CARE HOMES FOR OLDER PEOPLE
Durban House Nursing Home Woodley Lane Romsey Hampshire S051 7JL Lead Inspector
Anita Tengnah Unannounced 01/6/05 10.00am 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. Durban House Nursing Home H54 S60803 Durban House V230315 010605.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Durban House Nursing Home Address Woodley Road, Romsey, Hampshire, S051 7JL 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) 02089 540239 J Sai Group Limited Miss Belinda Jane McClatchey CRH 33 Category(ies) of OP- Old Age: 33 registration, with number PD- Physical Disability: 6 of places PD(E)- Physical Disability over the age of 65 years: 33 TI- Terminally Ill: 6 TI(E)- Terminally Ill: 33 Durban House Nursing Home H54 S60803 Durban House V230315 010605.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1- No more than 6 beds may be used at any one time for sevice users in the category PD between 50-63 years of age. 2- No more than 6 beds may be used at any one time for service users in the category of TI between 50-65 of age. Date of last inspection 17/1/2005 Brief Description of the Service: Durban House is aregistered care home providing nursing and personal care to 33 service users in the older person catgory. The home is situated in a residential area in the village of Romsey on the outskirt of Southampton. Accommodation is provided on two floors with passenger lift and chair lift that allows access to all parts of the home. The manager is aware that certain part may not be fully accessible to wheelchair users and take this into consideration prior to admission. There are five shared rooms and the rest are single with wash hand basin or en suite facilities . There are a variety of aids and adaptations that are available to maintain and promote service users independence. J.Sai Group Ltd owns the service with another home in the Hampshire area. Durban House Nursing Home H54 S60803 Durban House V230315 010605.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced inspection took place over a day on the 1st of June 2005. As part of the inspection process a tour of the building was undertaken. The inspection took place over six hours. The inspector spoke to 11 service users, 2 relatives, 6 staff and the manager. The process included examining care records, discussion with service users, staff and visitors. What the service does well: What has improved since the last inspection?
Care planning, assessments and wound care treatment have improved. These were found to be informative and reviewed regularly to reflect any changes in the needs of service users.
Durban House Nursing Home H54 S60803 Durban House V230315 010605.doc Version 1.30 Page 6 A programme to fit locks to all service users bedrooms appropriate to their needs have been completed. Recruitment procedures have improved and all checks are undertaken prior to employment as required. The provider undertakes unannounced visits to the service as required and reports are sent to the Commission. 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. Durban House Nursing Home H54 S60803 Durban House V230315 010605.doc Version 1.30 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 Durban House Nursing Home H54 S60803 Durban House V230315 010605.doc Version 1.30 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) 1,3,6 There is a good pre-admission process that ensures that service users needs are assessed prior to admission and the home can meet them. EVIDENCE: The manager was reviewing the statement of purpose and service users guide. The home has a comprehensive pre-assessment document in place. The manager or her deputy assesses all service users prior to admission. Records of pre-assessment showed that these were satisfactory. Staff stated that these are used initially to formulate care plans on admission and before the longterm needs assessments are completed. The care manager’s assessment for a newly admitted service user was available. There were some evidence in care plans seen that family/ service users are involved in the assessment process and the manager reported that these are being developed further. The home does not provide intermediate care. Durban House Nursing Home H54 S60803 Durban House V230315 010605.doc Version 1.30 Page 9 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) 7,8,10 The health needs of service users are well met with evidence of multidisciplinary working taking place. Care planning and reviews reflect that the changing needs of service users are monitored and needs met. Personal support is offered in such a way as to promote and protect service users’ privacy and dignity. EVIDENCE: Arrangements were in place to meet the assessed needs of service users. Care plans were formulated and included risk assessments and manual handling assessments. These were updated and reviewed regularly. The record seen of a service user that had risk assessment undertaken for fall. Following a review of her medication, there was an improvement in her mobility and this was reflected in her care plans. Equipment for the prevention and treatment of pressure ulcers were available in conjunction with Waterlow score that calculated the risks. Wound care plans were detailed, and included body chart, wound mapping and regular review. Advice was sought from other health care professionals. The district nurse was
Durban House Nursing Home H54 S60803 Durban House V230315 010605.doc Version 1.30 Page 10 involved in the management of pressure ulcer in one care plan seen and a change of dressing was initiated. There were detailed and up to date records of visits from the GP and any changes in treatment were clearly recorded to inform practice. Service users and relatives spoken to were complimentary with regards to the care that they were receiving. Service users stated that staff were very kind, they spoke proudly of their bedrooms and that they could receive visitors at any time. Four service users spoken to state that they had autonomy and choice with regards to the activity of daily living. They chose when they went to bed and whether to remain in their rooms or join others in the conservatory. Although they were aware that keys to their bedrooms were available they had chosen not to hold the keys. They stated that staff were kind and respected their choice of remaining in their rooms as they chose. Durban House Nursing Home H54 S60803 Durban House V230315 010605.doc Version 1.30 Page 11 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) 12,15 The arrangements for meeting the social and cultural needs of service users are well managed. Meals are varied and choices are offered. The practice of serving all courses of meals at the same time does not offer autonomy to service users. EVIDENCE: Service users spoken to report that meals were always very good and this was something they all looked forward to. Comments from service users included that meals were very good and plentiful. Hot and cold snacks were available at all times and on request. A choice of meals was offered although they felt they did not need to deviate from the main menu. Lunchtime meal was observed, was nicely presented and appeared well balanced and nourishing. Care staff were available to offer support with meals in a sensitive manner. It was also noted that both courses such as main meal and hot desserts were served at the same time. This was discussed with the manager and remedial action should be taken to ensure that if desserts are hot then these should be served at the appropriate time following the main course. The local vicar was visiting the home on the day of the inspection and attends the home regularly to administer communion. Two service users spoken to said
