Inspection on 17/07/07 for Homelands Nursing Home

This inspection was carried out on 17th July 2007.

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

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

Other inspections for this house

Homelands Nursing Home 08/07/08

Homelands Nursing Home 25/04/06

Homelands Nursing Home 21/09/05

Homelands Nursing Home 07/06/05

Homelands Nursing Home 24/11/04

Homelands Nursing Home 12/07/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Homelands Nursing Home Horsham Road Cowfold West Sussex RH13 8AJ Lead Inspector Sheila Gawley Unannounced Inspection 17th July 2007 10:00 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 Homelands Nursing Home DS0000024155.V341432.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. Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Homelands Nursing Home Address Horsham Road Cowfold West Sussex RH13 8AJ 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) 01403 864581 01403 865066 Medicrest Limited Mr Kamta Prasad Fakun Care Home 43 Category(ies) of Dementia (6), Dementia - over 65 years of age registration, with number (17), Old age, not falling within any other of places category (26) Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. A total of 43 Service Users may be accommodated in two units. Unit one, 17 service users in the category dementia (DE(E)) over the age of 65 years, of whom 6 service users in the category dementia (DE) age 60-65 years may be accommodate. Unit two, 26 service users in the category old age not falling within any other category (OP), of whom 6 service users in the category Physical Disability, age 60-65 years may be accommodated. Unit two may also accommodate up to six service users in the category Physical Disability Elderly PD(E), over the age of 65 years 25th April 2006 Date of last inspection Brief Description of the Service: Homelands is a care home, which is registered to provide nursing care. It has two separate buildings known as the Main House and the Coach House and is located in the village of Cowfold. The Main House accommodates up to 26 service users in the category old age not falling within any other category (OP). The Coach House accommodates up to 17 service users in the category dementia, over the age of 65 years (DE(E)). Private accommodation provided in each house includes single and double bedrooms, some of which also include en-suite facilities. Communal accommodation includes two lounges and a dining room in the Main House and a lounge/dining room in the Coach House. The registered provider is Medicrest Ltd who has appointed Mr S Alagaratnam as the Responsible Individual who is responsible for supervising the management of the care home. The Registered Manager is Mr K Fakun who is responsible for the day to day running of the care home. The fees for this care home currently range from £535 to £562 per week Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit as part of the inspection process took place on the morning and afternoon of 17 07 07. The registered manager facilitated the inspection. The commission was in receipt of an Annual Quality Assurance Assessment (AQAA) and any documents required on the day were made available. Information on file with the Commission was also considered. Four residents were case tracked, their care plans and medicine administration charts were inspected and two of these three residents were spoken to. They expressed satisfaction with all aspects of the home saying that staff were very caring and the food was good. Other residents spoken to throughout the day stated that they received the care they need in a respectful manner and that staff are kind. Three relatives were spoken to on the day and all expressed satisfaction with the home. They stated that the staff were approachable and any concerns were dealt with. One further relative of a resident case tracked was telephoned who stated that he had no problem whatsoever with the home, that nursing staff always supervised the carers and that he was always made welcome when he visited. All of the above was considered in compiling this report. Most of the National Minimum Standards were met on this occasion but there were shortfalls in equipment and hygiene, which are, detailed elsewhere in this report. What the service does well: Residents spoken to stated that the staff are kind and that they are treated well. One resident stated, “I am comfortable and happy here”. Another stated “Staff are kind” and that she was consulted about the menu. A third resident stated that his visitors are made welcome and are offered refreshment. Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 not applicable People who use this service experience good outcomes because they are fully assessed prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A pre admission assessment is completd by qualified nurses. Family are invited to participate. Evidence of these assessments were seen in care plans. A relative spoken to stated that she was happy with the admission process. All residents are invitied to visit the home prior to admission unless ill health prevents this. It is confirmed in writing that assessed needs will be met. Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7-10 Residents have a comprehensive plan of care documented. The resident’s health care needs are met but faulty equipment may pose a risk. Medication is safely stored and administered in the home. Resident’s privacy and dignity is respected and protected by the staff. People who use this service experience adequate outcomes because although their needs are met according to their care plan, faulty equipment may adversely affect this. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All Mental, physical, social, nutrition, mobility, and continence needs are recorded. Professional visits are recorded and all care plans are reviewed monthly. There is a key worker system in place and this is being developed. The staff were seen giving care according to assessed need. Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 Page 10 Two of the four residents case tracked were spoken to and they confirmed that their needs are met in a timely and respectful manner. A relative spoken to also confirmed this. Many beds had bedrails, which had been retrofitted. There was not a policy on the use of bedrails and there was not full risk assessment in the care plans. Staff spoken to stated that they ensured that bed rails were correctly fitted but one accident has been recorded where a residents in the coach house had got his leg caught through the bed rail resulting in bruising. The mechanism on two air mattresses was not functioning correctly and although the mattresses had not deflated, on discussion with the manager, she instructed the staff to change these. She confirmed that new pressure relieving equipment had been ordered. Medicines are appropriately stored, administered and recorded in the home. Medicine administration charts inspected were up to date. Policies are in place and staff are aware of the West Sussex guidance on homely remedies. The home has a contract with a private company to dispose of unused medicines. One resident case tracked frequently refused medication and this was recorded and acted upon by discussions with the General Practitioner. Medicines are administered by Registered Nurses. Health professionals are contacted as need indicates, such as District Nurse consulted on pressure sore. A chiropodist, optical and dental service is offered in the home. Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 The lifestyle offered in the home does not meet all resident’s needs and preferences. Residents can maintain contact with relatives. Visitors are welcome and residents enjoy a varied diet. People who use this service experience adequate outcomes because although they receive nutritious meals they need more activities and stimulation. They need more opportunity to exercise control over their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A relative spoken to confirmed that she rarely sees activities in the home. She had on occasion witnessed bingo but not lately. On discussion with the manager he confirmed that he was in the process of recruiting an activities coordinator for three days a week. He was awaiting the Criminal Records Bureau Clearance and POVA check. Currently there is music and movement carried out by two people, one does it fortnightly and the other attends every six weeks. The needs of the residents with dementia in the Coach House were Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 Page 12 discussed with the deputy manager there. She is envisaging that when the activities coordinator is employed and the Coach House will have its conservatory extension completed, then the provision of daily activities for those residents will improve. The need for staff to be more involved in this process was discussed. A notice was seen advertising a summer tea. Two visitors spoken to confirmed that they are always welcome and are offered refreshment. Two residents spoken to in the Main House confirmed this. In the Main House many residents due to their physical or mental frailty have limited control over their lives but one resident spoken to stated that he chose to stay in bed and another stated that she preferred to stay in her room. The situation was similar in the Coach House with two residents in their room but all others sitting around the rather small sitting room. Residents are offered a nutritious menu, which allows choice. Residents do not however move into a dining room for meals therefore do not enjoy a change of environment at meal times. The main kitchen where all food is cooked for both parts of the home is situated in the Coach House. The chef was spoken to and he confirmed the choice in menu. The kitchen equipment is rather dated and he confirmed that the kitchen is to be totally refitted in the near future. He is also to implement the West Sussex Safer Food Better Business plan to ensure documentation to show food is safely handled. There were some food items in the fridge and freezers that were not labelled and dated. There was a large build up of ice around the rim of the two chest freezers, which suggests an insufficient seal. This was discussed with the chef. The floor of the small kitchen used for serving meals in the main part of the home was not clean with a build up of dirt at edges. This was discussed with the deputy manager. It will be a recommendation of this report that the Environmental Health Department be consulted on these issues. Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 Page 13 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 Complaints made by residents and their relatives are listened to, taken seriously and acted upon. All staff have received training to ensure residents are protected from abuse. People who use this service experience adequate as although staff are trained in protecting residents from abuse residents are not protected from faulty or inadequate equipment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents and relatives spoken to stated that complaints would be listened to and acted upon. West Sussex Adult Protection Procedures are in place and staff spoken to were aware of procedures in the event of an allegation of abuse. As detailed in standards 7-11 section of this report residents are not protected from faulty equipment. Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 Page 14 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): 19,22,26 Residents do not live in a completely safe and well-maintained environment. Specialist equipment to promote independence is not available. Hygiene is lacking in parts of the home. People who use this service experience adequate outcomes because the lift in the main house is inadequate and the home is not completely hygienic. This judgement has been made using available evidence including a visit to this service. Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 Page 15 EVIDENCE: All parts of the home were inspected. The bedrooms and sitting rooms and dining room were neat clean and free from offensive odour. The dining room in the main house is not used as such but is used as a smoking room. In the Main House the upstairs dining room is being redecorated following a leak. In both parts of the home meals are taken in the sitting area and residents do not benefit from a change in environment at meal times. The décor of the main house is tired in places with some wallpaper seen lifting, woodwork around a sink was worn and water stained some knobs were missing from furniture. Otherwise the rooms are comfortable and personalised. The rooms in the coach house were well decorated and pleasantly furnished. A radiator cover in the hallway was coming off. Residents and relatives spoken to stated that they were happy with the facilities. There are shortfalls in the specialist equipment needed to promote comfort, safety and independence. The electrical mechanism on two air mattresses was not functioning correctly and although the mattresses had not deflated, on discussion with the deputy manager, she instructed the staff to change these. The registered manager stated that all electrical