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Inspection on 05/06/07 for Flowerdown Nursing Home

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

This inspection was carried out on 5th June 2007.

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

During this visit it was noted that the general atmosphere in the home was good, with staff and residents relaxed and good interaction was observed between them. The assessment documents are very comprehensive and if completed fully would provide detailed assessments of service users that would give grounding to a plan of care. Service users have access to the health care they are entitled to and professionals allied to health attend the home to undertake assessments and give advice. The home provides nourishing well-presented food that service users report `has improved of late` and is `very good` and `there are always choices and they get you just what you want`, `the cook is very good here`. The atmosphere throughout the home was calm and the residents appeared unhurried with care being given at the resident`s own pace. Residents spoken to confirmed that they were able to make decisions about how they spent their day. They complimented all the staff on their kind and supportive approach towards them and many stated, "that nothing was ever too much trouble, I only have to ask and I get all the help I need".` The environment is pleasant and decorated to a good standard. Service user`s rooms are individual and pleasantly furnished with most having a pleasant outlook. The residents report a high level of satisfaction with their living accommodation. The environment is pleasant and the home is surrounded by well-maintained gardens with seating areas that residents take advantage of in the finer weather Residents spoken with said that the manager was approachable and offered support. Staff also spoke of the support they were receiving from the management. One resident saying `There are things I do not like but the staff are very good here`.

What has improved since the last inspection?

The manager is continuing to formulate a formal training programme and has accessed training for staff in the local hospital and other sources where training is free. Staff spoken to told the inspector that their training needs are met. The home is giving staff the opportunity to undertake the National Vocational Qualifications level 2 and 3. The organisation has undertaken a quality assurance survey to service users, relatives and other stakeholders. The manager has received the report of the outcomes from this which she will share with her staff and identify any issues for improvement. There were no odours detected in the home on this occasion.

What the care home could do better:

The manager told the inspector that some of the foreign staff have found the written English difficult although they have been to English classes and this can sometimes be to the detriment of the care plan recording. Six service user surveys were returned to the CSCI, albeit that a number had been completed by a relative. The comments on the surveys were positive in most cases, but there were some comments about the communication skills of some of the foreign staff and that although they had good spoken English they did not always understand what it being said to them. The manager must continue to formulate a training programme and keep a training matrix to easily identify the training that has taken place and by whom. The staff must continue to receive guidance and training on how the care plans should be completed. The information that is written down on a care plan should inform the day-to-day practices when meeting a resident`s needs. The manager must ensure that all staff have up to date moving and handling training. The manager should continue to develop the quality assurance systems within the home to ensure that the home is meeting the Statement of Purpose and that systems are being monitored to identify any failings.

CARE HOMES FOR OLDER PEOPLE Flowerdown Nursing Home Harestock Road Winchester Hampshire SO22 6NT Lead Inspector Jan Everitt Unannounced Inspection 09:15 5th June 2007 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.V339077.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 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 flowerdown@fshc.co.uk Tamhealth Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Carol Rose Taylor Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - N to service users of the following gender: Either Whose primary needs on admission to the home are within the following category: Old age, not falling within any other category Code OP. The maximum number of service users who can be accommodated is 53. 13th November 2006 2. Date of last inspection Brief Description of the Service: Flowerdown Nursing Home is registered to provide care and accommodation for fifty three older persons who require nursing care. The home has been extended over the years and accommodation is provided in forty eight single rooms and one shared room, situated on two floors of the old house and the new extension. The home has completed an extensive programme of redecoration and refurbishment. 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. The home accepts residents funded by Social Services with top-up fees. The fees for self funded residents is £650-£800. Fees range from £442.30 - £800 . Service users pay extra for hairdressing, chiropody and personal toiletries etc. Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site inspection visit to Fowerdown Nursing Home, which was unannounced, took place over a one-day period on the 5th June 2007 and was attended by one inspector. The registered manager, Mrs. Carol Taylor and the home’s deputy manager were present throughout the visit and were available to provide assistance and information when required The visit to the home formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The provider had returned the Annual Quality Assurance Assessment to the CSCI and the focus of this visit to the home was to support the information stated in this document and other information received by the CSCI since the last fieldwork visit made to the home on the 13th November 2006. . As part of the inspection process the records for four residents were examined and three staff personnel records were also examined. The inspector spoke to both residents and visitors to the home. All those spoken to were very satisfied with the care and services that were being provided. The inspector observed effective interaction between staff and the residents in communal lounge areas and the dining areas. During the visit accommodation was viewed including bedrooms, communal/shared areas and laundry. Documents and records were examined and staff working practice was observed where this was possible without being intrusive. Residents, visitors and staff were spoken to in order to obtain their perceptions of the service that the home provided. At the time of the inspection the home was accommodating 39 residents and of these 7 were male and 32 were female. No resident was from a minority ethnic group. Other matters that influenced this report included information that the Commission for Social Care Inspection (CSCI) had received since the random inspection visit of November 06, at which time the inspector checked compliance with the requirements from the inspection visit of May 06. Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The manager is continuing to formulate a formal training programme and has accessed training for staff in the local hospital and other sources where training is free. Staff spoken to told the inspector that their training needs are met. The home is giving staff the opportunity to undertake the National Vocational Qualifications level 2 and 3. Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 7 The organisation has undertaken a quality assurance survey to service users, relatives and other stakeholders. The manager has received the report of the outcomes from this which she will share with her staff and identify any issues for improvement. There were no odours detected in the home on this occasion. 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. The summary of this inspection report can be made available in other formats on request. Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 - Standard 6 is not applicable to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The pre-admission procedure should ensure that a comprehensive assessment is undertaken that assures people moving into the home that their needs will be met. However the assessment tool is not always being used effectively for all new admissions. EVIDENCE: A sample of five service user care plan documents was viewed, one of which related to a more recent admission for respite care. The pre-admission assessment tool is comprehensive and covers all aspects of physical and emotional care and would enable the assessing nurse to gain detailed information as a basis for developing care plans. The tool also includes a scoring for each aspect of care, to measure levels of dependency. The Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 10 inspector observed that because not all areas of the assessment tool had been completed fully, the dependency score could not be established accurately and it was difficult to identify needs. This was discussed with the manager who told the inspector that she agrees that some of her staff still need education on how to complete the document and use it to its full potential. The pre-admission assessment for another resident demonstrated historical information and it was suggested to the manager that a review of this person’s needs should be documented. Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service user’s health and social care needs are set out in care plans. However, the staff need to develop the system more fully and use the assessment document to give more detail and a more person centred approach. The residents are protected by the home’s policies and procedures for the safe administration of medications. Staff training ensures that the residents are treated with respect and that their right to privacy is respected at all times. Service users and their relatives are assured that end of life care plans are in place and their wishes respected. Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 12 EVIDENCE: The random inspection of November 06 identified that at that time the care plans reflected accurately the needs of the service users and that they were drawn up in consultation with the service user/relative. The inspector viewed a sample of 4 care plans at this visit, one of which was for the most recently admitted person who had come to the home for a period of respite care. The documents recorded general information about the service user. The care plans were variable in their content and the lady who had been recently admitted did not have any care plans written to describe her care needs. The files contained some incomplete assessment forms including a social assessment. The manager told the inspector that some of the foreign staff have found the written English difficult although they have been to English classes and this can sometimes be to the detriment of the care plan recording. Risk assessments were evidenced in care plans for tissue viability, moving and handling and nutrition. Corresponding care plans were written to manage any risks identified. Risk assessments were also present for those who use bed rails and the assessments demonstrated that the service user or the relative had signed as agreement with the use of the bedrails. The inspector observed that the daily notes were detailed and described how the service user had been cared for that day. The inspector observed that some of the care plans had not been consistently reviewed monthly. The inspector viewed the accident books. It was identified that one resident had frequent falls. The inspector tracked these records back to the care plans and daily notes. All but one had been documented in the daily notes, but there was no evidence that the pattern of these falls had been analysed to identify any emerging reasons why the person was falling. The inspector evidenced that the care plans had been signed by the service user or relative as evidence of their involvement and agreement. There was evidence in the residents’ records when other health care professionals, including chiropodists and opticians, who were present in the home at the time of this visit, make visits. The manager confirmed that residents are able to remain with the doctor who was attending them prior to their admission to the home if the doctor is agreeable. The home has access to three local doctors surgeries and is very satisfied with the service they provide. Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 13 One of the GPs visited the home during this inspection and spoke with the inspector. She told the inspector that she visits the home every week to review the residents the nurses request her to see, if there is a change in their condition. The medication records were viewed by the inspector and, with the exception of one, contained a clear photograph of the resident for identification. Policies and procedures are in place for the safe disposal of medications. The home has changed its supplying pharmacy and is satisfied with the service being provided. The registered nurses have had training updates for the safe administration of medication; this was evidenced in the training file. All medications are kept in a locked storage area. There were occasional omission of signatures identified on the medication record sheets but the records had been completed appropriately where a resident had declined or had been unable to take their medication. This was discussed with the manager and deputy manager, who anticipated auditing the MAR sheets on a regular basis to ensure they are completed as per policy. The inspector observed that storage of the medication was in locked trolleys and cupboards with no evidence of them being over stocked. The controlled drug registered was viewed and was recorded appropriately and the balance of tablets recorded in the register was that found in the cupboard. The records for the disposal of medication were maintained and the home has a contract with a clinical waste agent for the disposal of unwanted medicines. Under a separate agreement the controlled drugs are now returned to the supplying pharmacist. Service users spoken with and from a comment on a returned survey questionnaire would indicate that residents are provided with their medication at the appropriate time. Information on the core values of care is included in Skills for Care Induction programme that all new staff are undertaking. This identifies how staff must acknowledge the individuality of the service users and how they should treat them with respect and dignity. At the time of this visit staff were observed knocking on the doors of residents bedrooms before entering and generally interacting well with the residents. Residents and a relative spoken to during the inspection confirmed that the staff are respectful and polite at all times. The manager showed the inspector the folder issued to the home about the policies and procedures to guide end of life care. One service user has had this implemented. Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities are well organised and provide service users with a variety of activities to meet their social, religious and recreational wishes. Relatives and friends are welcome to the home at any time and service users are encouraged to maintain links with the local community. The home is striving to strengthen and improve links with the local community. Residents confirmed that they are able to have choice over many aspects of their daily lives. The home provides a varied nutritious diet to meet service user’s dietary needs. EVIDENCE: The home has an activities programme that is advertised in all bedrooms each week for activities Monday to Friday. The activities programme is created by the organiser, who is part of the care team but undertakes the activities organiser role every weekday afternoon. She reported to the inspector that she had not undertaken any specific training for activities that were appropriate and appertained to the service user group. Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 15 The home also has another activities organiser for a further two days a week who undertakes operating the library and shop and to also have one-to-one activities with those residents who are less able. At the time of this visit there were activities taking place in the afternoon. A service user told the inspector that she joins in all the activities, whatever they are, and she enjoys helping those who are less able. The home does not document a social history from service users at the time of the assessment. The activities organiser is therefore not aware of previous hobbies and occupations, which may help her to organise the activities around this information. However, she does maintain very good records for each resident about the activities they participated in and the level of their involvement or if they chose to decline attending or joining in. One service user told the inspector that ‘she does not participate in the activities as she feels unable to do so but thoroughly enjoys watching the others participating’. The home is also fortunate to have a mini-bus and although this was only purchased November 06 and staff training is now completed, the bus will be a welcome diversion for those wishing to go out. A survey questionnaire returned from a service user commented that ‘the mini bus is not utilised as fully as she would wish’. This was discussed with the manager, who told the inspector that it has been used for a number of service users to take them to vote but explained that the bus was purchased in the winter months, the staff have had to be trained and it will be used more now the better weather has arrived. The bus is also to be used for taking residents to hospital appointments. The manager said the use of the bus would always depend on the staffing allocation and the priorities of the home. The visitor’s book demonstrated that the home has a large number of visitors in and out of the home daily. There is no restriction on visiting, only if the service user does not wish to see visitors. The clergy from a local church visits the home each month and holds a service for those residents who wish to attend. Residents confirmed when speaking to the inspector that they are able to have choice over many aspects of their daily lives. They are able to choose what time they get up and go to bed, what clothes they wish to wear and where they spend their day and eat their meals. One resident spoken to stated that she is able to choose where she spends her days and that staff were happy to comply with her wishes. Another resident told the inspector that she has the ‘best room in the house and is so happy to have her bird table and watch the birds feeding’. She stated as with all the staff “nothing was ever too much trouble. Everybody is so kind”. Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 16 The home provides a varied selection of food. Menus are available and run on a four-week rotation. Residents confirmed that they are always asked what they want to eat and are able to change their mind at any time and will be offered an alternative. One resident commenting ‘I choose it one day and forget what I have ordered by the next’. The breakfast menu offers a cooked option as well as cereals and toast. Lunch offers two alternatives with fresh vegetables. A vegetarian option is available as required. Cakes provided at mid afternoon tea are always homemade. At suppertime a hot meals is offered as well as sandwiches. The inspector observed the lunch being served and it looked well presented and nutritious, with a variety of vegetables. The inspector also observed a large bowl of fresh fruit on display for people to help themselves to. The manager told the inspector that the chef visits each service user when they are admitted to ask what their preferences, likes and dislikes are or if they have any special diets to be catered for. The manager reported that the chef goes around talking to residents most days to ascertain their preferences and what they have liked or disliked on the menus. Catering staff are employed to prepare each meal, care staff do not prepare any meals. Staff were observed supporting those residents who require additional assistance at meal times. Residents are encouraged to come to the dining room for their meals but may have them in their room if they so wish. The residents spoken with all stated that the food was good and that they enjoyed it. One resident commenting that the food had ‘ improved of late’. One service user survey did comment that she needs assistance with her meals which are sometimes left with her and she is then forgotten’. Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints that have been made to the home, in general, have been handled appropriately and have provided residents and their families with confidence that their concerns will be listened to, taken seriously and acted upon. Robust procedures and staff training and awareness ensure that the residents are protected from abuse. EVIDENCE: The home has a complaints policy in place that is also stated in the Statement of Purpose to guide service users/relatives through the process. The AQAA reported that there had been three complaints in the last twelve months, two of which had been resolved and one was in the process of being investigated. The complaints log was viewed with actions and outcomes documented. The manager reported, and the AQAA stated, that the documentation of complaints needs further improvement so that more accurate evidence is recorded of what has been done when issues or complaints have been raised. The Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 18 manager told the inspector that she is awaiting a meeting with the operational manager to go through how this can be achieved. The service users and relatives surveys returned to the CSCI indicated that people would know who to go to if they wished to complain or raise an issue. One service user commenting that she would go ‘straight to the manager and she would then be sure that something would be done’. A relative commented that she ‘ensures that she and her husband are heard if they wish to raise a complaint about the care of their relative but, they consider, he is well cared for’. The home has a copy of the Hampshire Adult Protection procedure and the manager confirmed that she is aware of the procedure to be followed in the event that an incident of abuse is reported. The home provides training for staff for the protection of vulnerable adults. The members of staff spoken to confirmed that they have received this training previously and are aware of the procedure to be followed if they witnessed any incident that constituted abuse towards a vulnerable adult. The manager reported that the company who owns the home have reviewed all the policies and procedures for the home. Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a clean, hygienic and homely environment for service users to live in. EVIDENCE: The random inspection report of November 06 identified that the requirements around the environment that had been highlighted in the May 06 report had been met. The inspector toured the home. The home was clean with no offensive odours detected. The inspector observed that service users had personalised their rooms with their own belongings, one resident eager to show the inspector her pictures of embroidery that adorned the walls of her room. Service users who were visited in their rooms reported to be very satisfied with their environment Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 20 with one lady commenting ‘I have the best room in the house’. Another lady whose room was in another area of the home echoed this comment. Indeed the majority of rooms do look out onto well maintained gardens and grounds and the ground floor rooms, which are much coveted, have individual patios, on which some service users keep plant pots and bird tables. The home is in the process of replacing all beds with profiling beds that are fully adjustable and have pressure-relieving mattresses in place. At the time of the visit the home had twenty-five in place and it is in the business plan that the remainder will be replaced by the end of the year. On the day of this visit one of the lifts had broken down and this had resulted in some of the service users needing to change rooms the previous night to enable them to have access to the other lift on the other side of the house. It was fortunate that the rooms were empty otherwise these service users would not have been able to go downstairs, which many of them choose to do. During the visit the lift became operational. Staff spoken with at the time of this visit said they considered that there were now sufficient hoists available for both floors to enable them to meet the service users moving and handling needs. The home has been refurbished over the past two years and the furniture is appropriate and of good quality. A separate staff group services the housekeeping activity of the home and the head housekeeper was around the home supervising the staff at the time of this visit. She was spoken with and reported that she enjoys her job and has implemented systems and routines that her staff follow. The laundry