Inspection on 21/01/09 for Glentworth House Nursing Home

This inspection was carried out on 21st January 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Glentworth House Nursing Home 25/07/08

Glentworth House Nursing Home 21/08/07

Glentworth House Nursing Home 19/06/06

Glentworth House Nursing Home 23/11/05

Glentworth House Nursing Home 31/05/05

Glentworth House Nursing Home 14/01/05

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Glentworth House Nursing Home 40-42 Pembroke Avenue Hove East Sussex BN3 5DB Lead Inspector Jennie Williams Unannounced Inspection 21st January 2009 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Glentworth House Nursing Home DS0000062476.V373851.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. Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glentworth House Nursing Home Address 40-42 Pembroke Avenue Hove East Sussex BN3 5DB 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) 01273 720044 01273 723660 manager@glentworth-house.co.uk Whytecliffe Limited Manager post vacant Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability (33) of places Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service Users should be sixty-five (65) years or over on admission. Service Users should be sixty-five (65) years or over on admission. The maximum number of service users to be accommodated is thirtythree (33). 25th July 2008 Date of last inspection Brief Description of the Service: Glentworth House is a large detached nursing home with a purpose built extension, registered with the above listed conditions of registration. It is situated in a quiet residential area of Hove, close to local shops and public transport. There is no parking available at the home and restricted paid parking in adjacent streets. Parking time is restricted to a maximum of two hours, although residents and visitors are entitled to visitor parking permits, which are available on request from the home. Residents accommodation is located over two floors. The third floor is used for management and administration duties. There is a passenger shaft lift at the home that assists residents to access all residential areas of the home. There are twenty-one (21) rooms for single occupancy and six (6) shared rooms. All bedrooms, except one, are provided with en suite facilities. The local authority has contracted seven beds for Transitional and Interim Care. The purpose of this is to offer nursing support and rehabilitation to residents for up to a maximum of eight weeks (usually following discharge from hospital prior to returning home). The local authority provides specialist support such as physiotherapy. Specific rooms have been designated for this care. There is a lounge/dining room and conservatory for use by the residents. There are suitable numbers of toilet and bathing facilities located throughout the home to meet the needs of residents. The home has a well-maintained rear garden, which is easily accessed from the ground floor lounge. Fees range from £490 to £700 per week. Additional fees are: hairdressing, chiropody, toiletries, newspapers/magazines and private physiotherapy. Full information on additional costs is available from the home. This information was provided to the CSCI on the 21 January 2009. Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. It should be noted that following CSCI consultation, it was identified that service users prefer to be called people who use services. It was confirmed that the home uses the term residents. For the purpose of this report, people who use the service will be referred to as residents. This inspection was facilitated by the Responsible Individual, who is currently also undertaking the role of the appointed manager. For the purpose of this report, she will be referred to as the Responsible Individual. This unannounced site visit took place on the 21 January 2009 for eight and half hours. Evidence obtained at this site visit, previous information regarding this service and information that the CSCI have received since the last inspection forms this key inspection report. The last key inspection was undertaken on the 25 July 2008. Eleven residents, of either gender, were spoken with throughout the site visit along with three visitors. Discussions were had with ten staff members throughout the site visit, plus the Responsible Individual. Staff included carers and ancillary staff. Specific areas of care were viewed in 13 care plans. Medication procedures were viewed. Procedures and records for handling residents finances were inspected. Six staff files were inspected, along with training records. A tour of the environment was undertaken and some individual rooms were viewed. The quality assurance system, complaint records and quality monitoring checks in place were viewed/discussed. There were twenty-four residents residing at the home on the day of the site visit. What the service does well: The pre admission process ensures that only residents whose needs can be met at the home are admitted. Residents spoken with stated that they were happy with the care provided at the home. Prospective residents are provided with an opportunity to test drive the home prior to moving in. One comment received was couldnt find a better place and a relative commented made an excellent decision. Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 6 Residents lifestyle within the home is their own choice and residents are provided with sufficient stimulation to fulfil their interests and needs. Visitors are welcomed at the home. Residents are provided with varied nutritional meals and are provided with choice to ensure their preferences are catered for. Residents privacy and dignity are respected. Residents were generally complimentary about the staff working at the home with some comments made being; helpful and friendly, absolutely first class and pretty good. Activities are provided at the home that are within an individuals choice and ability. Residents live in a clean and homely environment and are provided with comfortable indoor and outdoor communal facilities. Staff receive training relevant to their roles to ensure that all need of residents are met. What has improved since the last inspection? No improvement plan was received following the last inspection, despite one being requested. The progress made on meeting requirements made at the last inspection were discussed with the Responsible Individual and improvements made observed. Seven of the nine requirements made at the last inspection have been met. Bed rails risk assessments are in place and for one resident where there was no information; this was addressed on the day of the site visit. The home has worked in conjunction with their supplying pharmacist to improve the information on Medication Administration Records (MAR) charts to ensure staff and residents are safeguarded by the procedures in place. The Responsible Individual also audits MAR charts. Dependency level assessments are regularly carried out on the residents and staffing numbers are amended accordingly to ensure there are suitable numbers of qualified, competent and experienced person working at the home in such numbers to meet the health and welfare needs of residents. A structured quality assurance and quality monitoring has been developed and implemented to obtain feedback from residents to ensure that the home is run in their best interest. Record keeping within the service is improving to ensure compliance and to ensure the home is managed effectively and residents are safeguarded. Information sharing with the CSCI has improved as required under legislation. Any recommendations made at the last inspection have been considered and action taken where deemed necessary. An example of this is the a copy of the most recent inspection report is now displayed at the entrance to the home. Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 7 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. Glentworth House Nursing Home DS0000062476.V373851.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 Glentworth House Nursing Home DS0000062476.V373851.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): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has information available for prospective residents/representatives on the facilities and services provided to make an informed decision if their needs can be met at the home. The pre admission process ensures that only residents whose needs can be met at the home are admitted. EVIDENCE: The Responsible Individual confirmed that the Statement of Purpose and Service Users Guide has been updated to reflect the correct number of transitional beds available at the home, as previously advised. It was confirmed that she will check these documents again to ensure that current management arrangements are reflected and that they provide information on the arrangements made for consultation with residents about the operation of the care home. These documents were not viewed at this site visit. No requirement or recommendation has been made in relation to these Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 10 documents, however the home needs to ensure a copy is sent to the CSCI when any changes are made. There was evidence that two newly admitted residents had been assessed prior to admission. Information is obtained from other health professionals wherever possible and copies of social services assessments are taken when available. Discussions were had with the Responsible Individual on ways the pre admission assessment could be expanded and to ensure it reflects equality and diversity issues, i.e. religion, sexuality, to further evidence that all health and social needs can be met at the home. No pre admission assessment was found for one resident, however the Responsible Individual confirmed that one had been undertaken. The home needs to ensure they confirm in writing to prospective residents that following an assessment the home is able to meet their needs. Of the residents that were asked, all confirmed that they or a representative visited the home prior to them moving in. The homes own quality assurance results also demonstrated that the majority of people knew enough about the home before they moved in. One resident commented that they didnt pre visit the home as they didnt need to because they already knew the home. When the Inspector introduced herself to residents in the lounge room, some comments received were couldnt find a better place and they go the extra mile. A comment from a visitor was made an excellent decision. One resident commented Its not my cup of tea. Staff spoken with confirmed that they felt all residents were appropriately placed at the home and that management takes appropriate action if someones needs can no longer be met at the home. It was confirmed that it is in the contract/terms and conditions that the first four weeks is a trial period, to ensure that the individuals needs can be met at the home and the home meets the individual’s expectation. The home does not have dedicated accommodation to provide intermediate care, however there are seven dedicated rooms to provide transitional care. The Responsible Individual confirmed that they undertake their own assessments for anyone needing to be admitted for transitional care. Respite care is available if there is a spare room. Glentworth House Nursing Home DS0000062476.V373851.