home. A local adult education college provided term time courses at the home in a range of subjects. The home’s proposed manager said that the home’s budget included a monthly sum to be spent on materials and equipment used to help promote social and leisure activities. People living in the home spoken to confirmed that local clergy visited the home regularly to conduct services. Individuals said that there were no rigid routines in the home and that they free to do as they want and get up and go to bed as they wished. Individuals’ preferences about a range of matters concerned with their lifestyle were noted in their plans of care. Two visitors spoken to during the site visit commented about the opportunities for people to participate in social activities. • • “They have outings and there seems to be a lot of entertainment here”. “I visit everyday ... there are a lot of organised activities and when she was more mobile she could take part in them, there is a great deal of freedom to do what she wants” People living in the home and visitors that were spoken to during the site visit confirmed that there were no restrictions concerned with visiting the home. Individuals visiting the home also said that that they were always made welcome. Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 18 There was a range of information available in the entrance to the hall about organisations that could provide independent advice to people living in the home and/or their relatives including information about the Independent Mental Capacity Advocate service (IMCA). The home’s AQAA stated, “The home will accommodate as much as possible of service users personal possessions which they wish to bring with them to the home”. During a tour of the building a number of rooms were seen including some that had been very personalised as a result of the presence of items of furniture and the personal belongings of the individuals’ accommodated. At the time of the site visit no one living at the home was managing their own financial affairs and one of the company directors of the organisation that owned the home was the signatory for the benefits of a number of people living in the home. Appropriate records were kept of any transaction made on behalf of anyone in such circumstances and of any money that the home looked after on behalf of or for people living in the home. Sensitive information that the home held about individuals was kept secure and the home had written policies and procedures about maintaining confidentiality and the right of people living in the home to access their personal files and case notes. The menus and records of food provided indicated that the food was nutritious and there was a wide range of meals provided. Individuals’ food preferences, dislikes, food related allergies and their nutritional and dietary requirements were recorded in their care plans and that information was also readily available in the home’s kitchen. Special diets and individual and special needs were catered for e.g. soft and pureed meals and diabetic. Responses from people living in the home canvassed for their views before the site visit about the food the home provided indicated, that 45 always liked the meals in the home, 25 usually and 10 sometimes and the rest of the respondents were unable to comment as they had peg feeds. One comment in a questionnaire about the food was “fantastic”. Individuals spoken to at the time of the site visit were all very positive about the food provided and confirmed that they had 3 meals a day and could have snacks and drinks at any time. They also indicated that they were asked in advance what they wanted from the choice of meals provided. • • “First thing in the morning they come and ask me what I want. It is always beautifully cooked. I had the beef today”. “The food has been excellent”. DS0000011422.V355448.R01.S.doc Version 5.2 Page 19 Dunwood Manor Nursing Home On the day of the inspection the main meal of the day included chicken casserole or beef stroganoff or a vegetarian option served with fresh vegetables. Staff were observed helping those individuals that required help and support at meal times they were sensitive and patient and people were not hurried and given plenty of time to finish their meals comfortably. Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 20 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. The home had a clear and satisfactory complaints procedure to address the concerns of residents and relatives/representatives. Robust procedures were in place to protect service users from the risk of abuse. EVIDENCE: The home’s complaints procedure was included in the Service Users guide that was provided to every person when they moved into the home and there was a copy in every bedroom. The director of care employed by the organisation said that the procedure was produced in a format suitable for people with poor or limited vision by using coloured paper and that the home was looking into other suitable alternative formats to address individuals’ needs e.g. audio tape. Responses in questionnaires received from people living in the home and relatives/representatives indicated that of the former 95 and 87 of the latter knew what to do and who to speak to if they had any concerns. People living in the home spoken to during the site visit indicated that they had confidence in raising any concerns with either the home’s manager or any senior member of staff. One relative said: • “What problems we have had have been quickly and efficiently resolved”. A record of complaints made to the home was kept that detailed the issue, and set out any agreed action to remedy the matter and its outcome. There had been 1 complaint made to the home in the previous 12 months. It was Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 21 apparent from the details kept by the home that it had been resolved satisfactorily. During the same period we received no complaints about the home. The home had written procedures available concerned with safeguarding vulnerable adults. These were intended to provide guidance and ensure as far as reasonably possible that the risk of people living in the home suffering harm was prevented. They included: • Abuse • Whistle blowing • Relationships • Racial harassment • Privacy and dignity • Physical restraint Staff spoken to said that they received training about protecting vulnerable adults and an examination of staff training records confirmed this. They were also