Inspection on 26/07/06 for Inglefield Nursing Home

This inspection was carried out on 26th July 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

Inglefield Nursing Home 23/07/08

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 09/07/2008.

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 26th July 2006 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.V294298.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.V294298.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) Buckland Care Limited Mrs Gaynor Pitman Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two named service users under the age of 65 can be accommodated in the category TI 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 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.V294298.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection is the first visit to Inglefield Nursing Home since it was purchased by Buckland Care Ltd, the purpose of the inspection being to evaluate and/or consider the service’s performance against the National Minimum Standards for Old Persons over the period since its re-registration. The inspection process considers various sources of information, which together have been used to support any judgements reached and the quality rating for the service, including: pre-inspection information provided by the service, information from previous correspondents, comments from patients and/or their relatives, professional sources, the fieldwork visits, records seen on the day and interviews with staff. In total two visits were made to the home, the first on the 26th July 2006, when key documents and records were inspected and the second on the 1St August 2006, when service users were consulted, staff interviewed and additional records reviewed. The following report has been drafted using the information gathered from the above sources and reflects the service’s performance against key national standards. What the service does well: The premises is in reasonably good condition and the administration manager was able to provide copies of the home’s proposed maintenance schedule, this included the refurbishment of bedrooms, replacement of carpets, etc. Staff training is also very good, with staff stating during conversation that they cannot always attend all of the courses run by the company/home, as they come thick and fast. This comment was supported by the detailed training records maintained by the manager and the schedule of forthcoming events, provided as part of the dataset bundle and observed advertised within the staff room of the home. The care planning records and general approach of the management and staff to documentation is good, with those records inspected during the fieldwork visit noted to be up to date, accurate, regularly reviewed and accessible to all relevant parties. Another positive for the home is the attitude and commitment of the staff, which throughout both fieldwork visit days was observed to be exceptional and Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 6 was commented upon by several service users and their families both in person and via comment cards provided prior to the fieldwork visit days. What has improved since the last inspection? What they could do better: During the inspection process, including the fieldwork visits, little was found to be wrong with the service being provided, although two issues of concern were highlighted: • A number of the staff recruitment files/records were noted to be missing key information, outcomes of Criminal Records Bureau checks, references, complete employment histories, etc. Fluid balance charts evidenced or suggested that service users were not always being provided with adequate hydration and the menu records indicate that consideration of how to increase fluid intake via alternative food sources has not been fully considered or acted upon. • 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. Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. 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 the available evidence, including a visit to this service. The home undertakes full and detailed pre-admission assessments with all new and/or prospective service users. The home does not provide an intermediate care facility. EVIDENCE: A number of service users’ plans were reviewed during the fieldwork visits and were noted to contain pre-admission assessment documents, which had largely been completed by the manager. Information, gathered during the pre-admission assessment visits, was clearly being transferred to, or used in the generation of the clients’ care plans and regular reviews and/or re-assessments ensured the plans were up to date and accurate, the evidence being that each file is reviewed by the named nurse monthly. Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 9 Comments provided by care managers largely support the view that the home’s approach to assessment and care planning is good, one care manager describing the plans as: ‘Clear and comprehensive care plans & risk assessments in place’. Service users and their relatives also confirmed that they either knew of the home or had visited the home prior to accepting the offer of a place, one relative stating: ‘We knew the home as my mother had resided here previously’ and another relative stating: ‘I visited with my daughter prior to accepting the offer of accommodation, the visit confirmed for me that Inglefield was the right establishment for my spouse’. Both the individuals referred to above and other service users also confirmed that their relative had been assessed pre-admission and that the whole experience of moving to Inglefield had been well handled by friendly and supportive staff. Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using the available evidence, including a visit to this service. Each service user has an individually prepared and managed care plan, which is maintained and updated by a named nurse. The health and social care needs of the service users are well managed and appropriately monitored. Few service users are able to manage their own medications, although arrangements can be made to facilitate self-medication for those who request to remain independent for this activity. People are treated with respect and their dignity promoted by the staff and policies, procedures and practices of the home. Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 11 EVIDENCE: As discussed above each service user is provided with an individualised care plan, eight of which were reviewed during the fieldwork visits, as part of the Commission’s case tracking process. These documents were found to be informative and insightful; and demonstrated clear links to the pre-admission assessment process, copies of the assessment tool retained on the file for reference purposes. It was also evident that each care plan was being regularly updated and reviewed, the named nurses signing and amending records on a monthly basis. Whilst many of the service users were in too poor a health to discuss the finer details of their care plans, several of them confirmed that they were aware that the staff maintained records about the care delivered and that prior to arriving at the home they had been visited by a member of the home’s staff. In addition to the information gathered directly from the service users, seven relatives returned comment cards, which also provided evidence of the home’s commitment to inclusive care planning, all seven people agreeing that: ‘If their relative/friend was not able to make decisions, they are consulted about their care’. The merit of the home’s care planning process was also noted in comment cards returned from professional sources, two care managers acknowledging: ‘Clear and comprehensive care plans & risk assessments are in place’. ‘I feel that there are excellent standards demonstrated at Inglefield’. In addition to the individual comments both care managers also confirmed, via the comment cards that: ‘There is a service user plan for the person(s) I have placed in the home’. ‘The service user plan is being followed and reviewed regularly within the home’. ‘I am satisfied with the overall care provided to the service user(s) that I have placed in the home’. Additional, comment cards returned by general practitioners and the medical review pharmacist also indicate that they are satisfied with the level of health Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 12 care support provided to the service users and find the staff willing to seek advice and guidance from professional sources. All five professional comment cards returned confirmed that people ‘are satisfied with the overall care provided to service users within the home’. ‘That the home communicates clearly and works in partnership with professionals’ and; ‘That patients are able to see professional visitors in private’. Four comment cards also indicate that: ‘any specialist advice provided is incorporated into the service user’s plan (care plan)’. Records, which form part of the overall care-planning package, provide further evidence of the home’s good work when it comes to supporting service users in accessing appropriate health care services and/or managing specific health needs. People’s care-planning records containing copies of hospital discharge summaries, correspondence from health care professionals (Consultants, Speech and Language Therapists, Dentists, etc.), continence assessments, wound care charts, Waterlow scores/assessments (skin integrity monitoring forms), nutritional assessments, blood pressure charts, fluid balance charts, etc. Several of the care plans implemented also focused on people’s specific health care needs, providing instructions for staff on how to manage a person’s continence needs, wound management and ensuring that adequate fluids were being consumed, etc. The latter, fluid management, was perhaps the only area of the home’s practice which caused concern for the inspector, as whilst care plans and monitoring tools are in place to manage and monitor this specific care need the evidence (completed charts) indicates or implies that service users are not consuming adequate amounts of fluid. This was discussed with the matron/manager who explained that it can at times be difficult to get some people to take more than a few sips of water, etc., at a time and that staff are regularly encouraging service users to drink. The possibility of increasing the service users’ fluid intake by other means was discussed with the matron/manager, the use of jellies, ice creams, soups (in cooler conditions), etc., all useful in boosting a person’s fluid intake. However, despite the above issue, the majority of the evidence gathered indicates that the home and/or the staff are providing good levels of support to Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 13 service users in respect of their health care needs and judgement supported by the service users’ relatives, people making comments like: ‘The nursing staff are excellent and the care and concern shown to their charges is obvious and genuine’. ‘The home is very well run with a very caring staff – who are always very kind & considerate to my wife’. ‘When new staff arrived from overseas there was a temporary drop in performance. Now it is better than it ever was before’. Whilst this inspection is technically the service’s first inspection, as it was recently purchased and re-registered by ‘Buckland Care Ltd’, the nursing home has been operational for a number of years, with previous inspection reports identifying no major problems or concerns with the way the home and/or the management support people with their medications, although previously gaps had been noted in the medication records. At this visit a review of the home’s medication management arrangements revealed that service users could self-medicate should they wish, although they are required to undergo an assessment process. Currently no-one is selfmedicating, as the present service users and/or their relatives have opted to allow the staff to manage their medicines on their behalf. The dataset, returned to the Commission prior to the fieldwork visits, also makes clear that the home has a full range of medication policies and procedures, copies of which were observed to be in the front