CARE HOMES FOR OLDER PEOPLE
Herncliffe Nursing Home Spring Gardens Lane Keighley BD20 6LH Lead Inspector
Gillian Sangster Announced 14 September 2005 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 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. Herncliffe Nursing Home J52 S29166 Herncliffe V178703 140905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Herncliffe Nursing Home Address Spring Gardens Lane Keighley BD20 6LH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01535 681484 01535 691693 P & B Kennedy Holdings Ltd Mrs Sheila Lambert Care home with nursing 105 Category(ies) of Physical dis - over 65 (105) registration, with number Old age (105) of places Dementia - over 65 (105) Dementia - over 65 (2) Herncliffe Nursing Home J52 S29166 Herncliffe V178703 140905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: The places for DE are for the specified service users only Date of last inspection 14/10/04 Brief Description of the Service: Herncliffe is in a residential area of Keighley adjacent to Cliffe Castle and other local amenities. There are parking facilities to the front of the property and a local bus stops nearby. The home is registered as a care home with nursing for one hundred and five older people. The home is divided into six units – Margaret, Constance, Terraces, Alexandra, Victoria and Garden Wing. There are three shaft lifts that access all areas of the home. Each unit has its own communal day areas as well as toilets and bathrooms. Kitchen and laundry facilities are located centrally, although each unit has its own kitchenette for making drinks and light snacks. Herncliffe Nursing Home J52 S29166 Herncliffe V178703 140905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was carried out by two inspectors between 10am and 5.20pm. The purpose of the visit was to check compliance with the standards. The registered manager was present during the visit and for the feedback. The inspectors spent time talking with residents, visitors and staff and observing practice. Records inspected included pre-admission assessments, care plans, accident reports, duty rotas, complaints and some policies and procedures. Some areas of the building were checked. Extensive building works are underway to improve the facilities by increasing the number of single rooms, providing en suite facilities, increasing communal space and providing specialist equipment to meet residents’ needs. The renovations have been ongoing over the last twelve months but the owners have tried to limit the disruption by doing the work in phases and keeping residents, relatives and staff well informed. What the service does well:
The home provides good standards of care and this was confirmed in comments made by residents and relatives. Residents and relatives said that they were given good information about the home which helped them decide about moving in. Pre-admission assessments were detailed. Residents said they were well cared for and praised the kindness of the staff describing them as “very good” and “caring”. Staff demonstrated a good knowledge and understanding of the residents’ individual needs. Residents said they were treated with respect and staff were seen to help residents discreetly and sensitively maintaining their privacy and dignity. A good choice of meals is provided and residents said that they enjoyed the food. Residents said how pleased they were with their rooms and enjoyed having their own belongings around them. Domestic staff are to be complimented on maintaining high standards of cleanliness while building works are ongoing. Staff training and ongoing development is well established. Over fifty per cent of the care staff are trained to NVQ level 2 or above. Staff praised the training opportunities and said that they were encouraged and supported to develop their skills, competence and knowledge. New staff said that they were well supported by the induction programme and system of mentorship. Herncliffe Nursing Home J52 S29166 Herncliffe V178703 140905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Herncliffe Nursing Home J52 S29166 Herncliffe V178703 140905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Herncliffe Nursing Home J52 S29166 Herncliffe V178703 140905 Stage 4.doc Version 1.40 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 standard(s) 1, 3, 4 and 6. Good information about the home is provided to prospective residents to allow them to make an informed choice about moving in. All residents are assessed to make sure that their needs can be met and have the opportunity to visit before moving in. EVIDENCE: The home has a brochure, which incorporates the statement of purpose and service user guide, providing detailed information about the services and facilities. This has been updated regularly to reflect the changes made to the building and staffing structures. Information about the home is freely available in the reception area. All residents are assessed before moving into the home. Comprehensive preadmission assessments were seen in care files. Service users and relatives confirmed that visits had been made to the home and sufficient information provided before making a decision to move in. The home does not provide intermediate care.