equipment had been tested this year but these two units were not listed and one had a sticker showing it had last been tested in 2000. The need for all equipment to be tested and for items, which may be in storage not to be missed, was discussed with the registered manager. Many beds had bedrails, which had been retrofitted. Staff spoken to stated that they ensured that bed rails were correctly fitted but one accident has been recorded where a residents in the coach house had got his leg caught through the bed rail resulting in bruising. The beds are also not adjustable. The need for some adjustable beds to be purchased to fully meet the needs of residents requiring nursing care was discussed with the manager who will raise this with the proprietor. The lift is not fit for purpose for the needs of the home. A member of staff was asked to demonstrate how a wheelchair and a staff member would fit in the lift. The back had to be removed so as to make the wheelchair fit and the staff member fitted with great difficulty and would be encroaching severely on the residents personal space. A recent accident had been recorded where a residents leg had been caught in the opening lift doors and had caused bruising to left Knee. One staff member stated that the difficulty in getting residents into the lift meant they were very reluctant to do so and this meant many residents upstairs were not brought down unless absolutely necessary. The need to address this situation was discussed with the manager. The lift in the coach house was adequate for resident and staff need. Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 Page 16 The small kitchen in the main house had a build up of dirt in the corners and needed a deep clean. The assisted bath equipment in the bathrooms was very dirty particularly where bolted to the floor. The bathroom on the ground floor had mould around the bath and a sink in the bathroom on the first floor needed grout to be replaced in the tiling and the mirror was stained. The bathrooms and toilets in the coach house were clean and well maintained. The manager stated that the plumbing problems have been fixed and that all taps have temperature control valves. A record is maintained of temperatures. Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Residents’ needs are met by an appropriate number and skills mix of staff. Residents are in safe hands at all times. Residents are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. People who use this service experience good outcomes because the home is suitably staffed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection there were adequate numbers of care staff on duty to meet residents needs. The home operates with the Overseas Nursing programme, which is supported by the City of London University. There is one domestic staff on in each part of the home daily. Given the hygiene issues highlighted in the environmental part of the report there was discussion with the registered manager as to whether he felt this number could be increased. Staff spoken to confirmed that there were training opportunities in the home. A training programme was seen which had training for medication, manual handling, infection control, first aid, COSHH, food handling, fire and dementia. Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 Page 18 Staff files inspected during the inspection contained all the documentation required. Relatives and residents spoken to stated that staff are at all times kind and respectful. Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 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 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 A person fit to be in charge manages the home. The home is being run in the best interests of the residents. The registered provider has ensured that residents’ financial interests have been safeguarded. The health, safety and welfare of residents and staff are protected. People who use this service experience adequate outcomes because more attention needs to be paid to maintenance and hygiene. This judgement has been made using available evidence including a visit to this service. Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 Page 20 EVIDENCE: The home has met the requirements of the last inspection. Documentation was available to evidence that residents receive pre admission assessment, are written to informing them that the home can meet their needs and the care plans includes interventions required to meet residents needs. The home has a friendly relaxed environment which relatives confirmed. Financial interests are safeguarded. The home does not manage accounts for residents. It may hold small allowances for residents and these are receipted and stored securely. Whilst staff receive mandatory training and systems and equipment is tested there are shortfalls in the health and safety of residents and staff. Faulty air mattress equipment was in use, it had not been labelled as tested this year and bed rails may not be fitted safely. The lift is not fit for purpose in that it cannot comfortably and safely transport a resident in a wheelchair and a staff member. These will be requirements of this inspection. Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 Page 21 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 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 2 X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 Page 22 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 OP22 Regulation 16 (1) (2) 23(2)(n) Requirement Service users have access to all parts of service users’ communal and private space, through the provision of ramps and passenger lifts, where required to achieve this, or stair lifts where they meet the assessed needs of service users and the appropriate requirements of the Environmental Health departments and the Health and Safety Executive Timescale for action 30/09/07 2 OP22 16 (1)(2) 23(2)© The recommended disability 30/09/07 equipment such as pressure relieving devices and adaptations such as bedrails have been secured or provided to meet the assessed needs of service users. Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 Page 23 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 OP19 Good Practice Recommendations It is recommended that the registered person seek the advice of the environmental health department on the matter of freezer seals and hygiene in the kitchen and bathroom areas. Homelands Nursing Home DS0000024155.V341432.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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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