Inspection on 23/07/08 for Inglefield Nursing Home

This inspection was carried out on 23rd July 2008.

CSCI found this care home to be providing an Good service.

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

Inglefield Nursing Home 26/07/06

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Inglefield Nursing Home Inglefield Nursing Home Madeira Road Totland Isle of Wight PO39 0BJ Lead Inspector Mark Sims Unannounced Inspection 23rd July 2008 09:30 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 Inglefield Nursing Home DS0000066620.V367527.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. Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Inglefield Nursing Home Address Inglefield Nursing Home Madeira Road Totland Isle of Wight PO39 0BJ 01983 754949 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) inglefieldnh@hotmail.co.uk Buckland Care Ltd Mrs Gaynor Pitman Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is 43. 26th July 2006 Date of last inspection Brief Description of the Service: Inglefield Nursing Home is situated towards the midpoint of Madeira Road, Totland and is close to both the facilities of the town and the waterfront, which opens up onto the Solent. The home comprises of 40 registered places, the majority offering single occupancy and en-suite facilities. Lounge and/or communal space is extensive, the property boasting three main lounges, a dining room and a quiet lounge for entertaining visitors if required. The grounds whilst not easily accessible to service users are nicely maintained with lawned areas, flowerbeds and established shrubbery around the property. Whilst as stated these areas are not easily accessible service users do have access to patio areas to both the front/side of the home and rear aspect, the latter being enclosed and smaller than the front patio area. Public transport to Totland is regular and a bus stop is within a short walk of the home. Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection was, a ‘Key Inspection’, which is part of the regulatory programme that measures services against core National Minimum Standards. The fieldwork visit to the site of the agency was conducted over five hours, where in addition to any paperwork that required reviewing we (the Commission for Social Care Inspection) met service users, staff and management. The inspection process involved pre fieldwork activity, gathering information from a variety of sources, surveys, the Commission’s database and the Annual Quality Assurance Assessment information provided by the service provider/manager. The response to the Commissions surveys was good, with thirteen service user surveys returned, prior to the report being written. What the service does well: What has improved since the last inspection? The service informs us (the Commission), that over the last twelve months the Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 6 following improvements to the service have been made: ‘The service user guide has been updated to accommodate the changing numbers of clients and includes relevant quotes from both past and existing clients. The home gained a proportion of a capital grant, which has enabled them to purchase a shower trolley to enable clients to have further choices in how their hygiene needs are met. The clients are offered the opportunity to have individualised grooming undertaken in the form of facials, manicures etc. The home has appointed an activities co-ordinator to improve the quality of life of those in our care. As a direct result there has been an increase in the number of activities being made available. The home has introduced a monthly Church service, which caters for all denominations. A hostess trolley has been purchased to ensure that clients’ meals are served at an appropriate temperature. The complaints procedure has been made more readily available to all through inclusion in the newsletter on alternate months. The home has installed a CCTV camera in the front hall to monitor the entry and exit of visitors and help promote security. There has been an increase in the level of training in the home in relation to adult protection and dementia awareness. The home has employed a fire safety consultant to ensure that all audit and assessment requirements are met adequately and appropriately. The home has employed a gardener to maintain the grounds of the building. Staffing hours have been rearranged to maximise input at those times of the day when clients’ needs are greatest. The home has been involved in the Governments South East Care Advice Service (SECAS) project, which has provided all staff with a skills analysis and a skills passport. Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 7 The Deputy Manager has achieved her Registered Managers’ Award’. What they could do better: No requirements or recommendations have been made following the inspection process. The service however, has identified via the AQAA documentation that they wish and/or intend to make the following improvements to the service over the next twelve months: ‘We are going to improve the home’s brochure to make it more user friendly and informative. In order to maximise client’ ability to make an informed choice about where they reside potential clients will be invited to spend a day at the home prior to admission. In order to streamline our system of care planning and risk assessment the manager is to critically analyse and update all these documents. The manager is to develop her knowledge and understanding of dementia care mapping to promote a positive delivery of care to those with dementia. In order to improve the home’s links with the local community the home is to pilot a project with the older persons voices circle and will have it’s own older persons champion in one of the clients. Our activities co-ordinator is to develop activities specifically designed to meet the needs of those with dementia such as the making of memory books. To allow everyone equal access to make comments