Inspection on 21/11/06 for Eastleigh (Nursing) Care Home

This inspection was carried out on 21st November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

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

CARE HOMES FOR OLDER PEOPLE Eastleigh (Nursing) Care Home Periton Road Minehead Somerset TA24 8DT Lead Inspector Shelagh Laver Unannounced Inspection 21st November 2006 09:30 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 Eastleigh (Nursing) Care Home DS0000067606.V319363.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. Eastleigh (Nursing) Care Home DS0000067606.V319363.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eastleigh (Nursing) Care Home Address Periton Road Minehead Somerset TA24 8DT 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) 01643 702907 Eastleigh Care Homes Limited Position Vacant Care Home 42 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (42) of places Eastleigh (Nursing) Care Home DS0000067606.V319363.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate 7 service users over 65 years, within the 42 beds total, whose secondary diagnosis is dementia in rooms 14-20. This is the first inspection of this service by CSCI. Date of last inspection Brief Description of the Service: Eastleigh Nursing home is a new service built next t o the established Eastleigh Residential home on the outskirts of Minehead. The home is situated in an elevated position and many rooms have exceptional views of Exmoor or the sea. The home has been constructed and equipped to a very high standard. All bedrooms have en-suite facilities. The bathrooms contain the most up-todate equipment. There are comfortably furnished communal dining rooms and sitting rooms. On the top floor of the building is a large laundry and kitchen. There is a computer room, activities room with gym and sauna. The grounds surrounding the home are landscaped with areas designed for “outdoor living” in the summer. There is a nurse on duty at all times and staff are provided with regular training. The home has a contract with Somerset Community Directorate and also provides care for service users who are self-funding. There is a pilot project currently running to provide Enhanced Nursing Care to seven service users with dementia who need nursing care. The care is provided in a designated unit. Eastleigh (Nursing) Care Home DS0000067606.V319363.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection of this new service registered in May 2006 to provide nursing care to people over 65. The home submitted an Annual Quality Assurance Assessment prior to the inspection. This document outlines the achievements and plans of the service measured against the National Minimum standards. Two inspectors visited the home on 21st November. The inspectors reviewed documents and records. A tour of the environment was made and service users were spoken with. A further visit was made to the home on 23rd November by one inspector. At this visit the inspector spoke with more service users and staff. The nurses in charge of the floors were able to demonstrate the computer system that eventually will contain all the records for the home. What the service does well: Approximately 50 of service users were spoken to. Others were observed resting on their beds and in the communal rooms. Service users told the inspector they were pleased with the care they received at the home. One service user said “We are well looked after….excellent care.” Another said the food is so good I am putting on weight…” Another person said “I have no worries here….it is great.” The husband of a service user told the inspector that his wife had been assessed in hospital before admission and that the family were given a statement of purpose. He confirmed he was happy with his wife’s care. “ Very good here…no concerns….” He felt he was able to raise concerns with staff if he had any. Staff told the inspector they were pleased with the way the home was developing. They gave examples of training and were pleased with the excellent equipment in the home. One member of staff speaking of the bathing and manual handling equipment said “It is so much easier for us and the residents here …..it is lovely for them” Another said “It is good working here…it is all coming together.” Staff spoken to were aware of service users needs and could give clear messages about their care and treatment. There has been a real attempt by the proprietor of the home to create a comfortable and pleasant environment that meets the needs of service users. Eastleigh (Nursing) Care Home DS0000067606.V319363.R01.S.doc Version 5.2 Page 6 The activities programme has commenced and was enjoyed by those service users that took part. What has improved since the last inspection? What they could do better: The proprietor and nurse managers acknowledged that there was still “considerable work to do.” The Cool Running computer system is designed eventually to provide all records for the service users and staff in the home. Examples of the records that can be created include comprehensive care plans and records of staff training and supervision. Unfortunately this is not fully in use. Not all service users have a clear care plan that will meet the National Minimum standards. Each service user has a file of assorted documents that provide the nurses and care staff with information that seems to enable them to provide care but it is essential that sufficient staff are trained to use this system in the correct way as soon as possible. The recording and administration of medication must be addressed by the nurses to ensure it conforms with best practice. There are aspects of care in the ENC unit that must be addressed and developed. Although the initial recruitment of staff to the home was good it was unclear from later files whether two references had been received or staff had had CRB clearance. All information in relation to recruitment must be available in the home. The home has balconies on the second floor. There must be risk assessments and clear policies and procedures to ensure the safety of all service users. Action must be taken to ensure that all service users are aware of the choices available to them at meal times. A choice of lunch is available but service users were not aware of this. A system must be established to ensure service users are able to make choices. The service of meals in the ENC unit must reflect that of the general home. Please contact the provider for advice of actions taken in response to this Eastleigh (Nursing) Care Home DS0000067606.V319363.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Eastleigh (Nursing) Care Home DS0000067606.V319363.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 Eastleigh (Nursing) Care Home DS0000067606.V319363.