Durban House Nursing Home H54 S60803 Durban House V230315 010605.doc Version 1.30 Page 12 this was a regular feature and they enjoyed the service. One service user stated that she attended church regularly with her daughter. There are daily activities available and the mobile library visits monthly. The next planned visit for the library was posted in the entrance hall. The manager reported of plans to introduce weekly entertainment from an external agent. Recent trips included a visit to Exbury gardens and shopping in Romsey. Other 1:1 activities included aromatherapy, nail care and the hairdresser visiting 3 times a week. Durban House Nursing Home H54 S60803 Durban House V230315 010605.doc Version 1.30 Page 13 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) 16,18 The home has a satisfactory complaint procedure and service users felt they were able to raise any concerns. EVIDENCE: The home has a complaint procedure and a complaint log was available. Records seen showed that there have been 2 complaints since the last inspection and they have both been resolved. Service users spoken to said they had no complaints and would approach the manager or nurse in charge if they needed. The home has the Hampshire Adult Protection procedure in place. There has been no allegation of abuse reported regarding this home. The manager is aware of the process to record and report all allegations to the appropriate authority for the safety of service users. The manager was planning training in Adult protection for all staff. Durban House Nursing Home H54 S60803 Durban House V230315 010605.doc Version 1.30 Page 14 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) 19,24,25 There has been considerable improvement to the décor, furnishing and the service provided a warm and homely surroundings for service users. EVIDENCE: A tour of the premises was undertaken as part of the inspection. The home was warm and clean throughout. An ongoing refurbishment was in place and several areas have been refurbished including renewal of carpets in some rooms, new curtains and beddings for all service users bedrooms except for the remaining six have been completed. Service users were complimentary regarding their bedrooms that were personalised. Five service users said that they spent most of their times in their rooms and enjoyed the lovely gardens. Furnishing was of good standard, clean and appropriate to service users needs. The home has large well-maintained gardens that were safe and accessible to wheelchair users. Seating was provided outside and 2 service users said they were looking forward to the good weather to access the garden facility. Durban House Nursing Home H54 S60803 Durban House V230315 010605.doc Version 1.30 Page 15 The home has five shared rooms and the provider plans to change one of these to a single room as part of the development of the service. Screens were available in all shared rooms and call bells were available in all bedrooms. Two assisted communal bathrooms have been refurbished and a communal shower room has been provided that will be shared by two service users. This will beneficial to service users as this area did not have any bathing facility previously. Equipments such as hoists and grab rails were sited around the home and a chair lift was also in place to promote and maintain service users independence. Durban House Nursing Home H54 S60803 Durban House V230315 010605.doc Version 1.30 Page 16 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) 30 The staff training at the home is well managed and ensures that service users are protected. EVIDENCE: There has been marked improvement in the provision of training for staff. A training plan was available and record showed that a number of staff have completed mandatory training in fire safety, moving and handling and infection control. Other training planned included palliative care, medication. The manager reported that one staff member attended monthly meeting and information is cascaded to other staff at the monthly trained nurses meetings. An update in medication administration and its effects have been completed by a number of staff. Durban House Nursing Home H54 S60803 Durban House V230315 010605.doc Version 1.30 Page 17 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) 31, 37,38 The manager has a clear development plan and is supported by staff. The record keeping at the home is well managed and assures safety of service users. EVIDENCE: The home has a registered manager and there is evidence of clear lines of accountability within the home. Service users and staff reported that the manager is approachable and always available if they have any concerns. Monthly staff meetings are held for trained staff and staff reported that this time is also used to discuss any new changes and looking at care planning for service users. Records with regards to Regulation 37 are maintained and copies of these are sent to the Commission as required. A sample of record seen showed that all
Durban House Nursing Home H54 S60803 Durban House V230315 010605.doc Version 1.30 Page 18 accidents/ falls were recorded. All records were maintained securely. Staff reported that at present there are no facilities for changing and to securely maintained their personal belongings. This was discussed and the manager reported that this would be planned as part of the extension. Durban House Nursing Home H54 S60803 Durban House V230315 010605.doc Version 1.30 Page 19 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 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x 3 3 x STAFFING Standard No Score 27 x 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x x 3 x Durban House Nursing Home H54 S60803 Durban House V230315 010605.doc Version 1.30 Page 20 NO 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 15 Regulation 12(1) Requirement The manager is required to ensure that meal times meal times are managed to take into account service users wishes with regards to serving of courses at meal times. The provider is required to ensure that staff have adequate storage facility and for the purpose of changing. Timescale for action 30/06/06 2. 38 23(3) 30/06/05 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 Durban House Nursing Home H54 S60803 Durban House V230315 010605.doc Version 1.30 Page 21 Commission for Social Care Inspection 4th Floor- Overline House Blechynden Terrace Southampton Hampshire National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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