Inspection on 26/04/05 for Elizabeth Fleming Nursing Home

This inspection was carried out on 26th April 2005.

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 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 24/01/06

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 DH5 9DY Lead Inspector Katie Tucker Unannounced 26 April 2005 10:00 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. Elizabeth Fleming Nursing Home B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Elizabeth Fleming Nursing Home Address Off Market Street Hetton le Hole Houghton le Spring DH5 9DY 0191 526 2728 0191 526 6187 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) Highfield Home Properties Ltd Julie Sherwood Care home with nursing 36 Category(ies) of DE(E) Dementia - over 65 (28) registration, with number MD(E) Mental Disorder -over 65 (28) of places PD(E) Physical disability - over 65 (9) DE Dementia (9) MD Mental Disorder (8) OP Old age (1) Elizabeth Fleming Nursing Home B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Unless prior agreement is sought from CSCI the staffing levels will be: During the day 1 x RMN and 3 care staff on the 20 place nursing unit, 1 x 2nd level nurse and a care assistant on the 8 place nursing unit and 1 x senior care and care assistant on the 8 place personal care unit. The manager will be supernumerary to the staffing complement and a RMN will be on duty throughout the 24-hour period. Date of last inspection 5/10/05 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 of the home was varied so that the home could cater for younger adults and during this process five places were deregistered 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 B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the Elizabeth Fleming Nursing Home and was conducted as part of the routine yearly programme. An inspector and a member of customer services spent 6 hours at the home and spoke to 20 service users and 4 relatives. The assessments, care plans and risk assessments, personal allowances records, staff rotas and staff files were examined. The staff, service users and relatives were asked about the service user plans, the complaints procedure, and life at the home. Staff discussed their care practices and access to training. The nurse in-charge discussed developments were being made at the home. The building was toured and proposed changes to the building discussed. Elizabeth Fleming Nursing Home provides services for people with a dementiatype illness (memory loss) and younger adults with mental health needs. Some of the people experienced difficulty communicating their views verbally. Therefore staff practice, attitude and approach were observed and judgements were made on the effectiveness of the approaches that were adopted. This type of observation formed a part of the inspection process as well as what people said and was backed up through the examination of records, comments made by service users, staff, relatives and the manager. What the service does well: The manager and staff actively encourage the rights of people living at Elizabeth Fleming Nursing Home. They work with people in a relaxed and caring manner and follow family life. People are included in conversations and are valued. A relaxed and supportive atmosphere is consistently seen at the home and service users and relatives always comment, on how friendly staff are towards them. The manager and staff have constantly shown a willingness to listen to concerns people may have and work with them to sort it out. Staff make sure the health needs of residents are met and have made very good links with all health care professionals. All residents have their own bank account and the administrator answers questions about their money if residents have concerns. Elizabeth Fleming Nursing Home B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc Version 1.30 Page 6 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 B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.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 Elizabeth Fleming Nursing Home B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.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) 3 The staff recognise and acknowledge the major shortfalls in the assessment documents. The assessment tool does not allow staff to evidence that they can meet the needs of the service user or provide all of the information that would be needed to care for individuals. EVIDENCE: Southern Cross Healthcare uses an assessment form, which is based on the Roper Tierney and Logan nursing model. This tool is suitable for those people who are able to communicate fully and have general nursing needs. However it does not provide sufficient information on the care needs of people with dementia or mental health needs. The assessment has a small space to cover issues relating to mental health but the limited space does not allow staff to fully record challenging behaviours, triggers and actions that can be taken to divert or reduce such challenging behaviour. The majority of care practices will be directed at working to support people’s mental health needs and this tool does not show that staff complete any of this type of work. Therefore the tool does not allow staff to demonstrate that they could meet the needs of the people who wish to use Birchdale. Also it does not assist the staff to evidence any decisions made about staffing requirements at the home. Elizabeth Fleming Nursing Home B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc Version 1.30 Page 9 A manager from another home run by Southern Cross Healthcare has collaborated with a neuro-rehab psychologist and elderly psychologist to design a more appropriate and comprehensive tool for people with dementia. She has also produced an assessment tool for people with mental health needs. These tools have been be very useful and encourage staff to provide a range of informative information. A large number of people have a dementia-type illness and the generation of life histories for these people must be treated as a priority. 