Inspection on 07/09/05 for Dunwood Manor Nursing Home

This inspection was carried out on 7th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 03/01/08

Dunwood Manor Nursing Home 06/02/07

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 Centre Sherfield English Romsey Hampshire SO51 6FD Lead Inspector Tim Inkson Unannounced 7 September 2005 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dunwood Manor Nursing Centre H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Dunwood Manor Nursing Centre Address Sherfield English Romsey Hampshire SO51 6FD 01794 513033 01794 519700 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Sentinel Health Care Ltd To be confirmed CRH 52 Category(ies) of DE(E) Dementia - over 65 - 2 registration, with number OP Old age - 52 of places PD Physical disability - 25 PD(E) Physical dis - over 65 - 52 TI Terminally ill - 25 TI(E) Terminally ill - 52 Dunwood Manor Nursing Centre H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: A total of 25 service users may be accommodated at any one time in the categories of PD and TI between the ages of 18 - 65 years. Date of last inspection 26.04.05 Brief Description of the Service: The home is owned by Sentinel Healthcare Ltd (the company) and is one of four homes that they own in the locality. Dunwood Manor is a large Victorian country house and was converted for use as a nursing home. It is set in extensive grounds with panoramic views of the surrounding countryside. It is located in Sherfield English within easy reach of the market town of Romsey. The home benefits from a mini-bus service. The building has 2 storeys and has been improved and refurbished over time. The east wing was extended and some accommodation upgraded in 2004. Adjacent to Dunwood Manor and on the same site is the sister care home, Waverley Lodge Nursing Home. Dunwood Manor is registered to accommodate 52 service users who require nursing care. It has 34 single and 9 double bedrooms, and 19 bedrooms benefit from ensuite facilities. The communal facilities comprise 3 lounges and a separate dining room. Other facilities include assisted baths, a laundry and full board. There is also a hydrotherapy pool in the grounds of the home and the resource is available to all service users and also to service users from 3 other nursing homes in the area also owned by Sentinel Healthcare Ltd. Dunwood Manor Nursing Centre H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the second of two inspections of the home that must be undertaken every 12 months. It started at 09:10 hours and finished at 16:30 hours. The inspection procedure included looking at some of the premises including a sample of 8 bedrooms to view their furnishings and equipment. It also included an examination of some documents and records, observation of staff practices where this was possible without being intrusive and discussion with residents (11) and their visitors/representatives (2), staff (4) and visiting health care professionals (2). At the time of the inspection the home was accommodating 51 residents with one of those in hospital at the time, of these 17 were male and 34 were female and their ages ranged from 25 to 99 years and 19 of the home’s residents were aged between 18 and 65 years. There was no registered manager in post as Sentinel Healthcare Ltd (the company) had been attempting to recruit a suitable individual since the resignation of the last manager in May 2005. The home’s deputy manager and the company’s operations manager were both present throughout the day to provide assistance and information when required. What the service does well: What has improved since the last inspection? Internal alterations in the home had resulted in better staff facilities. Dunwood Manor Nursing Centre H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 Page 6 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. Dunwood Manor Nursing Centre H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Dunwood Manor Nursing Centre H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The home’s systems and procedures for assessing the needs of potential and existing residents were good. EVIDENCE: The records of 4 residents were examined and these included copies of detailed assessments that the home had arranged of the needs of the individuals concerned. As at the last inspection of the home on 26th April 2005 it was apparent from discussion with residents and the documents examined that the needs of a potential resident were identified by the home before the person moved in and the home also wrote to the person to confirm that the home could meet their needs. A range of nationally recognised assessment tools were used by the home to highlight the likelihood of problems or specific needs. These were linked to plans that were devised to enable the home’s staff to provide the help each resident needed (see page 11). The assessments included: • “Waterlow”– to identify the risk of pressure sores H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 Page 9 Dunwood Manor Nursing Centre • • • • • Royal College of Nursing Assessment of Activities of Daily Living Moving and handling Nutrition Risk of falls Basic observations i.e. blood pressure; temperature and weight. All assessments were reviewed monthly. Dunwood Manor Nursing Centre H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 9 and 11 There were good plans of care in place that ensured that residents received the help and support that they needed. Procedures and systems for the administration of medication and management of death and dying were good. EVIDENCE: As at the last inspection of the home on 26th April 2005 the care plans of 4 service users were examined. The documents were detailed and the plans were based on the assessments the home carried out in order to identify what help individuals needed. The plans set out clearly the actions staff had to take and where necessary what equipment was needed to provide the support and assistance each person required. Discussion with service users and staff and observation confirmed that the help service users received was in accordance with their plans of care. There was evidence from the documents and discussion with residents and a visiting relative that individuals and/or their representatives were involved in developing their care plans. • “I look at her care plan and take note of it, they review it every month” (relative). • “I know what is in my plan and they do what is needed” (resident). Dunwood Manor Nursing Centre H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 Page 11 At the time of the inspection a pharmacist from the South Wiltshire Primary Care Trust was visiting the home to review the