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): 1345 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users or their families are provided with sufficient information before arriving at the home. Assessments of service users are completed prior to admission to the home. EVIDENCE: Service users and relatives spoken to had received information prior to admission to the home. The inspector was able to observe that requests for information were dealt with courteously and that families of prospective service were shown the home. Comprehensive assessments were seen in service users files. Additional information from health professionals was also seen. Eastleigh (Nursing) Care Home DS0000067606.V319363.R01.S.doc Version 5.2 Page 10 Eastleigh (Nursing) Care Home DS0000067606.V319363.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 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is evidence that service users are well cared for and that their health needs are met. Service users are treated with respect and their privacy is up held. All service users do not currently have a care plan that meets National Minimum standards. Medication administration does not reflect best practice and must be improved. EVIDENCE: There are plans to implement a comprehensive computerised system of care planning in the home and substantial investment has been made to this ends. However the system has not been fully implemented. This means that some service users do not have an organised care plan that meets NMS. Each service user does have a file containing information and guidance that seems to enable staff to provide care. Nurses and carers were seen referring to these files. Eastleigh (Nursing) Care Home DS0000067606.V319363.R01.S.doc Version 5.2 Page 12 Staff keep a daily log of care and nurses are recording events on the computer. It was possible to track wound care for example. The full implementation of effective care planning must occur within the next month. There is a summary of care in service users room. The inspectors did not think this was adequate. Service users observed appeared well cared for. There were turn charts in rooms and evidence that wounds are healed. Service users have access to GPs and on the second day of the inspection both the chiropodist and optician were in attendance. Specialist staff attend regularly to provide support to service users in the ENC. There is guidance in the contract for this pilot as to the standards of care to be provided. There are areas of care that should be reviewed in line with this guidance. All staff working in the ENC unit should be made aware of its contents. Both nurses and carers spoken to were able to describe the treatment and interventions provided to service users. The medication administration records indicated that staff were not aware of best practice requirements. Some hand transcribed prescriptions had no signatures. Entries on charts had been crossed out without signatures, dates or reasons. There were gaps in the administration charts. There was no guidance for administration on prn medications. Doses for controlled drugs were not recorded. Insulin in use is stored in the fridge. The manager must arrange training to ensure all nurses are aware of current practice required and must commence an auditing system to monitor compliance. Service users spoken to said that their privacy was respected. Staff were observed speaking respectfully to service users. Eastleigh (Nursing) Care Home DS0000067606.V319363.R01.S.doc Version 5.2 Page 13 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 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users in the main part of the home are able to choose how they spend their day. Service users receive a wholesome and appealing diet. Service users should be made more aware of the diet choices available to them. EVIDENCE: Service users in the main home were observed spending their days in a variety of ways. Some preferred to stay in their rooms while others were in the communal sitting rooms. Family and friends were observed to be welcomed in the home. There is a developing activities programme and planning is underway for Christmas events. The programme includes a carol service, sing-a-long evening and theatre presentation. There was evidence of a range of activities Eastleigh (Nursing) Care Home DS0000067606.V319363.R01.S.doc Version 5.2 Page 14 taking place in the ENC unit. The hairdresser attends the home regularly and there are facilities to provide beauty treatments and therapies. On both visits to the home the lunch was observed. In the two main dining rooms tables are laid attractively and service users are served at the table. Food looked appetising. A visit to the kitchen showed cakes and puddings were being made and fresh vegetables were used. At lunch each day an omelette or salad is available as an alternative to the main course of the day. However service users were not aware of this. It is recommended that a system of ordering that encourages and records choice is developed. It was also clear that snacks are available at any time for service users who are hungry. One night record showed that one service user had an 11pm sandwich but others seemed less of how they would get a hot drink if it was not a “set time.” One service user said he was “putting on weight …..” another food was “very good.” One said it was not what she was used to. In the Enhanced Nursing Care unit both the provision of food and the approach to service users needed some attention. Staff present service user with a ready plated meal and there was no choice offered to service user. Eastleigh (Nursing) Care Home DS0000067606.V319363.R01.S.doc Version 5.2 Page 15 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 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service user are protected by the polices and procedures in the home when they are fully implemented. EVIDENCE: The home has a complaints procedure. Service users and relatives said they would raise concerns if they were worried. The majority of staff received training on protecting vulnerable adults on commencement of employment. The Whistle Blowing policy must be reviewed to give clear instructions to staff. All key staff must familiar themselves with the procedures required to refer a member of staff to POVA. Eastleigh (Nursing) Care Home DS0000067606.V319363.R01.S.doc Version 5.2 Page 16 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 20 21 22 23 24 25 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The overall physical environment of the home is excellent. There is a need to address environmental requirements for best practice in the in the ENC. Attention is required to some aspects of infection control. EVIDENCE: This is a new building built and is equipped to the highest standards. Furnishings, equipment and decoration are of good quality. Bedrooms are well planned and have