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Inspection on 28/05/09 for Inglewood Nursing Homes Ltd

Also see our care home review for Inglewood Nursing Homes Ltd for more information

This inspection was carried out on 28th May 2009.

CQC 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The atmosphere at the home was relaxed and the residents were able to choose to spend their time in the lounge, conservatory or in their own rooms. Communication between residents and staff was friendly and reflected the staffs understanding of their needs and the support they require. The residents spoken with were positive about the care provided saying the staff are very good and offer the care they need. Visitors were equally positive saying the home is very good and the staff know what support and care the residents need and want.

What has improved since the last inspection?

No requirements were made following the last inspection.

What the care home could do better:

Two requirements have been made in this report and concern the regular review and update of care plans to reflect the changing needs of residents and the appropriate use of gloves and aprons by staff in line with the homes infection control policies and procedures. Other concerns were discussed with the manage during the inspection and have been included in the body of the report.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Inglewood Nursing Homes Ltd 7 & 9 Nevill Avenue Hampden Park Eastbourne East Sussex BN22 9PR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kathy Flynn     Date: 2 8 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Inglewood Nursing Homes Ltd 7 & 9 Nevill Avenue Hampden Park Eastbourne East Sussex BN22 9PR 01323-501086 01323-500102 Info@Inglewood.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Inglewood Nursing Homes Limited care home 60 Number of places (if applicable): Under 65 Over 65 60 0 old age, not falling within any other category physical disability Additional conditions: 0 60 The maximum number of service users to be accommodated is 60. The registered person may provide the following categories of service only: Care home with Nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) Physical Disability (PD) Date of last inspection Brief description of the care home Inglewood is a registered care home providing nursing care for sixty residents, who meet the registration category of elderly and physically disabled. The accommodation offered consists of fifty single rooms of which twenty-seven have an ensuite facility, five double rooms one of which has an ensuite facility. There are ample communal bathrooms with specialist equipment to ensure the safety of residents whilst bathing. The home has the necessary specialist equipment required to meet the varied needs of residents, including hoists, air mattresses and cushions. There is level access to all parts of the home by passenger lifts. The home is well maintained internally and Care Homes for Older People Page 4 of 25 Brief description of the care home externally, with well-tended gardens that are accessible for wheelchair users. The home is situated in a residential area of Hampden Park, near to an attractive park and the local shops. There are public transport amenities close to the home. Inglewood is set back from the road and has parking facilities to the front for approximately ten cars. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was carried out on the 28th May 2009 and took place over seven hours. The inspection included a tour of the home, a review of pre-admission assessments, care plans, staff records and training, medication records, activities, and menus. There were 51 residents at the home during the inspection. Sixteen of the residents were spoken with and two visitors to the home were happy to discuss the support provided. Care Homes for Older People Page 6 of 25 The manager, registered nurses and the staff on duty discussed the care and support they provide at the home. The Annual Quality Assurance Assessment (AQAA) was completed by the manager and returned to the Commission within the required timescale. The information provided was used to plan this inspection. The reader should aware that the Care Standards Act 2000 and the Care Homes Regulations 2001 use the term service user to describe those living in care home settings. However for the purposes of this report those living at Inglewood will be referred to as residents. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre admission assessments are completed on all prospective residents prior to the offer of a place, to ensure the home can meet their individual needs. Evidence: The manager confirmed that all prospective residents are assessed to ensure the home can meet their needs. This is then confirmed in writing and a place is offered at this time. The pre admission assessment process has recently been reviewed and assessments are now completed by the manager or the deputy manager with team leaders. The team leaders are responsible for many of the day to day decisions regarding personal support and care for residents, and their involvement in the assessment of prospective residents provides them with a clear picture of people needs. Therefore day to day support can be planned before people are admitted to Inglewood. Care Homes for Older People Page 10 of 25 Evidence: The assessments for three recent admissions to the home were examined. They included details of the residents medical history, their individual nursing and care needs, which identified the risk assessments that should be completed when they are admitted, as well as information about their interests and support from relatives or friends. Prospective residents, their relatives or representatives are fully involved in the admission process, and those spoken with said they were assessed by the manager and they agreed with her that the home could offer the support and help needed. This was confirmed in writing and information about the home is provided in the booklet, that the relatives and residents said they had been given. