CARE HOMES FOR OLDER PEOPLE
Friars Hall Nursing Home Friars Road Hadleigh Suffolk IP7 6DF Lead Inspector
Claire Hutton Unannounced Inspection 27th February 2006 10:45 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 Friars Hall Nursing Home DS0000024393.V285144.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. Friars Hall Nursing Home DS0000024393.V285144.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Friars Hall Nursing Home Address Friars Road Hadleigh Suffolk IP7 6DF 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) 01473 822159 01473 822682 Mrs Lalitha Samuel Mrs Laura A Hampson Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Friars Hall Nursing Home DS0000024393.V285144.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th May 2005 Brief Description of the Service: Friar’s Hall is a privately owned care home providing both nursing and personal care to a maximum of 42 older people. The home is located on the outskirts of the small market town of Hadleigh, where amenities such as shops, pubs, church and post office are available. Buses run from the town centre to Ipswich, Colchester and Sudbury towns. The home stands in it’s own grounds at the end of a long gravel drive. It had a car parking area, a garden with some seating for service users and a staff residence where nurses from overseas could be accommodated while they completed adaptation courses to allow them to practice in the United Kingdom. The building is a converted and extended Victorian house, with a shaft lift giving access to both floors. There were 30 single bedrooms, 26 with en suite toilet facilities, and 6 double bedrooms (1 with en suite toilet). The manager is a trained nurse and she has trained nursing personnel on the staff. Care staff are employed to carry out additional caring tasks. Friars Hall Nursing Home DS0000024393.V285144.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a routine inspection to follow up on matters from the previous visit in May 2005 and to assess those standards not covered at the last inspection. The visit lasted 4 ½ hours. During that time three residents were met and spoken with in private, five other residents who have developed a diagnosis of dementia were met or observed, three relatives were spoken with as well as an NVQ assessor at the home and their student carer. Whilst observing the drug round two nurses were spoken with. Records examined included five care plans with associated care records, sampling of records on residents finances, staff recruitment records, the roster and records relating to medication. Most of the communal areas within the home were visited as well as several bedrooms with the permission of the residents. What the service does well: What has improved since the last inspection?
Since the last inspection the home have made progress on the requirements made of them. The home identified ten residents who had developed signs of mental frailty since being at the home. These were then referred to the GP and through consultation with a local psycho geriatrician it has been agreed that the residents may remain at Friars Hall so long as their care needs can be met. If however those residents become unwell with persistent disruptive behaviour that cannot be managed by the home, then those residents will be re-assessed. Friars Hall Nursing Home DS0000024393.V285144.R01.S.doc Version 5.1 Page 6 The manager has developed a new assessment to be completed before residents move into the home and was able to give evidence of this now being used. A new more comprehensive manual handling risk assessment tool was being introduced and evidence of its use was seen in residents’ files. Staff had attended a seminar on falls prevention and strategies had been developed with staff. Currently the home did not have anyone who was falling on a regular basis. A review of how the call bells were being responded to had been undertaken. The matter had been discussed with staff. No resident had any concerns about time taken or response to using their call bell. The home has consulted with Suffolk Fire Service and implemented the use of ‘Dorguards’ to doors instead of wooden wedges. All areas of the home visited were found to be clean and without odour. 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. Friars Hall Nursing Home DS0000024393.V285144.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Friars Hall Nursing Home DS0000024393.V285144.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. (6 does not apply). People who come to use this service can expect information to be available and that their individual needs will be assessed by the home therefore, they can expect their individual requirements to be met. EVIDENCE: At this visit the manager was able to give a copy of the latest guide to the home. This was specifically for residents, their families and friends. The information contained in the booklet is both relevant and useful to residents in setting out what is offered by the home. It is suggested that when this is next reviewed it contain more detail on the relevant qualifications and experience of the registered provider, manager and staff at the home. In addition the views of the residents should be reflected in some way in the document. At the last inspection comment was made upon the scant information collated by way of assessment before residents moved into the home. This was reviewed this visit and the manager was able to show a new developed format that provides a more detailed assessment. Friars Hall Nursing Home DS0000024393.V285144.R01.S.doc Version 5.1 Page 9 Evidence was seen from two new residents files of this being appropriately completed. Therefore the home is able to determine that they are able to meet the needs of the prospective resident before they move into the home. Friars Hall Nursing Home DS0000024393.V285144.