prescribed medication for a number of residents registered with a local surgery. She said that he role was also to provide support and advice to the home at the conclusion of her review said that in her opinion the home’s medication administration systems and procedures were some of the best she had seen. The home had three lockable and secured trolleys in which medicines were stored. There was also a separate and suitable secure storage cupboard for controlled drugs. A record of the controlled drugs being administered in the home was kept and the balance of a sample of medication was checked and the relevant record was accurate. The home had written polices and procedures concerned with the management of medication and these included: • Control of drugs and medicines • Domestic and homely remedies • Self-administration of medicines • Drug error There was a copy of The Royal Pharmaceutical Society’s Guidance about the administration of drugs in care homes on each of the medicine trolleys and also specimen signatures of all the staff responsible for administering medication. Registered nurses administered medication and the deputy manager said that before they were able to do this their competence was assessed. At the time of the inspection there were no residents administering their own medication but the home’s deputy manager said that if an individual was able to do so and wanted to that this would be arranged. Records were kept of the administration of medicines and they were complete and up to date. The home had made appropriate arrangements for the disposal of unwanted and unused medicines as required by recent changes in legislation. The records of 2 recently deceased residents were examined. It was apparent from the details recorded in the daily notes for the individuals concerned that the home ensured that the staff were sensitive to the needs of terminally ill residents and that the comfort and dignity of residents who were terminally ill was a priority. The home’s deputy manager said that advice and support for managing death and dying was achieved through among other things, regular “link meetings” with the palliative care team from a local hospice. She also said that registered nurses attended relevant training on matters such as pain control and “I have never known someone to die on their own, someone is always allocated to be with them and a lot will have their family with them”. A quantity of information leaflets about bereavement were observed in the office used by the home’s deputy manager and she said these were being made available for all staff and residents. Dunwood Manor Nursing Centre H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14 The home had good procedures for enabling residents to exercise selfdetermination. EVIDENCE: A number of residents managed their own finances but the financial affairs of most residents were managed by their relatives or advocates. One resident said: • “I used to work in a bank years ago, my money is paid into my bank and I pay the home directly. When I can’t manage my brother will do it for me” Another said: “My dad looks after my money”. The home’s deputy manager said that if residents needed independent advice or advocacy that the home would support individuals to contact appropriate organisations or agencies. It was suggested that the home should make information about advocacy services readily available to enable residents that were able to do so to contact any such services directly. One relative said: • “Some while ago X advocacy services used to come and visit my daughter”. Dunwood Manor Nursing Centre H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 Page 13 A number of bedrooms were viewed and it was apparent from both observation and discussion with residents that residents were able to bring their personal possessions into the home. Some rooms had been personalised by various items including ornaments and/or furniture. One resident said: • “I have my own bed and a fridge for keeping food in”. A number of residents spoken to were aware that they could see records that the home kept about them. The home had a written policy and procedure about “access to personal files” and the plans of care for each resident was available to them in their bedrooms. Dunwood Manor Nursing Centre H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 17 The home had satisfactory systems for managing residents concerns and ensuring that residents could exercise their legal rights. EVIDENCE: As at the previous inspection of the home on 26th April 2005, the home’s complaints procedure was readily accessible to residents in the home’s Service Users Guide, a copy of which was in every bedroom. Residents spoken to expressed confidence in raising any concerns with the home’s or company’s management representatives. • “If I was unhappy I would speak to “the operations director” (resident). The home kept records of complaints and 3 had been made to the home since the last inspection. All had been resolved satisfactorily. There had been no complaints made to the Commission for Social Care Inspection (CSCI) about the home during that period. On the day of the inspection the home had received documentation for registering residents on the electoral roll. The deputy manager said that she was going to update the information and ask all residents if they wanted to benefit from the ability to vote by post. Several residents spoken to indicated that they could vote in elections but chose not to do so. Dunwood Manor Nursing Centre H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 26 The home’s bedroom accommodation generally comfortable, well furnished and suitable for service users needs. There were good systems and procedures to ensure the premises were clean and hygienic. EVIDENCE: Most bedrooms that were seen (8) were equipped and furnished to the expectations set out in the National Minimum Standards for Care Homes for Older People. The condition and appearance of some items of furniture in a few rooms was poor. Lockable storage space was not available for all residents but where this was requested it was provided. The home had in place a rolling and continuous programme of improvement and upgrading with existing shared rooms being converted to single use when the opportunity arose and the accommodation then being completely refurbished. When the programme is complete all bedrooms will have matching furniture of a good standard including lockable bedside cabinets unless a resident chooses to provide their own. Dunwood Manor Nursing Centre H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 Page 16 All shared bedrooms were provided with screening to provide privacy. All bedrooms were fitted