Inspection on 21/09/05 for Homelands Nursing Home

This inspection was carried out on 21st September 2005.

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

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

Other inspections for this house

Homelands Nursing Home 08/07/08

Homelands Nursing Home 17/07/07

Homelands Nursing Home 25/04/06

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 Mr D Bannier Unannounced Inspection 21st September 2005 09:45 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 Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 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.V251184.R01.S.doc Version 5.0 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 Medicrest Limited Mr Kamta Prasad Fakun Care Home 43 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (26) of places Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7 June 2005 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 ensuite 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 have 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. Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 9.45am. It took place over five hours. The inspector spoke separately to seven residents and to eight staff who were on duty. The inspector also looked around most areas of the Main House. The inspector also looked around the lounge/dining room, the main kitchen and the sluice in the Coach House. The inspector observed a mealtime in the Main House. Some records were also examined. What the service does well: What has improved since the last inspection? Improvements have been made to the home’s practices for recruiting staff. The manager has made sure all new staff has had criminal record checks conducted before they start work at Homelands. This will mean residents are protected from being abused. Representatives of the registered provider are visiting the care home regularly to monitor the care provided to residents. They are also writing reports of their visits and are able to demonstrate that the home is being run in the best interests of the residents. Residents’ records are now being stored securely. This means the information they contain is being kept in a confidential manner. Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 Page 6 Staff on duty takes time to talk to residents to make sure they are receiving what they need. It was also pleasing to see staff talking to residents whilst helping them with the main meal of the day. 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. Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 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.V251184.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 A comprehensive assessment of care needs has not been completed for residents before being admitted to Homelands. There have been no improvements made to assessment records since the last inspection. This is despite a requirement having been made at the last inspection. EVIDENCE: Three residents have been admitted to the Main House since the last inspection. Their care records, especially assessments and care plans, were examined. Each record included care assessments, which have been carried out by a social worker before the resident was admitted. During the last inspection, the manager was advised to develop a tool by which residents needs can be assessed. This would mean that he would have a clear way of assessing and identifying the needs of residents before they admitted. Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 Page 9 This information would be used to confirm that it is possible for Homelands to provide for their needs. Once the resident has been admitted the assessment would enable the manager to draw up a care plan. The care plan would provide information and directions to staff so that they would know what they should do to ensure they could provide the necessary care agreed with the individual resident. The manager told the inspector that he had not done so. The manager is advised to read this standard in order to gain information with regard to drawing up such an assessment. Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 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 the following standard(s): 7 A care plan has been drawn up for each of the newly admitted residents. There was no evidence that confirmed that the resident or their relative has been involved with this. Care plans are focussed on the long term and short term nursing needs of residents. Consideration has also been given to personal and social care needs. However, as there was no evidence that assessments have been carried out, it remains unclear how the manager has identified the needs of individual residents. Whilst records confirm that care plans have been reviewed regularly there was no evidence to demonstrate what they have been reviewed against. There was no evidence to confirm that residents and their families have been consulted and involved in this process. EVIDENCE: Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 Page 11 The inspector also looked at the records of two residents who live in the Coach House. The inspector noted that each of these residents have been prone to falling recently. One resident had severe bruising to her face. Records seen showed that she had fallen yesterday and that she was expecting to see her GP later in the day. The second resident was also expecting to see her GP. Her daughter was present and informed the inspector that she would be seeing the doctor with her mother. In each case there have been no recent assessments carried out. This would provide the staff with information and guidance with regard to the measures that need to be taken to reduce further falls. The care plan of one resident clearly recorded on 26th September 2004 that “ Qualified staff to carry out risk assessments”. There was no evidence that confirmed that such assessments have been carried out. The evaluation/outcome for this care plan simply records each time the resident has fallen. It also instructed “Regular check by staff”. There was no indication how frequent such checks should be and what action should be taken by staff to ensure the safety of the resident. The inspector informed the manager of his findings. Accident records seen indicated that each incident, which resulted in a resident falling, had been appropriately recorded. Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 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 the following standard(s): No standards in this section were assessed on this occasion. EVIDENCE: Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Complaints, received since the last inspection have been investigated by the manager and appropriate action taken to resolve them. All staff, including staff that have been appointed since the last inspection have subjected to criminal record checks at an enhanced level. EVIDENCE: Records seen indicated that four complaints have been received since the last inspection. Appropriate records have been kept of these complaints, including details of investigations and any action taken to resolve them. This demonstrates that complaints have been taken seriously by the registered providers and acted upon. It was of concern to note that one complaint, dated 11th September 2005, was about an incident of abuse. The record indicated that the manager had investigated the incident. When he was asked, the manager could not explain why the incident had not been reported to the local social services office in accordance with published adult protection procedures. Records of training confirmed that staff have provided with training regarding adult abuse. However, it was not clear why, in this instance, the manager had not followed the appropriate procedures. Following discussion the inspector advised the manager to notify social services of this incident without delay. Three staff has been appointed since the last inspection. Records since showed that all the necessary information has been obtained before they have starting Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 Page 14 work, particularly criminal record checks. This will ensure residents are protected from potential abuse. Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 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 the following standard(s): 19 and 26 Areas of the environment seen in the Main House and in the Coach House were safe and well maintained. The home itself was clean and hygienic. Some work is required to ensure there is no risk of cross infection particularly in the laundry and sluice rooms. EVIDENCE: Most areas of the Main House, including a number of bedrooms, toilets, bathrooms, the downstairs lounge, dining room, laundry and sluice room were visited. The lounge/dining room and sluice were seen in the Coach House. All these areas apart from the laundry and sluice rooms were clean, appropriately equipped and furnished to ensure residents are safe and comfortable. Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 Page 16 Residents said they were comfortable and satisfied with their accommodation. One resident told the inspector that her “ room is very nice. I can do what I want to. I can go to bed when I want to.” The inspector saw that there was no hot water available in the sluice room located in the Coach House. The inspector asked the nurse in charge where she and the staff go to wash their hands. The nurse in charge showed the inspector a bathroom, which is also used by residents. This is located some way from the sluice. This means that there is a high risk of cross infection to residents and staff after handling used bed pans or commode pots, soiled linen or soiled continence aids. The inspector went to view the sluice room in the Main House. There is a hole in the flooring where the old sluice was sited. This has now been replaced. This is an area where dirt and bacteria can gather. The flooring needs to be replaced to ensure it is impermeable, sealed and easily cleaned to prevent the risk of cross infections. Commode pots and bedpans were stacked on wooden shelving. This is not appropriate as it is not possible for them to drain sufficiently to ensure there is no risk of bacteria gathering in the bottom of pots and pans. Wooden shelving is porous and cannot be sanitised sufficiently. More pots were stacked and draining on metal racking. However, in some areas the plastic covering to the racking had perished and rusted metal was showing through. No amount of cleaning would ensure the racking was sufficiently sanitised to prevent infectious bacteria gathering. The manager is advised to replace the wooden shelving and the existing racking. This will prevent residents from being subjected to the risk of possible infections. There were three black bins in the sluice room. One bin contained a yellow sack in which were soiled continence pads. As the time was just after 2pm the inspector asked the nurse in charge how long they had been there. The inspector was told that they would have been there since staff on the morning shift had helped residents to get up and dressed. This practice is not acceptable as it increases the possibility of the spread of infection to vulnerable residents. There were no towels available to staff in the laundry room in the Main House. It is essential that appropriate materials are provided to staff to encourage regular and thorough hand washing in order to prevent the risk of cross infections after handling soiled materials. Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30 Homelands has adequate numbers of staff to care for the residents who are accommodated there. The Coach House and the Main House are staffed separately. The home’s recruitment procedure and practices are sufficiently robust to ensure vulnerable and frail residents are adequately protected. Newly appointed staff have not been provided with induction training within six weeks of starting work in the care home. EVIDENCE: Rotas were seen which showed that staffing levels, including trained nurses, catering and domestic staff were sufficient to ensure residents are well cared for. There is a separate rota for the Main House and for the Coach House. Three staff has been appointed since the last inspection. Records seen showed that the manager has obtained the necessary documents and information required. This confirms that staff have been subject to criminal record checks at the required level. This means that vulnerable residents are protected from potential abuse. There was no evidence, which confirmed that new staff has received induction training. This means that may not know what is expected of them and may not have the necessary information to carry out their tasks. The manager was Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 Page 18 advised that induction training must take place within the first six weeks of appointment. The manager was also advised that he must keep appropriate records of such training. Residents spoken to told the inspector that “staff are very kind” and “they are lovely”. The inspector noted that staff in the Coach House and in the Main House were talking to residents and interacting with them. One member of staff was polishing the nails of a resident. During the main meal residents were asked if they needed assistance in cutting up their food or eating their meal. Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 36, 37 and 38 Representatives of the registered provider are conducting regular visits to the care home to ensure it is being run in the best interests of the residents. Staff is being supervised on a regular basis by a more senior member of staff. Records are being kept securely and in the best interests of the residents. Work is required to improve the cleanliness and hygiene in the sluices in both the Main House and in the Coach House to ensure residents and staff is not at risk of cross infection. EVIDENCE: Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 Page 20 Records seen indicated that representatives of Medicrest Ltd visit regularly to monitor the management and care practices at Homelands. The inspector saw that the views of residents and staff have been asked for to ensure the home is being run in the residents’ best interests. Residents’ records are locked away in the office of the Main House and in the Coach House. The nurse in charge has access to them. This means that the information they contain is being kept confidentially. As mentioned previously work is necessary to ensure the cleanliness and hygiene in each of the sluices is maintained to a high standard. This will ensure that residents and staff are not risk of cross infection when dealing with soiled linen and clothing. Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 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 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x x 3 3 2 Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard 3 Regulation 14(1)(a) Requirement Timescale for action 26/10/05 2 7 14(2)(a) and (b) 3 10 12(2) 4 7 15(1) The registered person shall not provide accommodation to a service user at the care home unless, so far it shall have been practical to do so, the needs of the service user have been assessed by a suitably qualified or suitably trained person. (Previous timescale not met) The registered person shall 26/10/05 ensure that the assessment of service users needs is kept under review; and revised at any time when it is necessary to do so having regard to any change of circumstance. (Previous timescale not met) The registered person shall so 26/10/05 far as practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare. (Previous timescale not met) Unless it is impracticable to carry 26/10/05 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, DS0000024155.V251184.R01.S.doc Version 5.0 Homelands Nursing Home Page 23 5 7 15(2)(c) and (d) 6 26 13(3) 7 30 18(1)(c) (i) 8 30 17(2) Sch 4.6 (g) prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. The registered person shall where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service user’s plan; and notify the service user of any such revision. The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform inculding structured induction training. The registered person shall maintain in the care home the records specified in Schedule 4. In this instance – a record of all persons employed at the care home, including in respect of each person so employed – a record of all training undertaken, including induction training. 26/10/05 26/10/05 26/10/05 26/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 Page 24 No. Refer to Standard Good Practice Recommendations Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Homelands Nursing Home DS0000024155.V251184.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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