of the MAR sheet files and which describe for staff the assessment process service users are required to complete before being supported to manage their own medications. On scrutinising the process for managing service users’ medications it was evident that records are well maintained with all ‘Medication Administration Records’ (MAR), controlled drugs registers, receipt and return records and sample signatures and initials, etc. available for inspection, accurate and up to date. It was also apparent from discussion with the matron/manager that she is now monitoring the MAR sheets to ensure a repeat of last year does not occur and that staff are properly completing the medication records, which given the improvement would appear to be working. The home’s storage facilities for the medication received are more than satisfactory with all medications secured within a locked room, within purpose built locked cabinets (that comply to European standards) and/or specific medication trolleys. Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 14 The medications were also noted to be stored according to the patient’s name and stock or bulk items are maintained within separate cabinets. Comments received from the ‘Medication Review Pharmacist’ indicate that she has no concerns with regards to the home’s approach to managing medications and has ticked to confirm: ‘She is satisfied with the overall care provided to service users within the home’. However, a general practitioner commented that: ‘There have been occasions in delay in starting medications once prescribed’. When raised with the matron/manager she stated that she did not know of any occasions when medications had been deliberately delayed, however she did recount how, on occasions, if the pharmacy have to order in a specific medicine this can cause a slight delay but felt this was a prescription issue and not a nursing failure. Three other general practitioners who also replied to the Commission, via the comment card process, indicated that ‘service users’ medications are appropriately managed by the home’. Seven comment cards returned by the relatives of service users provided evidence of the respect shown to people involved with the service, all seven clearly documenting how the management and staff welcome people to the home, keep them appraised of issues or events affecting their relative’s wellbeing and involve them in decision-making when their relative is unable to determine for themselves. Several of the cards also contain additional comments, which also support the notion that the home and/or the staff are mindful of people’s rights to privacy, dignity and respect, people commenting that: ‘The nursing staff are excellent and the care and concern shown to their charges is obvious and genuine’. ‘The home is very well run with a very caring staff – who are always very kind & considerate to my wife’. ‘My mother has been at the home for over 9 months now and both myself and sister have been happy with the facilities and staff’. ‘It is a wonderful home and very well run’ Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 15 The home’s internal quality auditing programme also provides evidence of how people feel about the staff and/or the service provided with 20 out of 22 returned questionnaires indicating that ‘people’s needs are met in a sensitive and dignified manner’. Observations of staff interactions and dealings with patients and/or their visitors/relatives further evidenced the positive attitudes and respectful approaches of the staff when managing or attending to people’s needs. One such interaction occurring on the second day of the fieldwork visits when a client’s visitor/relative was seeking information about her next of kin, the initial exchange occurred within one of the main corridors and rather than discuss the service user’s needs or health, etc. in public the staff member invited the visitor to come to the quiet lounge where they could talk in private. Privacy was also an issue commented upon by the professionals involved in visiting the home, with all of the comments received indicating that people are able to visit their clients in private. In addition to the general comments made one of the care managers also states on the comment card that: ‘I feel that there are excellent standards demonstrated at Inglefield’. Inglefield Nursing Home DS0000066620.V294298.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 & 15 Quality in this outcome area is good. This judgement has been made using the available evidence, including a visit to this service. The lifestyle experiences for service users can be limited by their health care needs, although steps are taken by the staff to manage these limiting factors and promote socialisation and stimulation. Visiting arrangements are satisfactory and meet the needs of both the service users and their relatives. Choice and control over people’s lives is limited by their health needs, although where possible choice and control are promoted. Meals are wholesome, appealing and well balanced. EVIDENCE: The home’s internal survey documents that 12 out of the 22 respondents find the home’s activities and/or entertainments programme is satisfactory, people making comments like: ‘mum especially enjoys having a sing-a-long’ and ‘the music is good when it comes and we always attend’. Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 17 The other ten people opted not to complete this section of the survey and so provided no useful or meaningful information, which the home could use. Activities within the home are generally brought to service users’ attention via the home’s newsletter, which the matron/manager produces on a monthly basis and which is accessible to both service users and visitors alike. August’s newsletter, which is subdivided into six sections and includes a spot the difference competition on the back advertise all forthcoming events: Section 4 ‘Planned Events’: • • • • • • • • • • • • Every Tuesday Libby the PAT dog will visit Every Thursday Merlin the PAT dog will visit Thursday’s 3rd and 17th August – Memory Lane with Ian Rolf 2.30pm Wednesday 2nd, 9th 16th and 23rd August Sing-a-Long 11.00am Friday 4th August – walk to pub Friday 11th August – Picnic in the park (weather permitting) Friday 11th August – Exercise Class 2.45pm Saturday 19th August – Summer Barbecue 6.30pm Monday 21st August – Art and Craft 11.30am Friday 25th August – Fish & Chip Lunch 12.00pm (weather permitting) Friday 25th August – Music & Movement 2.45pm Wednesday 30th August – Games Afternoon. In addition to the advised activities programme people are also afforded the opportunity to sit in the garden/patio areas when the weather is good, people observed on both fieldwork visit days to be outside enjoying the warm and pleasant weather. People also have access to daily newspapers, televisions and radios; and on a weekly basis have a hairdresser visit, the latter evidenced via the dataset completed by the matron/manager. In discussion with service users and/or their relatives it was ascertained that activities provided by the home are largely considered appropriate, although some people clearly preferred to organise and arrange their own entertainment, opting not to socialise with other patients whose health conditions they found distressing. In conversation with one relative it was established that her husband was unable to communicate or mobilise independently and was often confined to bed for long periods due to his health needs. This relative was quick to praise the staff for the care and attention provided to her husband, stating that the social contact and stimulation created when the staff come to tend to his pressure area care, provision of nutrition and Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 18 medications, etc., was the best entertainment and activity he can receive, her husband responding positively to the physical and audio stimulus. As mentioned throughout the report the inspectors had the opportunity to meet with and/or observe people during visits to service users, providing evidence that the home’s visiting arrangements are appropriate and meeting people’s needs. Seven out of the seven comments cards returned by relatives also provided evidence of the suitability of the home’s visiting arrangements with people remarking on the fact that they are able to visit their next of kin and that these visits can be undertaken in private. The home also requests that all visitors to the home (and staff) sign in and out on arriving and exiting the premises, which proved a good indicator to the number of visitors to the home and the varying times that people choose to undertake their visits. In conversation with 3 relatives visiting their next of kin during the fieldwork visit days the arrangements for visiting were described as good and the welcome to the home ‘warm and friendly’. During the fieldwork visit(s) and as part of the inspection process generally it was established that people are provided with simple choices: • • • • • Rising and retiring times Meal options Where they sit Participation in (internal and external) activities When they bath, etc. Larger or more demanding decisions, regarding people’s personal lives, etc. are often decided in consultation with relatives, friends and/or advocates. One service user in particular discussing how the decision to move to the home had been taken after discussing the options with her sons, whilst a relative described how she and her daughters had discussed the suitability of Inglefield for her husband before deciding to accept the offer of a place. Where people are unable to make decisions for themselves their relatives confirmed, via the comment cards and discussions, that they are actively involved in all aspects of their care, etc. and are kept informed of developments and/or changes in their care needs. Mealtimes at Inglefield Nursing Home are something of a dichotomy, with some service users enjoying a dining experience that is very much a social occasion, whilst others, due to health considerations, etc., dine in isolation, the Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 19 latter comment is not intended to be a criticism rather a reflection of the differing needs of the clientele. Generally the quality of the food provided at Inglefield is good with one relative using that very phrase ‘good’ to describe the meals provided to their next of kin, during a conversation. In addition to the comments made during the fieldwork visits the home’s internal quality auditing tool records how 20 out of 22 people surveyed were satisfied with food provided, comments made including: ‘Mum always says the food is lovely’ ‘Excellent food, I enjoy lunches myself’. Meals are prepared within the home’s kitchen and transported to the dining room, lounge or service user’s bedroom by the staff. On the first day of the fieldwork visits the inspector spent time observing the staff during lunchtime, noting how attention is given to those who require assistance, whilst those requiring no attention are supported through encouragement and communication. The meals observed appeared to be well presented and alternatives (to the main meal) were noted to be available to those who either could not or did not require the main meal option. The sample menu provided by the matron/manager, as part of the dataset information, highlights that the meals provided to service users are generally varied and nutritionally balanced, as they contain a mix of vegetables, meats, fish, fruit, etc. In conversations with staff it was also established that people can, should they wish, have additional snacks throughout the day and that a kitchenette is accessible to staff just off the main kitchen. Staff were also observed taking drinks trolleys around the home at various times of the day and that light snacks are available, biscuits, etc., at this time if desired. Inglefield Nursing Home DS0000066620.V294298.