Inspection on 18/10/05 for Fulford Nursing Home

This inspection was carried out on 18th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fulford Nursing Home 23/04/08

Fulford Nursing Home 26/04/07

Fulford Nursing Home 25/07/06

Fulford Nursing Home 25/01/05

Fulford Nursing Home 27/07/04

Fulford Nursing Home 06/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Fulford Nursing Home 43 Heslington Lane York North Yorkshire YO10 4HN Lead Inspector Jo Bell Unannounced Inspection 18th October 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Fulford Nursing Home DS0000028003.V257090.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fulford Nursing Home DS0000028003.V257090.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Fulford Nursing Home Address 43 Heslington Lane York North Yorkshire YO10 4HN 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) 01904 654269 01904 651919 ‘This is york’ website Mr Raymond Hancock Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Fulford Nursing Home DS0000028003.V257090.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 40 years plus Date of last inspection 17th May 2005 Brief Description of the Service: Fulford Nursing Home is a privately owned care home offering nursing care for up to 28 service users. The home is a large detached property with well maintained grounds. Service users can access the facilities in Fulford, which include shops, a local church, library, schools, hairdressers and the GP surgery. Fulford Nursing Home DS0000028003.V257090.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Tuesday 18th October 2005, the acting manager Donna Crockford was available to assist with the inspection. A tour of the premises took place, service users, relatives and staff were spoken with. Observations took place in the lounge and dining areas and policies and procedures were inspected. The home has made progress in the care practices at mealtimes, and the home is due to be refurbished, which will have positive benefits for the service users and staff. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fulford Nursing Home DS0000028003.V257090.R01.S.doc Version 5.0 Page 6 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 Fulford Nursing Home DS0000028003.V257090.R01.S.doc Version 5.0 Page 7 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): 4 Service users’ needs can be met in the home. EVIDENCE: The home carries out a pre-assessment prior to the service users being admitted to the home. The home collectively has the skills, knowledge and experience to meet service users needs. The home have some service users who have developed dementia whilst resident in the home, they are aware of the need to have input from the community psychiatric team, and specific dementia training. Staff can meet social, physical and spiritual needs and are aware of the issues involved. Fulford Nursing Home DS0000028003.V257090.R01.S.doc Version 5.0 Page 8 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): 7,8,9 & 10 Service users health needs are met, privacy and dignity is maintained in the home and staff have a good rapport with the service users and their relatives. EVIDENCE: Service user care plans were inspected, these had improved since the last inspection. Risk assessments were in place and these were regularly reviewed. It was evident that the nutritional assessments had been updated and staff had attended training specific to nutrition. Those service users who were undernourished had received input from the community dietician and the GP. Evidence in the care plans identified input from the dentist, chiropodist and continence advisor. The management of the home are aware of how to access healthcare professionals. The medication system in the home was examined. A medication policy is in place which staff are aware of and working to. The controlled drugs book was completed correctly and the fridge temperatures were recorded on a daily basis. The home use the monitored dosage system, the medication charts were inspected and completed appropriately. Fulford Nursing Home DS0000028003.V257090.R01.S.doc Version 5.0 Page 9 The medication room itself requires some attention, the window area was dirty, exposed copper piping was evident and one of the walls had missing paint/wallpaper. All this area needs a thorough clean. Privacy and dignity in the home was maintained, one lady had recently had her hair ‘set’, and all residents were observed to be clean and tidy. Staff had a good rapport with the service users and clearly enjoyed chatting with them. It was identified that the bathroom/shower rooms did not have a ‘vacant/engaged’ sign in place. This would be beneficial to ensure staff do not walk into the bathroom when a service user is receiving personal care. Service users spoken with said the staff were kind and they were well looked after. Fulford Nursing Home DS0000028003.V257090.R01.S.doc Version 5.0 Page 10 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): 13,14 & 15 Service users exercise autonomy and choice in the home, this was evident at lunchtime with the improved care practices. EVIDENCE: Visitors were observed in the home and they confirmed they could visit at any time. This was also confirmed by inspection of the visitors’ book. The home are able to offer privacy during visiting if required. Staff in the home confirmed that links with the local community are maintained; this is through the church services both offered in the home and at the local Church of England church in Fulford. Service users are able to be autonomous in the home, a discussion took place with the provider regarding service users going out for walks in Fulford, and this would need to be risk assessed. Service users are able to get up and go to bed when they want. One service user confirmed this, and staff said that service users can retire when they want to. The home does not handle service users finances, except for a small amount of pocket money. Service users are encouraged to bring their personal possessions into the home, this was observed to be correct. The care practices at mealtimes were observed. This has been reviewed since the last inspection and has improved considerably. Those service users who Fulford Nursing Home DS0000028003.V257090.R01.S.doc Version 5.0 Page 11 require assistance at mealtimes are given assistance first, the other service users are then escorted into the dining room. The chef has recently changed the menus, which continue to offer two hot meals at lunchtime and a choice of deserts. The provider stated that new chairs and tables are being ordered to ensure service users are comfortable and safe in the dining room. The home have recently employed a breakfast assistant to help over the busy morning shift; this has had a positive impact on the service users and staff. Fulford Nursing Home DS0000028003.V257090.R01.S.doc Version 5.0 Page 12 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 & 18 Service users are aware of how to make a complaint and they said they felt safe in their environment. EVIDENCE: Service users are aware of how to make complaints; this is detailed in the home’s complaints procedure. No complaints have been identified, and the home have shown an improvement in communication which ensures service users can discuss any concerns prior to a formal complaint been made. The home have an adult protection procedure in place, and have a copy of the local authority procedure. A discussion took place with the acting manager regarding the procedure to follow if an allegation