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): People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst staff practice reflects an understanding of residents personal and healthcare needs, the documentation in place for some people does not fully reflect the level of care provided and there is a risk that care may not be consistently provided. Residents are generally safeguarded by the medication procedures in place. EVIDENCE: Care plans were viewed with the assistance of the Responsible Individual. Whilst it remains an outstanding requirement regarding care plans and the information recorded, the home demonstrated a willingness to take on board comments made and a commitment to ensuring improvements are made. The Responsible Individual confirmed that they are in the process of reviewing all paperwork used within the home. Clearer information needs to be recorded by the nurses when they have attended to any wound care. The level of information recorded was not Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 12 consistent. A clear description of the wound provided will assist staff in monitoring the effectiveness of the treatment in place. There was no information in the care plan regarding pressure areas for one individual, this was addressed by the Responsible Individual at the time of the site visit. Where there was evidence that advice had been sought from a mental health professional, staff were advised to monitor the individual. There were no records made in daily notes regarding moods or the individuals mental well being. Where records identified that an individual had lost 10kg in weight within a month, it was recorded to weigh this person again within a week. Records and daily notes viewed for up to nine days later identified no information that this person had been reweighed. For another resident, records demonstrated that an individual lost 7.1kg in four days. A staff member thinks this person had been reweighed four days later as they think the weight may have been recorded incorrectly for two months. There were no records to identify if this was an error or if it was followed up again. The GP visited around this period, however there was no mention made regarding weight loss. The Responsible Individual confirmed that training for the use of a universal nutritional assessment tool has been arranged for staff. Previous information shared through Safeguarding Adults procedures identified that there were some shortfalls in the recording of care provided or identifying if someone had refused care i.e. if someone had refused a bath. The Responsible Individual confirmed that some staff have undertaken a care planning course provided by the Older People Nurse Specialist Team (OPNS). It was reiterated to the Responsible Individual and some staff the importance to ensure clear records are maintained. A quality review nurse continues to visit the home and review documentation in place. The Responsible Individual confirmed that any shortfalls noted during the audit has been addressed. Other specific areas of care viewed identified that there was guidance in place for staff on how to meet these needs. Care plans continue to have pre-populated information and the Responsible Individual is ensuring that staff personalise these to the individuals. The Responsible Individual confirmed that nurses are now responsible for ensuring all monitoring charts are correctly filled in. A visitor spoken with confirmed that they have seen their relatives care plan and has been involved in reviewing the care plan. The homes quality assurance results identified that some residents spiritual needs were not met at the home, however also identified that they did not want a religious service provided within the home. Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 13 There was evidence that residents have access to health professionals. There were records of visits from GPs, tissue viability nurse and from the mental health team. A resident also confirmed that they have access to health professionals when needed. Advanced care plans are in the process of being implemented. Where a risk assessment was not in place for the use of bed rails, the Responsible Individual addressed this at the time of the site visit. Where previous Safeguarding Adults investigations identified concerns regarding the use of oxygen, the home has taken action to ensure similar issues do not occur again. Processes in place for dealing with medicines were viewed with the assistance of a staff member. It was confirmed that there are policies and procedures in place for all aspects of medicines. Following requirements made at the last inspection in relation to ensuring robust medication procedures are followed, the home has been working in conjunction with their supplying pharmacist in changing Medication Administration Record (MAR) charts. Separate MAR charts are now in place for regular prescribed medicines, as needed (PRN), controlled drugs and prescribed creams for all individuals. The home is continuing to work with the GPs regarding repeat prescriptions to ensure that stock is not stored within the home. A registered nurse confirmed that they find the new MAR charts a lot easier to work with. The Responsible Individual confirmed that following the last inspection; weekly audits were undertaken on medicines within the home. This has now been changed to monthly audits due to the monitoring identifying improvements. New MAR charts were in place, so limited entries could be observed. On viewing MAR charts and blister packs, there were a couple of incidents where it appeared medication had been administered but not signed for. No requirement or recommendation has been made in relation to this as the Responsible Individual can identify who was responsible for these errors and address it with the individual staff responsible. Staff need to ensure it is clearly identified when a resident has refused their medicines. It was confirmed that records are maintained of all medicines entering and leaving the home and unused medicines are disposed of through a licensed company. There were accurate records being maintained of controlled drugs. Residents spoken with confirmed that they felt that their privacy and dignity are respected. A visitor stated that they are offered a private room for discussions if they choose. It was confirmed that they always find their relative to be always clean and presentable. The homes own quality assurance surveys identified that residents felt their privacy and dignity are respected. Glentworth House Nursing Home DS0000062476.V373851.