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 and 9 People who use this service can expect to have their care needs documented and known by care staff and be assured that their medication will be appropriately stored and administered. EVIDENCE: Care plans and associated records were examined for five residents in total. Three lots of records were examined for people identified as having developed some mental frailty since moving to the home. The area of mental frailty was discussed with the manager and how the home was managing matters. The manager gave an assurance that no ones’ behaviour was disruptive to other residents and staff at the home were able to support the residents appropriately. An assessment of needs were seen to be in place, but some did not have a date or name/signature of the author on them. Plans were developed from the assessments and contained specific instructions to staff, for example, how an individual liked their personal care and dressing, individuals eating and drinking habits and sleep patterns. Nutritional assessments and weight charts were completed and up to date. Friars Hall Nursing Home DS0000024393.V285144.R01.S.doc Version 5.1 Page 11 A new format for manual handling had been introduced that was more comprehensive and clearer for staff to follow. This was gradually being introduced for all residents who required it. What was not in place, but agreed by the manager would be developed, was an assessment of residents mental state and cognition. This is required in order that their condition can be satisfactorily monitored over time. Care plans for two new residents were examined. There was evidence of a full assessment completed by the manager before the resident moved to the home. This was then developed into a plan of care. The new manual handling assessment that used a colour code to guide staff was in place along with an assessment of continence. Property lists were completed for residents and the daily statement of care given was good. The administration of lunchtime medication was observed. This was dome appropriately and residents were treated with respect and kindness by the nursing staff offering medication. The process of dispensing, administering and then signing was followed. The use of codes for recording was appropriate. The system in place was a monitored dosage system supplied by a local chemist. Medication including controlled drugs were appropriately stored and accounted for. Friars Hall Nursing Home DS0000024393.V285144.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): 14 and 15 People who use this service can expect to receive a good quality meal that they will like and residents are likely to be supported to exercise a degree of control over their lives. EVIDENCE: Three residents were met and spoken with during the inspection. Discussions were held around choice and control over their lives. Each person was satisfied that they had the level of control that they wished to have. Specific questions around choice of activities, getting up in a morning and going to bed were all met with positive answers. One resident was quite clear that the staff at Friars Hall are supportive and respect choice. Staff were observed during the medication round and were seen to ask residents if they would like medication such as painkillers or similar and their decision was respected. Even in the case of a resident refusing a prescribed medication that was of benefit to them, the nurses respected their choice and did not place any undue pressure on the resident. The choice of dietary needs were seen in the care plans along with nutrition assessments and in general terms a choice of main meal was available each day for residents.
Friars Hall Nursing Home DS0000024393.V285144.R01.S.doc Version 5.1 Page 13 The main meal was displayed upon a chalkboard near the kitchen for residents to see each day. In the dining room 26 people sat at small tables that were nicely presented with cloths, flowers and condiments. A choice of orange or cranberry juice was offered to residents. At the last inspection the residents spoke very favourably about the quality of food and how good the cook was. This time different residents also held the same view. ‘good tasty food’ said one resident. Standard 12 was not reassessed upon this occasion and therefore will be looked at upon the next visit to the home. Friars Hall Nursing Home DS0000024393.V285144.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service can expect their complaints or concerns relating to abuse to be listened to and acted upon. EVIDENCE: Since the last inspection the home had received one complaint that the home have investigated and responded to appropriately. The home have a complaints procedure set out as part of their service users guide. This meets the regulations set out. In relation to protecting residents from abuse the manager was aware of the local procedure should it need to be used and had the appropriate referral forms for doing so. Care staff have training on understanding and dealing with matters of abuse as part of their TOPPS induction training through the local provider at Kerrison conference centre. The manager also stated that this is part of supervision given to staff on a regular basis. Friars Hall Nursing Home DS0000024393.V285144.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,23 and 26 Friars Hall is generally well maintained and residents can expect to live in comfortable surroundings that meet their needs. EVIDENCE: Friars Hall was reasonably well maintained internally. The grounds are quite extensive with good parking facilities. The communal areas of the dining room, two lounges and conservatory were quite pleasant, warm in temperature and allowed people to move freely around and socialise. At the last inspection the dining room was set for 27 people, but the home had more residents accommodated. When asked how the home would accommodate all residents for dining a staff member said they would put tables in the lounge area. In practice, some residents had their meals in their rooms and others on tables in their armchairs. This was still the case at this inspection. Since the last visit a new bin store had been developed and there are plans to have a new porch put on the home.
