Inspection on 25/07/06 for Fulford Nursing Home

This inspection was carried out on 25th July 2006.

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

The inspector 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 18/10/05

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 Ms Anne-Marie Foster Key Unannounced Inspection 25th July 2006 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.V306030.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. Fulford Nursing Home DS0000028003.V306030.R01.S.doc Version 5.2 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 Mr Raymond Hancock *** Post Vacant *** Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Fulford Nursing Home DS0000028003.V306030.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 40 years plus Date of last inspection 18th October 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 wellmaintained grounds. Service users can access the facilities in Fulford, which include shops, a local church, library, schools, hairdressers and the GP surgery. Weekly fees range from £446 - £560 as at 1st June 2006. Fulford Nursing Home DS0000028003.V306030.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place over six hours; the nurses on duty and the business manager were available to assist the inspector. The inspector had chance to speak with residents, staff, and visiting health professionals. The home had also provided the inspector with information regarding fees, staff rotas, menus and other information in the form of a preinspection questionnaire. Surveys had been sent out to ten relatives of residents; nine of these were returned and this information and other notifications received by The Commission were used as part of the inspection process. What the service does well: What has improved since the last inspection? The dining and lounge area have been refurbished and new furniture has been installed, this area now looks fresh and is comfortable for residents. The laundry room and laundry practices have improved; the flooring to the laundry has been replaced, and staff are now using red linen skips for soiled laundry therefore reducing chances of cross infection. The medication room has been improved with redecoration and boxing in of copper pipes. The home has now appointed a manager who has applied to become the registered manager and this will have a positive effect on the running of the home. Over 50 0f care staff now have their NVQ2 certificate in care meaning that residents are in competent hands. Staff are clearer about the role of social services, and the need to contact them with regard to adult protection procedures and residents are further protected. The business manager has reviewed the quality assurance system and is currently collating replies to questionnaires; this should help the home to assess its performance. Fulford Nursing Home DS0000028003.V306030.R01.S.doc Version 5.2 Page 6 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.V306030.R01.S.doc Version 5.2 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 Fulford Nursing Home DS0000028003.V306030.R01.S.doc Version 5.2 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): 3 and 6 Quality in this outcome area is good. Pre admission assessments are carried out, so that the prospective residents can be sure that the home is able to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Good pre admission information was seen in the residents care plans, the acting manager or senior colleagues go out to do an assessment and also work alongside relatives and allied professionals to develop a full picture of the care needs of the prospective resident, so they can be sure that those needs can be met. One resident reported that her needs had been met, and that she felt able to return home because of the assistance that she had received, this indicates that staff were assisting appropriately those residents that stay for intermediate care, and were maximising their independence. Fulford Nursing Home DS0000028003.V306030.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. Overall the needs of the residents are met, however the plans of care and medication system need to be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents say that their needs are met; three residents said that staff work hard and that “we have everything we need”, also nine comment cards received from families, were, on the whole complimentary and positive, which indicates that the home is generally able to meet the resident’s needs. Six care plans were inspected, four were good; they were individualised and had been reviewed regularly. Two, however did not accurately reflect the nursing care that was being given to residents with major needs; one did not reflect that the resident had a pressure ulcer, the other had an inadequate nutritional assessment for a resident who had lost a large amount of weight, this lack of accurate and up to date information will put the resident at risk of not having their needs met. During the site visit, whilst being assisted on a tour of the home with one of the nursing staff, the inspector entered a residents room and found medication left on the table next to a beverage at the bedside, this had Fulford Nursing Home DS0000028003.V306030.R01.S.doc Version 5.2 Page 10 been left by the nurse doing the drug round: this poor practice compromises the safety of the residents and staff. Service users said that they are treated with dignity and respect by the staff and a good rapport and positive interaction with staff was noted. The staff however were noted to frequently address the residents with generic terms of endearment such as ‘lovey’ sweetheart darling etc. this practice is acceptable as long as each resident agrees to it, but otherwise the preferred form of address must be used in order to ensure that the residents right to dignity is respected at all times. Whilst the downstairs double toilet now has a vacant/ engaged sign on it, there is still no lock, also staff agree that the signs are not always used, there is a plan to refurbish this toilet in the autumn, however currently the residents privacy is still compromised by this arrangement. Fulford Nursing Home DS0000028003.V306030.