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. Staff collectively had a good range of knowledge about triggers for behaviour, people’s preferences and how to reduce people’s anxiety. The staff spoke in a relaxed and sensitive manner towards service users. Staff can describe the needs individual’s have and how to meet these needs. Service users and relatives were very complimentary about how staff worked and their caring and considerate nature. People said ‘You couldn’t get a better set of people’ and ‘it’s a hard and thankless job but the staff are always kind and helpful’. Elizabeth Fleming Nursing Home B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc Version 1.30 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, 8 and 10 Staff consistently demonstrate they can meet the healthcare needs of service users. The record keeping practices although they are improving continue to need minor adjustments. At times the current staffing levels can lead to service users dignity being inadvertently compromised. EVIDENCE: The staff have been working hard to develop the care plans and risk assessments used at the home. The assessment document does not lead the staff to identify presenting needs. Often care plan focus on these needs but they are not recorded at all in the assessment. Staff are developing a wide range of focused care plans and risk assessments. However, at times they are using language that does not accurately reflect the actual nature of incidents. Terms such as ‘aggressive’ were used. These do not tell the reader exactly what happened in the incidents and therefore staff will not be able to plan full strategies to deal with this potential. The nurse-in-charge recognised this shortfall. The manager over the last year has been assisting staff to develop recording skills and this is becoming evident in the detail of recordings made. Currently staff produce several records such as care plans and risk assessment on the same need. This level of repetition is unnecessary and time consuming. Elizabeth Fleming Nursing Home B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc Version 1.30 Page 11 All of the actions needed to meet a need should have been recorded on one document therefore it would not need to be duplicated. Risk-taking assessments are used to reflect all of the activity that will present a risk, such as going unaccompanied to a smoking area or mingling with people who have low tolerance to noise. Staff have consistently demonstrated the ability to recognise when additional support needs to be sort from other nurse specialists. The deputy manager has successfully established good links with local GP practices and provides a nurse practitioner clinic for one GP surgery. Throughout the visit staff contacted GP’s and other medical services appropriately, recognised when further medical advice needed to be sort and when people needed hospital or GP appointments. Doctors and consultants visited the home and staff spoke with confidence and professionalism to these people. There advice was sought about what actions needed to be taken and the visiting medical professionals valued the staff input. On the whole staff preserved people’s individuality, privacy and dignity. On a few occasions staff inadvertently left bathrooms or approached service users in public places still protective clothing. This occurred often because the range of needs they were trying to meet at a particular time was extensive. Currently some of the services users have needs in excess of those expected to be meet by the current staffing levels. Where people needed constant one-to-one support and additional member of staff is needed. An appropriate level of staffing should reduce the chance for staff to feel hurried and pressured to meet all of the service users’ need. Therefore the likelihood of staff compromising people’s privacy and dignity would be reduced. The manager as good practice re-enforces with staff the ethos of the home and how to value people and this should be continued. Elizabeth Fleming Nursing Home B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc Version 1.30 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 and 15 Many of the people experience difficulty making active choices. Staff have a good understanding of people’s likes and dislikes and will promote individual choices. However the specific needs of others and staffing levels in relation to those needs would lead, at times, to limitations being imposed and meals being difficult to co-ordinate. EVIDENCE: Service users living in the nursing unit for people with dementia do not have access to a designated smoking area. In order for them to have a cigarette they need to go to the smoking room in the younger adults unit. There is insufficient seating in this area and some of the service users object strongly to people using this room. Thus staff have to chaperone service users to this unit. Relatives who were visiting said they ‘found this intrusive and felt that it was vital that a smoking area was developed in the nursing unit’. Limitations that are in place have to be recorded in the service user plan and agreed with the service user or their representative. 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. Several of the service users discussed the pool competition that was taking place at Elizabeth Fleming Nursing Home. All were hopeful of winning the competition. The home employs an activity coordinator who is arranging different activities for each group of individuals. Elizabeth Fleming Nursing Home B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc Version 1.30 Page 13 Staff on a daily basis attempt to provide engaging activities to do within the home. Conversations with service users were conducted with an easy rapport and were inclusive. 