Inspection on 12/12/06 for Ingleborough Nursing Home

This inspection was carried out on 12th December 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

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

CARE HOMES FOR OLDER PEOPLE Ingleborough Nursing Home 1 High Street Ingleton Carnforth North Yorkshire LA6 3AB Lead Inspector John McGarva Key Unannounced Inspection 12th December 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ingleborough Nursing Home DS0000068935.V325156.R02.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. Ingleborough Nursing Home DS0000068935.V325156.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ingleborough Nursing Home Address 1 High Street Ingleton Carnforth North Yorkshire LA6 3AB 01524 241593 01524 241165 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) Ingleborough Nursing Home LLP Mrs Linda Deaville Care Home 53 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (53), of places Physical disability (2) Ingleborough Nursing Home DS0000068935.V325156.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Service Users in category (PD) to be aged 40 years plus and 2 residents in DE (E) category. Date of last inspection 31/01/06 Brief Description of the Service: Ingleborough is a care home providing both Nursing and Personal care for up to 53 people over the age of 65 years, up to 2 people with physical disabilities over the age of 40 years and up to two people with dementia. In practice a maximum of 48 people are in residence as the number of shared rooms has been reduced from sixteen to fourteen. It is privately owned and was first opened as a Residential home in May 1977 and registered to provide Nursing care in November 1983. It was previously a hotel and is located in the Dales village of Ingleton on a sloping site. Built of stone, on three floors, including the ground floor and two small vertical passenger lifts provide level access to all floors. There are pleasant garden areas to the rear western side of the home with attractive features, including a pond. Parking is available in the private car park on the easterly side of the site and being in the centre of the village, local amenities are easily accessed. The fees charged at 30/11/06 are between £360 - £500 per week. Ingleborough Nursing Home DS0000068935.V325156.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection, which took place on Tuesday 12th December 2006, and Mrs Wendy Thistlethwaite, deputy manager and Mrs V Sedgwick (Business manager) were available to assist with the process. The inspection started at 10.00hrs and finished at 13.45 hrs, 3.75 hrs in total. There were 33 residents in total in the home, 28 of whom were nursing cases and 5 receiving personal care only. The inspection focused on the key standards and also matters, which were raised at the last inspection. Discussions took place with the deputy manager, business manager, nurses, care staff and residents. The residents appeared well cared for and all those spoken to made favourable comments about the care they receive from all the staff. What the service does well: What has improved since the last inspection? Some decoration to the communal areas has taken place. More of the care staff are contributing to the care records in accordance with good recommended practice. Ingleborough Nursing Home DS0000068935.V325156.R02.S.doc Version 5.2 Page 6 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. Ingleborough Nursing Home DS0000068935.V325156.R02.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 Ingleborough Nursing Home DS0000068935.V325156.R02.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&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The resident’s needs are sufficiently assessed thereby providing the foundation on which the care plans can be developed. EVIDENCE: Evidence from the case tracked residents records confirmed that pre-admission assessment sheets are completed prior to admission. Pre-admission assessments are undertaken either in hospital or the resident’s place of residence prior to admission to help ensure that they are able to meet the residents needs. Intermediate Care (Standard 6) is not provided in this home. Ingleborough Nursing Home DS0000068935.V325156.R02.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): 7,8,9, & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A good standard of care is being provided by staff that is well-motivated. EVIDENCE: The ‘Standex’ system of documentation is deployed. This system permits for several residents’ plans and documentation to be kept in one metal-framed holder and they are kept in a lockable trolley. Into these, all information relating to the resident’s needs are kept. The nursing staff in the main records the daily cares statements and increasingly the care staff are being encouraged to participate in the records of care given. The care plans are specific to the individual resident and identify all pertinent issues, which helps ensure that all health and social needs are met. Ingleborough Nursing Home DS0000068935.V325156.R02.S.doc Version 5.2 Page 10 The timings of the daily statements are not always recorded in the daily statements, but those that were deploy the 24 hr clock in accordance with good practice. There is nurse and care staff allocation to individual residents, which is clearly stated in the documentation, and some of the residents spoken to could recall who were their particular carers were. The dependency of many of the residents is high with thirteen being incontinent of urine, six with confusion, and seven with mental health problems. Twenty-four require to be moved by wheelchair with the majority requiring assistance with feeding, washing, dressing and toileting. The residents spoken to were all pleased with their care and said that they could get up and go to bed when they wished, one said that she “couldn’t fault it”. The Nomad seven-day blister pack system of drug storage and dispensing is deployed and seems to be working satisfactorily. Ingleborough Nursing Home DS0000068935.V325156.R02.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): 12,13,14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is meeting the resident’s social and dietary needs in a sensitive and caring manner. The quality of the meals provided is good and commented on favourably by staff and residents alike. EVIDENCE: The resident’s routines of daily living are tailored to their needs and choice. Although there are no dedicated activities organiser employed in the home, the provider feels that the resident’s social needs are sufficiently addressed by the care staff. There are mini biographies of the residents within the care plans so that the staff can relate to them on a more personal basis. Ingleborough Nursing Home DS0000068935.V325156.R02.S.doc Version 5.2 Page 12 The care staff do as much as possible to meet the resident’s social needs and involve themselves in activities such as bingo, dominoes as well as weekly visits out in the mini-bus. There are weekly ‘movement to music’ sessions, entertainers are brought into the home on a regular basis and there are two electric organs to assist with this. When there are many high dependency cases, the care staff is unable to spend too much time in socialising and diverting the residents. Conversely, with so many residents’ rather frail, social activities perhaps is not what they particularly need or desire. However an effort should be made to recruit an activities organiser so that the residents social needs can be more appropriately focussed and addressed. Religious services take place on a regular basis as well as some residents visiting the local church. A physiotherapist and an exercise therapist visit on a weekly basis and residents spoken to mention how much they appreciate this service. Ingleborough Nursing Home DS0000068935.V325156.R02.