CARE HOMES FOR OLDER PEOPLE
Ings House Nursing Home 350 Bradford Road Liversedge West Yorkshire WF15 6BY Lead Inspector
Sally McSharry Key Unannounced Inspection 12th December 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ings House Nursing Home DS0000001086.V314464.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. Ings House Nursing Home DS0000001086.V314464.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Ings House Nursing Home Address 350 Bradford Road Liversedge West Yorkshire WF15 6BY 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) 01924 411166 01924 410131 ken.woolford@btconnect.com Mr John Keen Mr Kenneth Royston Woolford Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (31), Physical disability (1) of places Ings House Nursing Home DS0000001086.V314464.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th December 2005 Brief Description of the Service: Ings House care home was built in the early 1800s and was extensively renovated and refurbished in 1990, when it was converted for use as a nursing home. It is situated just off a main road from Heckmondwike to Cleckheaton and it is convenient for those travelling on public transport. Shops and local amenities are located fairly closely within 5 minutes’ walking distance. The home offers single and twin accommodation, some with en-suite facilities for up to 32 elderly people. The registered manager informed the Commission for Social Care Inspection on 20/12/06 that fees range from £331.26 to £512.47 per week. Additional charges include hairdressing, private chiropody, newspapers, clothing, dry cleaning and personal toiletries. Information about the home and the services provided are available from the home in the statement of purpose and service user’s guide. Ings House Nursing Home DS0000001086.V314464.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit carried out to the home by an inspector on the 12th of December. I arrived at the home at 09:00 am and left the home at 13:30pm. The last inspection carried out by the Commission took place on the 19th December 2005. During this visit the inspector spoke to some of the service users, visiting relatives, some of the staff and the home’s senior nurse. The registered manager was on annual leave on the day of the visit. The inspector read care records, audited a sample of medications, reviewed staff recruitment and training records, carried out a brief tour of the building and observed service users having lunch. Prior to the inspection eleven service user questionnaires were sent to Ings House to obtain service users’ views about living at the home. Six completed questionnaires were returned. Some service users in the home are very frail and may have difficulty completing a questionnaire. Relative surveys were sent out to eleven of the service users’ relatives or friends. When the inspector wrote this report seven of the relatives had responded. Other information used in the inspection process included notifications from the provider to the Commission for Social Care Inspection about deaths, illnesses, accidents and incidents at the home, copies of the monthly management visit reports produced by the provider and a pre inspection questionnaire completed by the provider and registered manager. The inspector would like to take this opportunity to thank everyone who participated in the inspection process. What the service does well:
Ings House Nursing Home DS0000001086.V314464.R01.S.doc Version 5.2 Page 6 Ings House continues to be a well run, well managed care home, providing nursing and personal care of a good standard. The home has a well established and experienced staff team who work hard to maintain standards of care in a friendly environment. One relative commented in the questionnaire, “This home is a welcome place where others are not.” Ings House gives prospective service users information about the home to help them make a decision as to whether they want to come and stay at the home. Before prospective service users are admitted to the home a member of staff also visits the prospective service user to assess their needs. This helps ensure the home and staff at the home can meet those needs. Service users and relatives who responded in questionnaires to the CSCI confirmed that they are happy in the home and that the home provides care of a good standard. One relative said there was “ very good care and support” provided. A service user said that they were, “ very happy. This is my home from home. All staff excellent-very caring”. Care records are generally clear and provided detailed information about the service user and how their needs are to be met whilst at Ings House. The care is regularly reviewed and service users and relatives are invited to attend annual review meetings at the home. Service users and relatives confirmed that service users receive the medical assistance and support they require. Medications are generally managed well in the home. However one recommendation has been made about recording medications in this report. Service users said they were happy and content and their privacy and dignity is maintained in the home. Social activities are offered in the home and contact with families, friends and the community are maintained. Service users said the meals provided are good and that there is a choice available. Visitors to the home confirmed that they are made to feel welcome and that they are offered hospitality. Most service users and relatives are aware of the complaints procedure. However, relatives and service users who spoke with the inspector said they were happy and had no reason to make a complaint. Generally the home was clean, tidy and well maintained. Service users and relatives confirmed in returned questionnaires that this was always the case. Service users and relatives confirmed that staff at the home are caring and that they listen to service