Inspection on 10/01/07 for Nayland House Care Home

This inspection was carried out on 10th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Nayland House Care Home 03/12/08

Nayland House Care Home 05/12/07

Nayland House Care Home 14/08/06

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

CARE HOMES FOR OLDER PEOPLE Nayland House Care Home Nayland House Off Bear Street Nayland Colchester Essex CO6 4LA Lead Inspector Deborah Kerr Unannounced Inspection 10th January 2007 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 Nayland House Care Home DS0000066407.V328759.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. Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nayland House Care Home Address Nayland House Off Bear Street Nayland Colchester Essex CO6 4LA 01206 263199 01206 264019 nayland.house@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited 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) Post Vacant Care Home 54 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (54) of places Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide care for one named person with a diagnosis of dementia (as named in application for variation dated 16th June 2006) 14th August 2006 Date of last inspection Brief Description of the Service: Nayland House is owned by Southern Cross Healthcare and is registered to care for 54 older people and one person over the age of 65 with a diagnosis of dementia. The home provides respite care as well as 24-hour long-term care. The home has been decorated and furnished throughout to a high standard. All bedrooms are for single occupancy. All areas of the home and surrounding gardens can be accessed via passenger lift, stairwells and ramps. The gardens and courtyards have been landscaped and planted to create places of interest throughout the year. The home has a Statement of Purpose, Service Users Guide and a Southern Cross Healthcare brochure providing information for prospective service users, these are available on request. The current fee to reside in the home is £571.38 per week. Further details about charges are available in the Statement of Purpose. Additional charges not covered by the fees include hairdressing, chiropody, manicures, toiletries, magazines and papers. Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over two days lasting a total of ten and half hours. This was a second key inspection for 2006/7, which focused on the core standards relating to older people and the progress made to address the 14 requirements set at the inspection in August 2006. The report has been written using accumulated evidence gathered prior to and during the inspection, including a complaint in December 2006 made to the Commission for Social Care Inspection (CSCI) regarding the provision of food and catering facilities. Time was spent talking with 10 residents, 5 staff, 2 visitors, the district nurse and chiropodist. The deputy manager, supporting manager from a sister home and the operations manger were available throughout the inspection. A number of records were inspected including those relating to residents, staff, training, medication, quality assurance and a selection of policies and procedures. What the service does well: What has improved since the last inspection? There continues to be a process of change at the home, the newly appointed manger resigned in September 2006. A new manager has been appointed and is scheduled to commence employment on the 22nd January 2007. Residents and staff spoken with said they are looking forward to the new manager starting. To improve communication between relatives and the home, weekly surgeries have been introduced, providing relatives with the opportunity to meet with the manager to discuss, issues, worries or concerns relating to the care of their relative. Fourteen requirements were made at the last inspection. Evidence was seen that their had been some improvements made regarding the implementation of revised care plans, completion of pre admission assessments, mealtimes and provision of a new medicine room. However there Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 6 were a significant number of requirements that have been partially or not fully addressed. What they could do better: Resident’s contracts need to be updated to reflect the terms and conditions of residence with Southern Cross Healthcare and reflect the current fees. The home needs to establish the number of residents that have developed the condition dementia whilst living at the home and provide evidence that they can continue to meet their needs. Where a resident has been identified as displaying some behaviour that can be challenging to others, a behavioural support plan needs to be completed to include agreed strategies for managing this behaviour. To protect residents from the abuse, all staff must have training in the protection of vulnerable adults. Supplementary records and progress notes in care plans must be used more effectively to identify interventions, which meet the health care needs of residents. The palliative care and end of life needs of the residents must be discussed and documented in their care plan, so that at the time of their death they are assured that staff will treat them and their relatives with care sensitivity and respect. Arrangements for risks that adversely affect the health and safety of residents, such as falls are identified and managed within the risk management framework. A check of the Medication Administration Record (MAR) charts reflects that staff must be more vigilant when recording and administering medication. Residents must be provided with opportunities for meaningful stimulation through daily routines, leisure and recreational activities, which suit their needs, preferences and capabilities. Particular consideration needs to be given to people with dementia and other cognitive impairments. Staffing levels must be reviewed regularly to ensure there is sufficient staff on duty at all times to meet the changing needs of the residents. In line with the recommendations made by the Environmental Health Officer (EHO) the cooker must be thoroughly cleaned and refurbished or replaced to ensure that the home has appropriate equipment to prepare and cook food. Moving and handling equipment and wheelchairs need to be stored appropriately when not in use and not left in bathrooms or corridors. Consideration should be given to providing information about the home in a format suitable for the people with a visual and/or other sensory impairments. Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 7 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. Nayland House Care Home DS0000066407.V328759.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 Nayland House Care Home DS0000066407.V328759.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. To ensure the home can meet their needs residents can expect to have an assessment of their needs undertaken, however they cannot expect to have an up to date contract of the terms and conditions of residence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and service user guide require updating with the names of the new manager and administrator. These documents accompanied by the home’s brochure provide detailed information about the services provided, including the complaints procedure. Consideration should be given to providing this information in a format suitable for the people with a visual and/or other sensory impairments. The contracts of two residents require updating to reflect the terms and conditions of residence with Southern Cross Healthcare and reflect the current fees. The contract of the third resident, who recently moved to the home, was not signed or dated. Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 10 A previous requirement was made for an assessment of residents needs to be completed prior to admission, including those for respite care. The deputy provided assessments for new admissions, respite and for a resident returning to the home following their discharge from hospital to identify changes in their care needs. The previous manager had raised their concerns that they had residents living in the home with dementia outside of their category of registration. They had begun the process of liaising with the local general practitioner (GP) to assess identified residents to obtain a formal diagnosis. A discussion with the operations manager identified that the number of residents who have developed the condition dementia whilst living at the home must be established and evidence provided to the Commission for Social Care Inspection (CSCI) confirming the home can continue to meet their needs. Discussion with residents and their relatives confirmed that they were given the opportunity to visit the home prior to making the decision to move into residential care. Nayland House Care Home DS0000066407.V328759.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 adequate. Residents can expect to have their health, personal and social care needs set out in a care plan, however they cannot always expect this plan to be appropriately implemented, monitored and updated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans of three residents were inspected to track the care and the level of support they required. New care plans have been introduced comprising of five sections, which cover the resident’s health, personal and social care needs. Information in these plans is detailed and sets out the objectives for the long and short term care needs of each resident. Each plan had a physical and social assessment completed identifying their general health, well being and identified where specific health needs required additional intervention. For example, one resident recently discharged from hospital diagnosed with eating and swallowing difficulties had assessments completed in relation to nutrition, pressure area care, moving and handling, continence and falls. Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 12 Information in the assessments stated that the resident required regular two hourly changes of position whether in their bed or in their wheelchair and that they required regular fluids. The supplementary health charts were not being used to record that these tasks were being completed. The progress notes were not being used effectively to monitor the residents’ health. Staff had documented at the beginning of October that a resident had a pressure area developing and that their gums were sore and bleeding requiring attention by a professional. There were no further entries until the beginning of November where the district nurse was contacted to address an open pressure wound and a mouth infection. Eight-days later the resident was admitted to hospital in a very poor state, dehydrated and with a pressure sore. A district nurse confirmed they have been visiting the home for a number of years and has seen the impact the changes of ownership, management and staffing have had on the home, which they felt had contributed to a deterioration in the level of care being provided. However they felt that the current staff team and additional training provided by the district nurses has had a positive effect and they have seen a decrease in the number of residents that are now requiring their attention. They confirmed that residents are provided with pressure relieving equipment either by the home or by the district nurses where more specialised equipment was required. They regularly audit the equipment provided to ensure that the equipment is being used for the resident for whom it was originally intended and that it is in good working order. An audit of the incident and accident log showed that between September – November 2006 there were fifty-four falls. Twenty-nine of these occurred in November. This was discussed with the supporting manager who agreed to look into the number of falls and to seek advice from a falls co-ordinator. A new medication room has been built and houses both medication trolleys and a small fridge. A new controlled drugs cupboard has been ordered and is to be installed within the medication room. The home uses the Monitored Dosage System (MDS). Each resident has an information sheet with their personal details, room number, GP and identified allergies. The Medication Administration Records (MAR) charts seen in association with the blister packs confirmed that medicines were being signed and administered in line with the home’s policies and procedures with the exception of one missed signature. Eye drops prescribed for a resident commencing 17th October were still in use on the 10th December 2006. The instructions on the box stated discard within four weeks after opening. The deputy and a senior member of staff conduct regular monthly medication audits. Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 13 Senior staff also undertake an audit of the controlled drugs at the end of each shift. This is to countercheck and sign to acknowledge the stock of controlled drugs for each resident. A check of one resident’s temazepam held against the entries in the controlled drugs book confirmed the records were accurate. Three residents currently self medicate and risk assessments are in place identifying the support they require to safely manage their own medication. However assessments were last updated in September 2006 and did not indicate how frequently these were reviewed to ensure residents are taking their medication correctly. Information held in the medication room confirmed that six senior staff had attended medication training in July 2006. Residents were observed being called by their preferred name and felt that staff respected their privacy. The interactions between residents and staff were observed to be friendly and appropriate. The revised care plans did not have information relating to the end of life needs of the residents. This was discussed with the operations manager that these issues need to be discussed with each resident and documented in their care plans, so that at the time of their death they are assured that staff will treat them and their relatives with care sensitivity and respect. Nayland House Care Home DS0000066407.V328759.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): 12,13,14,15, Quality in this outcome area is adequate. Residents can expect to live in a home that supports a lifestyle that matches their expectations, however residents with dementia and other cognitive impairments must be provided with opportunities for meaningful stimulation, which suit their needs, preferences and capabilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans identified specific goals to ensure that the daily routines of residents match their experiences and previous lifestyles. However, particular consideration needs to be given to the lifestyle of people with dementia and other cognitive impairments. A resident with a neurological degenerative condition and limited speech was observed being taken to the blue lounge where they were placed in front of television chat show about sexual relationships. Their care plan states that they love to be involved with activities in and around the home, attend communion, and that they will read the daily paper if provided and assisted. A church service had taken place in the conservatory during the morning, however the resident was observed sitting in the lounge all morning. Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 15 The activities co-ordinator has produced a newsletter of activities and events for January 2007. These included art sessions, flower arranging, cooking, communion, coffee mornings and a quiz night. There were also a range of films, jigsaws and word puzzles in the blue lounge and conservatory for resident’s to watch and do as and when they chose. Activities were advertised on a notice board in the entrance hall, these were in large print and picture format. This format was discussed with the activities co-ordinator to develop the newsletter to include photographs, large print and colour to make it easier for people with sensory impairments to read. Comments on what it was like for residents to live in the home included “It is not bad living here, I get everything I need”. Another commented, “I receive wonderful care”. Residents spoke of having to wait for their call bells to be responded to. One residents call bell was monitored and it took 15 minutes before staff responded. Discussion took place with the supporting manager and operations manager about staffing levels and that these must be reviewed regularly to ensure there is sufficient staff on duty at all times to meet the changing needs of the residents. Residents confirmed they are able to maintain contact with family and friends. Many of the residents have their own telephones in their room. There is also a public telephone available. The visitor’s book reflected there are regular visitors to the home and relatives were seen visiting during the inspection. The home does not act as appointee for any residents, residents either manage their own money with the support of their families or have a power of attorney to manage their finances. Residents are given the option of having a small amount of personal money held by the home for safekeeping. Their cash is held in a money wallet in the safe and the administrator keeps a record of all transactions. Two residents monies were checked against the records and were found to be accurate. Residents have a lockable draw in the rooms for small personal items of value. The cook discussed the preparation and provision of food. They confirmed they were aware of the individual needs of residents. A white board listed special diets, such as soft or liquefied foods, allergies and diabetics. A diabetic alternative, fresh fruit and yoghurts are always available. Menus are provided to residents to enable them to make choices about their meals. For residents with dementia or other cognitive impairments discussion took place about providing photographs or pictures of food so that they are able to make informed choices about their meals. Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 16 Meals are served in a choice of two dining rooms; alternatively residents can choose to have their meals in their rooms. Lunch consisted of beef curry and rice, fish or Stilton pasta bake accompanied by vegetables, followed by apple and peach pie. The food seen looked appealing and appetising. Residents spoken with commented “exceptionally good food” and “food is terrific”. The home has recently conducted a survey about the quality and provision of food within the home. The results are reported in the management and administration section of this report. Contents of the fridges and freezers showed a range of fresh and frozen foods provided by a local company and information provided prior to the inspection confirmed that the home buy in fresh fruit, vegetables and meat from local suppliers. Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 17 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): 16,18, Quality in this outcome area is adequate. Residents can expect to have their complaints listened to and responded to however; they cannot expect to be protected from abuse until all staff have attended training for the protection of vulnerable adults. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is on display at various places around the home. However some still refer to Ashbourne Healthcare and the print is very small making it difficult for residents with a visual impairment to read. Residents spoken with felt they could discuss any concerns directly with the home’s manager. The complaints log confirmed there have been five complaints made about the conduct and management of the home since the last inspection in August 2006. The operations manager confirmed two of these complaints had been referred to them as these related directly to the previous manager. The three other complaints have been investigated and the letters sent to the complainants. To improve communication between relatives and the home, weekly surgeries have been introduced, providing relatives with the opportunity to meet with the manager to discuss, issues, worries or concerns relating to the care of their relative. A requirement was made at the last inspection for all staff to access training for the protection of vulnerable adults in order to recognise and report allegations of abuse. Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 18 Information provided confirmed that 30 of the 44 staff currently employed have attended Resident Welfare training in August and October 2006. The home has a detailed Protection of vulnerable adults procedure, which reflects the Suffolk inter agency policy of June 2004 and includes information of the homes whistle blowing procedures. Accident reports refer to a resident displaying aggressive behaviour towards staff twice on the same day. Both incidents state the resident’s behaviour has changed and should be referred to the GP for an assessment. However in both cases no appointment was made. Progress notes recorded following one of these incidents staff had left the resident to calm down and returned to attend to their needs later. There is no behavioural support plan in place, which looks at the reasons for the change in their behaviour or agreed strategies of how staff are to manage this behaviour. Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 19 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): 19,20,21,22,24,25,26, Quality in this outcome area is excellent. Residents can expect to live in a home that is decorated and presented to a high standard, which is safe, comfortable and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is set in grounds made up of individual gardens and courtyards, landscaped and planted to provide areas of interest throughout the year. The décor inside the home is fresh, bright and clean creating a homely atmosphere. There are a few minor maintenance issues, which need to be addressed, the exterior paintwork on the windowsills is flaking and a broken window currently boarded over needs replacing. On the ground floor there are two dinning rooms, two lounges and a conservatory, offering comfortable seating areas with televisions and a video. Each resident has their own bedroom, with en-suite toilet and washing facilities. Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 20 Residents confirmed they are able to bring their own personal items, photographs and furniture. Rooms looked comfortable and personalised to meet their individual tastes. Additionally there are 7 large communal bathrooms with showers, for both assisted and unassisted bathing. Baths have been fitted with optional Jacuzzi-style, hydro-massage features. Fixtures and fittings in and around the home are domestic in nature and of good quality. Residents were observed walking freely around the home making use of all the different seating areas in lounges and corridors. The majority of the residents are mobile and can move around independently, with walking aids. Corridors are wide to accommodate residents whom use a wheelchair and or other mobility equipment. Handrails are fitted in some areas. Residents were observed wearing pendants linked to the nurse call system for them to ring for assistance in an emergency. Equipment to meet the needs of the residents had been provided, mobile hoists were observed being used to transfer residents where required. Moving and handling equipment and wheelchairs need to be stored appropriately when not in use and not left in bathrooms or blocking routes in corridors to fire exits. Conversation with the operations manger confirmed the home is considering making an application to their conditions of registration to provide a dementia care unit within the home. The operations manager accompanied the inspector to view the layout of the building and the area, which they felt could be made into a separate unit and create a safe environment for the residents but still be integrated within the home. Information regarding dementia care settings and the use of assisted technology was given to the operations manager for guidance of how to manage the risks to residents health and home environment should they proceed with their application. The premises, on the day of inspection were clean and hygienic and free from offensive odours. The laundry room was clean and tidy. The management of dealing with laundry and foul linen meets the department of health guidelines. Domestic staff spoken with confirmed they had received training for the Control of Substances Hazardous to Health (COSHH). Liquid soap dispensers and paper towels are situated in all the bathrooms and staff have access to disposable gloves and aprons. Random checks of water temperatures were made in three of the bathrooms and all were found to be within the required 43 degrees centigrade. Evidence was seen that temperatures were being recorded each time the bath was being used. Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 21 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 adequate. Residents can expect to be protected by the home’s rectruitment porcedures, however until dependency levels of residents and staffing hours are reviewed, residents cannot be assured that there are sufficient staff rostered each day to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Based on information provided on the staff rotas, staffing levels have reduced over the past two years from 48 staffing hours for the morning shift and 40 hours for the afternoon shift, to 36 hours in the morning and 30 hours in the afternoon. Occupancy has reduced from 47 to 37 over the same period; this is a slight reduction in hours per resident. Discussions with residents indicated that staffing levels do not always meet their needs. One resident spoke of staff “flitting in and out” and another resident suggested that the needs of the residents in general have increased requiring more care and assistance from staff and that they find they are having to wait longer. The response time to call bells was monitored and in one incidence took up to 18 minutes for the call bell to be responded to. This was discussed with the operations manager and support manager. A review of staffing levels and routines in conjunction with the residents’ dependency levels must be undertaken on a regular basis to ensure that there is adequate staff rostered to meet residents needs. Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 22 Staff files seen confirmed the home generally operates a thorough recruitment process, which includes obtaining all the appropriate paper work including Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks and in the case of overseas workers work permits and police checks. However, one employee’s file did not have an application form. Staff are issued with a handbook, which contains information about their terms and conditions of employment and professional code of conduct. Training records and files confirmed some training has taken place. Six care staff have obtained National Vocational Qualification (NVQ) at level 2 and a further four are currently working towards completion. Only 23 currently hold an NVQ. Once the other four staff have completed this will give a total of 38.46 of staff holding a recognised qualification, which does not meet the recommended ratio of 50 of the National Minimum Standards. A trainer tracker confirmed that some staff had attended training in moving and handling, food hygiene, resident welfare and fire safety. A notice was displayed to the remaining staff confirming they were required to attend these training sessions and all staff to attend health and safety. A series of dates for moving and handling had booked through January 2006. Dates for the other training were to be confirmed. Additional training to meet the specific needs of residents has included diabetic awareness, resident welfare and a certificate in the provision of activities in the care setting. A member of staff has also attended supervision training. Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 23 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): 31,32,33,35,38, Quality in this outcome area is adequate. Residents can be assured that the home is run in their best interests however cannot currently expect to have their health, safety and welfare protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There continues to be a process of change at the home, the newly appointed manager resigned in September 2006. Another person has been offered the post and is scheduled to commence employment on the 22nd January 2007. In the interim the manager of a neighbouring Southern Cross home and the operations manager are supporting the deputy manager to manage the home. The home has a new administrator; both the deputy and administrator confirmed they had been well supported in their roles. Staff spoken with felt the deputy has been managing the home well and that they are approachable and supportive. Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 24 Evidence was provided confirming the home has a system of continuous quality assurance and monitoring. The operations manager visits the home monthly to review the services and facilities being provided. Following their visit an action plan is agreed with the manager. An inspection evidence file has been implemented to identify each requirement and recommendation made following the most recent inspection by the CSCI. The documentation has been developed for the manager to provide evidence of the action taken to meet the requirements. Customer surveys are issued to residents and relatives’ to obtain the views about the service they receive. Residents and relatives are invited to attend regular meetings and weekly surgeries have been introduced for relatives to voice any issues, worries and concerns about the care of their relative. A recent residents’ survey regarding the provision of food confirmed a mixed response. Overall residents were happy with the quality of food, however provided suggestions of additional dishes they would like to see on the menu. Other issues raised was that the food was not always hot or sweet enough, there was not always enough gravy or seasoning and that they would like a better use of herbs and spices. One resident commented as a diabetic they would like more variety. The administrator manages small amounts of money for approximately twenty residents. They liaise with family members to ensure that the resident has sufficient funds in their wallet for personal items. The administrator keeps a record of all transactions. Incident and accident reporting forms are not being completed correctly. In the case of two incidents staff entered information about themselves instead of the residents involved and in the first instance looks like staff had been aggressive to a resident. Further exploration into the incident reflected the residents had been verbally and physically aggressive to the staff on both occasions. A number of concerns were raised with CSCI prior to Christmas regarding the cooking arrangements and facilities. The cooker had broken and out of action for seven weeks. Concerns were raised about the process of food being brought into the home from the sister home based in Great Horksley and the process of reheating food. The home did make arrangements to hire a cooker for the Christmas period. A request was made for an Environmental Health Officer (EHO) to visit the home to investigate these concerns. The EHO was satisfied that the process of transporting and provision of food met with food safety standards, but recommended that the cooker and extraction filter are refurbished and thoroughly cleaned. Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 25 The EHO report also refers to the poor design and layout of the kitchen, which makes it difficult for staff to keep some areas clean and free of food debris. Time was spent talking with the cook who confirmed that the cooker is due to be serviced and that the oven is now working; however two of the gas rings are not working properly. The EHO report also raised some concerns about the storage of food and recommended the home use the Safer Food Better Business pack. This provides information and documentation to help monitor the Hazard Analysis Critical Control Points (HACCP), which relate to the safe storage, preparation and provision of food. The cook provided evidence that they were keeping records of fridges and freezer temperatures and the temperature at which food is served. The kitchen door was being wedged open with a large tin of grapefruit. This was pointed out to the cook, as this practice was also raised as a safety issue at the last inspection visit. The fire logbook contained a generic risk assessment. However there was no date or signature of the person completing this assessment to reflect how current and effective the risk management strategies are. The logbook had not been completed since 14th December therefore it was not clear that weekly fire safety checks were being completed. There was no record of fire drills, however the supporting manager confirmed that the fire alarm had sounded on the morning of the second day of the inspection and this was treated as a fire drill. Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 26 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 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 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 X 18 2 4 4 4 2 X 4 4 4 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 2 Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 27 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 OP2 Regulation 5 Requirement The registered manager must ensure resident’s contracts are updated to reflect the terms and conditions of residence with Southern Cross Healthcare and reflect the current fees. The registered manager must make arrangements for risks that adversely affect the health and safety of residents, such as falls are identified and managed within the risk management framework. The home must ensure that where care plans identify planned interventions, to meet specific health needs of the residents these are recorded and monitored and where concerns arise advice is sought from health care professionals. The registered manager must make arrangements for the recording and safe administration of medicines in the care home. This is a repeat requirement from 03/11/05 and 14/08/06 DS0000066407.V328759.R01.S.doc Timescale for action 28/02/07 2. OP7 13 (4)(b) (c) 28/02/07 3. OP8 12 (1-3) 28/02/07 4. OP9 13 (2) 11/01/07 Nayland House Care Home Version 5.2 Page 28 5. OP11 12 (3) 6. OP12 16 2 (n) 7. OP18 15 8. OP18 13 (6) 9. OP22 18 (1)(a)12 13 (c ) 10. OP22 13 (4) (a)23 (2( (l) (n) The registered manager must make sure the palliative care and end of life needs of the residents are documented in their care plan so that they are assured at the time of their death staff will treat them and their relatives with care sensitivity and respect. This is a repeat requirement from 03/11/05 and 14/08/06 The registered manager must make sure that residents with dementia and other cognitive impairments are provided with opportunities for meaningful stimulation, which suit their needs, preferences and capabilities. Where the behaviour of an individual has been identified as challenging to others, the registered manager must develop a behavioural support plan which includes agreed strategies for managing this behaviour. The registered manager must ensure that all staff have training to prevent residents from suffering abuse or placed at risk of harm or abuse. This is a repeat requirement from 03/11/05 and 14/08/06 The registered manger must ensure that staffing levels and routines are reviewed to ensure that residents call bells are answered within acceptable time limits. This is a repeat requirement from 14/08/06. The registered manager must ensure that all parts of the home must be free from hazards for the safety of the resident’s, which includes making suitable DS0000066407.V328759.R01.S.doc 28/02/07 28/02/07 09/02/07 28/02/07 09/02/07 11/01/07 Nayland House Care Home Version 5.2 Page 29 provision for storage of wheelchairs and equipment so that they are not stored in corridors and bathrooms. This is a repeat requirement from 14/08/06. 11. OP27 18(1)(a) A review of staffing levels in conjunction with the residents’ dependency levels must be undertaken to ensure that there are adequate staff rostered to meet needs. This is a repeat requirement from 14/08/06. 28/02/07 12. OP29 19 1(b) Sch 2 The registered manager must 11/01/07 not employ a person at the home unless they have obtained in respect of that person the information and documents specified in paragraphs 1 to 7 of Schedule 2 of the Care Homes Regulations. The registered manager must have with regard to the size of the care home and the number of residents adequate facilities for the preparation and storage of food. This must include refurbishment and thorough clean of the cooker and extraction filter. The registered manager must take adequate precautions against the risk of fire, testing fire equipment at suitable intervals and for reviewing fire precautions. The registered manager must make sure that incident /accident reports are completed accurately, which includes information specified in Sch 3 of the Care Homes Regulations. DS0000066407.V328759.R01.S.doc 13. OP38 16 2 (g) 28/02/07 14. OP38 23 (4) (c) (v) 11/01/07 15. OP38 17 1 (a) Sch 3 28/02/07 Nayland House Care Home Version 5.2 Page 30 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 OP1 Good Practice Recommendations Consideration should be given to providing information in a format suitable for the people with a visual and/or other sensory impairments. Residents who have been assessed as able to selfadminister their medication should be regularly reviewed (which is evidenced) to ensure they are confident to continue this. 50 of staff should be trained at NVQ level 2 and should complete the induction and foundation training in line with Skills for Care, Common Induction Standards within twelve weeks of employment. 2. OP9 3. OP28 Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Nayland House Care Home DS0000066407.V328759.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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