Inspection on 24/01/06 for Elizabeth Fleming Nursing Home

This inspection was carried out on 24th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Elizabeth Fleming Nursing Home 22/07/08

Elizabeth Fleming Nursing Home 09/05/07

Elizabeth Fleming Nursing Home 24/10/06

Elizabeth Fleming Nursing Home 26/04/05

Elizabeth Fleming Nursing Home 05/10/04

Elizabeth Fleming Nursing Home 26/05/04

Similar services:

The Highlands

Blenheim House

1 Lanark Close

Beaconsfield Court Care Home

Ann Charlton Lodge

The Gardens Care Home

Westmoor View Nursing Home

Ashlea Mews Residential Home

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

CARE HOMES FOR OLDER PEOPLE Elizabeth Fleming Nursing Home Off Market Street Hetton Le Hole Houghton Le Spring Tyne & Wear DH5 9DY Lead Inspector Mrs Katie Tucker Unannounced Inspection 24th January 2006 8:30 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 Elizabeth Fleming Nursing Home DS0000018191.V267859.R01.S.doc Version 5.1 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. Elizabeth Fleming Nursing Home DS0000018191.V267859.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Elizabeth Fleming Nursing Home Address Off Market Street Hetton Le Hole Houghton Le Spring Tyne & Wear DH5 9DY 0191 526 2728 0191 526 6187 elizabethfleming@highfield-care.com 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) Southern Cross Care Homes Limited Julie Gray Care Home 36 Category(ies) of Dementia (9), Dementia - over 65 years of age registration, with number (28), Mental disorder, excluding learning of places disability or dementia (8), Mental Disorder, excluding learning disability or dementia - over 65 years of age (29), Old age, not falling within any other category (1), Physical disability over 65 years of age (9) Elizabeth Fleming Nursing Home DS0000018191.V267859.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. During the day 1 x RMN and 3 care staff on the 20 place nursing unit, 1 x 2nd level l nurse and a care assistant on the 8 place nursing unit and 1 senior care assistant and a care assistant on the 8 place personal care unit. During the night will be 1 x RMN and 3 care staff. These staffing levels will be exclusive of any additional staffing arrangements agreed in individual service users contracts. The manager will be supernumerary to the staffing complement and an RMN will be on duty throughout the 24 hour period. The DE service user category includes one place for one particular service user The MD(E) service user category includes one place for one particular service user. 26th April 2005 2. 3. 4. Date of last inspection Brief Description of the Service: The Elizabeth Fleming Nursing Home is a 36-place bungalow style home. The home provides personal and nursing care for older and younger people with either dementia type illnesses or mental health needs. Originally the Elizabeth Fleming nursing Home opened in 1994, as a 40-place home for older people with dementia type illness and required nursing care. In February 2002 the registration changed so younger adults could be cared for and during this process five places were de-registered and could not be used. Recently major works have been commenced to change the design of the building. Two 8-place units and one 20-place unit have been created. The home is now registered for one unit, which can provide care for 8 younger adults who have nursing needs and a mental health or dementia-type illness. One unit can provide care for 8 older people with personal care needs and a mental health need or dementia-type illness. The 20-place unit can provide nursing care for older people with a mental health need or dementia-type illness. The home is at the top of Market Street, not far from the main part of Hettonle-Hole. It is opposite the post office and a range of shops. A bus stop is close to the home. Elizabeth Fleming Nursing Home DS0000018191.V267859.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Elizabeth Fleming nursing home inspection was carried out as part of the routine yearly programme. No one was told that the visit was to take place. An inspector visted and spent half a day at home. The inspector looked at the residents’ records, medication and staff information. The staff were asked about the residents’ records, the guidelines for safeguarding adults, their training, staffing levels and changes to working practices. The residents were asked about their lives at the home. Elizabeth Fleming provides a service for people with memory loss as well as for people with mental health needs. So some of the people have difficulty making their views known. Therefore staff practice, attitude and approach were watched and judgements made on how well staff worked with people. During this inspection key standards were focused on but not all were checked. What the service does well: The manager is a strong leader and is very competent. She has a passion for delivering good quality care for people with dementia care needs as well as for those with mental health needs. The qualified staff understand the needs of the service and care a great deal about the resident’s. And, the management team are very skilled at spotting gaps in the service and putting successful measures in place to improve practices. The manager and nurses keep abreast of new developments around looking after the people who live at the Elizabeth Fleming Nursing Home. Where new practices are appropriate for the service they help staff introduce them at the home. The nurses work hard to motivate staff to develop and change their practices. The manager team are aware of the difficulties people experience when facing change and are putting strategies in place to assist people deal with their anxiety. Staff have been completing a range of training including dementia care, working with people who have sensory impairments and the mandatory training. Over 60 of care staff have completed NVQ level 2 Awards. The majority of the remaining care staff are working towards the award. Plus some staff are working toward a Level 3 in care. The manager is keen that staff continue to receive training and is planning to provide specialised two-day training in dementia care. People are encouraged to lead as independent lifestyles, as possible. Therefore the younger adults regularly go out on their own and the older people are helped to make choices. The administrator is very forward thinking Elizabeth Fleming Nursing Home DS0000018191.V267859.R01.S.doc Version 5.1 Page 6 and made sure all of the residents were able to open bank accounts so they can control their own monies. 