Inspection on 26/06/06 for Hyde Nursing Home

This inspection was carried out on 26th June 2006.

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

Hyde Nursing Home 26/09/07

Hyde Nursing Home 24/11/05

Hyde Nursing Home 13/05/05

Hyde Nursing Home 07/12/04

Hyde Nursing Home 15/06/04

Hyde Nursing Home 16/07/03

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

CARE HOMES FOR OLDER PEOPLE Hyde Nursing Home Grange Road South Gee Cross Hyde Tameside SK14 5NY Lead Inspector Mrs Fiona Bryan Unannounced Inspection 26th June 2006 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 Hyde Nursing Home DS0000025436.V298337.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. Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hyde Nursing Home Address Grange Road South Gee Cross Hyde Tameside SK14 5NY 0161 367 9467 0161 368 7707 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) Tameside Care Limited Mrs Helen Hubbert Care Home 100 Category(ies) of Dementia - over 65 years of age (25), Physical registration, with number disability (75), Physical disability over 65 years of places of age (50), Sensory impairment (2), Terminally ill (1) Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. No more than 4 service users under the age of 55 years to be admitted to the home. No more than 10 service users may be admitted for personal care only. Four registered nurses must be on duty 24 hours a day. The home manager shall be supernumerary to the above staffing requirements. The home is registered for a maximum of 100 services users to include: *up to 25 service users in the category of DE(E) (Dementia over 65 years of age). *up to 75 service users in the category of PD (Physical disability under 65 years of age). *up to 50 service users in the category of PD(E) (Physical disability over 65 years of age). *up to 2 service users in the category of SI (Sensory impairment under 65 years of age). *up to 1 service user in the category of TI (Terminally ill under 65 years of age). The registered person must ensure that at all times a named person is identified as the clinical lead/lead nurse who is able to provide clinical leadership and advice to the registered manager. 24th November 2005 6. Date of last inspection Brief Description of the Service: Hyde Nursing Home is a purpose built home, owned and operated by Tameside Care Limited providing accommodation for up to 100 service users requiring nursing care. Fees for accommodation and care at the home range from £470.75 to £495.35 per week. Additional charges are also made for hairdressing and chiropody services, newspapers and personal toiletries. Details of the facilities provided by the home are contained in the service user guide, which is displayed in the reception area of the home. The home is a two-storey building, divided into four separate courts: Newton, Flowery Field, Godley and Werneth. Each court has a maximum of 25 beds, 15 Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 5 on one floor and ten on the other. The courts link into a central area known as The Pavilion. Godley, Newton and Flowery Field Courts provide accommodation for service users who require general nursing care. Werneth Court provides accommodation for 25 service users with dementia who require specialised nursing care. All bedrooms are single with en-suite facilities. Each of the four courts has two dining rooms, two quiet rooms, two lounges and four bathrooms. Passenger and wheelchair lifts provide access to both floors. The Pavilion overlooks the Mary Secole gardens and is the central core of the home, serving as the social and recreational focal point, equipped with a hairdressing salon and shop. The home is built on the site of Hyde Hospital. Public transport is within easy access, providing links to all towns within Tameside. Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this key unannounced inspection, which began on 26th June 2006 and was completed on 28th June 2006. Time was spent talking to residents, relatives and staff and observing the home’s routine and staff interaction with residents. Five residents were looked at in detail, looking at their experience of the home from their admission to the present day. A tour of the building was conducted and a selection of staff and residents’ records was examined including records of care, medication records, employment and training records and staff duty rotas. Since the last inspection a new manager has been appointed who has successfully registered with the CSCI. What the service does well: What has improved since the last inspection? Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 7 Since the last inspection extensive refurbishment has taken place on Werneth and Newton Courts. Both Courts have been totally redecorated and new furnishings, carpets and curtains have been provided, together with large televisions and music centres for the communal areas. Good use of colour has created a calming and restful environment for the residents. The atmosphere on Werneth Court appeared much more peaceful, which the inspector attributed to the enhanced environment and the better continuity of care provided by a more stable staff team. During this visit it was observed that refurbishment of Flowery Fields Court was nearly complete to the same high standard as the other Courts and it was reported that Godley Court was to be similarly focused on. The majority of staff have now received training in the protection of vulnerable adults and recruitment procedures within the home now protect the residents from abuse. What they could do better: Significant improvements were noted in the assessment and care planning processes within the home and better systems are now in place to ensure that records are regularly reviewed and updated. However, the content of assessments and care plans was often very generic with the same phrases and suggested actions used for the majority of residents and little consideration of individual needs. The inspectors were concerned that some of the residents, especially those with more diverse needs such as the small number of younger adults that reside at the home may not have all their needs met because of the lack of a person-centred approach to planning care. Staff must carefully consider the lifestyle needs of each resident against the services the home can realistically provide to ensure that they are able to successfully manage their needs. Information given to prospective residents in the form of the service user guide needs to be reflective of what the resident can truly expect if they decide to come and live at the home. Especially in relation to arrangements for the social care needs of residents the service user guide gave the impression that more opportunities were available than perhaps actually were. Interaction between staff and residents was good and staff treated residents with kindness and respect, but there appeared to be little flexibility in routines to allow residents more choice and control over their lives. Please contact the provider for advice of actions taken in response to this Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hyde Nursing Home DS0000025436.V298337.