users. There is an ongoing commitment to training and the home has above the recommended 50 of care staff with NVQ level 2. Ings House Nursing Home DS0000001086.V314464.R01.S.doc Version 5.2 Page 7 There are clear staff recruitment records that show the necessary checks and references have been carried out to help protect service users from unsuitable staff. The home is managed well and the standard of records held at the home is good. Information is clear and accessible. Quality assurance measures are in place and service users and relatives are asked to comment on the service provided by Ings House and the staff. Any issues identified are acted upon and the manager is keen to review practice and policies to ensure best practice is maintained. Records show that regular planned maintenance checks are carried out to help ensure the safety of service users and staff. What has improved since the last inspection? What they could do better:
Care should be taken to ensure movement and handling plans are specific to each service user and include specific information about the sling to be used if the service user is to be hoisted. Staff should record whether one of two tablets have been given when a variable dose is prescribed by the GP. Please contact the provider for advice of actions taken in response to this
Ings House Nursing Home DS0000001086.V314464.R01.S.doc Version 5.2 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ings House Nursing Home DS0000001086.V314464.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 Ings House Nursing Home DS0000001086.V314464.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): 3 and 6. No service user moves into the home with out having had their needs assessed and been assured their needs can be met. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Relatives and service users both in returned questionnaires and during conversation at the time of the visit confirmed that they had been provided with information about the home before admission. This helped them make the decision to come and stay at the home. Service users and relatives also confirmed that the manager and senior nurse from the home carried out a pre-admission assessment before formally offering a place at the home. A record of the pre-admission assessment carried
Ings House Nursing Home DS0000001086.V314464.R01.S.doc Version 5.2 Page 11 out is held on each service user’s file. This assessment process helps ensure that the home and the staff at the home are able to meet all the service user’s needs. Ings House does not currently offer intermediate care. Ings House Nursing Home DS0000001086.V314464.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): 7, 8, 9 and 10. Service users health, personal and social care needs are set out in an individual plan of care. Suitable risk assessments are carried out and monitored. Service users are able to make decisions about their lives with the support of staff. Medications are generally managed safely. Service users are treated with respect, their privacy and dignity is maintained by the staff in the home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each service users has an individual care plan. A sample of three care plans was read in detail.
Ings House Nursing Home DS0000001086.V314464.R01.S.doc Version 5.2 Page 13 Care plans are detailed and individual. They reflect personal preferences and wishes and provide care staff with the information they need to care for the service user’s health, welfare and social needs. Care plans are regularly reviewed and updated to reflect the changing needs of the service user. Risk assessments are routinely carried out and where necessary the help and support of other health care professionals and specialist is obtained. Service users and their relatives are included in the development of care plans. At least annually service users and their representatives are invited to attend a review of care with the staff in the home. During the visit it was noted that some movement and handling plans did not include specific information about which sling is to be if the service users is to be hoisted. This was discussed with the senior nurse, who agreed to add the information as soon as possible. It is a recommendation of this report that the information about which sling to use is added to all movement and handling plans. Medications are well managed. A sample was audited and most could be reconciled with records. However some medications are prescribed giving the option of one or two tablets to be administered. Not all staff have recorded whether one or two tablets have been administered. This means these tablets could not be account for. It is a recommendation of this report that staff make a clear record of the dose of medication given. Service users and relatives both in written responses in questionnaires and during conversation at the time of the visit confirmed that staff are kind and caring. Service users said they felt safe and that staff protected their privacy and dignity. Ings House Nursing Home DS0000001086.V314464.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Service users’ social, cultural, religious and recreational needs are being met; they are helped to maintain contact with their families and the local community. Service users are able to exercise some choice and control over their lives. Meals provided are varied. Meals are served in a pleasant environment and service users who need support receive the assistance they require. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Activities are offered in the home. Service users were seen taking part in activities during the visit. Some were reading, others listening to music and one was doing artwork. The activities organiser attends the home daily Monday to Friday and interacts well with the service users. There was a lot of laughter in the home on the day of the visit.