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. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elizabeth Fleming Nursing Home DS0000018191.V267859.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Elizabeth Fleming Nursing Home DS0000018191.V267859.R01.S.doc Version 5.1 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 the following standard(s): 3 and 6 The assessment records are being changed to show how staff can care for individuals. EVIDENCE: Southern Cross healthcare has worked with a clinical psychologist to design a new assessment tool. This has recently been introduced at Elizabeth Fleming and staff are in the process of completing it for all of the residents. Also a more informative life history has been designed. This is needed as working with people in relation to their life history is strongly advocated in all respected professional and advisory circles. People with dementia tend to revert to previous routines and patterns of behaviour and having this information allows staff to work more effectively with people and reduce the challenges that may be presented. By understanding how people have lived and their lifestyles, what often seems to be unusual behaviour when seen in the context of what people previously did becomes perfectly reasonable. Discussion centred around how staff would gather information about the time period people were focused upon. Elizabeth Fleming Nursing Home DS0000018191.V267859.R01.S.doc Version 5.1 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 the following standard(s): 7, 9 and 10 The care records design is being changed to assist staff evidence the good practices they use. Medication practices are maintained to a good standard. EVIDENCE: The style of writing staff use is very informative. However, limitations in the previous assessment document did not help staff to show they plan care around people’s greatest needs. Resident’s records needed to cover the social care, as well as health needs of all residents. And, the plans need to take into account information about each person’s social background and lifestyle. Although risk assessments have been used in relation mobility. Tools for showing that the risks people take have been judged to be acceptable needed to be more widely used. Sometimes plans have been repetitive. The owners and manager are aware that plans must reflect how people’s aims and goals are met. Thus new records are being developed. Residents or relatives need to sign all records to show they have agreed to the plan. The medication was being accurately booked in and recorded when given to residents. Also it was being stored correctly. Staff were very knowledgeable about the types of medication being used at the home. Elizabeth Fleming Nursing Home DS0000018191.V267859.R01.S.doc Version 5.1 Page 10 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 the following standard(s): 12 and 13 Staff on the whole have a good understanding of people’s likes and dislikes and will promote individual choices. EVIDENCE: Several of the younger adults regularly go out to the local shops. One person has recently joined a walking group and found this to be very stimulating and enjoyable. Those using the personal care unit and dementia care nursing unit have more limited opportunities because of the nature of their needs. However, the range of activities on the dementia care units are in the process of being tailored to individuals life experiences. The activity co-ordinator has been looking at how activities are delivered on the unit and some planned trips out for people as a part of her programme. The manager recently attended a course on caring for people with dementia care needs and found this extremely useful. She intends to ensure staff attend this training at the home and hopes that very person-centred approaches to activities will be introduced in the near future. Relatives and service users said that staff were ‘very kind and approachable’. They felt that people went out of the way to make the home a friendly and supportive place to live. People said the staff really valued and cared about their relatives. Elizabeth Fleming Nursing Home DS0000018191.V267859.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 18 The manager follows the local authorities protection of vulnerable adults procedures. EVIDENCE: Elizabeth Fleming has an appropriate protection of vulnerable adults policy and follow Sunderland Social Services Department guidance. In this guidance Southern Cross Healthcare has to put in a section about what they would do if an allegation of abuse were made. Staff have had training around protecting service users. The Social Service Department has a continuous programme of training for all the staff working in care. The staff from Elizabeth Fleming nursing home attend this training. Elizabeth Fleming Nursing Home DS0000018191.V267859.