Friars Hall Nursing Home DS0000024393.V285144.R01.S.doc Version 5.1 Page 16 The home was clean throughout and any odours detected previously were not present on this visit. The inspector travelled in the modern smooth lift to visit individuals in their rooms. Bedrooms contained all the appropriate furniture. Those rooms in the new extension had lovely views of the garden from the window. More than one resident said they were happy with their individual accommodation and that it met their needs. At the last inspection residents in shared rooms spoken with said they would prefer to have curtains hung from the ceiling and not a curtain on a frame, which was difficult to move and use independently. This recommendation has not been actioned. Friars Hall Nursing Home DS0000024393.V285144.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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, and 29 People who use this service will find that there are sufficient trained staff on duty who are appropriately recruited. EVIDENCE: The staffing roster was examined and this showed sufficient staff employed at the home. Staffing levels were maintained with eight staff on a morning shift, six staff on an afternoon shift and four on at night. This numbers included the nurse on duty. The home also employed sufficient cleaning and catering staff. Both residents and relatives spoken with felt there were sufficient staff on duty to care for the residents. The recruitment records for three staff were examined and were found to have all the checks in place that are required by regulation. The records relating to staff development were also examined for these same three people. A member of care staff recruited in the UK completed her induction training with a local provider at Kerrison conference centre. She has gone on to enrol in her NVQ 2 through the YMCA. The records for two nurses recruited from overseas were also examined. The manager explained that even though they are trained nurses, she finds it beneficial for them to complete the induction training the same as care staff – therefore ensuring they are as up to date with procedures such as manual handling. Those nurses that come from overseas are doing adaptation training initially work as care staff, as seen on the roster and this helps with their orientation to the English
Friars Hall Nursing Home DS0000024393.V285144.R01.S.doc Version 5.1 Page 18 culture. During the inspection an NVQ assessor was seen with a carer completing elements of her NVQ. Friars Hall Nursing Home DS0000024393.V285144.R01.S.doc Version 5.1 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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, 35 and 38 People who use this service can expect to find an approachable manager and owner who are keen to resolve any concerns. EVIDENCE: The manager of the home is a level 1 qualified nurse. The Manager has been at the home for seven years and feels that they have a good working relationship with the owner. The owner is regularly at the home and knows many of the residents. Residents and relatives spoken with felt that the manager was approachable and able to solve any concerns that may arise. In relation to residents finances the home keep a same amount of personal money fro residents who request the home keep it safe. In these cases there are individual records kept and an audit trail in place should there be reason to question the situation for an individual. Friars Hall Nursing Home DS0000024393.V285144.R01.S.doc Version 5.1 Page 20 At the last inspection there were two areas of health and safety that were identified, one related to infection control measures and this appeared to have been addressed, the second was the high number of fire doors propped open throughout the home. Advice was sought from the local fire service on this matter and the home have now introduced the ‘dorguards’ to enable certain doors to be kept open. Friars Hall Nursing Home DS0000024393.V285144.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 Friars Hall Nursing Home DS0000024393.V285144.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 OP1 Good Practice Recommendations When the service users guide is next reviewed it should contain more detail on the relevant qualifications and experience of the registered provider, manager and staff at the home. And the views of the residents should be reflected in some way in the document. For relevant residents there should be an assessment of resident’s mental state and cognition. This is required in order that their condition can be satisfactorily monitored over time. In addition all assessments should be dated with the authors name/signature. In order to preserve the privacy and the independence of the residents, full-length curtains on a track should be suspended from the ceiling of shared bedrooms. 2 OP7 3 OP23 Friars Hall Nursing Home DS0000024393.V285144.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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