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. Service users maintain contact with family and friends and are helped to exercise control over their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home now employs an activities organiser who works on two weekdays, and also plans daily activities for the remaining days, residents report that they enjoy these activities. Community contact is maintained by relatives who can visit freely and through contacts with the local church, the recreational and social needs of the residents are catered for. Residents have a choice with their daily routine and can choose how to spend their day, and are helped to exercise choice and control over their lives. The menus and lunch time meal was observed, the residents have a good variety to choose from and on the day the cook was offering a further alternative as well, the lunch looked wholesome and appetising, it was freshly prepared and was appropriate for the hot day, all five of the residents spoken with said they thoroughly enjoyed their meal, which was served in an unhurried fashion with several care staff available to assist as necessary, and the residents were able enjoy a wholesome balanced diet in a congenial setting. Fulford Nursing Home DS0000028003.V306030.R01.S.doc Version 5.2 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 and 18 Quality in this outcome area is good. Service users are confident that their complaints will be taken seriously. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the service users spoken with said that they knew who to report a complaint to, and felt confident that they would be listened to; a complaints book is available on the entrance hall, as is a comment box and a copy of the complaints policy, the business manager was able to confirm that complaints are taken seriously, and acted upon within a set timescale, and the residents are protected by a the complaints procedure. The home has a clear abuse awareness policy and procedure, that is reviewed regularly, along with the local authority guidance it also has other up to date policies including managing residents monies, and dealing with challenging behaviours, this will help to ensure that residents are protected from abuse. Fulford Nursing Home DS0000028003.V306030.R01.S.doc Version 5.2 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): 19,20,21,24 25 and 26 Quality in this outcome area is poor. Service users live in a safe home, however more needs to be done to improve the environment, including bathing and toilet facilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The layout of the home and its age mean that it is not purpose built so residents rooms are small and just meet the minimum standard of required space, bedrooms looked cluttered, in particular where those residents need incontinence pads; these are just piled up in the bedrooms due to lack of storage space, also several bedrooms had curtains that were thin, and poorly hung, and these rooms did not appear homely and comfortable. There are two communal sitting areas, one of which is a lounge/dining room, the other, a separate lounge has been recently refurbished and looks pleasant and fresh, and is comfortable for residents. Grounds are kept tidy and looked Fulford Nursing Home DS0000028003.V306030.R01.S.doc Version 5.2 Page 14 pleasing, and on the day of the site visit residents were helped to sit outside in the fresh air, and could enjoy the access to outdoor communal facilities. There is only one usable bath, which has recently been refurbished to a standard appropriate for a care home, however this one bath is not enough to meet the needs of 28 residents. The shower room is in a poor state and on the day of the inspection was untidy, with several used razors left by the sink, along with denture sterilising tablets and unnamed toiletries and clothing, and therefore residents have insufficient and unhygienic bathing facilities. The double toilet downstairs by the back door needs refurbishing, paint is peeling off the tiles and the woodwork, and the cupboards have doors that have fallen off and not been replaced, the toilet door does not have a lock and whilst a sliding vacant/ engaged sign is now in place staff admit that this does not necessarily get used and so the residents right to privacy and comfort is compromised. On the day of the site visit the inspector noted frayed towels and several beds made up with stained, poor quality or worn linen, and whilst it was noted that the washing machine operated to high temperatures, stains had not been removed from linens and these sheets should be discarded in order to ensure that residents have a clean, comfortable bed. Radiator covers were noted to be in need of review and repair, three were seen to have a mesh cover which did not actually guard the radiator as the mesh was touching it, and two others had no mesh at all to guard the radiator, it was a hot day and so the radiators were turned off, but radiators must be guarded unless there are guaranteed low temperature surfaces; in order to prevent thermal burns. This must be done before colder weather makes this a more serious problem. The home was found generally to be clean, however two resident’s rooms smelled strongly of urine, the domestic was dealing with these, and also the home uses a carpet cleaning contractor regularly, who deep cleans the carpets periodically, to address the issues of malodour .The laundry was inspected and found to be clean and the floor, which has been recently renewed, was found to be satisfactory and this will reduce the risks of cross infection. Fulford Nursing Home DS0000028003.V306030.R01.S.doc Version 5.2 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. Resident’s needs are met by the skill mix of staff, however at times there are inadequate numbers of staff on duty, which could affect the quality of care given. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The rotas provided to the commission demonstrate good numbers of staff on duty, and on the day of the site visit four care staff plus one qualified nurse were on duty, and so enough staff were available to meet the needs of the residents on this day. Two residents spoken to agreed that there were enough staff on duty and that their needs were met, but they also reported that some did not turn up for their shift, and this was confirmed by one staff member, who thought that weekends were particularly a time when staff might ring in due to sickness and that their shift was then not covered, also nine comment cards were received from family and friends of residents and two of these expressed an opinion that there were not always enough staff on duty, this is an area that needs monitoring in order to protect the residents and ensure that their needs can be met. More than 50 of care staff have their NVQ 2 certificate in which compliments the skill mix of staff. The home has a robust recruitment system, six staff files were inspected and found to contain all of the information required by regulation e.g. two good written references, a Criminal Records Bureau check and an application form, this will help to ensure that residents are further Fulford Nursing Home DS0000028003.V306030.R01.S.doc Version 5.2 Page 16 protected by the employment of suitable people. The home has a good staff training programme, one new recruit was pleased with all of the training she had been given so far, all staff receive induction and foundation training and other relevant training, which will help to ensure that are trained and competent to do their jobs Fulford Nursing Home DS0000028003.V306030.R01.S.doc Version 5.2 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): 31,33,35,and 38 Quality in this outcome area is good. The home is run in the best interest of service users and matters to ensure their health and safety are well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager is a nurse with management experience, and is currently undertaking her registered manager award, she has applied to become registered manager, staff were positive about her management skills as were residents, and four relatives comments cards were complimentary, meaning that the residents live in a home that is run by a person who is fit to be in charge. Quality assurance systems are currently being redeveloped at the home and the business manager has recently sent out questionnaires to contacts and stakeholders of the home seeking their views and opinions, this is good practice and so will help the home to assess its performance as to Fulford Nursing Home DS0000028003.V306030.R01.S.doc Version 5.2 Page 18 whether it is meeting its aims and objectives and statement of purpose. The business manager kept Resident’s monies safe, and clear receipts and running totals were inspected, also these monies were stored safely meaning that resident’s financial interests were safeguarded. Whilst action should be taken to provide adequate radiator guards, the other health and safety policies and procedures of the home were inspected and are adhered to, in particular it was evident that staff receive their mandatory training, including fire safety, moving and handling, infection control, food hygiene and first aid, and the home ensures that a trained first aider is on duty each day, this means that the welfare of service users and staff is promoted. Water temperatures in the home were tested and found to be satisfactory, the home employs a maintenance man and test certificates for water storage, gas boiler, electrical systems, environmental health were all in order, the kitchen and pantry was inspected and was found to be very clean, the laundry and sluice areas were also inspected and found to be satisfactory, and residents are protected by a robust health and safety system. Fulford Nursing Home DS0000028003.V306030.R01.S.doc Version 5.2 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 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X 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 2 X 1 X X 1 2 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Fulford Nursing Home DS0000028003.V306030.R01.S.doc Version 5.2 Page 20 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. 1 Standard OP7 Regulation 15,12 Requirement Timescale for action 30/09/06 2 OP9 13 (2) 3 OP21 23 (j) 4 OP24 16 Care plans should be in sufficient detail to ensure staff know what to do to meet the resident’s needs. Staff must adhere to the 01/08/06 administration of medication policy, and not leave medications unattended or secondary dispense medication. Bathing facilities must be 30/09/06 improved for residents. The provider should advise the Commission how this is to be achieved by 30/09/06 Bed sheets that are permanently 31/08/06 stained and unsightly should be replaced. Fulford Nursing Home DS0000028003.V306030.R01.S.doc Version 5.2 Page 21 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 3 4 Refer to Standard OP8 Good Practice Recommendations Care plans should reflect the care that they is actually being carried out e.g. if dietary supplements are being administered this should be recorded in the care plan. Resident’s preferred term of address should be remembered and ensure that all staff should be aware sure of and how to use this address. The provider must make a review of the resident’s rooms in particular to the quality of the curtains and lack of storage space to see how these areas could be improved. The home must have contingency plans to replace staff on the rota when there are shortfalls due to absence, to ensure resident’s needs can be met at all times. OP10 OP19 OP27 Fulford Nursing Home DS0000028003.V306030.R01.S.doc Version 5.2 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. Extracts may not be used or reproduced without the express permission of CSCI Fulford Nursing Home DS0000028003.V306030.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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