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 & 18 Quality in this outcome area is good. This judgement has been made using the available evidence, including a visit to this service. Service users are confident that complaints or concerns are handled appropriately. Appropriate measure is taken to ensure service users are protected from abuse. EVIDENCE: In discussions with both service users and their relatives it was established that they would feel confident in bringing a complaint or concern to the attention of the management and/or staff, as they felt the matter would be appropriately addressed. All seven relative comment cards returned indicate that people are aware of the home’s complaints procedure, with one respondent indicating that they have used the procedure, with varying degrees of satisfaction at the outcome. Generally the complaints process would appear to meet the needs of the service users, the home’s internal audit indicating that 10 of the respondents had used the complaints process and were satisfied with the outcome, whilst the remaining 12 people surveyed elected not to respond to this question, which could suggest that either they were unhappy with the response to their concern or had no concerns to raise. Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 21 As one of the comment cards returned to the Commission, and all 3 people spoken with during the visit, indicated that they had no complaints about the home or service provided, it is perhaps safer to surmise that generally the latter assumption is more accurate. Information contained within the dataset, provided prior to the fieldwork visits, indicates that within the last twelve months 3 complaints have been received and that all 3 have been successfully managed within the 28 day timescale. The dataset also establishes that the home has a complaints process and that this was last reviewed and updated in July 2005. Service users whilst unable to discuss the finer points of the home’s complaints process were able to confirm they were happy within the home, people stating: ‘I have no complaints and would speak to Gaynor (matron/manager) if I did’ ‘Why should I have any complaints I like living here’. The seven professional comment cards, returned to the Commission, also establish that they have never been approached by people to raise concerns or make complaints about Inglefield and 13 out of the 14 comment cards returned indicate that people are generally happy with the overall care and/or service provided. The information provided as part of the dataset evidences that adult protection training is available to the staff and that the last update or ‘introduction to adult protection’ was scheduled to take place some time after July 2005, although no specific date is documented. What is clear is that all new employees are required to complete a full and detailed induction programme, which addresses all of the units defined by ‘Skills for Care’ under the new ‘Common Induction Standards’, four files which contained completed induction booklets were seen during the first fieldwork visit day. In discussion with staff, whilst none specifically mentioned the abuse training, it was established that the home and specifically the manager provides access to numerous educational and skills development courses and that at the core of their roles is the health, safety and wellbeing of the service users. As already mentioned within the body of the report, relatives feel the home is meeting the needs of their next of kin and no concerns regards their safety or wellbeing was identified. Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 22 Observations also demonstrate or support the belief that people feel happy and safe within the home, service users and staff interacting well throughout the fieldwork visits. The dataset also provides a clear statement of the fact that the staff are provided with access to an adult protection policy and procedure and that this again was last updated in July 2005. The comment cards of two care managers surveyed also make clear that they are satisfied with the service provided to their clients, one card making a clear declaration that the standards provided at the home are ‘excellent’. Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 23 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 & 26 Quality in this outcome area is good. This judgement has been made using the available evidence, including a visit to this service. The home is well maintained both internally and externally and evidence exists of the ongoing refurbishment and redecoration programme. The home was found to be clean and tidy throughout and domestic staff observed on duty during both days of the fieldwork visits. EVIDENCE: A tour of the premises evidenced that the home is clean, tidy and generally well maintained throughout. The grounds and exterior areas of the property are pleasant, neatly arranged and accessible to service users. Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 24 The administrator, on the first fieldwork visit day, provided a copy of the home’s 2006/2007 maintenance programme, which includes or incorporates details of both cosmetic and functional works to be carried out i.e. curtains need replacing in Room 25 and/or pointing along full length of original building at ground floor level. The ‘Inglefield Newsletter’ also contains details of the forthcoming maintenance programme and invites people to bring issues or concerns, regarding the building, to maintenance person’s attention. During the tour of the premises the maintenance person was observed repairing the French doors in one of the service user’s rooms, whilst the administrator was heard discussing, with an external operative, the replacement or repair of the vanity units in several en-suite amenities. An additional comment, included in a relative comment card: ‘My mother has been at the home for over 9 months now and both myself and my sister have been happy with the facilities and staff’ and the fact that 22 out of the 22 respondents to the home’s internal audit describe the home as ‘clean and comfortable’, suggests that the home’s environment is meeting people’s needs. Comments on the cleanliness of the home include: • • • • • ‘The home is always nice and clean’. ‘I am very pleased with the home – everything is spotless’. ‘Very clean and comfortable and always smells nice when you walk in’. ‘Always smells nice’. ‘The cleaning staff are excellent. S is always cheerful and with a friendly word’. On both fieldwork visit days members of the home’s domestic staff were observed around the home, cleaning and tidying both communal areas and individual people’s bedrooms. Information contained within the dataset indicates that 4 domestic staff are employed by the home for a combined total of 55 hours a week. Inglefield Nursing Home DS0000066620.V294298.