This inspection was carried out on 19th January 2006.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.
The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.
CARE HOMES FOR OLDER PEOPLE
Flowerdown Nursing Home Harestock Road Winchester Hampshire SO22 6NT Lead Inspector
Marilyn Lewis Additional Inspection 19th January 2006 12:00 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.V278041.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. Flowerdown Nursing Home DS0000011652.V278041.R01.S.doc Version 5.1 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.V278041.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One service user date of birth 19th November 1939 can be accommodated 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.V278041.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This additional inspection was undertaken to look at the home’s compliance with requirements issued at the last inspection dated the 11th October 2005. Since the last inspection a new manager has been recruited and she took up her post at the end of October 2005. During this visit the inspector met with the new manager, the deputy manager, three staff members and four residents. Care plans were sampled for four residents and records were seen for staff recruitment and training. Only standards where requirements had been issued at the last inspection were assessed on this occasion. Information on standards assessed on previous inspections for 2005/2006 can be found in the inspection reports dated 11th April 2005 and the 11th October 2005. What the service does well: What has improved since the last inspection?
Staff were spending time chatting to residents in the lounges and on a one to one basis with residents who were in their own rooms. Residents spoken with said that the new manager and deputy manager were approachable and offered support. Staff also spoke of the support they were receiving from the management team. Care plans seen for four residents indicated that an improvement had been made in the information provided on the assessed needs of the residents and the care plans seen showed evidence that the residents or their relatives had been involved in a recent review of the documents. Risk assessments had been undertaken for mobility, nutrition, continence and pressure areas and they were contained in the care plans. Staffing levels for day shifts had been reviewed and rotas indicated that sufficient staff were on duty to meet the needs of the residents. Residents spoken with said that they did not have to wait long when they asked for assistance and they felt that enough staff were on duty.
Flowerdown Nursing Home DS0000011652.V278041.R01.S.doc Version 5.1 Page 6 Some bedroom and bathroom doors are not fitted with locks to ensure the residents have privacy when required. At the time of this visit Four Seasons were undertaking a major refurbishment of the home. The manager said that the fitting of locks to doors without them was part of the refurbishment programme. At the time of the last inspection no staff members were involved in training for National Vocational Qualifications. (NVQ) Since then an NVQ assessor has been recruited by the organisation and a training programme is being arranged. The new manager has experience in providing training for staff employed at care homes and she has reviewed staff training requirements and is arranging a training programme to cover all aspects of care provision. Recruitment records seen for staff on the last inspection did not contain all the information required. On this occasion the records seen for three staff members contained proof of identity, confirmation of qualifications and two of the three had two written references. The manager arranged for the second reference for the third person to be forwarded from the organisation’s human resources department. The records indicated that Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks had been completed. What they could do better:
Rotas seen for night duty indicated that for the current week only one trained nurse was on duty for four of the seven nights. The manager was in the process of reviewing staffing levels for night duty and had arranged to work alongside the night staff for that night. The home must demonstrate to the commission that a sufficient number and skill mix of staff are on duty at night to meet the needs of the residents and taking into account the layout of the home. Please contact the provider for advice of actions taken in response to this
Flowerdown Nursing Home DS0000011652.V278041.R01.S.doc Version 5.1 Page 7 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.V278041.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Flowerdown Nursing Home DS0000011652.V278041.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Not assessed at this inspection. Flowerdown Nursing Home DS0000011652.V278041.R01.S.doc Version 5.1 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 the following standard(s): 7 The amount of information provided in residents’ care plans has improved and staff have the information required to meet the needs of the residents. EVIDENCE: Care plans seen for four residents indicated that an improvement has been made and reviews are taking place at least once a month. Three of the plans seen had been updated to reflect the current needs of the residents. The fourth had been reviewed but required further updating as there was no continence plan but the records indicated that the resident was doubly incontinent and also mobility had decreased since admission and the plan did not reflect this. However the information contained in the care plans was much improved from the time of the last inspection and the manager was aware that further work was required and arrangements were in place for all care plans to be audited. Care plans seen contained completed risk assessments for mobility, nutrition, pressure areas and continence. Risk assessments were also in place for the use of bed rails. However one risk assessment did not indicate whether bed rails were in place but the form had been signed by a relative.