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 Hyde Nursing Home DS0000025436.V298337.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4 Quality in this outcome area is adequate. The home’s statement of purpose and service user guide do not always accurately reflect the lifestyle a prospective resident may expect if deciding to live at the home. Assessments had been undertaken prior to a prospective resident entering the home; more thought needs to be given as to how the assessments can reflect individual preferences and social requirements so the home can be sure it can meet people’s diverse needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Copies of the service user guide were displayed in the reception area and available for anyone to take a copy. There was some evidence that the Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 11 information in the service user guide did not always match with the resident’s experience. This is further discussed later in this report. The home is registered to accept up to four residents who are under the age of 55 years. One of these residents said he had visited the home prior to admission and confirmed he was told there would be more elderly residents than people his own age. Five residents were case tracked and the care files of several other residents were examined in relation to specific care needs identified by the inspectors. Since the last inspection record keeping has improved and all residents had been assessed prior to their admission to the home, although some parts of the assessments were better than others, with the emphasis being on residents’ personal and health care needs and less detail being included regarding their social background and interests. Assessments were not very person-centred and tended to contain “stock phrases”. There was also some doubt about the accuracy of some of the risk assessments, for example the nutritional risk assessments for one resident indicated that they were of average weight, when the record of their weight on admission to the home indicated that they were in fact potentially underweight. This was difficult to definitely establish as there was no record of the resident’s height and their body mass index (BMI) was not recorded. Individual care plans and assessments had been provided by Social Services and were present in residents’ files. There was evidence that residents or their representatives had been involved in the assessment process and discussion of their care needs and the majority had signed their care plan to indicate this. Although the home appears to be able to meet the majority of residents’ needs there was some doubt as to whether all the needs of the younger adults had been fully considered. Little thought seemed to have gone into practical considerations such as the size of bed required for one of the residents and his ability to manoeuvre his wheelchair in the size and layout of his room. The manager stated that the bed provided was exactly the same style and type as the bed the resident had been provided with during his year in hospital but the fact remained that it was too short for him. Staff were knowledgeable about residents’ preferences and care needs. Hyde Nursing Home DS0000025436.V298337.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is adequate. Many aspects of care planning have significantly improved; more rigour is now required to ensure that all needs are identified, risk assessments are based on accurate information and care is delivered as planned. The home’s policies and procedures for dealing with medicines ensured residents were protected. Residents felt they were treated with kindness and respect. The home is taking a particular interest in providing quality end of life care; the expected extra staff training in this topic will be of benefit to staff, residents and their relatives and friends. This judgement has been made using available evidence including a visit to this service. Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 13 EVIDENCE: Five residents were case tracked and the care files of several other residents were examined in relation to specific care needs identified by the inspectors. Care plans covered all activities of daily living and in the main had been developed in relation to needs identified during the assessment process. Some care plans were vague, using words such as “encourage” and “offer” rather than being specific in terms of the outcome to be achieved and how this would be measured. Care plans for social care needs tended to be generic with the same interventions written for all residents such as “take to the Pavilion, encourage to participate in group activities, encourage to play games”. Wound care plans had improved with detailed wound assessments in place and information about the progress of treatment provided. Evidence was available that the tissue viability nurse had been accessed and given advice, all of which was documented. When residents were weighed their nutritional risk assessments were not always reviewed at the same time and the scores for the risk assessments were consequently inaccurate. For example one resident lost 3.2kgs between 28/4/06 and 28/5/06 but when their nutritional risk assessment was reviewed on 3/6/06 the score did not reflect the recent weight loss. The corresponding care plan, which was also reviewed on 3/6/06, said to “continue as plan”. Discussion with the manager indicated that the resident had lost weight due to being successfully treated for oedema and losing fluid, but this was not reflected in the care plan. Mental health care needs were often overlooked in care plans, for example there was no care plan to address one resident’s challenging behaviour, although it was mentioned in a care plan for communication that the resident be verbally abusive and to talk to them calmly. The daily record for this resident indicated that on 19/6/06 they were very aggressive to other residents and staff. The GP was contacted and prescribed medication but this was not detailed in the care plan. There was also no care plan for another resident who was being treated for depression. Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 14 There was some evidence that residents’ personal hygiene needs were not always being met as described for in their care plans. For example one visitor said she had had to mention several times that staff had not assisted her relative to brush his teeth. Examination of the resident’s toothbrush found it to be dry and the toothpaste unused. One of the staff said she was under the impression the resident could manage this part of his hygiene himself but as the resident was unable to use one hand he needed some supervision or support. Carers complete daily checklists indicating what personal care tasks have been performed for the residents or what they have managed independently. Examination of these records indicated that at least 4 residents were only having baths once every 10 days. Records indicated that residents had been seen by their GP’s, chiropodists and opticians. Staff said that there was a key worker system. The main responsibilities of the key workers seemed to be ensuring that residents had a bath each week and liaising with their families regarding any sundry items the residents might need. Carers said that they did not get involved in making entries in the residents’ care files but had their own files with checklists (as previously mentioned) that they completed each day detailing the personal care that had been undertaken with each resident. The quality of care planning in general has significantly improved since the last inspection but consideration now needs to be given as to how they can be made less generic. Expansion of the key worker system may help to further identify residents’ individual preferences and needs and move the care plans towards a more person centred perspective. Examination of a number of residents’ medication administration records indicated that medicines were received, stored, administered and disposed of satisfactorily. Residents said that the staff were kind and helpful. One resident said “the staff are very good. I can’t say anything about them – they help me”. A visitor confirmed that staff were nice with his relative and kept him informed of her condition. Another visitor said that things had improved at the home over recent months and he felt confident that his relative was being well cared for. Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 15 The home has been selected to take part in a pilot project looking at best practice for end of life care for residents. The manager had recently attended a full day event discussing the Gold Standard Framework, which looks at the quality of life for residents and identifies their preferred place of care when they reach the end stages of life. Inclusion in this project will provide extra staff training and all residents and their relatives will be involved. Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 16 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): 12, 13, 14 and 15 Quality in this outcome area is adequate. Although efforts have been made to develop the range of activities provided by the home, further consultation is needed to ensure that the home satisfies all of the residents’ social and recreational needs and to ensure that the information in the service user guide is truly reflective of the lifestyle residents can expect. Visitors are encouraged and welcomed into the home. More flexibility in routines and more awareness of situations when advocacy may be advantageous to residents would allow staff to assist residents to exercise more control over their lives. Dietary needs of residents are well catered for with a balanced and varied selection of food available that meets residents’ tastes and choices. This judgement has been made using available evidence including a visit to this service. Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 17 EVIDENCE: Since the last inspection a new activities organiser had been appointed who had been in post for approximately 6 weeks. The activities organiser had not yet received any training about providing activities for older people and people with dementia and would benefit from this. Individual activities records were available on Flowery Fields Court and Newton Court that indicated that some residents had participated in sing-a-longs on the units, bingo and arm chair aerobics. Little else was recorded and it was noted that chiropody was classed as an activity. The activities organiser has started taking a mobile shop around each Court so residents have the opportunity to purchase confectionery and toiletries themselves. Staff were observed on Flowery Fields Court sitting and talking with residents just before lunch. On the day of the site visit, Werneth Court had a quiet, calm atmosphere. Groups of residents were sitting in different lounges. Staff were in close proximity and appropriate music was playing, which several of the residents were enjoying and singing along to. Staff on Werneth Court said that a member of the Community Mental Healthcare Team was providing SONAS sessions 2-3 times per week for groups of residents on Werneth Court. The SONAS sessions are a structured programme for groups of residents with dementia. The manager said it was planned that some of the home’s own staff would undertake the training so they could continue with the SONAS sessions themselves. Staff said that residents on Werneth Court did not tend to go to the Pavilion and activities centred on the television and music. It was reported that the activities organiser visited the Court to do manicures and that residents were taken into the garden. Staff said that if the activities organiser had not arranged any event for that day they would try to provide some social stimulation for the residents such as playing dominoes or cards. Some residents had undertaken some arts and crafts, for example they had made Easter bonnets and England flags for the World