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a relevant complaints procedure and the staff has received abuse awareness training. EVIDENCE: The complaints procedure of the home meets the required standard. Staff are aware of how to respond to any complaints made by either the residents or their representatives. There was a complaint made about the service to the CSCI and this was discussed with the provider and deputy manager during the inspection. It was determined that the issues involved did not provide valid criticism on the particular points raised and that some statements made by third parties could not be verified. One member of the care staff spoken to said she had not received training in abuse issues in recent times. The training records of the staff are not kept in their personal files but kept elsewhere for easier access. Ingleborough Nursing Home DS0000068935.V325156.R02.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, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment meets the standards for homes registered before 2002. There are avoidable risks to the health and safety of the residents in respect of sink hot water temperatures. EVIDENCE: The home meets the standards for homes registered before 2002. Although registered to take 55 residents, in practice no more than 49 are admitted. There are twenty-three single rooms, and sixteen shared rooms. The ratio of residents sharing when full would be 71 , but on the day of inspection there were thirty-three residents. Ingleborough Nursing Home DS0000068935.V325156.R02.S.doc Version 5.2 Page 15 Currently, eight are used as doubles and thirty-one as singles. (34 sharing) In practice, ten double and twenty-nine single rooms are in use. (41 sharing) Only three of the single rooms and two of the shared rooms have benefit of ensuite toilet facilities and in consequence commodes are used extensively. There is both ramped and level access to all parts of the home and two threeman vertical lifts are available to provide level access to all three floor. The premises are clean and there are systems in place to help reduce spread of infection including the homes policies & procedures, liquid soap dispensers and disposable towels in each residents room, toilets, bathrooms, sluice rooms, clinical room, laundry and kitchen. The care staffs also carry their own hand-wash cleaner when moving between locations. Protective plastic aprons and latex gloves are also available in appropriate locations. Red dissolvable ‘alginate’ bags are used for the safe handling of soiled linen. There are three sluice rooms with hopper sinks and on the first floor, a single sluice disinfector is provided for the safe disinfection of the commode pans and urinals. The hot water taps to the sinks in the resident’s rooms, toilets and bathrooms do not have thermostatic valves to reduce the temperature to no more that 43 degrees centigrade. There are warning notices on the front of the sinks proclaiming that the water is ‘very hot’, however, many of the residents lack cognition to enable them to benefit from this and in consequence are at risk from scalding. This was discussed with the provider during the inspection. There is a handyman employed to attend to the day-to-day maintenance. Ingleborough Nursing Home DS0000068935.V325156.R02.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is sufficient staff to provide personal care to the residents and satisfactory recruitment practices are followed. EVIDENCE: There is sufficient permanent care and nursing staff to meet the present needs of the residents. Sixteen of the care staff have NVQ Level 2 or above qualifications, representing 64 of the total number, thereby exceeding the CSCI standard. Two of the care staff have NVQ Level 3 qualifications. There is a training programme in place for the care staff, which meets the National Training Organisation (NTO) standards. Formal Supervision has been introduced and some senior care staff has been trained to deliver this on a six weekly basis. Ingleborough Nursing Home DS0000068935.V325156.R02.S.doc Version 5.2 Page 17 The staff confirmed that they receive routine statutory training in the areas of Heath & Safety, Moving & Handling and Fire safety at the recommended intervals. Six staff has a First aid certificate. Other training opportunities held off-site include Health & Hygiene. An inspection of staff files confirmed that the recruitment procedures at the home meet the required standard including Criminal Record Bureau (CRB) checks. Ingleborough Nursing Home DS0000068935.V325156.R02.S.doc Version 5.2 Page 18 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, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management is focused on benefits to the residents and there is a caring ethos in the home. EVIDENCE: The manager is a First Level nurse who has many years of experience of looking after the elderly and achieved NVQ Level 4 in management. From discussions with other members of staff it is evident that she has an open approach and in consequence they feel they are part of the decisionmaking processes. Ingleborough Nursing Home DS0000068935.V325156.R02.S.doc Version 5.2 Page 19 Regular meetings with the staff also help facilitate this. One of the members of staff said she “loves it here, all family here”. The home has introduced a Quality Assurance system based on the RNHA system and the care staff attends quality assurance meetings to address the issues that have emerged from the residents or their representatives expressed opinions. The residents or their relatives on their behalf arrange the management and control of their personal monies. There are systems in place for the staff to receive training in the areas of Health & Safety, First Aid, Fire Safety and Moving and Handling and staff confirmed this in conversation. Regular servicing and records of this are maintained of the gas boilers, lifts, hoists and other equipment in the home. Ingleborough Nursing Home DS0000068935.V325156.R02.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 1 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Ingleborough Nursing Home DS0000068935.V325156.R02.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP25 Regulation 13(3)(4)( a)(c) Requirement The provider must develop a strategy, which will prevent the residents from being scalded from the wash hand basins in their bedrooms or communal bathrooms and toilets. Timescale for action 01/06/07 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 OP7 OP12 OP18 Good Practice Recommendations The timings that the daily statements are made should always be recorded utilising the 24 hr clock. The appointment of an activities organiser should be considered. All care staff should receive annual training in abuse issues. Ingleborough Nursing Home DS0000068935.V325156.R02.S.doc Version 5.2 Page 22 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ingleborough Nursing Home DS0000068935.V325156.R02.S.doc Version 5.2 Page 23 - 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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