was visited and was clean and well organised and the staff member was able to describe the procedure for dealing with soiled linen and the infection control principles. The machines were fit for purpose. All staff have undertaken infection control training and policies and procedures are in place. The inspector observed that appropriate aprons, gloves and hand washing facilities were available throughout the home. Staff spoken with demonstrated knowledge of what the principles of how the spread of infection could be controlled Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home employs sufficient staff to meet the needs of the current service users in residence. All staff now undertake a more formal induction training to ensure they are competent to do their job. Currently service users are in safe hands at all times. The home has robust recruitment procedures for new staff to ensure protection of the service users. It is evident that regular training does takes place although the registered person needs to ensure that all staff are up to date with key health and safety areas. EVIDENCE: At the time of the inspection there were 39 people in residence. The duty rotas were viewed by the inspector and recorded that 2 trained nurses and 7 carers were on the am duty and 2 trained and 6 on the pm duty. Two trained nurses and two carers are on waking duties throughout the night. At the time of this inspection there appeared sufficient staff on duty to meet the needs of the service users. Staff were not rushing about and were observed to be taking time to interact and be with the residents. The inspector observed that the home employs a mixed gender staff and this is conducive to having a Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 22 mixed gender client group. The manager reports that the male carers are well accepted by the ladies but if a resident identified that they wished to have the same gender carer, this would be documented and respected. The inspector observed that the lunchtime period was busy, as there are a number of residents that needed assistance with their feeding, and a number of residents who choose to eat in their rooms. The inspector observed a number of carers around the lunch trolley serving food, at the same time a buzzer was persistently ringing from upstairs, this had to be pointed out to one of the carers by the inspector before it was responded to. Comments on the survey cards received from relatives and service users indicate that they consider they usually receive the care and support they need but one service user commenting that ‘sometimes the carers are slow to respond and sometimes ignore the resident when they are giving personal care and prefer to talk to their colleague about other things’. The overall impression from the surveys returned and talking to service users at the time of the inspection, indicated that overall there are sufficient staff on duty but there are times when it does not feel there are enough, or that the turnover of staff causes difficulties with care. This was discussed with the manager who said that they had had a turnover of staff in the last year but she now had an excellent team that worked well together, and one that she felt confident would deliver a good standard of care. The home has a separate staffing group for the housekeeping duties in the home. The laundry lady spoke to the inspector and reported that she had worked at the home for many years and it had improved and that the present team working in the home created a good atmosphere in the home. The inspector observed that she ran a clean, well-organised laundry. The organisation has introduced the Skills for Care Induction Programme that the deputy manager will coordinate with new staff and take overall management of this programme. The AQAA identified that over 50 of staff have achieved their NVQ level 2 or above qualifications. The manager reported that she actively encourages the staff to undertake this qualification. The staff spoken with reported that they are well supported in their training needs and trained staff are given the opportunity to attend training to enable them to meet the required standards of knowledge to maintain their NMC registration. The manager told the inspector that the organisation does provide training in various subjects but it is held a long distance from the local area and therefore staff do not access this. She reported that she was fortunate that she is able to access training sessions from the local hospital. A sample of recruitment files was viewed by the inspector and demonstrated robust recruitment practices. The information contained in them included CRB and POVA checks, references, one being from a previous employer, interview Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 23 notes were also recorded. All information was gathered before the commencement of employment and the inspector concluded that the recruitment practices of the home were robust. The personnel files also contained the personal appraisals and supervision notes for the staff. The random inspection of November 06 identified that the home did not have a formal training programme for staff and that there was no training matrix to identify training that had taken place or was due to take place. Staff training files were viewed at this visit and these demonstrated that staff do receive a variety of training and also the mandatory health and safety training annually, but that these are not recorded on a training matrix that would easily identify what training has taken place and by whom and that if all staff had received the mandatory training. This was discussed with the manager and she told the inspector that she is still in the process of organising the training programme and along with that she will produce a training matrix. She also acknowledges that the moving and handling annual updates are late owing to sickness of the home’s trainer. She has accessed a variety of other training from various sources and the deputy manager, who is newly appointed and is a trained nurse tutor, will be taking on the in-house training and induction of staff as part of her role, for which the manager will be allocating supernumerary hours. The inspector spoke to some of the staff and they reported that they do receive appropriate training to enhance their ability in the job and that they are supported by the manager to do so if they wish to go to a particular training, or a training need has been identified. Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is able to demonstrate that she is suitably qualified to ensure that the home is well run. There are organisational and internal systems in place that monitor the quality of the service provided. Procedures are in place to ensure that the residents’ financial interests are safeguarded. Close monitoring of practices within the home safeguard the health, safety and welfare of residents, staff and visitors to the home. Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager is now registered with the CSCI and has been in post for two years. She has gained her Registered Managers Award and has had many years experience in nursing both as a clinician and manager. Comments from staff and observing interaction between the manager and staff, visitors and service users, the inspector concluded that the manager is respected and liked. One staff member spoken with commenting that the manager is ‘brilliant’. A relative commented that ‘things had improved since the new manager has been in post’. The manager, who had returned from sick leave just the previous day, told the inspector that she receives support from the regional manager who visits the home weekly and that whilst she was off sick the regional manager visited more regularly and was freely available to the home. The organisation has introduced their quality assurance system known as Team Audit Process (TAP). This system involves the heads of departments i.e housekeeping, nursing, administration and management taking responsibility for the auditing of the systems and administration within their departments with the manager having overall responsibility to verify the results. The organisation has undertaken a quality assurance customer satisfaction survey that has been distributed to service users, relatives and significant others. The results have been distributed to the home and the manager showed the inspector the results. The report showed that half of the questionnaires were returned and the overall outcome was very good. There were some negative comments from relatives, and these have been discussed with the regional manager and have been addressed. Those that have not are being addressed currently. The report was in text but the results were demonstrated by pie charts indicating the percentage of satisfaction, dissatisfaction, no comment etc. and graphically identified a high level of satisfaction in all areas of the service. Organisational polices and procedures were recorded on the AQAA as being current and these were evidenced at this visit. Regulation 26 visit reports were viewed at the home and demonstrated that they are not taking place monthly. The manager reports that the reason for this was that the new regional manager had not been able to undertake these monthly owing to pressure of her workload, but she anticipated that these would be completed as from this month. The home takes care of one resident’s money that a relative leaves for them. This is kept in a separate zipped container in a secure place. A receipt is given Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 26 to the relative at the time the money is received and when the service user needs a receipt is kept from whatever they have purchased. The inspector did not check the balance of this money on this occasion. The AQAA recorded the dates of the servicing of the equipment and systems. A sample of these was viewed by the inspector and was found to be current. The fire log was viewed and was up to date with the testing of the fire alarm system. The head housekeeper was spoken with and she demonstrated a wide range of knowledge with the use of and the storage of the COSHH chemicals used in the home. She observed a toilet cleaner left in a bathroom and instructed the domestic person to remove it immediately. The inspector observed that the cleaning trolleys were not left unattended. The manager showed the inspector the documentation for the formal risk assessment of the environment that is being undertaken in July. Health and safety meetings are held three monthly in the home to discuss issues around the risks in the environment. The inspector observed that a resident who had been recently admitted for respite care was using and storing oxygen in their room. This was discussed with the manager as to the correct storage procedures for oxygen and that a notice should be displayed on the door of the room where oxygen is in use. She conceded that she had not been aware of this and that she would rectify this immediately. Health and safety training is undertaken by staff annually and this was supported by the staff spoken to, who confirmed that they do attend the training. Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 27 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 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 28 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 OP3 Regulation Reg 14(1) Requirement Timescale for action 31/07/07 2. OP7 Reg 15(2)(b) 3. OP30 18(1) The registered person must ensure that the assessment process of the service user is thorough, to enable their care needs to be fully identified and person centred care plans to be formulated. The registered person must 30/07/07 ensure that care plans are reviewed monthly or at appropriate intervals to ensure the changing needs of the service users can be identified. The registered person must 30/08/07 continue to develop the staff training programme to ensure that the staff undertake appropriate training to enable them to be competent to do their job. A training matrix should be developed to identify training needs and enable the manager to easily identify what training has taken place and by whom. This was partially met at the previous visit of November 06 and continues to being developed. DS0000011652.V339077.R01.S.doc Version 5.2 Flowerdown Nursing Home Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP33 Good Practice Recommendations It is recommended that the visiting operational manager leaves a copy of the Regulation 26 visit report at the home each month to report on the conduct of the home. Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Flowerdown Nursing Home DS0000011652.V339077.R01.S.doc Version 5.2 Page 31 - 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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