Inspection on 20/07/07 for Ivelhurst Nursing Home

This inspection was carried out on 20th July 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ivelhurst Nursing Home 22/02/07

Ivelhurst Nursing Home 06/10/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Ivelhurst Nursing Home Ivelhurst Nursing Home 27 Preston Road Yeovil Somerset BA21 3AD Lead Inspector Shelagh Laver Unannounced Inspection 09:30 20th July 2007 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 Ivelhurst Nursing Home DS0000066074.V341896.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. Ivelhurst Nursing Home DS0000066074.V341896.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ivelhurst Nursing Home Address Ivelhurst Nursing Home 27 Preston Road Yeovil Somerset BA21 3AD 01935 426777 01935 415777 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) Ivelhurst Nursing Home Ltd Position Vacant Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Ivelhurst Nursing Home DS0000066074.V341896.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Elderly persons of either sex, not less than 60 years, who require general nursing care Up to two persons, of either sex, between the ages of 50-60 years, who require general nursing care 22nd February 2007 Date of last inspection Brief Description of the Service: Ivelhurst is a well established care home providing both personal and nursing care for older people. The home can also provide nursing care to up to two younger people. The home was purchased in January 1988 by the current owners. There are arrangements to provide care for service users funded by both social and health services. It became a registered company in March 2006. The responsible individual for the company is Mrs Ada White who is also company director. Eight new rooms were commissioned in 2006 and fitted and furnished to a high standard. Ivelhurst is a large traditional building situated in a residential area in Yeovil. The home provides nursing for up to 34 service users and at least one trained nurse is always on duty. The accommodation consists of a large lounge that leads to a paved area and two smaller communal areas . There are seven rooms in the old building that have en-suites. All eight single bedrooms in the extention have en-suites. Ivelhurst Nursing Home DS0000066074.V341896.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. In the past twelve months this established home has experienced problems with management and care delivery. There has been a period of uncertainty that has now resolved. A new manager Cheryl Stratton was appointed in November 2006 and an action plan to improve standards in the home was formulated. The home has been improving steadily in all areas since this appointment. A random inspection carried out on 22/05/07 saw improvements in personal care, staff supervision and activities. At this last inspection there was still work to be done on the new care planning system. Care plans seen at this key Inspection were of a good standard. An example of the manager’s auditing of plans was seen to be robust and detailed. Two inspectors undertook this Key inspection. The visit lasted six hours. Inspectors walked around the home and talked with people in their rooms and in the dining room and sitting room. They spoke to the manager and staff. The records required were supplied by the manager who was available to answer all questions. Prior to the inspection the manager had completed an Annual Quality Assessment Audit (AQAA) that provided information about the service. Nine comment cards received from people in the home confirmed that people received the help and support they needed and that staff listened to them. One comment completed by a friend of a service user described in detail the changes that had occurred in the home over the past year and how that had improved the life of the people in the home. It was good to see that when people had received help to fill in the comment cards the name of the staff who provided assistance was noted. People told the inspectors about care at the home. All were pleased with their in the home. “Staff are kind.” One newly admitted person said “It is beautiful here. Staff are polite.” Another said “It is not like my old home but people are kind and the food is very good….Staff always come if you ring the bell. They are very good.” One relative came to see the inspectors to say how very pleased she was with the care her mother was receiving. Ivelhurst Nursing Home DS0000066074.V341896.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The new care planning system has been implemented and staff have been trained to use it. A key worker system has been introduced. Registered nurses use management systems to monitor care and monitoring of people. Nurses are clear of their responsibilities with regard to peoples care. Ivelhurst Nursing Home DS0000066074.V341896.R01.S.doc Version 5.2 Page 7 The home has two monthly meetings for people in the home. All hallways have been recarpeted. Outside space has been developed providing a pleasant secure garden. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ivelhurst Nursing Home DS0000066074.V341896.R01.S.doc Version 5.2 Page 8 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 Ivelhurst Nursing Home DS0000066074.V341896.R01.S.doc Version 5.2 Page 9 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): 1 2 3 4 5 Quality in this outcome area is good. All people are assessed prior to admission. There is a range of information available for service users and their representatives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The brochure produced by the home uses out dated photographs. The fees range from £504 to £675. The manager is experienced at undertaking assessments. Assessment documentation was seen in care plans. There is a procedure in place that includes visits and the use of professional information. People are welcome to visit the home prior to admission and some people will come to the home for a short stay before moving on as their health improves. The manager has recently undertaken an admission without a visit using Ivelhurst Nursing Home DS0000066074.V341896.R01.S.doc Version 5.2 Page 10 telephone information. It was clear she had used all possible sources of information to gain a view of the persons’ needs. One comment card said “my mother was admitted straight from hospital....but we were shown round and advised that my mother could move later….the staff were helpful and caring and she settled well.” Ivelhurst Nursing Home DS0000066074.V341896.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 11 Quality in this outcome area is good. Personal care is planned and delivered in a manner that meets peoples’ needs with respect and kindness. Medication practice is sound. Service users have access to appropriate healthcare professionals This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new system of care planning has been embedded. There was evidence that fluid and nutritional intake is monitored and that action is taken to prevent pressure damage. People seen during the inspection appeared comfortable and looked well presented. Nurses on duty during the inspection were knowledgeable and up to date with people’s needs and treatments. Three care plans were seen. These included risk assessments for mobility,falling and tissue viability. Plans are now audited by the manager. There was evidence of regular up-dating. Ivelhurst Nursing Home DS0000066074.V341896.R01.S.doc Version 5.2 Page 12 There was evidence that care plans are discussed with relatives and service users. There were recorded doctors’ visits and evidence of reviews. Medication administration indicated a generally safe system. Controlled drugs records were accurate. Variable doses are recorded. Hand transcribed prescriptions should have two signatures. There are charts in peoples’ rooms that show creams are applied regularly. Staff were seen to treat people with kindness and respect. There was evidence that some peoples’ health improves in the home. One relative said “They have got my mother walking again. They couldn’t be kinder.” Staff were seen to knock at doors and address people appropriately. The inspectors saw cards sent to the home thanking staff for care at the end of peoples’ lives. There were thanks for “the care and kindness you showed my mother during the last weeks of her life.” Another card mentioned “kind and supportive gestures to the family.” Ivelhurst Nursing Home DS0000066074.V341896.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. People to make choices about their day-to-day lives. Visitors are always made welcome in the home. There is choice at meal times and people eat in pleasant dining rooms. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People now have access to two sitting rooms and a choice of dining areas. One relative came to tell inspectors how she enjoyed bringing her mother to the small sitting room. This room opens onto the garden where the raised beds had been planted by people in the home. The home has been trying to develop the activities available for people in the home. There have unfortunately been changes in co-ordinators but there are now opportunities for socialisation. The current activities co-ordinator is imaginative and supported by the manager. There are quizzes and bingo and when possible individual activities. There are events planned for the summer including a fete and trips out. A “daily anagram” encourages competition and interest. The activities co-ordinator is gradually recording social activities preferences in care plans although these are all completed yet. People spoken with confirmed Ivelhurst Nursing Home DS0000066074.V341896.R01.S.doc Version 5.2 Page 14 that they could chose how they spent their day. People are encouraged to come to the sitting room or dining room for part of the day. On the afternoon of the inspection a small group of people were making a fruit salad for their tea. There is a choice of meals and one person said “if we say we don’t like the meal or just don’t fancy much there will be something else.” Not everyone was as pleased and the manager agreed that the first bi-monthly survey two monthly survey would be on food in order to gain everyones’ views on the menu offered. There was praise in two comment cards for the home-made cakes and puddings. Ivelhurst Nursing Home DS0000066074.V341896.R01.S.doc Version 5.2 Page 15 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 18Quality in this outcome area is good. There is a complaints policy that is clearly written and is accessible to service users and visitors. Formal complaints are addressed and actions recorded according to policy. Managers of the home are aware of the appropriate procedures to be taken to protect service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has policies and procedures in respect of recognising and reporting abuse, making a complaint and whistle blowing. Since the last inspection the home has received one complaint. The manager responds promptly to concerns and ensures that complaints are fully investigated. Service users stated that they would be comfortable to approach the manager or a member of staff if they had any concerns about their care. Ivelhurst Nursing Home DS0000066074.V341896.R01.S.doc Version 5.2 Page 16 All new staff are checked against the POVA register before they commence work and undergo an enhanced Criminal Records Bureau (CRB) check. 