Flowerdown Nursing Home DS0000011652.V278041.R01.S.doc Version 5.1 Page 11 The manager said that manual handling assessments for all the residents were being reviewed and records seen indicated that this had begun. The four care plans seen indicated that the resident or their relatives had been Involved in the development and review of the documents. A resident spoken with said that a staff member had discussed her care plans with her and she had agreed with them. Flowerdown Nursing Home DS0000011652.V278041.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: Not assessed at this inspection. Flowerdown Nursing Home DS0000011652.V278041.R01.S.doc Version 5.1 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): EVIDENCE: Not assessed at this inspection. Flowerdown Nursing Home DS0000011652.V278041.R01.S.doc Version 5.1 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): EVIDENCE: At the time of the visit Four Seasons was undertaking a major refurbishment and redecoration of the home. The manager of the home said that locks were due to be fitted to bedroom and bathroom doors that did not have them. This will be checked at the next inspection. Flowerdown Nursing Home DS0000011652.V278041.R01.S.doc Version 5.1 Page 15 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 Residents are protected by the home’s recruitment procedures and staff now have the opportunity to attend training sessions and gain qualifications. Staffing levels at night need to be reviewed to ensure the number and skill mix of staff on duty can meet the needs of the residents. EVIDENCE: Staffing levels have been reviewed and the rotas seen indicated that sufficient staff were on duty during the day shifts. Three residents in the lounge said that they felt they did not wait long for assistance when they asked for help. The rota for night duty indicated that for four of the seven nights of the week only one trained nurse was on duty. The manager said that although the home was registered for 53 residents the number was being kept to below 50 until the new management team had familiarised themselves with the operating requirements of the home and that she was reviewing the staffing levels at night particularly with regard to the number of trained nurses on duty. The manager had already arranged to work alongside the night staff that day. The manager must be able to demonstrate to the commission that the number and skill mix of staff on night duty are sufficient to meet the needs of the residents. Flowerdown Nursing Home DS0000011652.V278041.R01.S.doc Version 5.1 Page 16 It was also noted from the rotas that some staff members were working up to 72 hours a week. The manager said that this would be discussed during staff supervision. Four Seasons has recruited an NVQ assessor and a training programme is being developed for staff at the home. Currently one staff member who holds level 2 is going on to do level 3 and another carer is also starting level 3. Two staff members spoken with during the visit said that they had been asked to commence the training programme to obtain the qualifications. The NVQ training programme will be assessed during the next inspection. The new manager has experience in providing training for staff employed in care homes and she said that a training programme was being developed following an audit of staff training requirements. The manager is a trainer for manual handling and all staff are receiving updates, with the theory sessions already underway. At the time of the inspection the trained nurses were attending training sessions on venu puncture and catheterisation. A session on diabetes had been given recently and the manager said that she was arranging monthly training sessions on topics relevant to the service such as tissue viability, dementia awareness, wound care, abuse and communication. Three staff members said that the opportunities for training had improved and that they received support and encouragement form the new manager and the deputy manager to undertake training. An improvement was noted in the information obtained for staff recruitment records. Records seen for three staff members contained proof of identity, work permits where required and confirmation of qualifications. Two written references were in place for two of the staff members and the third contained one. The manager telephoned the organisation’s human resources department to obtain the second reference. The records indicated that POVA checks had been completed for the staff members before they had started work in the home and CRB checks had been completed. Flowerdown Nursing Home DS0000011652.V278041.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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): EVIDENCE: Not assessed at this inspection. Flowerdown Nursing Home DS0000011652.V278041.R01.S.doc Version 5.1 Page 18 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x x x STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x x x Flowerdown Nursing Home DS0000011652.V278041.R01.S.doc Version 5.1 Page 19 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 OP27 Regulation 18(1)(a) Requirement Staffing levels must be reviewed for night shifts with regard to the number and skill mix of staff on duty. This is a partial outstanding requirement of the inspections dated 11/04/05 and 11/10/05 Timescale for action 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Flowerdown Nursing Home DS0000011652.V278041.R01.S.doc Version 5.1 Page 20 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
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