or suggestions about how the home can be maintained or improved a secure facility will be made available in the front hall. The home is to have a new wireless call bell system installed to ensure that client’s are responded to adequately and appropriately. Staff could have more knowledge and understanding of the Mental Capacity Act and as a result the Manager plans to introduce some distance learning workbooks to meet this need. As the home employs a number of staff for whom English is not their first language the manager plans to access language courses for these staff to promote adequate and appropriate communication between the staff and the Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 8 clients at all times. In order to ensure that the home maintains its reputation for having a skilled workforce the programme of National Vocational Qualifications (NVQ) will continue until 100 achievement is gained. In order to monitor systems administration systems more effectively the manager intends to adopt a better use of information technology’. 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. Inglefield Nursing Home DS0000066620.V367527.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 Inglefield Nursing Home DS0000066620.V367527.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. EVIDENCE: The service tells us, via their AQAA that: ‘The home has a comprehensive pre admission assessment process, which clearly indicates whether or not it can meet the needs of the individual being assessed. The assessment includes needs related to personal care and physical well being, dietary and nutritional requirements, communication abilities, medical problems, risks, level of continence, medication administration, social interests, hobbies, religious and cultural beliefs etc, input from other members of the multi disciplinary team and the client’s social network. Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 11 The Manager, her deputy or a senior member of staff, always undertakes the pre admission assessment. Prospective clients and their advocates are encouraged to view the home and discuss individual need prior to making their decision on choice of home. The home provides a comprehensive brochure, statement of purpose and information booklet. Each client is provided with a statement of terms and conditions of residence and the service provision within the home. Each client has an individualised care plan based on the pre admission assessment undertaken’. The assessment process for the person most recently admitted to the home was reviewed during the fieldwork visit, with their care plan found to contain both a professional summary of care and an in house assessment completed by the manager. The assessment tool is designed to dovetail into the care planning process and therefore create a seamless document, which encourages information transferences i.e. data recorded on the assessment can be easily copied over to the care planning document as the groupings are the same. Information taken from the service users surveys indicates that twelve of the thirteen people received a contract as part of their admission to the home and that twelve of the thirteen people also felt they had received sufficient information about the home before deciding the placement was right for them. One person provided an additional comment: ‘we were taken around and shown the home and the room, which my husband would be using’. The home does not provide an intermediate care service and so this standard is not applicable. Inglefield Nursing Home DS0000066620.V367527.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The service tells us, via their AQAA that: ‘The home provides a full range of policies and procedures, which support the health and personal care of clients. Individualised care plans identify a need or problem, a goal and a plan of care developed to achieve the goal. Care plans are devised with the clients or their advocates where this is possible. Care plans are reviewed on a monthly basis by a named nurse and allocated key worker. Risk assessments are in place to promote safety and protection. All clients are given full access to the multi-disciplinary team, as required and Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 13 regular visitors to the home include: General Practitioner’s (GP), Specialist Nurses, Consultants, Dentists, Physiotherapists, Opticians and Chiropodists. The home has an agreement with the local health centre to provide a ‘Doctor’s round’ once a week as a matter of routine. An ancillary worker is employed and this role includes assisting client’s to receive regular fluids ensuring that the care staff team have more time to spend meeting their physical and emotional needs. All clients have their privacy and dignity maintained. The ordering, storage, administration, recording and disposal of medication is adequate and appropriate and is reviewed regularly by the registered nurses, with support from the medication review Pharmacist and the GP’s The home has a programme of constant provision of evidence based research provided by registered nurses allocated to an area of specific care. The home has a record of successful use of the end of life care pathway’. Three service user plans were reviewed during the fieldwork visit and generally all of the plans were found to be informative documents, which were well structured and indexed, which enabled the user to quickly locate the section of the plan they required. The plans are pre-printed and/or pre-populated documents, which require alterations by the staff to make them specific to the service user. On reading through the three plans it was evident that the personalisation of the plans is not always achieved, with some aspects of how people’s care is to be provided mirroring that of another person, thus losing some individuality. This was discussed with the manager, who explained that sometimes the service users can present with the same ailments and/or medical histories and that this can result in their care plans looking similar. The manager has however, acknowledged a willingness to look at this aspect of the homes’ care planning process, which remain a functional and practical tool. The home’s risk assessment tools have been incorporated into the general care planning documents, although they remain easily identifiable from the care plans. The risk assessments are realistic tools, which identify the risk, rate how likely the event is to occur and provide a plan on how to minimize the impact and/or reduce the risk to the person. Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 14 Information taken from the service user surveys indicate that all thirteen people feel they receive the care and support they require, people providing additional comments: ‘any problem is always quickly addressed and corrected’ and ‘care given is very good’. The service user plans reviewed during the visit, also contained specific health and social care records, which document the service users involvement with any professional service, GP, Opticians, Community Nurses, etc. People’s files also contain copies of correspondence from the professional health and social care services, which confirmed outcomes of clinic visits or appointments to attend clinics, etc. Arrange of health screening tools are also used by the staff to monitor people’s wellbeing, including Waterlow scores, which measure damage to skin tissues, Nutritional assessment tools, Incontinence assessment tools, etc. These documents, along with other care planning records are reviewed and updated on a monthly basis or as the persons’ health care needs change. Again the indication from the service users is that they receive the medical support they require, twelve of the thirteen surveys ticked ‘always’ in response to the question relating to medical care. Additional comments including: ‘a doctor is call when necessary. There is always a staff nurse on duty’. Equipment, to support the nursing and care staff deliver appropriate care and support, is also readily available with the tour of the premises enabling us (the Commission) to observe staff using hoists or to observe equipment stored ready for use, shower trolley, hoists, etc. The service has also a visitors and/or quiet room, which can be used by the service users to entertain health and social care professionals, should they not wish to use their bedroom during visits. This facility can also be used to entertain families or friends and provides a private area away from the rest of the home during visits. The service users preferred term of address is also document on their service user plan and the interaction between the staff and the service users and the staff and the visitors was noted to be appropriate, respectful and friendly. The environment is designed to provide a degree of privacy for the service users’ with communal facilities fitted with appropriate locks, which can be operated by people with both physical and cognitive impairments. Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 15 Bedrooms are either single occupancy or shared, with the shared rooms fitted with screening to provide privacy during the delivery of personal care. All toiletries, etc, were stored separately to prevent sharing. A declaration made via the ‘dataset’, which forms part of the AQAA documentation, indicates that polices on: ‘Equal opportunities, diversity and anti-oppressive practices’ and ‘Values of privacy, dignity, choice, fulfilment, rights and independence’ are made available to staff by the provider organisation. The review of the homes’ medication system established that all medications are correctly held and secured. The medication administration records (mar sheets), were generally well maintained and accurate. Medication stocks are kept to a minimum and records indicate that the home’s medication fridge is checked on a daily basis to ensure it operates within safe and acceptable parameters. Staff observed administering medicines did so safely and appropriately, taking the medication to the service user, administering the medicine and then returning to sign the medication record. The Dataset establishes that policies are available to the staff on the ‘control, storage, disposal, recording and administration of medicines’ and that the management and handling of ‘controlled medications has been appropriate over the last twelve months with no reported concerns or issues. Training records indicate that in the April of 2007 the Qualified Staff completed updated training on the use of Bulk Prescribed Medications, and presently are using this system to dispense and administer medications to service users’. Inglefield Nursing Home DS0000066620.V367527.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use services are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities could be improved to better meet individual’s expectations. EVIDENCE: The service tells us via the AQAA that: The home provides a wide range of activities. There is local community involvement with visiting clergy, local primary school children providing entertainment at important times of the year such as Easter and Christmas, weekly visits by PAT dogs. Clients are encouraged to personalise their rooms with their own possessions. The home has an open visiting policy and provision is made for those who wish to receive their visitors in private rather than in communal settings. Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 17 The home encourages social interaction between clients and provides a range of communal areas in which this can take place. Client’s who are able are encouraged to continue with the hobbies of their choice. All clients are given choices about menu selection, rising and retiring times, where they wish to spend their time and how they wish to do this. The home has a flexible routine to accommodate all needs. A varied menu is provided and all special diets catered for. Should a client request something that is not on the menu that day, their request will be honoured so far as it is reasonably practicable. Clients have a choice of area in which to take their meals. There are enough staff available to assist those clients who have difficulty or are unable to feed themselves. Relatives are given the opportunity to join the client’s for their meals at no charge. Each client is given a birthday card and has a cake made for their special day. Parties are organised for those who would like to have them. The home provides the clients and their family and friends with a monthly newsletter informing them of any activities taking place, staff news, planned maintenance and a fun activity for them to undertake’. The service employs an activities co-ordinator, who is responsible for planning and delivering activities and entertainments to the service users’. The manager evidenced, via the minutes of the last residents meeting, referred to as ‘happy hour’ that this is how they plan and monitor the activities organises. A schedule of the next months’ activities is produced by the activities coordinator in advance and this is then display around the home and/or provided to the service users for information. A copy of the June 2008 ‘Inglefield Newsletter’ was seen during the fieldwork visit and found to contain details of months activities programme and a large word search puzzle, the manager stating that each month she includes either a cross word or word search for people’s entertainment. Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 18 The activities co-ordinator also delivers one-to-one support for people who are unable to attend organised events, the records maintained documenting when visits to service users in their bedrooms have taken place and the activity undertaken. Information provided by the service users, via the surveys, indicate that people are generally satisfied with the activities provided, with ten people ticking ‘always’, one sometimes and two people not ticking a box, in response to the question: ‘are there activities arranged by the home that you can take part in’. People again made additional comments: ‘we have a good variety of music, movement and films’, ‘arts and crafts, memory lane, music and movement, film night, bingo, summer fate, barbecues’. The home’s visiting arrangements are detailed within the ‘service user guide’ / ‘statement of purpose’ literature, copies of these documents are available to people within the home and have recently been updated. During our visit a number of visitors were observed arriving at the home and being welcomed by the staff and manager prior to meeting up with their nextof-kin. Two visitors spoke to us (the Commission) during the tour of the premises, discussing how they are supported to take their relatives out for trips or walks, the happy hour meetings and the generally good levels of care and support provided within the home. As mentioned earlier, within the report, a quiet lounge or visitors room is available for the use of the servicde users and their relatives, which provides additional privacy during visits should they require. The home produces a three weekly rotational menu, although in discussion with the manager it was established that this is not a hard or fast menu and is flexible. The manager also described how the home shops separately for one client, as they have specifically requested or expressed their like for pulses and nuts, etc. The menus offer choice and variety of meal, the manager stating that menus and foods are discussed at service user meetings and then with the chefs to discuss feedback from the service users and their relatives. The minutes of the meeting dated the 20th June 2008 document that menu selections were discussed as a topic, with one person saying that the menus Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 19 were at times wrong and that some dishes could be swimming in sauces, graves, etc. The manager undertook to discuss this with the catering team. At the last Environmental Health Office visit the home’s kitchen was award Five Stars for cleanliness and hygiene. Inglefield Nursing Home DS0000066620.V367527.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, and are protected from abuse, and have their rights protected. EVIDENCE: The service tells us via their AQAA that: ‘Policies and procedures are renewed annually to ensure that they remain current and relevant. Client/advocate complaints are responded to immediately and feedback given on Investigation, as required. Full records of complaints are made. All clients/staff/advocates are given open access to the complaints procedure. Confidentiality is maintained in line with the Data Protection Act. Recruitment procedures undertaken ensure that the clients are protected from harm by the employment of appropriate staff and all recruitment checks are undertaken as required. Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 21 Protection of vulnerable adults promoted through adequate, information guidance and training’. The dataset, which forms part of the AQAA documentation, establishes the existence of the home’s complaints and concerns procedure and that this was last reviewed in the June of 2007. The dataset also contains information about the home’s complaints activity over the last twelve months: No of complaints: 0. No of complaints upheld 0. Percentage of complaints responded to within 28 days: 100 . No of complaints pending an outcome: 0. Details of the home’s complaints process are contained within the ‘service users guide’ and ‘statement of purpose’, which are accessible to people within the home or visiting. Complaints also feature at on the agenda of the service user meetings, when people are asked to raise any concerns or complaints, at the last meeting no issues were raised under this heading. The indication, from the survey respondent is that people are generally aware of the home’s complaints process and when service users have raised concerns these have been appropriately