Ings House Nursing Home DS0000001086.V314464.R01.S.doc Version 5.2 Page 15 One service user commented about activities in the questionnaire, “ I don’t often join in (by my choice) But I am always asked.” Service users and staff advised that they had had an early Christmas party to coincide with the visit by two entertainers who the service users particularly enjoy. Photographs of the party indicated that everyone had had a good time. Links with the community are maintained through visits from various churches and the occasional visit from local school children and Brownie groups. Service users and relatives confirmed that they are always made to feel welcome at the home. Hospitality is offered. Several service users and relatives made mention of the friendliness of the staff. Service users confirmed that they are able to make choices in the home, such as when they get up in a morning and go to bed at night, what they have for meals, where and how they spend the day and what they wear. All service users who were asked or completed questionnaires said the meals provided are varied and very good. The lunch being served at the time of the visit looked and smelt appetising. Service users confirmed it was very good. Service users also confirmed if they do not like the meal offered an alternative is always provided. Ings House Nursing Home DS0000001086.V314464.R01.S.doc Version 5.2 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Service users and their relatives and friends are confident to make complaints and that these will be listened to and taken seriously. Service users are protected from abuse. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaints have been made since the last inspection. Service users and relatives both in returned questionnaires and during conversation at the time of the visit indicated that they were aware of the complaints procedure and would not hesitate to use it if required. They also indicated that they were happy and content in the home and with the care provided. One service user commented that they were “very happy. This is my “home” from “home”. All staff excellent-very caring” Staff are aware of the adult protection policy and procedure and training about this has been provided to staff with in the last 12 months. Ings House Nursing Home DS0000001086.V314464.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Service users live in a safe, well-maintained environment. The home is clean pleasant and hygienic. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the visit the home was clean, tidy and well maintained. Service users indicated in the returned questionnaires that the home is always clean and tidy. Since the last inspection some redecoration has taken place, some new curtains, carpets and bedroom furniture has been provided.
Ings House Nursing Home DS0000001086.V314464.R01.S.doc Version 5.2 Page 18 New “touch” bedside lights have been provided. These light up automatically when touched. New pictures depicting scenes in Yorkshire have been provided. The accommodation is of a good standard and comfortable. Liquid soap and paper towels are available throughout the home and alcohol hand wash dispensers have also been added to many hand wash areas. Ings House Nursing Home DS0000001086.V314464.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Suitable numbers of staff are employed. The staff receive induction and foundation training and are competent to work in the home. Staff recruitment policies and records protect service users. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Relatives in returned questionnaires indicated that they felt there was sufficient staff in the home to meet service users needs. Service users indicated that they get the support from staff that they need and that staff listen to them. One service users said they receive very good care and support. A relative also commented, “excellent care is given to both of my parents. The homes strength is their staff.” Training records show an ongoing commitment to training with in house training provided as well as training from external sources. Induction training is also provided and documented.
Ings House Nursing Home DS0000001086.V314464.R01.S.doc Version 5.2 Page 20 Since the last inspection good progress has been made with National Vocational Qualification (NVQ) training and the home now has 59 of its care staff training to NVQ level 2 or above. Exceeding the standard. A sample of recruitment records was audited during the visit and found to hold the necessary check and references required to help protect service users from potentially unsuitable staff. Ings House Nursing Home DS0000001086.V314464.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Service users live in a home with an experienced and competent manager of good character. The home is run in the best interest of service users. Service users financial interests are safe guarded. The health, safety and welfare of service users and staff are promoted and protected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Ings House Nursing Home DS0000001086.V314464.R01.S.doc Version 5.2 Page 22 Mr Woolford is the registered manager of the home. Since his appointment he has obtained the Registered Managers Award and an NVQ level 4 in care. Mr Woolford is an experienced manager; both service users and staff spoke of their confidence in Mr Woolford. Service users said they would discuss any problems or concerns directly with Mr Woolford. Quality assurance monitoring is well established in the home and since the last inspection regular thorough and detailed monthly management visits have been carried out and a report produced. An annual quality monitoring survey is carried out which includes service users and relatives. The results of the survey are made public and an action plan is developed to address any issues highlighted. The home does not hold any personal money on behalf of service users. If service users require any money it is supplied by the home. The home then recharges the amount to the service users monthly bill. No one at the home acts as an appointee for any of the service users. The manager continues to review and up date the homes policies. Currently the Adult Abuse, Health and Safety, Infection Control and Drugs policies are being reviewed. There is written evidence to show that the home carries out regular health and safety and maintenance tests and checks, as well as a general cleaning programme. Since the last inspection care has been taken to ensure weekly fire alarm tests and checks have been carried out weekly. Ings House Nursing Home DS0000001086.V314464.R01.S.doc Version 5.2 Page 23 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 2 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 Ings House Nursing Home DS0000001086.V314464.R01.S.doc Version 5.2 Page 24 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. 1. Refer to Standard OP8 Good Practice Recommendations Care should be taken to ensure movement and handling plans are specific to each service user and include specific information about the sling to be used if the service user is to be hoisted. Staff should record whether one of two tablets have been given when a variable dose is prescribed by the GP. 2. OP9 Ings House Nursing Home DS0000001086.V314464.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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
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