Inspection on 21/02/08 for The Hall Nursing Home

This inspection was carried out on 21st February 2008.

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

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

The Hall Nursing Home 22/09/06

The Hall Nursing Home 10/02/06

The Hall Nursing Home 01/07/05

The Hall Nursing Home 10/03/05

The Hall Nursing Home 29/10/04

The Hall Nursing Home 22/01/04

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

CARE HOMES FOR OLDER PEOPLE Hall Nursing Home, The 100 Old Station Road Bromsgrove Worcestershire B60 2AS Lead Inspector Keith Salmon Key Unannounced Inspection 21st February 2008 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 Hall Nursing Home, The DS0000004112.V358290.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. Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hall Nursing Home, The Address 100 Old Station Road Bromsgrove Worcestershire B60 2AS 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) 01527 831375 01527 873746 Southern CC Ltd Post Vacant Care Home 43 Category(ies) of Dementia - over 65 years of age (12), Learning registration, with number disability (1), Old age, not falling within any of places other category (43), Physical disability (6), Physical disability over 65 years of age (43), Terminally ill (6) Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. An age limit of 55 - 65 years applies to people with needs in category PD. 8 beds are for the rehabilitation of people over 50 years of age. An age limit of 52 - 65 years applies to the person in category LD. 4. The home may also accommodate 2 people under 65 years with a learning disability and a physical disability. 1 bed for the rehabilitation of people over 40 years of age Date of last inspection 22nd September 2006 Brief Description of the Service: Operated by Southern CC Limited, The Hall is a 43-bedded care home offering nursing care including for a number of residents with dementia related care needs. Situated close to the centre of Bromsgrove the home is a timber-framed building with brick-built additions. Set in attractive grounds, with car parking to the front, accommodation comprises 39 single and 2 double bedrooms with most having the benefit of en-suite facilities. The Home comprise four discrete sub-units – namely ‘Poppy’ and ‘Roses’ providing care for residents with general nursing needs, Sunflower for residents with dementia related needs, and the ‘Rehabilitation Unit. This latter unit provides ‘intermediate’ care for up to 8 weeks for those persons requiring rehabilitive care between leaving hospital and returning home (it is noted that this service will cease as from 1 April 2008 with the places being given over to care as provided in ‘Poppy’ and ‘Roses). Each unit has a lounge and dining room. There is passenger lift access to the first floor. Although the Registration Certificate states the home can accommodate six people with a terminal illness the ‘terminal illness’ category no longer exists for any care home with nursing and will be removed from the Home’s registration categories. It is, of course, expected the home will be able to provide ‘end of life care’ to residents. Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 5 Fees charged are determined following pre-admission assessment and, therefore, are not stated in published information, such as the Home’s brochure or Service User Guide. Physiotherapy and occupational therapy are provided as part of the basic fee, with additional charges made for chiropody, hairdressing and newspapers. Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This Unannounced ‘Key’ Inspection commenced at 10.00am, concluded at 4pm, and was conducted by Mr Keith Salmon. The Home is currently without a registered manager and present, on behalf of the Home, was the nurse in charge of the shift, Mrs. Margaret Vaughan. In addition to an inspection of ‘Key’ Standards, this Inspection also sought to review progress in meeting ‘Requirements’ arising from the most recent Unannounced ‘Key’ Inspection, held in September 2006. This Report is based on observations made during a tour of the Home, a review of care related documentation, staff files and duty rotas, plus a range of other documents/records reflecting the general operation of the home. The report also utilises information submitted by the home through a very detailed and comprehensive Annual Quality Assurance Assessment (AQAA), which provided a useful framework for us to evaluate quality of service and progress made. The Inspector also held individual discussions with 5 Residents, 3 Visitors, the nurse in charge, and several other members of staff, including nursing and care staff, the Catering and Housekeeping Manager, Administrator, Chef and Maintenance Man. At the end of the inspection visit outline feedback on the findings and conclusions reached by us was given to the Owner by telephone. What the service does well: Care services are offered in a comfortable, homely environment, and provide a good response to the needs, and preferences, of the Residents and their relatives. Particular strengths are the provision of meals and activities, where meals provision, which includes a wide choice of well-prepared meals each day, and a range of activities well matched to resident’s capabilities and preferences. Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? The Home has addressed and fully met all but one of the requirements arising from the previous Key Inspection. In doing this the Home has successfully addressed issues relating to • • • • • • • • • • Care planning documentation Written consent to use of bed-rails Medicines administration records and storage Provision of ‘privacy curtains’ in shared bedrooms Infection control in the laundry Staff checks prior to commencing employment at the Home Safeguarding the interests of residents in respect of personal monies managed by the Home Ensuring chemicals are secure at all times to prevent access by residents. The risk assessment for transporting washing to and from the laundry must be reviewed. The health & safety poster must be completed to provide information for staff. There is an ongoing redecoration/refurbishment programme which in recent times has seen improvements to décor, furnishings, fabrics, carpeting in some areas including redecoration of bedrooms as they become vacant. Also, the lay out of communal areas has been a reviewed, resulting in the creation four smaller more intimate communal areas. Purchased overhead hoisting equipment to improve dignity in public areas and profiling beds . Overhead ‘hoisting’ equipment is now provided in all communal bathrooms and toilets that have wheel chair access What they could do better: Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 8 Revision/rewriting of the ‘Resident’s Handbook’ be completed as soon as possible following the appointment of the new Manager. The medicines refrigerator should be replaced. The home should review its use of colour and signage throughout the home to improve the orientation of people with dementia. The wash hand basin in laundry should be repositioned and a temperature control valve fitted to the hot tap. 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. Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 9 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 Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 10 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): 1 & 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective Residents, and/or their relatives, are provided with information, which enables them to make a decision as to the home’s ability to meet care needs and lifestyle wishes. However the information seen still relates to the previous owners and manager. Processes to ensure appropriate and thorough care needs assessment, prior to admission, are effectively applied, and subsequent findings are utilised to ensure appropriate placement and care provision. Residents entering the Home for rehabilitation (intermediate care) are appropriately assessed and cared for. EVIDENCE: The Home’s service user’s guide, which is in the form of a ‘Resident’s Handbook’, is still using resident information documentation issued by the previous owners. These documents make direct reference to the previous Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 11 owners and the previous Registered Manager. Conversation with the new owner (Mr. S. S. Jeebun) confirmed that plans are in hand to revise/rewrite the related documentation – including input from the new manager (yet to take up post). It is recommended that this revision be completed as soon as possible following the appointment of the new Manager. The ‘Rehabilitation Unit provides ‘intermediate’ care for up to 8 weeks for people requiring rehabilitive care between leaving hospital and returning home. The Owner informed us this service will cease as from 1 April 2008 with the places being given over to care as provided in ‘Poppy’ and ‘Roses. In the meantime the provision of care is seen to meet the particular needs of residents admitted to the unit for rehabilitation; this was reflected in the detail found within care plans and the amount of physiotherapy input. Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The content, organisation and quality of entries within care plans, indicate Residents’ individual assessed care needs are met. The reception, storage (with the exception noted below), disposal and record keeping, in respect of medicines’ administration are all in accordance with accepted ‘good practice.’ The care provided is delivered considerately and effectively with Residents’ privacy and dignity being respected. EVIDENCE: Five requirements issued at the previous inspection in respect of this ‘outcome group’ addressed several areas of care including care-planning documentation, medicines management. The requirements and action taken were as follows: - Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 13 • Care plans must be further developed to ensure that they record specific instructions for care staff to follow, to ensure that residents needs are met in full. Timescale of 28/04/06 partly met. Following the recent change of ownership there has been the introduction of new design of care plans based on ‘activities of daily living’. A review of eight care plans showed them to be comprehensive in addressing all aspects of care with informative daily recording of outcomes/progress with evidence of regular review by the Manager or Nursing Staff. • Written consent must be obtained prior to the use of bedrails and risk assessments must be reviewed each month. Review of care plans showed evidence of consent to the use of bedrails is obtained where necessary. All prescribed dietary supplements must be recorded as administered. Review of care plans showed the required records are now maintained. ‘Allergy’ boxes are completed on the front of all Medication Administration Records and, handwritten entries on Medication Administration Records are signed & checked by a second nurse. Medicine Administration records (MAR sheets) were seen to be appropriately maintained. Creams & ointments that are Prescription Only Medicines (POM) must be securely stored at all times. Inspection of medicines storage showed medicines are now securely stored. The temperature of the room where externals medicines are store must be checked and recorded each day. The room temperature is now checked and recorded each day – records reflect an ambient temperature of consistently about 22o Celsius. • • • • All of the above requirements are met. One area of concern is the controllability of the internal temperature of the medicines refrigerator, which serves all four units. Inspection of the daily records showed that the temperatures recorded showed a fairly consistent maximum of 4o Celsius and a minimum which was recording frequently reported to be as low as 1o Celsius. This is not satisfactory in that the requirement to store medicines, which are to be, refrigerated between 4o Celsius and 8o Celsius is not being met. It was explained to us that there are Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 14 difficulties with managing the refrigerator temperatures between that range despite close monitoring and moving the refrigerator to different parts of the home. It is recommended that the drugs refrigerator be replaced so as to reliably ensure the integrity of the medicines stored therein. Apart from the above shortfall, inspection of medicine storage provision and administration records demonstrated the Home’s practices now fully meet the guidelines of the Royal Pharmaceutical Society. The continuation of good practice is supported by annual visits by a pharmacist from the supplying dispensary. Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of activities is offered, which are consistent with individual Resident’s capabilities and relatives’ expectations. Opportunities for contact with family/friends/community are established and encouraged. The Home provides a very good daily choice of attractive and nutritious meals based on Residents’ preferences. EVIDENCE: The provision of social/leisure activities is a noteworthy strength at New Hall. Two activities organisers are employed who between them cover Monday, Tuesday (9am to 4.30pm), Wednesday and Friday (both days 11am to 6pm). Thursdays are covered once every two weeks by visits from and entertainments/activities group (Mobility Plus). Specific activities arranged include; group exercises, 1:1 conversations (most days) including people in bed, nail and hand care, musical entertainers, trips in minibus monthly (e.g. Webb’s garden centre, local parks, visits to local pantomimes), skittles, hoopla, passing balloons. The two activities staff also Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 16 exercise a broad based role, which extends to helping Residents with feeding when required, which in itself provides the opportunity for 1:1 contact (which residents told us they value). The home invites entertainers into the home routinely and special occasions such as valentines day,christmas etc are celebrated in conjunction with famlilies and friends of service users. Relatives/visitors spoken with were very complimentary regarding the quality of service provided and the caring approach of all staff. It was quite evident to us the routines of daily living are very flexible and based on a ‘person centred’ approach to care provision. The home has made links with the community in order to facilitate access to community services by service users. A church service is held at the home every month and any service user wishing to attend a church service can do so by arrangement with the home. The provision of meals is also particularly noteworthy in that each day, at both lunchtime and at teatime. Residents have a choice from two cooked main course or soup, sandwiches, or salad. Drinks and snacks are available throughout the day. Food is traditionally based and, in the view of Residents and relatives with whom we had discussions, interesting, well presented, and very enjoyable. Specific dietary requirements are met and menus adapted to individual preferences/need. Birthdays are acknowledged and flowers and tea parties organised. Family are involved and accomodated. Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system with evidence that Service Users and relatives feel their views are listened to and acted upon. Robust procedures and practices are in place to ensure that individuals are protected from abuse. Residents and relatives/visitors are provided with up-to-date information about adult protection. EVIDENCE: The Home’s Complaints Procedure is displayed within the entrance to the Home, and up-to-date information advising on how to proceed in making a complaint is found in the Service Users’ Guide. Also information is available to staff service users and relatives regarding advocacy. Evidence was observed confirming Staff have POVA clearance, and satisfactory CRB checks before commencing employment. Staff spoken with possessed the relevant knowledge, gained through wellplanned induction and on-going training, to safeguard service users from abuse. Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 18 Review of relevant records and documentation evidenced the home has a clear complaints procedure, which is given to residents and their relatives before they move into the home. The Inspection Record maintained by CSCI shows a regular flow of information from the Home reporting any incidents and/or complaints to CSCI as required under Regulation 37. Crosschecking with records held at the home showed active and effective response by the home together with comprehensive record keeping. Training records evidenced an ongoing programme of staff training in relation to complaints and the protection of vulnerable people. Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24, 25, & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe, well-maintained environment with communal rooms and bedrooms, which are satisfactorily decorated with furnishings being in good order and presenting a ‘domestic’ ambience. The Home has good provision of specialist equipment, consistent with meeting the assessed care needs of service users and the demands of tasks carried out by Care Staff. The home is clean and there are satisfactory standards of hygiene. EVIDENCE: The tour of the home demonstrated the lounge/sitting and dining areas offer a good variety of size and outlook, with furnishings and decoration being of good order and presenting a comfortable ‘domestic’ ambience. Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 20 Bedrooms, most of which have en-suite facilities, are personalised and appear to suit individual needs. There is an ongoing redecoration/refurbishment programme which in recent times has seen the redecoration of a number of bedrooms, often to suit individual Resident’s tastes. As part of this programme the lay out of communal areas has been a reviewed, resulting in the creation four smaller more intimate communal areas. Environment has been improved further by the purchase of new furniture for ‘Rehab’ conservatory and ‘Poppies’ dining room. Purchased overhead hoisting equipment to improve dignity in public areas and profiling beds . To facilitate the provision of care to Residents overhead Hoistingis now provided in all communal bathrooms and toilets that are wheel chair accessible. The grounds are spacious, attractive, and are accessible to Residents with mobility problems. At the previous Key Inspection a number of requirements were made in respect of this ‘outcome group’. These were as follows: • The registered person must review the adequacy of the privacy curtains in the shared bedrooms. The Home has three shared (double) bedrooms. Inspection of each showed they now have provision of adequate privacy curtains. • ‘Clothes must not be hand washed in the same sink that is used by staff for washing their hand’s and ‘Foul laundry must not be sluiced by hand.’ Discussion with laundry staff indicated there is good understanding of the reasons for both requirements and that practices have now changed to ensure compliance. However we do have some concern about the positioning of the hand wash basin in that it is located in an area of the laundry which is difficult to reach and access can easily be blocked by laundry trolleys (as was the case at this inspection.) Also, the temperature of water temperature coming from the hot tap was too hot to facilitate thorough hand washing, without recourse to filling the basin with hot and cold water, so as to attain a comfortable temperature. To address both these issues it is recommended the basin be repositioned, and a temperature control valve fitted to the hot tap. Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 21 A further requirement in this area was: • The home must review its use of colour and signage throughout the home to improve the orientation of people with dementia. Advice can be sought from the Alzheimer’s Society. To date this requirement has not been addressed. It is possible progress in respect of this has been delayed due to the possibly unsettling effect of a change of ownership and the current absence of a Registered Manager. It is strongly recommended attention be given to addressing the particular care needs of Residents with dementia related illness. Prior to this inspection visit concerns regarding problems with the lift were brought to our attention. During the tour it was noted there is a problem with closure of the external door closing completely – this sometimes has the effect of delaying activation of the lift and a note to this effect was attached to the door. We were informed that the lift engineer from the company contracted to maintain the lift had visited. The home was informed the lift was safe to use and would work providing staff ensured the outer door was pushed to. The maintenance man informed us that spare part necessary to remedy the fault was on order with delivery expected within the following week. Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels and skill mix are sufficient to ensure the provision of safe care to Residents. Recruitment procedures are sufficiently robust to ensure that Residents are not placed at risk. Staff receive training, which enables them to be competent to carry out their role in providing safe care to Residents. EVIDENCE: Following the change of ownership, a ‘human resources person, is now employed by the organisation to ensure thorough checks are conducted prior to employing any person within the home. Staff employment files relating to the five most recently employed staff were reviewed, and demonstrated recruitment practices at the home to be satisfactory, with all elements required by Care Homes Regulations being completed, and evidence retained on file. Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 23 At the previous key inspection the following requirement was made: • The registered person must ensure that they seek confirmation from the Nursing & Midwifery Council that trained staff have a current PIN and evidence of this must be retained in the employees records. Review of the employment records relating to two most recently employed nursing staff showed this requirement to be met The staff training files evidenced the proportion of Care Staff, who hold NVQ Level 2, or higher, exceeds the minimum 50 required by the Standard. Files further evidenced that staff have undertaken appropriate induction training, plus mandatory training, including - moving and handling, medication administration, adult protection, care planning, risk assessment, infection control, and fire awareness. Records suggest the retention rate of staff is good. Annual appraisals are conducted from which training needs are identified and provided within resources available. Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35, & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The interim arrangements to cover the absence of a registered manager appear to be working satisfactorily. The systems for consultation with Residents require further development. Service Users are safeguarded by the financial procedures operated in the home. Health, safety, and welfare of service users, and staff, are promoted fully by safe working systems being in place. Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 25 EVIDENCE: The Home changed ownership in November 2007. At that time Home was without a registered manager, the previous manager Maggie Green having left just prior to the change. Jane Lewis (Clinical Manager) is nominally in charge pending appointment of a new Manager. We were informed, by the Owner, interviews in respect of this had been held a few days prior to this inspection, and a substantive appointment is imminent. It is recommended that following taking up post the new manager should make application, to CSCI, for formal approval as soon as possible. On the day of this inspection Jane Lewis was away from the Home, the person in charge for the shift being Mrs. Margaret Vaughan – an experienced level 1 Registered Nurse. The current situation in respect of management of the Home presented some potential difficulties in accessing files and gathering information. However, input from the nurse in charge, the Administrator and Housekeeping Manager, together with a telephone conversation with the Owner, ensured all information required was accessed. As part of monitoring quality assurance the home has systems in place for measuring & monitoring the quality of the service including issuing questionnaires. The manager and the Director of Quality for the Company hold monthly meetings with the staff team. They review each area of the service based on the National Minimum Standards and they cover all 38 National Minimum Standards in a year. Improvement plans/action plans are created according to the outcome of the review of the standard. Questionnaires were sent to the families & other healthcare professional at the beginning of the year. The value of these is limited by them being utilised on an annual basis and it is recommended that residents, relatives, and other interested parties have opportunity to make comments via questionnaires on a more frequent basis. Questionnaires sent out by CSCI prior to this inspection. Twelve were returned of which 4 were from residents, 5 from relatives, and 3 from health professionals. The consensus was care provide at the Home addresses resident’s assessed needs and is of good quality. Specific examples of comments included: From relatives; • • • • My (relative) is very happy here Activities, particularly trips, are very good …a genuine caring atmosphere …helping to maintain a good qulity of life within (my relative’s) capabilities DS0000004112.V358290.R01.S.doc Version 5.2 Page 26 Hall Nursing Home, The • • • …treated with respect …the staff respond quickly and effectively to any concerns I might have The home offers appriopriate care in a friendly atmoshere From health professionals; • • …care staff always try hard to implement recommended remedial therapies The staff have a good working relationship with the multidisciplinary team and the Primary Care trust (PCT). A requirement from the previous key inspection was: • Money belonging to any service user must not be paid into a bank account unless the account is in the name of the service user that the money belongs to. Evidence was reviewed which confirmed all financial transactions are properly conducted, including the maintenance of comprehensive records relating to Residents’ personal monies, with signatures obtained where necessary. The home has infection control policies and procedures and all staff are provided with infection control training at induction. Adequate provision of aprons,gloves,hand wash soap,alcohol gel and paper towels was seen. Tour of the Home, and comments from residents and relatives provided evidence the cleanliness of the home, and the management of odours, is good. The home maintains a routine maintenance program covering fixtures, fittings and equipment. At the previous key inspection 4 requirements were made in respect of this group of outcomes i.e. • • • • All chemicals must be secure at all times to prevent access by residents. Bedrails must be checked by the home every month to ensure that they remain safe to be used. These checks must be recorded. The risk assessment for transporting washing to and from the laundry must be reviewed. The health & safety poster must be completed to provide information for staff. Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 27 Specifically, during the tour chemicals were found to be secure, evidence was seen bedrails are now checked as part of routine maintenance, and staff have access necessary information with regard to ‘Health and Safety’. We were told about the arrangements that have been put in place, following review, for the transporting washing to and from the basement laundry. Whilst the new arrangements appear satisfactory no evidence was available to show that a policy relating to the revised practices has been written. It is strongly recommended a policy relating to this is written, and brought into use, as soon as possible. At the time of this inspection no potential hazards were identified and review of relevant records provided evidence that Health and Safety Policies/Procedures/Practices are satisfactory, maintenance and servicing of equipment regularly undertaken, and appropriately documented, and all COSHH requirements met. Records are maintained for hot water supply to outlets accessible to Residents. Water temperatures tested during the Inspection were found to be satisfactory. Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 28 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 Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 29 CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 X 18 3 3 X X 3 X 3 3 3 STAFFING Standard No Score 27 3 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 Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations It is recommended revision/rewriting of the ‘Resident’s Handbook’ be completed as soon as possible following the appointment of the new Manager. It is recommended that the drugs refrigerator be replaced so as to reliably ensure the integrity of the medicines stored therein. It is strongly recommended the home reviews its use of colour and signage throughout the home to improve the orientation of people with dementia. Advice can be sought from the Alzheimer’s Society. It is strongly recommended a policy relating the revised practices for transporting washing to and from the laundry is written, and brought into use, as soon as possible. 2. OP9 3. OP19 4. OP38 Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hall Nursing Home, The DS0000004112.V358290.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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