en-suite facilities. There is a selection of communal areas including an activities room on the top floor. The grounds around the home include outdoor sitting areas. Eastleigh (Nursing) Care Home DS0000067606.V319363.R01.S.doc Version 5.2 Page 17 Residents are able to meet with relatives in their rooms or in communal areas. Bathrooms are comfortable and easy to use. They have been equipped to the highest standards. There are sufficient hoists including over bed hoists. On the day of the inspection the home was clean and tidy. The signage for the ENC unit should be put in place. Currently the notices stating Assisted Toilet would not help a person with dementia to access it. There is plenty of guidance available on environmental adaptations that may assist service users with dementia and these should be implemented. Staff must also be more aware of potential hazards to service users with dementia and take action to reduce the risks for example dental creams and razors should be stored in the lockable cupboards. Through out the home there are handwashing facilities for staff. An open bin in the bathroom was replaced by flip top model as discussed. Staff need to be aware that once a sterile dressing has been opened any unused portion should be discarded as it is no longer sterile. There is a well equipped laundry. Sluices are provided on each floor. Eastleigh (Nursing) Care Home DS0000067606.V319363.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient staff to meet service users needs. There are sound recruitment policies and procedures in place. It was not clear that these were followed on all occasions. EVIDENCE: Staffing levels in the home appeared adequate and there are two RGNs on duty at all times. The ENC unit was staffed with 2 carers and a “runner” for 5 service users. Domestic staff spoken to felt they had sufficient time to keep the home clean. There was evidence that staff who joined the home initially had a thorough induction programme. The home has made arrangements for the delivery of an NVQ programme and the progress of implementation will be inspected at the next inspection. A training plan for the home should be drawn up. The professional up-dating of trained nurses should be discussed and planned to meet the needs of the staff and the home. There is a need for medication training for trained nurses. There is a need for further training to ensure staff are aware of the current best practice required for providing care to service users with dementia. Although the initial recruitment of staff to the home was good it was unclear from later files whether two references had been received or staff had had CRB Eastleigh (Nursing) Care Home DS0000067606.V319363.R01.S.doc Version 5.2 Page 19 clearance. Recruitment monitoring is undertaken at the company head office in South Molton and files are sent to the home when fully complete. The system is not working and the manager at Eastleigh must ensure that there is evidence that pre-employment checks have been completed before they commence duty at the home. Eastleigh (Nursing) Care Home DS0000067606.V319363.R01.S.doc Version 5.2 Page 20 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 32 33 34 35 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management systems need to stabilise and mature. There are systems in place to promote the health and safety of service users and staff. Risk assessments and management arrangements must be put in place for all the environment but urgently with regard to the balconies. EVIDENCE: Since the home has opened it has been supported by the owner and Pauline Arlsford who has clinical responsibility for all the homes. The home had recently appointed a new manager Mrs Susan Pike who had been in post for three weeks. The management of the home will therefore be further assessed at the next inspection. Following the opening of the home it was agreed there Eastleigh (Nursing) Care Home DS0000067606.V319363.R01.S.doc Version 5.2 Page 21 had been a period of uncertainty when management time had been taken reacting to “teething problems.” There is an experienced deputy in post and the clinical manager continues to support and direct Mrs Pike. The management team should be pro-active in allocating responsibilities to key staff to meet the issues raised in this report. There is evidence that there is commitment to running the home in the interests of the service users. A maintenance person has been appointed. Wardrobes were secured to the walls by second day of the inspection. An assessment of profiling beds used with bedrails must be undertaken to ensure their safe management. PAT testing has been undertaken. Fire records included alarm testing, testing of emergency lighting and staff training. There is an Emergency fire plan and risk assessment are undertaken. COSHH sheets are available and staff confirmed they had had training. Eastleigh (Nursing) Care Home DS0000067606.V319363.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 3 3 2 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X X 2 Eastleigh (Nursing) Care Home DS0000067606.V319363.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) Requirement The full implementation of effective care planning must occur within the next month. The manager must arrange training to ensure all nurses are aware of current good practice of medication management and must commence an auditing system to monitor compliance. The manager must implement a system that ensures service users are aware of the choice of food available. The standard of food service in the ENC unit must be the same as the rest of the home. There must be evidence in the home that all staff have been recruited in accordance with NMS 29 and Schedule 3. A training plan must be prepared that addresses the development needs of the home including medication, dementia care and computer training. The Whistle Blowing policy must be reviewed to give meaningful guidance to staff and to include DS0000067606.V319363.R01.S.doc Timescale for action 04/01/07 2. OP9 13(2) 04/01/07 3. OP15 16 (i) 04/01/07 4. OP29 19 04/01/07 5. OP30 18 (1) 01/02/07 6. OP18 13(2) 04/01/07 Eastleigh (Nursing) Care Home Version 5.2 Page 24 7. OP38 13 (4)a 8. OP22 13 (2) external agencies to be contacted. There must be risk assessments in place for all service users with regard to the balconies on the second floor. There must be evidence of assessment of service users if bed rails are needed. When used with profiling beds the rails must be safe and conform to guidance provided the manufacturer. 04/01/07 04/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP22 Good Practice Recommendations There should be appropriate signage in the ENC unit. Eastleigh (Nursing) Care Home DS0000067606.V319363.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. 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