Herncliffe Nursing Home J52 S29166 Herncliffe V178703 140905 Stage 4.doc Version 1.40 Page 9 Herncliffe Nursing Home J52 S29166 Herncliffe V178703 140905 Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10. Care records are detailed but further improvements could be made by making the care plans more personalised so that staff are clear exactly what action they need to take to meet the resident’s needs. Residents’ health care needs are met. Residents are treated with respect and their privacy is upheld. EVIDENCE: Residents’ care records were checked. The care plans address the assessed needs of the residents. Monthly evaluation takes place ensuring that changing needs are identified and appropriate action taken. Care planning was well documented and up to date. However improvements could be made by making the care plans more personalised to the individual. For example one care plan said “ assist with personal hygiene needs” rather than providing specific detail about what staff needed to do to help the resident such as “ can clean own teeth but needs staff to help with washing “. This person-centred approach is particularly relevant to residents with dementia and needs to be detailed to make sure that staff are consistent in delivering care. Recognised assessment tools are in use and risk assessments were in place. The daily records need reviewing as they comprise solely of entries stating
Herncliffe Nursing Home J52 S29166 Herncliffe V178703 140905 Stage 4.doc Version 1.40 Page 11 “care as plan”. The daily records should show how the resident has spent their day including meeting social as well as physical health care needs. The manager said that she is reviewing the care records and looking at different formats focusing more on person-centred care. Staff spoken with showed a good understanding of the residents’ needs and residents said that their needs were being met. This needs to be reflected in the care records. Arrangements are in place for residents to access health care needs as required. The home has set up a scheme for relatives to purchase hip protectors as these are expensive to purchase and wear out rapidly. Hip protectors have been shown to reduce the incidence of fractures in residents who are at high risk of falling. Staff were observed knocking on doors before entering and asking discreetly about personal care. Residents said that staff treated them with respect and made sure their privacy and dignity was upheld. It was noted that some confidential information about residents’ care needs was displayed in public areas and this needs to be addressed. Herncliffe Nursing Home J52 S29166 Herncliffe V178703 140905 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 14 and 15. Residents are supported to maintain contact with friends and relatives. Staff encourage residents to maintain as much control and choice over their lives as possible. Residents enjoy the food and are offered a good choice of meals. EVIDENCE: The home has many visitors. Those we met said that they were able to visit at any time and were always made welcome. They said that they were kept informed and found staff to be friendly and helpful. Relatives confirmed that they were happy with the care provided. Staff described how choice and independence is encouraged. For one resident this included making their own bed and choosing their clothes. Additional communal space has given residents more choice about where they spend their time and the opportunity to sit in a quiet area. Many residents have their own telephones and there is a pay phone in the main entrance. Staff confirmed that the induction training includes residents’ rights and clearly addresses the staff’s responsibility to uphold these rights. Radios were playing loudly in the kitchen and corridor in one part of the home, which seemed to be for the benefit of the staff rather than the residents. Lunch was observed and the atmosphere was calm and relaxed. Staff were sat with residents who needed assistance rather than standing over them.
Herncliffe Nursing Home J52 S29166 Herncliffe V178703 140905 Stage 4.doc Version 1.40 Page 13 Residents were relaxed and good relationships were evident. Residents said that they enjoyed the food and were given a good choice of meals. Daily menus are displayed throughout the home giving residents the opportunity and time to choose alternatives. Herncliffe Nursing Home J52 S29166 Herncliffe V178703 140905 Stage 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. Complaints are listened to and dealt with appropriately. Systems are in place to protect residents from abuse. EVIDENCE: The complaint procedure is displayed throughout the home and is included in the statement of purpose. Complaints are dealt with appropriately and detailed records are kept. Residents and relatives said that they would feel able to raise any concerns with staff. All trained staff and thirty of the care staff have attended Adult Protection training since the last inspection. The manager said that a third of the care staff have still to attend and is organising further training. All areas of the home have a copy of the Adult Protection procedures to follow if abuse is suspected or reported. Herncliffe Nursing Home J52 S29166 Herncliffe V178703 140905 Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 22, 23, 24 and 26. The home is well-maintained and the environment is kept safe while building improvements are ongoing. Bedrooms are decorated and furnished to a high standard and personalised with the resident’s own belongings. The home is kept clean and odour-free. EVIDENCE: Only some areas of the home were inspected at this visit. Building work is ongoing in the home to improve the facilities and increase the communal space. Residents, relatives and staff are kept informed of the developments through the home’s newsletter. The communal space on Constance and Garden wings is currently restricted while building work is in progress to provide increased lounge and dining space. Staff are managing the situation well by trying to minimise the disruption for the residents. Although the main lounge on Garden wing has been reduced a separate sensory room has been created with lights, music, aromatherapy and equipment to create a calming atmosphere that can be put to use when other