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): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents lifestyle within the home is their own choice and residents are provided with sufficient stimulation to fulfil their interests and needs. Residents are provided with choice in relation to food to ensure their preferences are catered for. EVIDENCE: Residents spoken with confirmed that their routines of daily living are to their own choice and preference. Residents were observed to move freely around the home throughout the site visit. Bed times etc are to the individuals preference and a resident commented that they choose when to have a wash. The majority of residents confirmed that there were enough suitable activities provided at the home if they choose to be involved. A resident confirmed that they prefer to remain in their own room and this is respected. Staff spoken with confirmed that action is being taken to improve the provision of activities to residents. They are confident that is will be addressed. It was confirmed that various outside entertainers visit the home and outings will be arranged when the weather permits. The Responsible Individual confirmed that Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 15 every two to three months activities are arranged at the home where relatives/representatives/visitors are invited to attend. Recent events included a Christmas party and a Halloween party. A staff member working at the home will be commencing 10 hours a week to spend time for them to talk with residents, take people out into the community and arrange other activities. There are no visiting restrictions at the home and visitors spoken with confirmed that they are always welcomed at the home and offered refreshments. The majority of residents were satisfied with the food provided at the home. Comments received from residents regarding the food ranged from very good and have choice, sometimes choice and very accommodating for needs. Staff comments regarding food were really good and excellent. The cook confirmed that they have no restrictions in the kitchen and if an individual does not like the main meal on offer, they are able to choose an alternative. Menus are devised on a four weekly rota, devised by the Responsible Individual. Residents were seen to be offered refreshments throughout the day. The homes own quality assurance surveys identified that the majority of residents were satisfied with the food. Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 16 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): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints are dealt with by the home and action taken where necessary, ensuring those who raise complaints that they are listened to. Residents and staff are safeguarded by the Safeguarding Adults procedures in place. EVIDENCE: The home has a complaints procedure available to all people and a copy of this is on display at the entrance to the home. Residents confirmed that they knew how to complain, who to speak to and felt comfortable to raise any concerns. Two residents commented that they had previously raised concerns and felt that the home took appropriate action to address their concerns. Staff spoken to confirmed that they knew what procedures to follow should a resident/representative wish to raise a complaint within the service. There have been two complaints raised since the last inspection. A central log of complaints is kept and records are maintained of concerns raised and any action taken by the home to address the issues. A visitor confirmed that they would feel comfortable to make a complaint, however have not had to do so to date. The homes own quality assurance surveys identified that some residents have been offered the opportunity to vote when elections are held. Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 17 There have been no Safeguarding Adults investigations made since the last inspection. No further concerns have been raised with the CSCI from other professionals since the last inspection. Staff confirmed that they receive training in Safeguarding Adults procedures and know the procedures to follow should an allegation be raised with them. Safeguarding Adults training includes information about whistle blowing and staff confirmed that they would feel comfortable to whistle blow within the service. The Responsible Individual confirmed that training for staff on the Mental Capacity Act has been arranged. Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 18 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): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and homely environment and are provided with comfortable indoor and outdoor communal facilities. EVIDENCE: Residents accommodation is provided over three floors and there is a passenger shaft lift that provides access to all areas. On tour of the environment, it was observed that the home is generally well maintained and residents live in a homely environment. A resident spoken with confirmed that their room was comfortable. Some individual rooms observed were noted to be personalised to reflect the individuals character and preference. The homes own quality assurance surveys identified that residents were happy with their rooms. Work has been done and is continuing to be done to improve the standards within the homes environment. The Responsible Individual confirmed that Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 19 there have been no major changes to the environment since the last inspection and there is an ongoing maintenance programme. They will be developing a new maintenance programme for the new year. It was confirmed that all beds are adjustable, ensuring these meet the needs of those residents who require nursing care. The home has recently had a mattress audit undertaken to ensure all residents are provided with suitable mattresses to benefit their well-being. Staff confirmed that they are provided with sufficient equipment to undertake their duties; including manual handling equipment and protective clothing. It was noted that the television in the lounge room was fuzzy and the television and radio were both on. A visitor confirmed that they noted this was often the case. The home needs to ensure that this is to the residents choice, having both the television and radio on at the same time. The reception on the television needs to be improved. The person responsible for the laundry confirmed that a new laundry system has been put in place that ensures a better service is provided. Washing machines were observed to have a sluice cycle in place. One bathroom was observed to being used as a storage area. The homes quality assurance surveys viewed identified that most residents were happy with the laundry service provided. Visitors spoken with confirmed that they found the home clean and free from offensive odours when they visit. The homes quality assurance surveys also identified that residents found the home to be clean. Staff also commented that the cleanliness has improved. Care and ancillary staff all receive infection control training. Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 20 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): People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents needs are being met with the number and skill mix of staff on duty. Residents are not always safeguarded by the recruitment procedures in place. EVIDENCE: Residents and visitors were complimentary about the staff working at the home and some comments received were; staff demonstrate genuine caring, helpful and friendly, very helpful and generous and kind and considerate. Visitors felt that there were sufficient staff on duty at the times they visit. The majority of residents confirmed that they felt there were sufficient staff on duty. For those who felt there were not enough staff on duty, most confirmed that someone was always around when they needed assistance. Staff confirmed that there were sufficient numbers of staff on duty. It was confirmed that on the day of the site visit there were two registered nurses and seven carers working the morning shift and one registered nurse and five carers working in the afternoon. This does not include the Responsible Individual or ancillary staff who work at the home alongside the care staff. It was confirmed that one registered nurse and two carers work a waking night. Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 21 The Responsible Individual confirmed that dependency level charts are regularly completed and staffing numbers are adjusted accordingly. Six new carers have been employed since September 2008. A senior carer, who has also been delegated the responsibility for staff training, confirmed that there are 12 carers employed at the home of which five have obtained National Vocation Qualifications (NVQ) level 2 or above. An additional three have been signed up to commence this training. Staff files viewed identified that further robust recruitment procedures need to be followed. Of the six staff files viewed, records maintained identified that three staff members had commenced working at the home prior to a POVA First check being returned. The Responsible Individual confirmed that no staff member works directly with residents until at least a Protection of Vulnerable Adults (POVA) First check is returned and works supervised until a full enhanced Criminal Record Bureau (CRB) check is returned. Staff may attend the home for orientation and to commence their induction. One file had no evidence of a CRB being returned, however the staff member confirmed they had received one and this was confirmed in writing from the home following the site visit. For one file, it identified that the most recent employment was related to care, however no reference had been requested from the previous place of employment. One file did not have evidence that the individual was eligible to work in the UK. One application form did not have any explanation of gaps in employment from 1991 to 2006. Attention needs to be paid to identify who references are from and how the referee knew the person. It was discussed with the Responsible Individual ways to ensure references are authentic. There are processes in place at the home to ensure that all nurses at the home have current registration with the Nursing and Midwifery Council (NMC). The staff member responsible for training evidenced that a lot of effort has been made to ensure all staff receive training relevant to their roles. It was confirmed that all staff are up to date with mandatory training. A staff member stated definitely enough training opportunities. Registered nurses also confirmed that they receive additional training relevant to their roles. New staff undertake an induction programme and there was evidence that the home is using the Common Induction Standards as set by Skills for Care. Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 22 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): People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Work is continuing to be undertaken to ensure staff and residents benefit from clearer leadership within the service. The newly implemented quality assurance system in place assists in ensuring the home is run in the best interest of residents. EVIDENCE: Whilst there have been different people appointed by the registered providers to manage the service, the home has been without a Registered Manager since April 2005. The Responsible Individual, who is a Registered Manager at another service owned by the company, is currently overseeing the home. She has done the Registered Manager Award and has current registration with the NMC. She confirmed that an application to begin the registration process with Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 23 the CSCI will be submitted when the newly appointed manager at their other service has completed their probationary period. Staff were complimentary about the Responsible Individual managing the service and feels that the running of the home feels more organised and they have clearer roles and responsibilities. One commented that they feel the management is much more approachable and there is better communication within the service. One staff member commented that the morale within the home is brilliant and is much improved than previously. Staff find the Responsible Individual approachable and supportive. The home has a quality assurance and quality monitoring system in place to assist in ensuring that the home is run in the best interest of residents. Surveys are sent to residents on an annual basis and ensure that they meet formally with relatives/representatives at least annually and documents these meetings. Surveys had recently been done and the Responsible Individual proposes to audit these. Recent surveys viewed were overall positive. The home will ensure that action is taken wherever possible as identified. The Responsible Individual confirmed that there are monthly checklists in place where audits are undertaken of complaints, documentation, health and safety checks and the environment etc. It was recommended that she monitors the recruitment process to ensure robust recruitment procedures are followed, as this area is currently delegated to someone else. Regulation 26 visits were not currently being undertaken as the Responsible Individual is currently in day-to-day control of the home. As the registered provider is a limited company, the Responsible Individual needs to ensure that someone undertakes these monthly visits to monitor the home on behalf of the company. Reports of these visits must be available at the home for viewing. No improvement plan was received as requested following the last inspection report. The Responsible Individual thought this had been sent and assured that it would be forwarded on. This had not been received at the time of writing this report. A management review meeting was held following the last inspection and a warning letter sent to the provider to advise them that outcomes for people who use the service must be improved and that the CSCI will continue to monitor the home. The home does not hold any personal allowances. Residents either manage their own money or have representatives that assist them to manage their finances. Invoices are sent to relatives/representatives where needed for toiletries, hairdressing and chiropody etc. There was evidence within the staff files that they receive supervision. It was confirmed that clinical supervision is currently being arranged for all registered nurses. Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 24 It was confirmed that staff participate in fire training and undertake fire drills. It was confirmed that there were no shortfalls noted at the last visit undertaken by the East Sussex Fire and Rescue Service and that the homes fire risk assessment has just been updated. The Responsible Individual and two other staff members are booked on a Health and Safety course designed for care home staff. Records are maintained of accidents/incidents and the Responsible Individual monitors these on a regular basis. The previous AQAA, completed in May 2008 identifies that all equipment, as applicable, has been serviced or tested as recommended by the manufacturer or other regulatory body. Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 25 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 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 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 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 X X 3 Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 26 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 14 (1)(d) Requirement That written confirmation is provided to prospective service users following assessment, that the care home is suitable for the purpose of meeting their needs in respect of their health and welfare. That clear and up to date information pertaining to individuals are maintained, up to date and all care provided be accurately recorded to evidence that the home is meeting the needs of residents. Timescale 30.09.08 not met. That robust recruitment procedures are followed to ensure that residents are safeguarded. Timescale for action 27/02/09 2. OP7 15 & 17 15/03/09 3. OP29 19 Schedule 2 27/02/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 27 No. Refer to Standard Good Practice Recommendations Glentworth House Nursing Home DS0000062476.V373851.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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