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using the available evidence, including a visit to this service. Staffing levels are sufficient to meet the needs of the service users. The home has achieved the target of 50 of the care staff trained to National Vocational Qualification (NVQ) level 2 or above. The recruitment and selection practices of the home are not sufficiently robust to ensure that the wellbeing and safety of service users can be assured. In-house training and development opportunities for staff are good. EVIDENCE: Copies of the staffing rosters, supplied as part of the dataset information, indicate that the home is well staffed and that sufficient nursing and care staff are available, across the twenty-four hour period, to meet the needs of the service users. Observations, on both fieldwork visits days, provided further evidence of the fact that adequate staff are available to meet people’s health and social care needs, this being particularly evident during shift changes when the numbers of staff commencing work and those completing their duties are most noticeable. Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 26 It was also evident during mealtimes that sufficient staff were available to support people when eating, either in their bedrooms, the dining area or lounge and the tour of the premises revealed that staff were available around the home, people observed to be involved in a multitude of duties and/or tasks. In discussion with staff it was established that carers normally work in units of two with the home subdivided into four sections, three floors and the new annex. In addition to the care staffing pairs, etc., qualified nursing staff are also available, with a minimum of two staff per shift available within the home. Service users’ relatives generally consider there to be sufficient staff available with six out of the seven comment cards returned recording that ‘in my opinion there are always sufficient numbers of staff on duty’. Professional comments would also appear to support the fact that sufficient and appropriate staff levels are maintained, people’s testimonies indicating that: ‘there is always a senior member of staff to confer with’ and that people are ‘satisfied with the overall care provided to the service users’. Staff training is a key responsibility of the matron/manager who produces, oversees and maintains all staff training plans/matrix and records. As part of the dataset information provided the matron/manager included copies of the home’s teaching session programme and both mandatory and non-mandatory courses completed since July 2005. Mandatory:• • • • • Infection Control Food Hygiene Fire safety Manual Handling First Aid Non-mandatory:• • • • • • • Euthanasia and Living Wills Recruitment Selection and Equal Opportunities Falls Prevention Introduction to Adult Protection Communication Skills Managing MRSA Understanding Strokes DS0000066620.V294298.R01.S.doc Version 5.2 Page 27 Inglefield Nursing Home • • • Understanding Dementia Managing Arthritis Team Working Teaching Session Programme:• • • • • • • 03/10/05 15/11/05 19/01/06 18/02/06 13/03/06 23/05/06 22/06/06 – – – – – – – Understanding strokes Promoting appropriate communication skills in care delivery Understanding and managing dementia Managing Arthritis How to work as part of a team Understanding Parkinson’s disease Understanding heart disease New staff are also expected to complete the ‘Skills for Care’ Common Induction Standards, as part of the introduction to care work and the home, four completed copies were shown to the inspector by the deputy matron on the first fieldwork visit day. In discussion with staff it was quickly established that training is continuously available at Inglefield, with a student nurse, placed at the home, confirming that she had attended several in-house educational sessions and found these informative and interesting. Staff are also being supported to access National Vocational Qualifications (NVQ) level 2 courses or equivalent, although the information supplied by the home, via the dataset, initially indicated that the home was not meeting the 50 ratio recommended within the National Minimum Standards, as the figures supplied were inaccurate. However, on the second fieldwork visit day the matron/manager advised the inspector that 17 of her 29 care staff possess a NVQ level 2 or above and that 8 more staff are due to complete their courses soon. The ratio with 17 out of 29 care staff currently holding an NVQ level 2 or above is 59 , although if all 8 staff completing their courses pass this could rise to 86 . The home’s recruitment and selection process has at previous inspections always been found to be satisfactory and has been considered therefore to support and protect service users. At this visit the files of five staff were reviewed and each was found to contain the following information: • • An application form Details of interview DS0000066620.V294298.R01.S.doc Version 5.2 Page 28 Inglefield Nursing Home • • • Contracts Induction information Employment correspondents However, some information was missing from the files reviewed: • • • Only two files contained two references and on one of these they were not the person’s last employer. One file had no Criminal Records Bureau check One application form lacked details of the person’s employment history, whilst a second stopped in 2004, without clarification as to why. Inglefield Nursing Home DS0000066620.V294298.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 at least once during a 12 month period. 