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 staff availability. However, the activity co-ordinator is planning trips out for people as a part of her programme. Some of the service users need one-to-one support for various reasons or need to be cared for by a specific gender of staff. The knock on effect can lead to other service users choices to go out or participate in certain activities or have their personal care needs attended to when they want being limited. But staff consistently showed they were aware of people’s likes and dislikes and actively promoted service users choices and tried wherever possible to reduce this effect. The meal that people were joined for was very enjoyable. The portion sizes were very ample and the opportunity to have second helpings available. Service users said that ‘the meals were always very good’ and ‘the cooks make a very good meal’. People said there was always plenty to eat and that they could get food during the night if they were hungry. Staff demonstrated a good understanding of how to encourage people to eat a good meal. However due to the high needs of people on the dementia care nursing unit and even though staff came from the personal care unit assist during the meal, it was very pressured and a protracted affair. During lunch, for some people, it took a considerable length of time prior to them receiving or finishing a meal. Staff followed good practice and supported one person at a time whilst verbally prompting others but there were more people who needed full staff support than staff available to undertake this role. Elizabeth Fleming Nursing Home B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc Version 1.30 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 Staff, service users and relatives are made aware of the complaints procedure and staff have demonstrated that they adhere to the procedure. EVIDENCE: The complaints procedure is made available to service users and relatives through the service user guide. Copies are also located throughout the home. Relatives said that the found the staff and manager easy to approach and friendly. They said they felt comfortable discussing any issue that concerned them with the staff. Relatives gave examples of this and one relative said that they were supported by staff to raise concerns over the availability of a smoking area on the nursing unit. Other relatives and residents said that they had ‘never had anything to complain about’. The manager and staff have consistently shown themselves to be open and willing to listen to concerns people may have. The manager has followed the appropriate complaints procedure and where it cannot be resolved by the home this has been referred to the most appropriate person. Elizabeth Fleming Nursing Home B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc Version 1.30 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) 19 The recent refurbishment of Elizabeth Fleming Nursing Home was to a very good standard. However the speed at which some items can be repaired such as water pressure is problematic at times. For the health and safety of service users and staff Southern Cross need to provide an additional smoking area. 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 more friendly for people with cognitive problems. Recently the staff redeveloped a snoozelum and this is a popular resource for all of the units. Also a games room has been developed in the unit for younger adults. Proposals have been made to develop a conservatory at the rear of the home but it has not been confirmed that these will go ahead. Also discussions around providing a second smoking room have been ongoing for sometime. Elizabeth Fleming Nursing Home B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc Version 1.30 Page 16 Presently the 20 place unit for people with a dementia and nursing needs does not provide a smoking room. This lack of facility has been an issue for some time. People have to use the smoking room in the younger adults unit. This room has insufficient space or seating for the current numbers of people who smoke. Some of the service users have difficulty mixing with less able people and the competition for seating is high. Also to have a cigarette service users from the dementia care nursing unit are reliant on staff to get to this room and this poses a problem at times. Relatives and service users were adamant that if this facility was created in the dementia care nursing unit it would be extremely beneficial for all of the smokers on this unit but also for others as the people would be less anxious. The hot water in some bathrooms was extremely slow and running at below 38°c. The handyman described how Southern Cross Healthcare was aware of this problem and the home had been pushing for it to be rectified. A proposal was in the process of being agreed to have works done to improve the overall system. Whilst the inspection was being conducted it was confirmed that this would be done, as a matter of priority. The handyman was very knowledgeable about the home. He was able to confirm that appropriate measures had been taken to maintain the spa baths as well as other the items in the Elizabeth Fleming Nursing Home. Elizabeth Fleming Nursing Home B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc Version 1.30 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) 27, 29 and 30 Staffing levels at times do not meet the needs of all of the people using the service. The employment procedures need to be made more robust. Staff are being given access to a wider range of training and this will benefit service users. EVIDENCE: The manager is pro-active about recruiting staffing and ensuring staffing levels meet those stipulated in the conditions. Some of the people at Elizabeth Fleming Nursing Home have very high dependency levels and need one-to-one support. Although specific placing agreements have been made for some people this is not the case for all of the people that need this level of support. Thus often staff time has to be spent with these individuals and this reduces the actual levels available for others. The staffing levels in place are around the collective needs of people. Where people have needs in excess of this it is expected that arrangements would be made to meet these requirements and thus it would be expected that additional staff would be in place to meet the one-to-one needs of those individuals. The manager does not ensure that when applicants fill in the forms that they fill in all of the information about their previous employment history. The manager must be able to verify people’s work history. Although the POVA list is now in operation and CRB checks are completed these only came into force in 2002. Therefore anyone dismissed prior to 2002 from a care service would Elizabeth Fleming Nursing Home B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc Version 1.30 Page 18 not have had their information submitted to this list or may not have been prosecuted. The manager by not asking for this information or ensuring the forms are completed fully will be prevented from gathering all relevant