handled. During the visit the manager produced copies of the homes training matrix, which indicates that all staff have completed ‘safeguarding adults’ training, this corroborated the information contained within the AQAA, which states that staff have undertaken ‘safeguarding training’. The homes tells us, via their AQAA and dataset, that policies on the protection of service users are in place, ‘Safeguarding adults and the prevention of abuse’ and ‘Disclosure of abuse and bad practice’, both policies updated/reviewed in the June of 2007. The dataset also establishes that over the last twelve months three safeguarding referrals have been made to the Local Authority, a statement support by a review of our database, which established that three alerts have been brought to the Commission’s attention during this period. Our database also indicates that these reports/referrals have all been resolved. Inglefield Nursing Home DS0000066620.V367527.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: A tour of the premise was undertaken in the company of the manager. The tour established that the home is in a good state of repair, is well decorated throughout and that the fixture, fitting and furnishing are of a good quality. Access to the home has been created to accommodate people using wheelchairs, with a gentle slop leading to the main entrance and a lift providing access to the all floors. Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 23 The communal areas or facilities are also spacious and well set out, with the choice of lounge providing a variety of environment for the service users, whilst the bathrooms and toilets are large, accessible amenities. Many of the bedrooms, seen during the tour, provide en-suite facilities and a mix of profiling and height adjustable beds provided. It was also established or observed that the rooms visited contained items of an individual nature, pictures, ornaments, pieces of furniture, etc, which had been used by the occupant to personalise their room. The service tells us via the AQAA that: ‘Policies and procedures are in place, which are relevant and accessible. We have a safe, well maintained home that meets both individual and collective need. The grounds of the home are maintained and attractive and clients have the option of several outdoor areas in which to sit when the weather is clement. Annual service and inspection of building systems/services/structures are undertaken and action taken to address any issues as required. All communal areas, living space, facilities and adaptations comply with Legislation and are appropriate for the client group. The staff of the home work hard to ensure that the environment remains as odour free as possible. All staff are trained in infection control and adequate and appropriate precautions are taken to prevent any cross contamination. There are adequate and appropriate laundry, sluicing and hand washing facilities. There is a range of specialised equipment available and individual room sizes accommodate all. There is a range of areas in which visiting can take place’. The home employs maintenance personnel, who during the fieldwork visit and more specifically the tour of the premises were observed updating the décor and furnishings in one of the home’s shared bedrooms. The view of the services users, as relayed via the surveys, is that the environment is ‘clean and fresh’, with comments like: cleaning is done daily and there are devises about for freshening the air. Our room has French Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 24 windows so is always fresh’. On entering the home visitors are asked to sanities their hands, by way of an automatic gel dispenser, they are also asked to use this device on leaving the home, as pre-caution against cross-contamination of infectious agents. On entering the home we (the Commission) witnessed a visitor using the gel to cleanse their hands before continuing on into the home. The home employs domestic and laundry staff that were observed during the visit undertaking their duties. The home was noted to be free from odours and very clean and tidy throughout. Communal toilets and bathrooms were noted to contain liquid soaps; paper towels and bins for the disposal of waste and all chemicals were stored in accordance with the ‘Control Of Substances Hazardous to Health’ (COSHH) regulations. The laundry, which is located within the main building, is the responsible of the laundry personnel who laundering residents clothing and returning them to the clients room. Clothes are labelled to reduce the possibility of lose or the item being returned to the wrong person, although the laundry operative did say that if people bring in new clothes and forget to label them or inform staff this can lead to delays in returning items. Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 25 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): Standards 27, 28, 29 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and provided in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. EVIDENCE: The service tells us via the AQAA that: ‘Staffing hours have been rearranged to maximise input at those times of the day when client need is greatest. A further eight staff have been given the opportunity to undertake their National Vocational Qualification (NVQ) training and the Deputy manager has achieved her Registered Managers’ Award (RMA). More outside agencies have been accessed for training e.g. fire safety, end of life care. Training that has been provided or accessed in the past twelve months includes: Safeguarding vulnerable adults. Manual handling. Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 26 First Aid. Food hygiene. Working as part of a team. Stoma care. Dementia awareness. Infection Control. Fire Safety. Eating and Drinking for the older person. Managing Stress in the workplace. Managing visual disabilities. Managing continence. Managers training for dementia awareness. Instructors update training in manual handling and first aid. Managers’ training Mental Capacity Act. All staff have been part of the Governments South East Care Advice Service (SECAS) project and have had skills analysis undertaken in order to have skills passports made. Introduction of an activities co-ordinator to support care staff to meet all clients’ need’. Copies of the home’s duty roster were seen during the fieldwork visit and indicated that staff are employed in the disciplines care and nursing staff, domestic and ancillary staff, maintenance and administration staff. Information taken from the service users surveys indicates that people are generally happy with the home’s staffing levels and the deployment of staff, with six people ticking ‘always’ and seven ‘usually’ in response to the question: ‘are the staff available when you need them’. Additional comments made included: ‘bells are answered as swiftly as possible always’, ‘almost always, after a short wait at times’ and ‘ the staff are excellent but not always available. I feel at least one extra should be on duty, especially in the afternoon’. As the response from the service users and/or their relatives who helped them complete the forms is not entirely supportive of the home’s staffing arrangements, the manager might consider addressing this issue via the home service users (happy hour) meetings. Observations made throughout the day tended to support the fact that sufficient staff are employed at the home and that the needs of the service users were being meet, with nursing staff, care staff, domestic, laundry, maintenance, catering and administration staff all seen around the home during the fieldwork visit. Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 27 Details of the home’s staffing arrangements, their skills and experience are also set out within the homes’ ‘statement of purpose’ document, which as mentioned is accessible to people within the home. During the fieldwork visit we were provided with sight of the training matrix, which monitors and records staffs completion of mandatory courses, mandatory events including: ‘induction, manual handling, food hygiene, first aid, fire safety, safeguarding and dementia awareness. The matrix is also used to track staffs NVQ achievements and progression through the various levels. The manager maintains these records, which are a useful management tool and are informative documents, which can also be used as part of the homes’ or company’s quality auditing process. Each staff member is also provided with their own training and development portfolio, which they are required to bring with them to their appraisals. Whilst no completed copies of the portfolio’s were available to be seen during the fieldwork visit a template or blank copy was produced for our (the Commission’s) scrutiny. The manager also provided us with sight of the home’s induction programme and associated documentation, which is based on the ‘Skills For Care’ (SFC) common induction standards. During a conversation with the manager she provided us (the Commission) with an update on the courses completed since she (the manager) compiled the AQAA information: ‘managing terminal illness, managing stress and the cause, prevention and management of pressure injury’. Staff are made aware of forthcoming training and development events by way of adverts, which were seen on display within the staff room, staffs training and development needs are also discussed during their appraisal and supervision sessions. Information taken from the dataset indicates that currently the home employs thirty-four care staff. Twenty-two of the thirty-four care staff have completed a National Vocational Qualification (NVQ) at level 2 or above and this gives the home a percentage of 65 of its care staff possessing an NVQ at level 2 or above. The dataset also indicates that seven people are completing their NVQ, which would increase the percentage of staff holding an NVQ level 2 or equivalent to 85 should their be no changes in the staff team in the meantime. Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 28 Information contained within the dataset also establishes that a recruitment and selection strategy/procedure exists to support the management staff when employing new staff. It also indicates that all of the people commencing work within the home over the last twelve months have undergone satisfactory pre-employment checks. On reviewing the files of the two most recently recruited staff all of the required checks were in place, Criminal Records Bureau (CRB) checks, Protection Of Vulnerable Adults (POVA) checks and two references. The files also contained completed application forms, work permits, health declarations, photographs of the employee, interview summaries, personal information and information used to support the CRB application process. Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 29 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): Standards 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. EVIDENCE: The service tells us via their AQAA that: ‘All policies and procedures for the home are reviewed annually and as required by the Manager of the home. The Manager of the home has relevant qualifications, which exceed requirements and she keeps herself regularly updated. Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 30 The Deputy manager of the home has achieved both her NVQ level 4 care and her RMA. The manager is supported by her Deputy on site and by the Company Area Manager who is always available to her. Monthly Regulation 26 visits are undertaken by the Area Manager or a Representative. The home has an open, positive and inclusive approach. The Manager meets with the clients individually on a regular basis. Supervision, appraisal and mentoring strategies are used to maximise performance. The manager undertakes unannounced ‘spot checks’ of practice to ensure safe practice and continuity of care. The Manager organises named nurse and key worker allocation to ensure standards of care are maintained. Time is given to staff on a one to one basis to address any issues or concerns they may have. Open and transparent management systems are in place. The Manager undertakes budgeting and financial activities on a monthly and weekly basis to ensure the maintenance of the financial viability of the home. Where possible, clients are encouraged to manage their own finances but where the home keeps personal allowances for the clients this is undertaken in a safe and secure manner. All health and safety requirements met as required including the safe disposal of waste, appropriate accident reporting, etc. The record keeping and storage of records within the home complies with the requirements of the Care Standards Act and the Data Protection Act. The Manager supplies CSCI with notification notices as required. The home has achieved investors in people status’. In conversation with the manager she (the manager) confirmed that she possesses both a professional nursing qualification and has completed appropriate managerial qualification. She has also completed educational Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 31 and/or teaching qualifcations and provides a large percentage of the home’s in house training and development courses. The manager, as stated in the AQAA is support in the day-to-day running of the home by her deputy manager, who during the manager’s recent abcence (on leave) from the home , managed the service. There is also evidence of good support from the provider organisation, with the Area Manager undertaking Regulation 26 visits and producing reports of those visits, which were available for review/consideration. The evidence contained throughout this report indicates that the home is being well run and that the manager has introduced a number of management and communication tools to ensure the smooth running of the service. Comments taken from the service users surveys evidence how people living at the home or their relatives view the service and its management: ‘ I am extremely grateful to Inglefield Nursing Home and all the staff who look after my sister she is luck to be so well cared for’ and ‘I have visited many home’s and Inglefield is of a very high standard. Very homely feeling always’. The home’s approach to quality assurance is also good, with the service users clearly provided with an opportunity to discuss concerns or influence the provision of care, etc, via the service user (happy hour) meetings, as commented upon by one person completing a survey: ‘we now have a small committee to decide about activities and a happy hour once a month, which matron presides for us to air our views’. Minutes of the meetings are maintained and were seen during the fieldwork visit. The minutes for the meeting of the 20th June 2008, also provide evidence of the managers’ uses of a questionnaire to gather information from clients’, the meeting used to provide feedback on the results of the most recent survey. Care plans and risk assessment documents are being reviewed and updated accordingly and other records, like those relating to the receipt of medication, and training and development matrix, etc, accurately maintained, as previously reported. Records seen within the management office provide evidence of monitoring visits being undertaken by the provider organisation, in accordance with Regulation 26 of the Care Homes’ Regulations. The dataset indicates that a policy is available for the staff on assisting people manage their finances, etc: ‘management of service users money, valuables and financial affairs’, which was last reviewed and updated in the June of 2007. Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 32 During the tour of the premise, people were noticed to have lockable facilities within their bedrooms, which can be used to store valuables and monies should the service user wish. However, the evidence indicates that service users generally prefer their monies to be held by the home, with people’s monies managed and/or overseen by the administrator. The homes’ management and storage of residents’ monies was reviewed and considered safe and appropriate, with people’s monies held individually and separate accounts or books maintained of the amounts stored. The books or accounts are regularly audited by the manager and the administrator; who signs too confirm completion of their audit, all transactions are double signed and have an accompanying receipt. The service tells us, via the AQAA and dataset information that health and safety policies and procedures are made available to the staff and that domestic appliances and personal equipment is regularly maintained and serviced. Health and safety training is made available to staff, with the training matrix and plan providing evidence of the courses attended and those to be attended by staff, including: health and safety, infection control and moving and handling, first aid, etc. The tour of the premise identified no immediate health and safety issues, and the environmental risk assessments consider both potential areas of harm and how these can be managed. The approach of the service in combating potential points of crosscontamination of infectious agents, the locating of an automatic sanitising hand gel within the front hallway, providing further evidence of their commitment to protecting people wellbeing. Generally the service users and their relatives are satisfied with the service being provided at the home and raised no concerns in relation to either Health or Safety issues. Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 33 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 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 Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 34 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Inglefield Nursing Home DS0000066620.V367527.R01.S.doc Version 5.2 Page 36 - 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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