Cup. One resident said they got “fed up” and there wasn’t much to do. They said they tended to get up and sit and watch television. No activities were listed for the day of the inspection. As stated earlier in this report, the service user guide gives the impression that lots of social events and activities take place in the home, including trips out to the theatre etc. but Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 18 the inspectors did not feel that this was an accurate depiction of what was provided in reality. Some of the younger adults currently residing at the home attend a Day Centre once or twice a week. The inspectors had more concerns about these residents and whether their needs were being fully met, as there seemed to be little recognition of their diverse needs as younger people in a care home setting. For example there seemed to be little consideration about their ability to go out of the home or meet with people their own age. In discussion with the manager it was acknowledged that efforts had been made and were still ongoing to explore options for them in terms of lifestyle but this is an area that needs to be considered carefully and on an individual basis every time the home assesses if it is able to meet a younger person’s needs. It was reported that the activities organiser is currently creating pen pictures with each resident, which will be put in their care files on completion. However, if the activities organiser does this in isolation the opportunity for all staff to better understand residents as individuals may be minimised. As previously discussed more involvement of the key workers and a more person centred approach to planning all aspects of the residents’ care would help to identify ways in which their needs could be met. Visitors confirmed that they were made welcome in the home and were able to visit at any reasonable time. It was pleasant to see visitors using the Pavilion as an area off the Courts for them to take residents and spend time together. Thought had been given to making families with young children welcome and toys were provided in the Pavilion to keep them entertained. Residents felt that they were able to make some decisions in respect of their daily routine, for example deciding what time to get up and go to bed. However one of the inspectors observed that soft diets were served first to approximately five residents on Flowery Fields Court and the other residents were left waiting at the tables for their meals, which were left in the hot trolley during this time. One of the residents told the inspector she was hungry and was waiting with her knife and fork in her hands whilst a carer assisted another resident seated at the same table to eat. Staff stated that the resident was always hungry but did serve her meal when the inspector intervened. However, the other residents who did not require soft diet continued to have to wait. Practices such as these can be considered institutional as there is little allowance for individual circumstances on any given day and routines appear to be quite strictly adhered to. One resident was quite distressed as she felt that her relatives were making decisions on her behalf without consulting her. Although there may have been issues regarding this resident’s capacity to make informed decisions the inspector felt that access to the advocacy service should have been considered and arranged for her. Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 19 Since the last inspection lunchtime had been moved to 1pm as the interval between breakfast and lunch had not previously been sufficiently long for residents to build up an appetite. The majority of residents asked said they enjoyed the meals. Care plans provided details of residents’ dietary preferences. It was reported that questionnaires regarding the catering had been given to all residents who were able to participate and many had responded. The chef had also spoken individually with residents and changed the menus according to the feedback. The menus rotate over a three week period and offer a good variety and selection of meals for residents to choose from. The main meal of the day is served at lunchtime and a roast dinner is served twice a week. Soup and sandwiches are always provided at teatime and a hot meal is also available. The inspectors observed staff asking what people wanted to eat and residents had been shown the menu and were able to choose either chicken grill or lamb casserole. The meals looked appetising and residents seemed to be enjoying them. A large bowl of fresh fruit was provided in the dining room. One resident was vegetarian but did eat fish. This was clearly documented on his care plan. This resident said meals had been “very hit and miss” and he had complained but he felt they were improving. Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. The home has a satisfactory complaints system with evidence that residents feel that their views are listened to and acted upon. Staff knowledge and understanding of adult protection issues provides a safe environment to protect residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed prominently around the home and gives timescales by which a complainant can expect a response and contact details for the CSCI. A record of complaints had been maintained since the last inspection. All complaints are brought to the attention of the manager so she can monitor them and ensure they are dealt with appropriately. The record of complaints included details of any investigation that had been undertaken and the outcome. The majority of staff have received training in the protection of vulnerable adults. Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 21 Information regarding the prevention of abuse and the procedures for reporting potential abuse are displayed prominently in the reception area of the home. Staff when questioned, were aware of the procedures to follow regarding complaints and in the event of suspected abuse. One of the senior managers within the company has been given the remit for investigating any complaints of abuse and ensuring that such incidences are reported to the relevant agencies and dealt with according to local procedures. Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 22 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, 20, 22 and 26 Quality in this outcome area is good. Recent investment has significantly improved the appearance of this home creating a comfortable and safe environment for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection Newton and Werneth Courts have been completely refurbished to a very high standard. Flowery Fields Court is in the process of being upgraded – at the time of the site visit the decorators were working and new carpets were waiting to be fitted. It was anticipated that work in this Court would be completed in 2-3 weeks and then it was planned to start upgrading Godley Court. Newton and Werneth Courts had new furniture, carpets and curtains. Good use had been made of calming colours, which made each Court feel restful and Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 23 relaxing. Practical floor coverings in the dining areas enable staff to maintain the cleanliness and hygiene of the Courts. One of the residents said the improvements were lovely and the Court was now “very posh”. On Werneth Court a Snoozelen room has been created as a peaceful, calming place to take residents who may be agitated or need to be in a quiet area. Each lounge had new large screen televisions and music centres. A large flat screen television had been purchased for the Pavilion. The grounds of the home were well-maintained and provided plenty of benches and small tables for residents and visitors to sit and enjoy being outside. Gardens were nicely planted and landscaped. Smaller maintenance jobs had also been ongoing in conjunction with the major refurbishment work, such as replacement of a fridge and washing machine, repair of hoists and the waste disposal unit and the purchase of 12 new fire doors. The heating system had also been overhauled and 16 fans obtained. It was reported by a resident that their nurse call bell had not worked for three days and they had had to call out for assistance during the night. The inspector struggled to get the call bell to work and the staff member who responded said it must not have been reset properly since the last time it was used. Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 24 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, 28, 29 and 30 Quality in this outcome area is good. Staffing levels are satisfactory the majority of the time. The home exceeds the standards for the percentage of care staff who have completed NVQ training and a comprehensive training programme ensures staff have the skills and knowledge to care for the residents. Recruitment procedures are robust and protect the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the site visit there were sufficient staff on duty in the home. During the day staff levels are usually maintained at 1 nurse and 4 carers for each 25-bedded Court. At night staff levels are usually 1 nurse and 2 carers for each Court although staff said that this sometimes fell to 1 nurse and 1 carer due to staff absence at short notice. One of the nurses commented that staffing levels were generally satisfactory but the requirements for staff fluctuated due to the dependency of the residents, and she had found that when the Court was full and the residents’ needs were high, staff sometimes struggled to meet them all. The nurse was not entirely sure whether her views would be taken into account regarding the Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 25 admission of a new resident onto the Court – the nurses do not generally undertake the pre-admission assessments, which are undertaken by the manager or deputy manager. The nurse felt that she may be consulted if a prospective resident had particularly complex needs. Most staff said that staffing levels were more stable than they had been previously and one visitor thought that there were now more “regular” staff who knew the residents. Three staff personnel files were examined and all contained all the information and documents required to ensure that their suitability to work in a care home had been established. Of 60 care staff, 40 have successfully obtained NVQ level 2. Three care staff have obtained NVQ level 3 and a further 6 staff are currently enrolled in training. These figures exceed the target set by this standard. Training records indicated that a variety of training had been delivered to staff over the past year including training in the management of diabetes, infection control, challenging behaviour, care planning, customer care, POVA, deaf awareness, equality and diversity, wound care, depression dementia and delirium, safe handling of medicines and care of enteral feeding tubes, in addition to mandatory training in fire safety, food hygiene and moving and handling. Staff confirmed that they had received various training. Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 26 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): 31, 33, 35 and 38 Quality in this outcome area is good. The manager has a good understanding of the areas in which the home needs to improve and is supported well by senior staff in providing clear leadership throughout the home. The home regularly reviews aspects of its performance through a good programme of self-review and consultations, which include seeking the views of residents and relatives. Residents’ financial interests are safe guarded. Health and safety policies and procedures protect residents and staff. his judgement has been made using available evidence including a visit to this service. Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 27 EVIDENCE: The manager was registered with the CSCI in May 2006. Although the manager is not a registered nurse she has worked in residential social care settings since 1987. She has consistently attended training, achieving an HNC in Care Management in 1998 and the Registered Manager’s Award in 2004. Mrs Hubbert is also qualified as an NVQ Assessor and has attended training in a range of subjects varying from First Aid and Health and Safety to Elder Abuse, Moving and Handling and Mental Health Awareness. She commenced employment as manager of Hyde Nursing Home in November 2005. The company also employs a peripatetic clinical nurse lead to support the manager regarding nursing issues within the home ad provide clinical supervision to the nursing staff. Staff said that the manager was approachable, had time for them and was seen regularly on the Courts. Residents/ relatives meetings are held once a month on all Courts and the dates are advertised on notice boards on