of abuse is made. It was evident that the acting manager was not clear on the role social services would take in this process. This needs to be addressed. However, it must be noted that future training is planned for all staff regarding adult protection and the acting manager was aware that the most important action was to keep the service user safe. Fulford Nursing Home DS0000028003.V257090.R01.S.doc Version 5.0 Page 13 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 & 26 Service users are happy in their environment. However, the home needs to improve the cleanliness of the laundry area to ensure service users are safeguarded against cross-contamination. EVIDENCE: The home have a maintenance plan in place, and service users spoken with said they were happy in their environment. A refurbishment is planned over the next 3 months. This will enhance the communal areas, bathrooms and toilets. The home has an infection control policy in place, the acting manager is aware of how to deal with any infection outbreaks. Handwashing procedures are adhered to and staff have received infection control training. It was identified in the laundry area that soiled linen was left in a red bag on top of the washing Fulford Nursing Home DS0000028003.V257090.R01.S.doc Version 5.0 Page 14 machine, this should be placed in an appropriate skip. Staff bring the soiled clothes into the same area where clean clothes are placed. This should be reviewed. The floor covering in the laundry was very dirty, stains were evident and one area behind the door did not have floor covering or skirting board. The floor covering should be impermeable and the walls should be readily cleanable. All this area must be thoroughly cleaned to prevent cross contamination. The home should also provide a lock on the laundry door, as currently service users are able to access this area freely. Fulford Nursing Home DS0000028003.V257090.R01.S.doc Version 5.0 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 & 30 Service users needs are met by the numbers and skill mix of staff. Service users are protected by the robust recruitment procedure in place and comprehensive induction training is given. EVIDENCE: The home meets the minimum staffing levels. The previous deputy of the home is now the acting manager, and the previous registered manager is working as a first level nurse supporting the acting manager. At the inspection there were two registered nurses and three care staff for 28 service users, this was adequate and service users needs could be met. The home are offering NVQ Level 2/3 training to all care staff. Even though they have not achieved their 50 they are committed to developing their staff and this should be achieved in the near future. One senior carer has been given housekeeping responsibilities which is working well. Fulford Nursing Home DS0000028003.V257090.R01.S.doc Version 5.0 Page 16 Staff spoken with confirmed that this training was being offered. Training records were inspected and an induction programme is available for staff when they first commence employment. This is then interlinked to Skills Council training which is a programme for staff which can take up to 6 months. Two monthly supervision is also offered which identifies competencies and any performance management issues. The recruitment procedures of the home were inspected. An appropriate procedure is in place and the home ensures a CRB check with POVA are in obtained prior to commencing employment. Two written references are sought and the management are aware of how to verify registered nurses identification numbers. Fulford Nursing Home DS0000028003.V257090.R01.S.doc Version 5.0 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): 31,32,33,35 & 38 The home is run in the best interests of the service users. The quality assurance system in the home should be more robust to ensure views from service users, relatives and staff are obtained and acted upon. EVIDENCE: The acting manager is an enrolled nurse with management experience. A permanent registered manager needs to be appointed as soon as possible. The acting manager is competent in her role and has a good understanding of the needs of the service users. Staff view her management style positively and through improved communication are working closely to promote team working. Staff morale has improved and the home is run in a professional and friendly manner with support from the previous registered manager. The home has a quality assurance system in place. Comment cards were available and regular auditing of care plans and medication takes place. Service users spoken with felt they could discuss any concerns with the acting manager. A residents forum meeting was planned for the following day. The Fulford Nursing Home DS0000028003.V257090.R01.S.doc Version 5.0 Page 18 home should develop their quality assurance system further to ensure they obtain the views of the service users, relatives and staff. Service users finances are not dealt with in the home, apart form each service users having a small amount of pocket money. All transactions are recorded and each service user has an individual purse containing money for hairdressing, chiropody or for toiletries. This process is explained to service users when they are admitted into the home. This money was stored in a secure environment. Health and safety in the home was inspected. Staff receive mandatory training including fire safety, moving and handling, infection control and food hygiene. Staff are trained in first aid, however the home do not have a designated member of staff on duty at all times, this should be addressed. The home have a maintenance person who records water temperatures, does routine maintenance and keeps a record of all certificates issued. As previously discussed the laundry room and medication room need to be made safe. All other areas of the home were safe. This will also be enhanced when the refurbishment takes place. Fulford Nursing Home DS0000028003.V257090.R01.S.doc Version 5.0 Page 19 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 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 1 x x x x x x 1 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 3 2 x 3 x x 3 Fulford Nursing Home DS0000028003.V257090.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 4 5 6 Standard OP9 OP9 OP9 OP19OP26 OP19OP26 OP31 Regulation 23 23 23 23 23 9 Requirement All areas of the medication room need a thorough clean The copper piping exposed must be boxed in Any bare plaster must be covered with either paint or wallpaper The laundry area must be thoroughly cleaned The floor covering must be replaced The home must appoint a manager who can be registered with the CSCI Timescale for action 25/10/05 18/11/05 18/11/05 25/10/05 18/01/06 18/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP10 OP18 Good Practice Recommendations The bathroom doors should have a vacant/engaged sign to prevent loss of privacy for service users Staff need to be clear regarding the role social services DS0000028003.V257090.R01.S.doc Version 5.0 Page 21 Fulford Nursing Home 3 4 5 OP26 OP28 OP33 have in adult protection procedures A review of the ‘dirty and ‘clean’ areas of the laundry should take place A lock should be fitted to the laundry door 50 of care staff should have achieved an NVQ Level 2 or equivalent by 2005 The quality assurance system should be reviewed Fulford Nursing Home DS0000028003.V257090.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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