with carpets and all their doors were fitted with suitable locks. Adjustable beds were provided for residents receiving nursing care. Comments from residents and visitors about bedroom accommodation included the following: • “I think my room is nice, its quite spacious”(resident). • “The southern aspect is really nice”(visitor). • “The view from here is lovely”(resident). • “There is nothing wrong with the room”(resident). As at the last inspection of the home on 26th April 2005, the building was clean, hygienic and free from offensive odours. At the time of this inspection house-keeping staff were observed undertaking cleaning tasks and all staff observed during the inspection were seen to be using protective clothing appropriately. There were a range of policies and procedures concerned with infection control these included: • Clinical waste • Spillage of bodily fluids • Laundry health and safety There were sluice disinfectors located on both floors of the home. Residents said the home was kept clean and comments about the cleanliness of the home included: • “The cleaners come into my room every day and it’s kept nice and clean”. The home’s laundry facilities were appropriately sited and equipped. The laundry was in another home owned by the company that is located on the same site as Dunwood Manor. Dunwood Manor Nursing Centre H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 Recruitment procedures for new staff were satisfactory ensuring the protection of residents. EVIDENCE: Records of staff that had been employed in the home since the last inspection on 26th April 2005 were examined. There was evidence that all the required pre-employment information and checks had been obtained and carried out properly before they started work e.g. references, enhanced criminal records bureau certificates and work permits. Dunwood Manor Nursing Centre H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 37 and 38 The home had good systems and procedures in place for monitoring and maintaining the quality of the service it provided, keeping statutorily required records properly and ensuring that the living and working environment was safe. EVIDENCE: The home had a written policy about monitoring the quality of the service it provided. The way this was done included: 1. Audits of some of the documentation and staff practices in the home e.g. medication records and care plans. Records of audits indicated that omissions had been identified and action to remedy these or improve working practices had been identified and implemented. 2. Surveys of residents, relatives and staff had been conducted by the company to obtain their views. The results were being collated at the company’s head office and the results would be published. Similar surveys had been done some 18 months before. Dunwood Manor Nursing Centre H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 Page 19 3. The company’s operations manager visited the home at least monthly under Regulation 26 of the Care Homes Regulations 2001 in order to complete a report about “the conduct of the home”. While doing these visits she had spoken with residents and their representatives and staff to get their opinions about the care provided in the home. Copies of these reports were kept in the home and also sent to the CSCI. The home had a range of written policies and procedures copies of which were kept in the home’s nurses’ station/office and were readily available. Staff spoken to said that they were helpful and could be referred to for guidance and that they informed their practice. The policies and procedures were reviewed regularly and updated as necessary. The following statutory records were seen during this inspection and all were complete and up to date. • The Service Users Guide • Reports made under Regulation 26 of the Care Homes Regulations • Records of staff employed in the home • Complaints • Accidents and incidents • Fire practices and drills and testing of fire safety equipment There was evidence from both discussions and records that all staff working in the home had received regular training in health and safety subjects that were relevant to their role in the home. These included first aid, fire safety, food hygiene, moving and handling, infection control and control of substances hazardous to health. Records also indicated that systems and equipment in the home were tested and serviced at intervals and with the frequencies either required according to relevant regulations or good practice. These included: • Fire safety equipment • Electrical wiring • Boilers and central heating • Nurse call system • Portable electrical appliances • Hoists and slings • Clinical equipment – e.g. fridge; suction pump; nebuliser • Lifts • Hot water systems –(tested for temperature and the presence of legionella). A report from an inspection by the local environmental health officer on 2nd June 2005 was seen and it stated that all catering areas had been inspected, including; records of food hygiene training; evidence of pest control; cleaning schedule; and temperature control procedures. No action had to be taken by the home as a result of the inspection. Dunwood Manor Nursing Centre H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 Page 20 Risk assessments had been completed for all working practices in the home. Potential hazards had been identified and measures that had been implemented to reduce or eliminate some risks included the installation of radiator guards and restrictors on windows above the ground floor. Some internal alterations to the building had resulted in working conditions being improved for staff. The old staff room on the first floor of the home had been converted to a nurses’ station/office. It was close to residents accommodation and accessible to staff. Former staff accommodation on the second floor of the home had been converted to a much larger and comfortable staff room with an adjoining kitchen and a training/conference room. Dunwood Manor Nursing Centre H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION x x x x x 3 x 3 STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x x x 3 x x x 3 3 Dunwood Manor Nursing Centre H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 Page 22 N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 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. 1. Refer to Standard Good Practice Recommendations Dunwood Manor Nursing Centre H54 S11422 Dunwood Manor V246220 070905.doc Version 1.40 Page 23 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton Hampshire, SO15 1GW National Enquiry Line: 0845 015 0120 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. 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