able to demonstrate an awareness of the different types of abuse and the action they would take if they suspected or knew that it had occurred. The home’s proposed manager had responded proactively when a person living ther had alleged that she had been injured because of the actions of a member of staff. The local authority had been contacted in order that the necessary safeguarding vulnerable adults investigation could be carried out. Appropriate action was taken by the home including the implementation of new procedures for night care staff. Where subsequent to a risk assessment it was considered necessary for some form of limitation to be imposed on the actions of an individual e.g. restrict movement to prevent falls (by installing bedrails). Written permission/consent was obtained from all interested parties including the individual concerned where they understood the need for such preventative measures to be taken. The use of such restraint was reviewed regularly. Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 22 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 environment was comfortable, safe and well maintained. More improvements could be made to enhance equality and diversity by further addressing idividuals’ specific needs. The home’s procedures and staff practice ensured that as far was reasonably possible residents were protected from the risk of infection. EVIDENCE: At the time of the fieldwork visit the exterior and interior of the premises, its décor, furnishings, fittings and equipment were in good repair. There was also no unpleasant odour anywhere in the building. The company that owned the home employed a team of maintenance personnel and at the time of the site visit some were redecorating a corridor on the first floor of the building. It was apparent from observation and previous knowledge of the home that several areas of the home had been redecorated and improved including a Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 23 lounge and a number of bedrooms. A programme of installing suitable locks on all bedroom doors had also been completed. New carpet had been laid in some of the shared/communal rooms. Due to the configuration of accommodation it had been possible to increase the number of single bedrooms from 34 to 37. This refurbished single bedroom accommodation had been provided with en suite WCs. These improvements had helped to further promote the dignity and privacy of the people living in the home. The home’s communal area comprised 2 separate lounges, a dining room and an activities room. There were extensive grounds surrounding the home and immediately outside one lounge was a large patio area and pathways. A small ramp provided wheelchair access to this area. The company’s director of care said it was the intention to improve the outside area in the near future. There was a range of types of assisted bathing facilities including a wet rooms/shower. Hoists, slide sheets and other suitable equipment was readily available for transferring and assisting people with poor mobility and weight bearing difficulties. There were suitable grab rails installed in WCs. Specialist chairs had been provided/made available for use to meet the needs of some individuals. There was some discussion about some features that could enhance the independence of people living in the home such as the installation of a loop system in communal areas. Also colour schemes and symbols to facilitate orientation for individuals with memory impairments. The care director for the company that owned the home indicated that such ideas would be given serious consideration to help address matters of equality and diversity. Responses from people living in the home who were canvassed for their views indicated that 85 thought that the home was always “fresh and clean”. Comments from visitors to the home including a health care professional about the cleanliness of the home were all positive and included: • “I have seen them cleaning the tops of wardrobes, which is not something I have seen elsewhere”. The home had comprehensive procedures in place concerned with infection control and the home’s AQAA stated: “We use the Department of Health Guide “Essential Steps” to assess the homes infection control management. We have updated policies on protective clothing and hand washing”. It was noted that in accordance with best practice all communal WCs that were seen were provided with liquid soap dispensers (that were full and working) Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 24 and paper towels. Protective clothing was readily available and staff were observed using gloves and aprons appropriately. The home’s laundry was appropriately sited and equipped and effective procedures were in place for the management of soiled laundry items Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People had safe and appropriate support as there were enough competent staff on duty at all times. They had confidence in the staff at the home because checks had been done to make sure that they are suitable to care for them. Peoples’ needs were met and they were cared for by staff who had relevant training and support from their managers. EVIDENCE: The care team working in the home comprised, 9 registered nurses and 18 health care assistants. Out of the latter 11 (i.e. 61 ) had a qualification equivalent to at least National Vocational Qualification (NVQ) at level 2 and a further 1 was working towards the qualification. The home’s proposed manager said that another 2 staff would soon complete 3 years residency in the United Kingdom which was essential criteria before they could start NVQ training. A large number of the qualified health care assistants were registered nurses in their countries of origin. One had recently obtained his registration with the United Kingdom Nursing and Midwifery Council and was due to begin employment as a member of the home’s nursing team following satisfactory assessment of his competency to manage medication safely. The gender mix in the nursing and care staff team comprised 20 female and 7 male. Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 26 At the time of the fieldwork visit the care staff rota setting out the minimum number and skill mix deployed in the home was as follows: 08:00 to 14:00 2 8 10 14:00 to 20:00 2 6 8 20:00 to 08:00 2 3 5 Registered nurses Health Care Assistants Total The home’s proposed manager was supernumerary and she was not included on the care staff rota. Apart from registered nurses and health care assistants the home employed other staff such as; activities organisers; chefs and kitchen assistants; housekeepers/cleaners. It was also supported by the head office of the organisation that owned the home with functions such as Director of Care, finance, human resources, remedial therapy and maintenance. There was no indication from staff, visitors or people living in the home that staffing levels were other than sufficient and that the staff working there had the necessary skills and competence to carry out their roles. Comments about this included the following: • “They act as my husband’s advocate in my absence. He is no longer able to communicate verbally but they still give him quality of life within his limitations”. “They create a warm friendly atmosphere and environment and all staff are very good at listening to concerns that I have time to time with my relative”. “My daughter is looked after very well”. “They do a wonderful job”. “I think that there are sufficient of us to provide the help that the residents need”. “We have 8 carers and 2 nurses on in the morning. I think that is enough”. • • • • • Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 27 • “The man that sees to my care is excellent, somebody gives me a bath or shower and they are all nice. You cannot expect everyone to be nice but they are”. At the last inspection of the home on 6th February 2007 it was noted that evidence that all the necessary pre-employment checks had been completed was not available for one new member of staff. On this occasion the records were examined of 4 staff that had been employed to work in the home since the last fieldwork visit to the establishment referred to above. It was apparent that all the necessary pre-employment checks to ensure among other things that they were suitable to work with vulnerable adults had been completed before they had started work in the home. All new staff received comprehensive induction training and health care assistants completed a common induction standards programme that satisfied the requirements of the training body for the social care workforce i.e. Skills for Care (previously the Training Organisation for Personal Social Services [TOPSS]). Staff training needs were identified through appraisals and individual supervision sessions and documentary evidence of regular supervision was seen. Staff spoken to confirmed that they participated in regular individual and clinical supervision sessions. The home’s proposed manager kept a central record of all training that staff had completed and could identify readily the training needs or requirements of any individual in the home’s staff team. It was apparent from discussion with staff and examining relevant records kept in the home that staff had opportunities to develop new skills and the training courses that they attended were relevant for their work roles e.g. clinical training, and in subject areas such as Dementia Care. The responses in the one questionnaire returned by staff working in the home indicated that the respondent had received training relevant to their role and that it helped them understand the needs of people living in the home and kept them up to date with ways of working. The respondent also indicated that there were usually enough staff on duty to meet the needs of people living in the home. Comments from staff about these aspects aspect of their employment included: • “I have done moving and handling, first aid, health and safety, food hygiene, the principles of care, fire safety. I have watched video and had to complete a test about some of these things. I have stated NVQ now.” Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 28 • • “We can go to the nurses if we have any problems … we have clinical supervision about once a month and we have annual appraisals”. “ I started in November and I had 3 days induction and I have covered moving and handling, fire safety, special diets, role of the key-worker, prevention of abuse, infection control, pressure sore prevention and stress management”. Staff spoken to appeared well motivated and expressed enthusiasm about working in the home and working with their colleagues. They were all positive about the home’s management team. Two of the home’s registered nurses had been on placements at the home during their nurse training and subsequently returned to the home to work when they qualified. • “I love it. We have a really good team of people. They are very supportive and always help if there is a problem. I had a good induction I was assessed for medication competency and was supernumerary for a long time. I am doing mentor training at Salisbury Hospital”. The company that owned the home had a training programme for its staff that and the venue for training subjects rotated among the different homes that were all within reasonable travelling distance. The programme included not statutorily required health and safety subjects but other topics that were concerned with the needs of people living in the home such as “dementia care” and “equality and diversity”. In the home’s AQAA it stated that the home was affiliated with Bournemouth University and regularly had student nurses on placement. Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 29 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 home’s proposed manager provided effective leadership and among other things was promoting the needs of individuals and diversity and equality. There were systems and procedures in place for monitoring and maintaining the quality of the service provided, supporting staff and promoting the safety and welfare of everyone living and working in the home EVIDENCE: The home’s proposed manager had been in her post and responsible for the day-to-day operation of it for almost some 8 months and had successfully completed the probation period required by the company that owned the home. An application was being prepared to submit to us in order for us to consider her “fitness” to be formally registered as the manager of the home. Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 30 A registered nurse since 1992 the proposed manager had worked for 11 years in another nursing home and been responsible for its day-to-day management for 5 years. Prior to taking up her post at Dunwood Manor she had managed a Children’s’ Home for 18 months. She obtained a relevant qualification in 2005 that indicated that she has the knowledge and experience to manage a care home i.e. the Registered managers Award. From discussion with the proposed and from observation and discussion with staff, people living in the home and visitors it was evident that among other things she was; knowledgeable; organised; sensitive; enthusiastic; approachable; popular and responsive. Comments from staff about the proposed manager all contained the common description of her as “lovely”. • • • “ … She is easy to talk to … nice with the residents …”. “ … She is approachable …”. “ … She is brilliant, very supportive and easy to get along with … K the deputy is brilliant as well …”. Comments from others about the general management of the home included: • • “The structure of the home’s management works well from their team approach”. “ The matron and deputy matron are extremely good and there is a marked willingness to comply with requests that may be out of the ordinary”. The home had systems in place for monitoring the quality of the service that it provided that included the regular use of questionnaires to obtain the views of people living in the home and other interested parties. The outcomes were published and included in the home’s Service users Guide that was made available to people interested in living in the home. The director of care carried out regular audits of the home’s management systems e.g. care plans; medication system and records; wound care plans. Meetings were held to enable the views of people living in the home and their relatives to influence day to day life in the home. As a result a regular hymn service had been implemented. A dedicated minibus driver had also been employed to ensure that regular outings could take place. There were a range of written of policies and procedures available that helped inform staff working practice. There was evidence that they were reviewed and amended, updated or added to as necessary. Among recently introduced Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 31 policies and procedures was “Advocacy”, with particular reference to the Mental Capacity Act 2005. The standard and quality of the service that the home provided may be reflected in the comments of people living in the home and relatives of individuals accommodated there that were included in questionnaires. • • • • • “Everything seems to be going smoothly”. “It is a lot better than the last place I was in”. The food is good and the bed is very comfortable”. “It makes residents feel happy and secure, the food is good, second to none”. “From the start my husband has been content. On the few occasions that we have brought him home he has wanted to go back because he feels secure there”. A comment in the one questionnaire returned by a member of staff working in the home was: • “I would happily place a resident of mine here”. The only negative comments concerned the loss of some clothing in the laundry and observations about some communication difficulty on occasions with staff whose first language was not English. The home provided support for individuals whose first and most important requirement was nursing care. This was often complicated by additional and complex needs such as physical impairment arising from different causes, and matters such as sensory impairment, learning difficulties and dementia. The home promoted person centred individualised care and attempted to ensure that this was applied though among other things, continually adapting the premises and installing appropriate equipment, staff training, relevant and stimulating organised activities for groups and individuals and guidance and information set out in its policies and procedures. In the home’s AQAA the following statements set out how they ensured equality and diversity was promoted and incorporated into day-to-day life in the home: • Policies and procedures adopted within the care home. • Religious needs can be met through the local community. Communion and hymn services are held in the home. With regular access to mini-bus service users will be able to attend local churches Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 32 • • • • We pride ourselves on having a mixed workforce with members of the team coming from various countries Annual review of policies and procedures. Feedback from service users acted upon. Annual staff survey and where appropriate feedback acted upon. It also stated: “When a service user does not want to manage their finances or do not have the capacity to do so we can offer to manage finances in the best interest of the user and encourage a service user to appoint a lasting power of attorney”. The records of money looked after for or on behalf of people were clear and included any transaction made on their behalf and individuals were provided with a monthly statement of their account and people could access information about their account at any time. Records examined indicated that the home’s equipment, plant and systems were checked and serviced or implemented at appropriate intervals i.e. passenger lift and hoists; fire safety equipment portable electrical equipment; hot water system; etc. There were contracts in place for the disposal of clinical and household waste. Records were kept of accidents Staff spoken to said and records examined confirmed that that they attended regular and compulsory fire and other health and safety training. There was a fire risk assessment for the premises and for each individual accommodated in the home. Regular risk assessments were completed of the premises and staff working practices. Matters requiring remedial action that had been identified by a local environmental health officer’s report of July 2007 had all been properly addressed. There were hoists, and other equipment available in the home that helped to promote safe working. Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 33 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 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 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 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 34 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. Standard Regulation Requirement Timescale for action 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 Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Kent ME16 9NT 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 Dunwood Manor Nursing Home DS0000011422.V355448.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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