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 19 and 26 The home is maintained to a good standard and works have been completed to improve the facilities. It is clean and tidy. EVIDENCE: The Elizabeth Fleming Nursing Home is a bungalow style building. It is accessible to people with a physical disability. Some consideration has been given to the different types of client groups when it was refurbished recently. The layout of units allows for work to be completed on dementia care unit to make these friendlier for people with cognitive problems. A conservatory at the rear of the home has been built and this provides a smoking room for the older persons nursing unit. However the extractor fan in this area does not adequately remove the smoke and should be replaced. Also a further lounge has been created in the younger people’s unit. Plus one of the lounges on the residential unit has been changed into a smoking area. The issues with the slow running water have been sorted out and staff reported that they no longer had problems filling the baths. Elizabeth Fleming Nursing Home DS0000018191.V267859.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Staff training is now being provided at a level that will really enhance the service. Staff records have minor shortfalls in their format. EVIDENCE: The manager ensures the conditions of registration are met. The level of need seen in the older persons nursing unit were not as marked as at the last inspection. But the owners need to be mindful of changing levels of dependency and make sure these are reflected in staffing levels. The manager has been working hard to ensure that staff receive specific dementia care training, managing challenging behaviour, attend multi-sensory courses as well as mandatory training. Over 60 of the care staff now hold an NVQ level 2 and nearly all of the remaining staff have been enrolled on this qualification. Staff are keen to train and practices have become more person centred. The deputy manager has commenced the registered managers award. The staff files include the appropriate information. However in light of the changes to the regulations and introduction of the Disability Discrimination Act 1995 the application form and health statement need to be changed. The new system for CRB clearances is extending the time it takes to confirm the individual is suitable to work at the home. The delays are leading to people starting without the full clearance. Also the mechanism for interviewing staff with disclosures needs to ensure the signatory completes, as they are able to see the original from sent to Southern Cross and so check the authenticity of the applicants CRB form. Elizabeth Fleming Nursing Home DS0000018191.V267859.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 33 The manager is competent and makes sure the service meets the needs of residents. Qualified first aid training and emergency first aid is needed. EVIDENCE: The manager is very competent and holds appropriate management qualifications as well as being a registered nurse. She constantly makes sure her practices are line with recognised good practice. With her skilled management team support they provide strong overall management of the home. New working practices are being introduced at the home and the manager recognises that staff find change difficult. Therefore changes are being introduced on a gradual basis. A quality assurance system is in place and this is monitored to ensure the service meets the needs of the home. Southern Cross Healthcare need to ensure sufficient staff have received up to date qualified first aiders training and all staff receive emergency first aid training. Elizabeth Fleming Nursing Home DS0000018191.V267859.R01.S.doc Version 5.1 Page 15 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X X X X X Elizabeth Fleming Nursing Home DS0000018191.V267859.R01.S.doc Version 5.1 Page 16 Are there any outstanding requirements from the last inspection? Yes 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. 2. Standard OP3 OP7 Regulation 14 (1) 15(2) 12 (2) Sc 3 3q Timescale for action The new assessment tool and life 29/08/06 histories must be introduced. Care plans must reflect the care 29/08/06 being given. An assessment of where individuals rights are limited must become an integral part of the service user plan. (Required at previous inspections timescale 8.02.05) A robust system for CRB 06/06/06 disclosures must be in place. (Required at the last inspection – timescale 02/08/05) CRB approval must be received prior to staff starting at work. The owners must make sure the recruitment practice reflects the amendments and requirements of the regulations. A full career history must be recorded on the application form. Requirement 3. OP29 17 (1) (c) 19 Elizabeth Fleming Nursing Home DS0000018191.V267859.R01.S.doc Version 5.1 Page 17 4. OP38 13 (4) The owner must ensure that sufficient staff are trained as qualified first aiders to cover the 24 hour period. (Required at previous inspections - timescale 8.03.05) 29/08/06 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. 2. Refer to Standard OP19 OP27 Good Practice Recommendations Consideration should be given to extending the garden to include the disused parking spaces at the side of the home. (required at previous inspections) Changes in dependency levels should be monitored and appropriate staffing levels are in place to meet the dependency levels of people. Elizabeth Fleming Nursing Home DS0000018191.V267859.R01.S.doc Version 5.1 Page 18 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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. Extracts may not be used or reproduced without the express permission of CSCI Elizabeth Fleming Nursing Home DS0000018191.V267859.R01.S.doc Version 5.1 Page 19 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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