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system provides staff with information about the needs of the residents so that they can plan appropriate support and care. However some of the information recorded was not up to date and this may affect the care provided for residents. Appropriate systems are in place with regard to medication and training is provided for staff to protect residents. Evidence: The manager and nurses advised that the care plans have been reviewed and the format has been changed to ensure that there is sufficient information about the needs of residents, which will enable staff to meet their individual needs. Six care plans were examined and the residents and relatives concerned were spoken with. The records showed that risk assessments had been completed including pressure relief, nutrition, falls and moving and handling, and a daily record reflects the support provided. Care Homes for Older People Page 12 of 25 Evidence: One of the care plans viewed was not up to date and had not been reviewed on a regular basis. The information regarding medication, wound dressing and continence was incorrect which may affect the support and care offered for this resident. Concerns were raised at the last inspection regarding care plans and a requirement has been included in this report. The manager advised that further training was planned for the registered nurses to ensure that all the care plans are completed appropriately, reviewed regularly with evidence that this is done with the full involvement of residents and their relatives, and that the daily record of care is linked with the information in the residents individual care plans. Residents are registered with a GP and visits from allied health professionals are arranged when necessary, including the Tissue Viability Nurse, Dietician and Continence Nurse. These visits are recorded in the care plan, and the nurse advised that if necessary an additional care plan sheet is completed to ensure staff are aware of any changes to residents needs. The relationship between residents, relatives, visitors and staff was noted to be relaxed and friendly, with staff treating residents with respect when offering personal support. Residents and visitors spoken with said the staff are very good and supportive, although they seem to be very busy at times, and it can take some time for them to answer the call bells. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A programme of activities is provided for residents to take part in if they wish. The meals at the home are good, choices are available and staff assist residents as required. Evidence: Group and one to one activities, from Monday to Friday, are organised for residents to participate in if they wish. These include art and craft sessions and trips out, as well as music, bingo and reminiscence. Residents spoken with, who expressed an opinion, said they could join in if they wished and that activity staff are very good at organising something. The manager and activity organiser confirmed that the home plans to extend the activities so that an activity is available for residents on each day of the week. They will also be looking at the involvement of care staff in providing some social support in line with a person centred care. Currently nursing and care staff concentrate on providing nursing and personal care. Links with the local community are good, a summer fete is planned and there are Care Homes for Older People Page 14 of 25 Evidence: regular visits from local church groups. Open visiting enables relatives and friends to visit the residents at times that suit them, and they can join them for meals if the wish. The visitors spoken with said the staff at the home are very welcoming, and they are offered a drink soon after they arrive at the home. The manager and the staff spoken with said the residents are encouraged to make choices about all aspects of their day to day lives and the residents who expressed an opinion said they could stay in their own room or use the dining room or lounge, depending on how they felt each day. However there were two residents at the home who were assisted with their breakfast at a set time each day. This was because they may take an hour with this meal, which means that two staff are not available to assist other residents. The concern is that this action was for the benefit of other residents in the home and the staff, but not the two residents concerned. The expectation is that all residents in a care home are encouraged to make choices about the support and care they receive. Discussions with the staff and manager identified that they have attended training with regard to the Mental Capacity Act and Deprivation of Liberty Safeguards, further advice and training regarding changes to the legislation may be required to ensure all residents are fully supported. Since the inspection the Commission has been advised that the allocation of staff to assist these two residents at a set time has stopped, they are now offered breakfast on the same basis as other residents in the home. The meals at Inglewood are good, choices are available and staff assist residents if required. Residents used the lounge, dining room, conservatory or their own rooms at lunch time. The same groups of residents sit together in the dining room and conservatory on a regular basis, but they were not all given their meals at the same time, and some residents were still waiting for assistance with lunch when others had finished their meal. Staff said that a colleague had recently left and other staff had been asked to do her work, which meant that lunch was delayed for some residents. One resident did not like the main choice and an alternative was provided by the chef when the staff were asked to replace it. The residents and visitors spoken with said the food is very good, they can have what they want and friends and family can join them if they wish. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures for recording and investigation complaints are in place, and the home protects residents by training staff in protecting vulnerable adults. Evidence: Residents and visitors spoken with said they are able to talk to the staff, nurses or manager if they have any concerns and they felt they would be dealt with straight away. Some have attended the residents and relatives meetings and they said these are a good idea and give everyone the chance to say what they think about the support and services provided at Ingelwood. Appropriate policies and procedures are in place and the manager confirmed that any concerns are responded to within forty eight hours, and any complaints are investigated within twenty eight days. Staff spoken with said they have attended training in protecting vulnerable adults. They were able to demonstrate an understanding of abuse, and where quite clear what action they would take if they have any concerns. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Inglewood offers a comfortable and homely environment for residents to enjoy. Training is provided for staff with regard to the control of infection, however it was noted that some staff are not following the home policies and procedures and this may put residents, relatives and staff at risk. Evidence: The home is an extended large building with 50 single and five double rooms, a large lounge, dining room, conservatory and activity room on the ground floor. There are attractive gardens to the rear of the home and parking spaces at the front of the building. An ongoing maintenance programme offers a comfortable, clean and homely environment for residents who are able to personalise their rooms with small pieces of furniture, pictures and ornaments. Training in the control infection is provided for staff and those spoken with have attended this and are aware of the home policies and procedures. The use of aprons and gloves was discussed during the inspection as some staff were using these inappropriately. Concerns were raised during the last inspection about staff not following the homes procedures, a requirement has been made for a review of the training provided. Care Homes for Older People Page 17 of 25 Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust recruitment procedures are in place to protect residents, and staff training ensures they are aware of their roles and responsibilities. Evidence: Residents and visitors spoken with said the staff are very good and are able to provide the care that they need, although they seem to be busy at times and take a while to respond to the call bells. Staff spoken with said they felt there were enough of them to provide the support and care the residents need. The manager confirmed that the staffing levels are based on the assessed needs of residents and would be reviewing them on the basis of the feedback from residents and visitors. The home has robust recruitment procedures and the personnel files viewed included all the relevant information including completed application forms, two references as well as the Protection of Vulnerable Adults (POVA) and Criminal Registration Bureau (CRB) checks. All new staff are required to complete induction training in line with skill for care, and the expectation is that they will go on to do the National Vocational Qualifications (NVQ) for their particular area of work at the home. Care Homes for Older People Page 19 of 25 Evidence: All mandatory training is provided for staff and there are records of the training they have attended and when these need to be updated. Staff spoken with said they have attended the required training and there are opportunities for additional training based on the support needs of the residents. These could include diabetes and stroke, and training has been arranged to look at the needs of people with dementia later this year. The manager advised that some of the training is provided at the home. If there is an empty room it is used for moving and handling, so that staff are able to use the hoists and aids available to assist residents with transfers. The conservatory is also used for some training and at these times the residents are unable to use this room. Whereas it may be appropriate to use an empty room for training as it does not affect any of the residents, using the conservatory has a direct affect on their choices. Inglewood is the residents home and the expectation is that all parts of the home are available for them to use if they wish. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management approach at Inglewood is open. Residents, relatives, friends and staff are encouraged to be involved in decisions about the services provided. The health and safety of residents is protected through ongoing system checks, maintenance and a rolling programme of staff training. Evidence: The ownership of Inglewood has changed since the last inspection and the home is now one of two in Eastbourne supported by the same responsible individual. The manager previously worked at the home as deputy manager, she is a registered nurse, has considerable experience in providing care and support for older people, and has completed a management course that is equivalent to the Registered Managers Award. The management approach is relaxed and open, which encourages residents, visitors Care Homes for Older People Page 21 of 25 Evidence: and staff to be involved in decisions about the services offered at the home if they wish. Regular residents and relatives meetings, in addition to questionnaires and daily conversations with management and staff encourage this. Feedback is also sought from all individuals and groups who have contact with the home as part of the quality assurance and monitoring system, and the manager advised that audits are completed on each area of the service regularly. The comments from residents and relatives during the inspection were very positive, they said the staff are very good, kind and very supportive, and the only concern was that staff seem to be very busy. Systems are in place to ensure the health and safety of residents, visitors and staff are protected. These include appropriate checks on the lift, hoists, fire alarms and extinguishers, as well as relevant staff training. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans are to be reviewed and updated on a regular basis and when the needs of the residents change. To ensure the care and support provided meets their individual needs. 31/07/2009 2 26 13 Training in the control of 31/08/2009 infection to be reviewed and updated as required to ensure staff follow the homes policies and procedures. To ensure residents are protected from unnecessary risks to their health and safety. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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