information and checking with previous employers. Southern Cross Healthcare Ltd recently merged with the previous owners of Elizabeth Fleming Nursing Home. Staff were aware that some practices would change and this included the CRB Clearance process. In the near future they will have to send the forms to the company’s headquarters and it is unclear as to whether the manager will remain a counter signatory. CSCI has been in discussions with Southern Cross about their current practices as they can compromise robust checking procedures when someone has a disclosure, as the manager has to complete the interview without knowing what convictions the person has. Staff at the Elizabeth Fleming are also worried that this new stage will increase the length of time they have to wait for the return of the CRB form. Staff were very enthusiastic about the training courses that they had been on and were going to attend. All welcomed the opportunity to go on courses. Recently staff have been completing mandatory training, mental health awareness training and a large proportion of staff either hold or are working towards an NVQ Award. Staff are waiting to go on dementia care training but the manager has been organising access to distance learning packs. Staff also discussed how the level of training had dramatically improved since the manager took up post and they expected that a continuous stream of useful training would continue. Elizabeth Fleming Nursing Home B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc Version 1.30 Page 19 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) 35 and 38 The administrator has actively promoted accurate financial systems and the rights of individuals. On the whole the health and safety needs of individuals are being met. EVIDENCE: Southern Cross Healthcare Ltd adopts the policy of not being appointee for individuals and either social service or families undertake this role, which is good practice. The small amounts on monies held in the home for service users daily expenditure. Any build up of monies is transferred into people’s savings accounts or sent or their appointee. The administrator has proactively pursued getting individual bank accounts and found that Halifax Building Society has been very receptive to people’s needs. All of the people on the younger adults unit are assisted to manage their own finances and regularly go to the local building society either with staff or on their own. This level of independence has been promoted by the administrator and is good practice. Elizabeth Fleming Nursing Home B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc Version 1.30 Page 20 A system for verifying service users or their representatives’ agreement to withdrawals is in place. Second signatures are obtained for transactions. Regular audits are conducted by a variety of people within Southern Cross Healthcare Ltd and these are evidenced. Southern Cross Healthcare have just introduced a week long audit and this is to be completed in the near future. Thus service users can be confident that the monies are handled properly at Elizabeth Fleming Nursing Home. The manager has nominated the administrator for a caring award in Southern Cross’ Recognising the Achievements of Staff Awards. The handyman actively promotes health and safety at the Elizabeth Fleming Nursing Home and was proud of the systems he had put in place and this was rightly so. Other than the slow running, cool water and lack of a smoking room in the dementia care nursing unit no health and safety issues were noted. The manager has been nominating staff to complete the four day at work first aid course. It is expected that within the next few months sufficient staff will hold this qualification to cover the 24 –hours a day. Elizabeth Fleming Nursing Home B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc Version 1.30 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 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 2 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 2 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x 4 x x 3 Elizabeth Fleming Nursing Home B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc Version 1.30 Page 22 Yes 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 3 Regulation 14 (1) Timescale for action An assessment tool, which allows 30.08.05 peoples mental health needs and dementia care need to be fully assessed must be introduced. (required at the last inspection - timescale 8.03.05) Service user plans must include social assessments. (required at previous inspections - timescale 8.02.05) Care plans must be sufficiently detailed to guide staff practice. (required at previous inspections -timescale 8.02.05) Requirement 2. 7 15 (2)12 (2) Schedule 3 (3) (q) 25.10.05 3. 19 23 (1) (a) 4. 27 18 (1) (a) An assessment of where individual’s rights are limited must become an integral part of the service user plan. (required at previous inspections timescale 8.02.05) The owners must provide a 30.08.05 dedicated smoking area in the older person’s unit as a matter of priority. (required at the last inspection - timescale 8.02.05) Sufficient staff must be 2.08.05 employed to meet the one-toone levels several service users require. Version 1.30 Page 23 Elizabeth Fleming Nursing Home B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc 5. 29 17 (1) (c) 19 The manager must provide evidence on the staff files that any gaps in employment history have been checked. (required at the last inspection - timescale 11.01.05 A robust system for CRB disclosures must be in place. All of the care staff must complete dementia care training. 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) 2.08.05 6. 7. 30 38 18 (1) (c) 13 (4) 25.10.05 30.08.05 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. 2. Refer to Standard 19 28 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) At least 50 of care staff should be trained to NVQ Level II by 2005. (required at previous inspections) Elizabeth Fleming Nursing Home B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc Version 1.30 Page 24 Commission for Social Care Inspection 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 B53 B02 S18191 Elizabeth FlemingV219540 26 Apr 2005 Stage 2.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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