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Inspection on 11/10/05 for Flowerdown Nursing Home

Also see our care home review for Flowerdown Nursing Home for more information

This inspection was carried out on 11th October 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents are protected by the home`s clear procedures for dealing with medicines. Residents are able to exercise control over their lives, can participate in a programme of activities and are offered a choice of well presented, balanced meals. Residents know that any complaints will be taken seriously and investigated. Residents are protected by the staffs` awareness of the procedures to be followed should abuse be suspected. The home provides a safe, clean environment and specialist equipment is available for those residents assessed as requiring it.

What has improved since the last inspection?

Residents` monies kept in the home are now stored individually.

What the care home could do better:

Written contracts have now been provided for each resident. However the delay in providing the contracts may mean that some residents had to make a decision regarding residency without the full information required. Care plans require risk assessments and regular review to reflect the needs of the residents and to provide staff with the information required to fully support and meet their needs. The lack of door locks on some bedroom and bathroom doors may put the residents` right to privacy at risk. Documents seen for the recording of fluid intake and turning of residents who are nursed in bed, indicated that there were an insufficient number of staff on duty at times, particularly during the evening. Only one member of staff holds a National Vocational Qualification (NVQ) level 2 or above. At present there is no NVQ training programme available for staff. Two staff records seen did not contain all the information required in Schedule 2 of the Care Homes Regulation, including two written references and Criminal Records Bureau (CRB) checks. Records were not available to identify training sessions attended by staff.