9 comment cards received from staff confirmed that they had received Protection from Abuse training. The manager should ensure that all staff are aware of the up-dated Somerset Safeguarding Adults and that appropriate training is provided to key staff. Ivelhurst Nursing Home DS0000066074.V341896.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): 18 20 21 22 23 24 25 26 Quality in this outcome area is good. People live in a clean and comfortable environment that meets their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has been refurbished this year including redecoration and new carpets. A tour of the building showed a pleasant environment for people with further improvements to bathrooms planned in the future. Housekeeping staff maintain a high standard of cleanliness. Communal rooms are comfortably furnished. Bedrooms are personalised. There is an attractive garden with raised beds and seating. Ivelhurst Nursing Home DS0000066074.V341896.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. Staffing levels in the home are appropriate to the needs of the service users. Training opportunities are good, giving staff the skills to meet the needs of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Duty rotas showed that there were sufficient staff on duty. There is always at least one trained nurse on duty. There is a comprehensive range of training available for staff. Over the past months there has been training and appraisal. There is a clear training plan for all care and support staff. Staff have already received training in the care planning system, tissue viability and an accredited “Medicines in Care homes” course. All permanent care staff have undertaken manual handling up-dates. All food handlers have had food hygiene training. Staff on duty were able to describe the training they had received recently. Topics planned for the rest of 2007 include infection control, nutrition and person centred approach to care. All are linked to improving outcomes for people. Three staff files were reviewed. There was evidence of sound recruitment practice however one file contained only one reference that could be seen. Of the 20 permanent care staff in the home 6 hold NVQ 2 or equivalent qualifications and 7 are working towards their qualifications at the moment. Ivelhurst Nursing Home DS0000066074.V341896.R01.S.doc Version 5.2 Page 19 7 comment cards received from staff confirmed that they induction and supervision was adequate and that all had received manual handling training. Ivelhurst Nursing Home DS0000066074.V341896.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. There is a clear management structure in the home leading to clear lines of responsibility. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager Cheryl Stratton was appointed in November 2006 with the appropriate qualifications and experience to run the home. She has been able to implement changes and improvements in the running of the home and improve outcomes for people in the home. Ivelhurst Nursing Home DS0000066074.V341896.R01.S.doc Version 5.2 Page 21 Minutes of meeting were seen confirming good attendance. There are two monthly residents meetings. There are meetings for the management team, nightcarers and relatives. There are plans to implement two monthly questionnaires on key issues as part of the quality assurance plans. There was evidence of health and safety maintenance. All servicing records reviewed at the home were up to date. Lifts and hoists had been serviced according to LOLER regulations. There are fire prevention and safety systems in place in place in the home. Staff training, alarm and emergency lighting checks and fire extinguisher servicing records were all clear and current. Fire drills are held regularly. Ivelhurst Nursing Home DS0000066074.V341896.R01.S.doc Version 5.2 Page 22 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 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 3 3 3 3 3 3 3 Ivelhurst Nursing Home DS0000066074.V341896.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 7 9 19 Requirement The manager must ensure that two references are in the staff file prior to commencing employment. Timescale for action 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations The activities co-ordinator should receive support to access training and resources in order to further develop the social provision in the home. 50 of care staff should have a National Vocational Qualification in care at level 2 or above. 3. 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