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 the available evidence, including a visit to this service. The manager possesses both relevant nursing and managerial qualifications and is an experienced leader. The home’s quality assurance systems ensure the home is run in the best interests of the service users. The arrangements for handling service users’ monies are satisfactory and designed to ensure people’s financial interests are safeguarded. The staff receive both regular supervision and annual appraisals. The health, safety and welfare of both the service users and staff team are appropriately managed and promoted. Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 30 EVIDENCE: Information contained within previous inspection report indicates that the matron/manager possesses both a Nursing Qualification and the Registered Manager’s Award (RMA). Evidence gleaned from the dataset and other documentation provided prior to the fieldwork visit, provides further evidence of the matron/manager’s qualifications and experience and indicates that she regularly accesses additional courses to maintain her own skills and knowledge basis. In addition to the registered manager, the home also employs a deputy matron, who currently is completing the Registered Manager’s Award and is herself a Registered Nurse. Comments provided by relatives of the service users indicate that the manager is both approachable and supportive, with one returned comment card recording: ‘Gaynor (head manager) is always accessible and informed about mum’, whilst a second comment indicates that: ‘When I have had a particular issue to discuss time has always been found - promptly’. Service users and/or their relatives are afforded the opportunity to comment on the service provided at the home via the internal client satisfaction survey, a copy of which was provided during the second fieldwork visit day along with a breakdown of the response, produced by the matron/manager. Comments contained within some of the completed questionnaires included: ‘The home is always nice and clean’ ‘Staff are always cheerful and welcoming and are pleased to help in any way they can’. ‘I find my husband is always lovely and clean’ ‘More open windows would be nice but probably residents’ choice’. ‘Mum always says the food is lovely’ ‘More varied salads and curry would be enjoyed from time to time’. Other files and/or records checked prior to the fieldwork visits indicate that Buckland Care Ltd is completing visits to the home in accordance with Regulation 26 and that copies of the reports produced following these visits are being forwarded to the Commission for information. Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 31 Another important element of any quality auditing system is the work undertaken with the staff, which from a training and development perspective is very good, as evidenced earlier within the report. Staff also confirmed, during conversations, that team meetings, appraisals and supervisions are regular occurrences and that generally they found or considered these events useful and productive, especially recently when the home was in transition, moving from one owner to another. Copies of several ‘performance assessment forms’ (supervision records) were seen during the fieldwork visit days and were noted to be signed by both the supervisor and supervisee, denoting that the outcomes and action/development plan, etc. has been agreed by both parties. Service users’ finances are largely managed by the home with the administrator overseeing the accounting for all monies deposited and/or spent on behalf the service users. The dataset indicates that none of the service users manage their own finances and therefore people’s monies are either managed internally or by the service users’ families and/or representatives. On checking through several service user ‘personal allowance accounts’ it was evident that these are being well run and managed, all accounts balanced, receipts were available to support all purchases, all transactions were double signed, monies were individually held and accounted for and all deposits and records held safely and securely. Evidence from previous inspection reports suggest that no changes have occurred in how service users’ monies are managed at Inglefield, despite its purchase by Buckland Care Ltd and that previously the home’s management of service users’ finances was considered appropriate and satisfactory. No immediate health and safety concerns were identified with regards to the fabric of the premises and full health and safety policies, etc. are made available to staff employed at Inglefield, according to the dataset. Health and safety training is also clearly made available to staff, with the dataset evidencing that staff complete first aid, fire safety, moving and handling, infection control and food hygiene. The availability of the maintenance person is also a benefit to the home, as this ensures that the general fabric of the environment is kept up together and does not pose an immediate risk to people. Access to paper towels and liquid soaps within bathrooms/toilets/en-suite, etc. are indicators of attention to infection control, as is the availability of a specific Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 32 infection control policy, which the management stated confirmed they possess via the dataset, the policy last updated in 2006. Inglefield Nursing Home DS0000066620.V294298.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 2 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 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Inglefield Nursing Home DS0000066620.V294298.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. 1 Standard OP29 Regulation Requirement Timescale for action 25/09/06 Regulation The home must ensure that its 19 recruitment and selection process is thorough and robust and operates in accordance with Schedule 3 guidance. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations The home should take steps to ensure service users receive adequate fluids. Inglefield Nursing Home DS0000066620.V294298.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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 Inglefield Nursing Home DS0000066620.V294298.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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