Herncliffe Nursing Home J52 S29166 Herncliffe V178703 140905 Stage 4.doc Version 1.40 Page 16 methods fail. This room is still being developed but offers an alternative for residents with dementia. A courtyard area has also been created for the residents from Garden wing so that they can freely walk around. Discussions were held with the manager and proprietor about the use of colours and pictures or signs to help residents with dementia find their way around the unit. Residents said they liked their rooms and were pleased that they could bring in their own belongings from home. The new bedrooms have been furnished and decorated to a very high standard. Discussions were held with one new resident who said she was very pleased with the standard of her room. A lockable facility with key was available although there was some uncertainty about the provision of a key for the bedroom door. Discussions about keys should be part of the admission procedure in order to establish any risk or preference to hold a key. The home has purchased new equipment as part of the improvement programme. This includes profiling beds with custom-made bed safety rails, specialist pressure relieving equipment and two new mobile hoists. The home was clean and the control of malodours was very good. One issue of hazardous substances not being locked away, in order to protect the residents from harm, was discussed with the unit manager. Herncliffe Nursing Home J52 S29166 Herncliffe V178703 140905 Stage 4.doc Version 1.40 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30. Staffing levels are sufficient to meet residents’ needs. Staff receiving ongoing training to maintain their competency and skills. EVIDENCE: Staffing levels have increased as new bedrooms have been registered and recruitment is ongoing. Each wing in the home has its own unit manager who is a registered nurse. The manager advised that eight new staff were due to start in post over the next week. The home employs a full team of ancillary staff, which includes six cooks working daily until 8pm. There is a housekeeper who oversees all the cleaning services and a full time cleaner on each wing. A laundry service is provided over seven days by a team of laundry staff. Bed linen and towels are contracted out to an external laundry service. The deputy manager is responsible for staff training and development and provides an annual programme of training and development for all staff working in the home. Domestic staff confirmed they had received training in health and safety, COSHH (Control of Substances Hazardous to Health), infection control and fire safety. It is recommended that domestic staff are also included in training about dealing with aggression and adult protection. Discussions were held with several staff. All confirmed that they had received mandatory training in moving and handling, fire safety and health and safety. A new staff member described her induction as “very thorough” and said she
Herncliffe Nursing Home J52 S29166 Herncliffe V178703 140905 Stage 4.doc Version 1.40 Page 18 felt well supported by her mentor. One of the qualified staff discussed the degree in dementia care which she is undertaking with Bradford University. The home has good links with the University and takes student nurses on placement on the dementia unit. The home is committed to NVQ training and over fifty per cent of the care staff have achieved NVQ level 2. Herncliffe Nursing Home J52 S29166 Herncliffe V178703 140905 Stage 4.doc Version 1.40 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38. The health and safety of staff and residents is maintained. EVIDENCE: The pre-inspection questionnaire provided information to show that all maintenance and service checks have been carried out and are up-to-date. Accident reports are well recorded and monthly audits are carried out to identify any trends. Herncliffe Nursing Home J52 S29166 Herncliffe V178703 140905 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 x 3 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 3 Herncliffe Nursing Home J52 S29166 Herncliffe V178703 140905 Stage 4.doc Version 1.40 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 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. 2. 3. 4. 5. Refer to Standard op7 op7 op10 op22 op18 Good Practice Recommendations Care plans should be person-centred and contain sufficient detail so that staff know what action they need to take to meet individual needs. Daily records should show how the residents social and personal needs have been met. Personal information about the residents should not be displayed in public areas. Appropriate use of colours and signs/pictures should be considered on Garden wing to help residents find their way around. Domestic staff should receive training in adult protection and managing aggression. Herncliffe Nursing Home J52 S29166 Herncliffe V178703 140905 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Aire House Town Street Rodley LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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