CARE HOMES FOR OLDER PEOPLE Flowerdown Nursing Home Harestock Road Winchester Hampshire SO22 6NT Lead Inspector Marilyn Lewis Unannounced Inspection 11th October 2005 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 Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 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. Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Flowerdown Nursing Home Address Harestock Road Winchester Hampshire SO22 6NT 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) 01962 881060 01962 881935 Tamhealth Limited Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number (53) of places Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. One service user date of birth 19th November 1939 can be accommodated 11th April 2005 Date of last inspection Brief Description of the Service: Flowerdown Nursing Home provides care and accommodation for fifty-two older persons who require nursing care. The home has been extended over the years and accommodation is provided in fifty single rooms and one shared room, situated on two floors of the old house and the new extension. The home has large well-maintained gardens and ample parking space. Flowerdown is owned and operated by Four Seasons Health Care, a large independent care provider in the UK. The home is situated in a semi rural area on the outskirts of Winchester, Hampshire. Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five hours on the 11th October 2005. The registered manager of the home left in July 2005 and a new manager is due to take up her post at the end of October 2005. The home also has a new deputy manager who has been in post for six weeks. During the inspection visit, the inspector toured the home and met with nine of the forty- eight residents, three staff members, the administrator and the deputy manager. Care plans were sampled for four residents and records for medicines, staff training and staff recruitment were seen. This inspection is the second inspection of the year 2005/2006 and key standards not assessed on this occasion were included in the inspection report for the 11th April 2005. What the service does well: Residents are protected by the home’s clear procedures for dealing with medicines. Residents are able to exercise control over their lives, can participate in a programme of activities and are offered a choice of well presented, balanced meals. Residents know that any complaints will be taken seriously and investigated. Residents are protected by the staffs’ awareness of the procedures to be followed should abuse be suspected. The home provides a safe, clean environment and specialist equipment is available for those residents assessed as requiring it. Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 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. Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 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 Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 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): 2 and 6 The delay in providing written contracts may mean that some residents have not been provided with all the details required when making a decision about taking up residency at the home. EVIDENCE: It has been an outstanding requirement of the last two inspection reports that each resident is provided with a written contract that gives details of the terms and conditions for residency at the home. At the time of this inspection basic written contracts were available but had not yet been personalised for each resident. The administrator said that the contracts were being completed in the next two days and would then be given to the residents. Since the inspection visit, the deputy manager has confirmed with the commission, that all residents have been provided with a written contract. The home does not provide intermediate care and therefore standard 6 does not apply. Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 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 lack of clear information in care plans could result in residents not having all their care needs met and although residents feel they are treated with respect, lack of door locks in some areas could mean their right to privacy is not upheld. Residents are protected by the home’s good policies and procedures for dealing with medicines. EVIDENCE: Care plans were seen for four residents. Although the plans contained some of the documentation required to inform staff of the actions needed to support the residents, there were gaps in the recording of the information. One plan contained forms for nutritional and risk assessments, which had not been completed and three contained incomplete continence risk assessments. A risk assessment for the use of restraint, such as bed rails had been signed by a relative but had not been completed to identify what form of restraint was being used. Two of the care plans stated that fluid intake and turn charts were to be completed. The recording on these charts was poor. Some of the charts did not Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 Page 10 clearly indicate the date and it was difficult to identify whether a chart had been completed on a daily basis. The turn charts indicated that on some days, turning of the residents was not undertaken as required in the evenings. The home has clear procedures in place for dealing with medicines. Medication records seen had been completed appropriately. Medicines kept in the controlled medicines cupboard were checked and the records matched the stock held. The system for disposing of used medicines has recently changed in the home and staff were aware of the new method. Books giving information on medicines, used by staff, were eighteen months old. The deputy manager said he would arrange for more up to date information on medicines to be available to staff. Residents spoken to said that staff treated them with respect at all times. However some residents in the original wing of the home do not have locks fitted to their doors and a bathroom in the same area is also without a lock. This has been an outstanding requirement of the last two inspection reports. The deputy manager said that a refurbishment programme is due to commence in November 2005 and that the provision of locks may be part of that programme. The deputy manager is to arrange for an action plan giving details of the refurbishment programme to be forwarded to the commission. Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Residents are able to exercise control over their lives, can chose to participate in a programme of suitable activities and are offered a choice of balanced, well presented meals. EVIDENCE: Since the last inspection the home has recruited an activities co-ordinator. However, the co-ordinator is only able to work on two days of the week and the deputy manager said that the home is advertising to recruit an additional co-ordinator to provided further activities. The activities programme displayed in the main hallway indicated that activities included quizzes, bingo, music and discussions on newspaper articles. Three residents spoke of enjoying the activities offered. One resident said that she had been visited by the activities co-ordinator to discuss her preferences for the activities arranged. The resident said that she appreciated that staff allowed her to spend time alone in her room as she wished. Local clergy visit the home and a communion service is held once a month for those who wish to attend. It was evident during the inspection that residents were able to exercise choice and control over their lives. Residents were able to spend time in the Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 Page 12 communal rooms or in their own room and at lunch were able to choose their preferred meal. Some residents were sitting in armchairs and some in wheelchairs. Those residents asked, stated that they were sitting in the chair of their choice. The home employs two cooks who have developed a monthly menu that has taken residents’ preferences for food items into account. On the day of the inspection visit lunch consisted of pork casserole, broccoli, cauliflower and potatoes, followed by apricot cobbler and cream. Corned beef salad or an omelette were offered as alternatives to the main meal. Seven residents spoken to at lunch said that they enjoyed the food provided at the home. Meals served at lunch were well presented and looked appetising. Residents were able chose to take their meal in the dining room or in their own room. Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Residents know that all complaints will be taken seriously and investigated and they are protected by the staffs’ awareness of the procedures to be followed should abuse be suspected. EVIDENCE: The home has a complaints procedure in place that indicates who will investigate the complaint and timescales for the process. The deputy manager showed the inspector a new system for recording complaints that has recently been put in place. The system clearly identifies the stages for handling the complaint and will give details of the final outcome. Three residents asked about the homes’ complaints procedures, knew how to make a complaint and indicated that they felt any complaint would be investigated. Two staff members spoken to about the homes’ procedures for suspected abuse were aware of the procedures, but would like an easy to understand version. The deputy manager said that he would produce a flow chart giving clear, simple guidelines for the procedures to be followed should abuse be suspected. Fourteen staff members had recently attended training on the protection of vulnerable adults. Staff made every effort to assist in two recent adult protection investigations undertaken at the home. Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 25 and 26 The home provides a clean, safe environment, with specialist equipment available for those residents who require it. EVIDENCE: On the day of the inspection the home looked clean and there were no offensive odours. However the carpet in one on the bedrooms was badly stained. The resident said that the stain had been present for some time and the deputy manager said that efforts to remove the stain had failed. New flooring is required in the room. Specialist equipment was in use for residents who had been assessed as requiring it, including pressure relieving mattresses and cushions. Hoists were available to assist residents with poor mobility. A passenger lift gives residents access to all areas of the home and grab rails and ramps are in place where required. Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 Page 15 A key pad entry system is in place for the main door of the home and all visitors are required to sign the record book on entering and leaving the property. A call alarm system is available in rooms used by residents. During the inspection call alarms were seen to be available and accessible to residents in their own rooms. Residents sitting in the lounges have only limited access to a call alarm but staff were seen to frequently enter the rooms and speak to residents there. The deputy manager said that a refurbishment programme is due to commence in November 2005. Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 The home’s lack of robust recruitment procedures, review of staffing levels and staff qualifications could put residents’ safety at risk. EVIDENCE: The home employs a deputy manager, nine registered nurses, three senior carers and sixteen carers. A manager is due to take up the position at the end of October 2005 and an additional registered nurse and senior carer start later in the week. The rota indicated that nine staff are on duty during the day and five at night. The home employs separate staff for administration, catering, laundry and domestic duties. Gaps in the records of turn charts for residents nursed in bed indicate that there are insufficient staff on duty at times, particularly the evenings. It was a requirement of the last inspection report that the staffing levels be reviewed with regard to dependency levels of the residents. Only one staff member employed in the home holds NVQ level 2. At present no member of staff is undertaking NVQ training. However, the deputy manager said that an NVQ assessor is visiting the home on the 20th October to discuss training with carers. The deputy manager is aware of the requirement for at least fifty percent of staff to hold NVQ level 2 or above or to be in the process of obtaining the qualification. Records were seen for three staff members. One of the records contained all the information required in the Care Homes Regulations. One of the other Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 Page 17 records contained one written reference and the other did not contain any references. Two of the staff members did not have Criminal Records Bureau checks completed before starting work at the home. It has been a requirement of the inspection report dated 11/04/05 and 10/11/04 that records contain all the information required in Schedule 2 of the Care Homes Regulations. No staff member is to commence work at the home unless a Protection of Vulnerable Adult (POVA) check has been completed. The deputy manager has only recently taken up his post and was not up to date with staff training at the home. Documents available did not provide a clear record of staff training. The home is to forward an up to date record of staff training to the commission. Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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, 33, 35 and 38 Residents’ financial interests are safeguarded by the home’s clear procedures for handling money. Residents’ health, safety and welfare may not be protected if staff are not following safe working practices. EVIDENCE: A new manager has been recruited for the home and is due to take up the post at the end of October. The deputy manager said that since taking up his post recently, he has spoken to all the residents on a one to one basis. He has also been able to speak to some relatives. Four residents said the deputy manager was approachable and willing to listen. Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 Page 19 It was not possible to fully assess standard 33 due to recent management changes that have taken place. This standard will be assessed again at the next inspection. Small amounts of money are held for residents at the home. Since the last inspection the monies have been stored individually, in a secure place. Records are kept of all transactions. Records seen for three residents matched the money held. It was noted from receipts that a store loyalty card not belonging to the residents was used for some of the purchases. The deputy manager was made aware of this and stated that all staff would be told that this must not happen. During a tour of the home it was noted that hazardous substances such as cleaning fluids were stored securely. The kitchen looked clean and the temperature of the fridges and freezers were being monitored and recorded. Fire records seen indicated that all staff had received fire safety training and had attended fire drills. As previously stated in standard 30, clear training records were not available to identify staff training so it was not possible to confirm staff had received training in moving and handling, food hygiene, infection control and first aid. Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 Page 20 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 2 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 x x x 3 x x 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x 3 x x 2 Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 Page 21 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. Standard OP7.2 Regulation 15(1) Requirement The registered person must ensure that residents’ care plans are reviewed at least once a month and updated to reflect their changing needs. The registered person must ensure that risk assessments are included in the care plans. The registered person must ensure that care plans are developed and reviewed in consultation with the resident or their relative/representative. The registered person must ensure suitable locks are fitted to all residents’ bedroom doors to ensure the residents’ right to privacy is upheld. This is an outstanding requirement of the inspections dated 10/11/04 and 11/04/05 The registered person must review the staffing levels with regard to the number and dependency needs of the residents. This is an outstanding requirement of the inspection DS0000011652.V253610.R01.S.doc Timescale for action 30/11/05 2. 3. OP7.3 OP7.6 13(4)(c) 15(1) 30/11/05 30/11/05 4. OP10.1 12(4)(a) 31/12/05 5. OP27.1 18(1)(a) 30/11/05 Flowerdown Nursing Home Version 5.0 Page 22 dated 11/04/05 6 OP28 18(1)(a) (b) (c) 19(1) The registered person must 31/12/05 ensure staff are provided with the opportunity to train for NVQ level 2 or above. The registered person must 30/11/05 ensure staff records contain all the information required in Schedule 2 of the Care Homes Regulations including two written references and POVA/CRB checks This is an outstanding requirement of the inspections dated 10/11/04 and 11/04/05 An up to date record of staff 30/11/05 training is to be forwarded to the commission. 7 OP29.2 8 OP30 18(1)(a) (b) (c) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Flowerdown Nursing Home DS0000011652.V253610.R01.S.doc Version 5.0 Page 24 - 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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