each Court. Minutes of the meetings indicated that the attendance of residents and their representatives was variable but there was evidence to suggest that their comments and suggestions were listened to and acted upon where possible, for example several of the residents said how much they were enjoying the armchair aerobics and more sessions were arranged as a result. Staff meetings had not been held frequently. This was an issue that was identified at the last inspection and appears to remain largely unchanged. Opinions between staff varied from being satisfied that the management team resolved issues to feeling that there was too much interference from management and an inability to understand the reasons why some working practices were changed. More staff meetings may assist staff in feeling more involved with the home’s plans for future development and foster a belief that their contribution is valued. Reports of regulation 26 visits made to the home by the registered provider or their representative are supplied monthly to the CSCI. The operations manager undertakes the visits and the manager stated that all visits were unannounced and included opportunities for residents, relatives and staff to speak with the operations manager. The company also employs a Quality Assurance manager who audits all aspects of the service twice a year. The Quality Assurance manager also has responsibility for ensuring that the staff at the home are aware of and comply Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 28 with current legislation in relation to their working practices and ensures all policies and procedures meet with current legislation. As the Quality Assurance manager visits all the homes within the group she is also able to disseminate examples of good practice that she identifies during her visits. Annual surveys are conducted which the manager stated were due to be distributed within the month. As previously mentioned catering questionnaires have already been given to all residents who were able to participate and menus were changed in response. A regular newsletter is produced that keeps all stakeholders up to date with developments within the company. The home has developed a sound system for monitoring the improvement and deterioration of residents. Each unit has to supply to the manager each month details regarding each resident’s weight, if they have pressure sores, if they require bedrails and if they have had any accidents within the home. The manager audits this information and will make further checks on individual Courts to ensure that care plans have been updated accordingly and appropriate referrals have been made. The home does not keep any money on behalf of residents. Any sundry item or service such as hairdressing that residents need is bought on their behalf and their relatives, representatives or solicitors are invoiced each month. Health and safety risk assessments were available for all areas of the home. Carers confirmed that they had received all health and safety training with updates and refresher courses. Fire drills are held twice a year and include both day and night staff. Two general assistants are responsible for the maintenance and health and safety checks of the building and equipment. Records were maintained of weekly fire alarm checks, fire exits, emergency lighting and door guards. The service file was up to date for lifts, hoists, bath hoists and gas safety. An environmental health inspection was conducted on 20/6/06, which was generally satisfactory with one requirement made for hand wash basins to be put in all the satellite kitchens. Accident reports are audited by the deputy manager and sent to the head office for further consideration. Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 29 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 2 X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 X 2 X X X 3 STAFFING Standard No Score 27 3 28 4 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 Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15 Requirement The registered person must ensure that each residents care plan sets out in detail the action which needs to be taken to ensure that all aspects of the health, personal and social care needs of the resident are met. (Timescale of 28/2/06 not met). The registered person must ensure that nutritional risk assessments are accurate. The registered person must ensure that personal hygiene needs are identified and carried out as planned. The registered person must ensure that the activities organiser receives training in the provision of activities for older people and people with dementia. The registered person must ensure that the nurse call system in each room is working properly at all times. Timescale for action 31/08/06 2. 3. OP8 OP8 13 12 15/08/06 15/08/06 4 OP12 18 30/09/06 5 OP22 16 31/08/06 Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 31 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. Refer to Standard OP1 OP3 OP4 Good Practice Recommendations The registered person should ensure that the statement of purpose and service user guide accurately depict the services that are offered by the home. The registered person should ensure that assessments and care plans are person-centred and provide specific information about the needs of individuals. The registered person should ensure that the lifestyle needs of younger adults are fully considered before they enter the home to ensure that their diverse needs can be met. The registered person should consider the expansion of the key worker system to maximise person centred care and assist in meeting residents’ diverse needs. The registered person should ensure that staff consider the adaptability of working routines to allow residents more choice and flexibility in their lives. The registered person should ensure that staff are alert to situations where advocacy may benefit residents and take steps to access advocacy on their behalf. The registered person should consider how staff can be assisted to feel more engaged in the future plans and developments of the home. 4 5 6 7 OP12 OP14 OP14 OP33 Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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 Hyde Nursing Home DS0000025436.V298337.R01.S.doc Version 5.2 Page 33 - 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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