Inspection on 14/08/06 for Nayland House Care Home

This inspection was carried out on 14th August 2006.

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 10/01/07

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 Seddon Unannounced Inspection 14 August 2006 10:00 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.V304503.R02.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.V304503.R02.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 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) www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited 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.V304503.R02.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) 3rd November 2005 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, and have their own toilet and wash hand basin, 3 have a shower. There are 7 large bathrooms with showers, for both assisted and unassisted bathing. Baths have been fitted with optional Jacuzzistyle, hydro-massage features. Corridors are wide and airy, with handrails fitted in some areas. The ground floor has 2 dining rooms, 2 lounges and a large conservatory. 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.V304503.R02.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 nine and three quarter hours. This was a key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection. This included the pre inspection questionnaire, nineteen residents ‘Have your say’ and one relatives/visitors comment cards and reviewing the progress of the requirements made at the last inspection in November 2005. Additionally a number of records held at the home were looked at including those relating to residents, staff, training, medication and health and safety records. Time was spent talking with the manager, administrator, district nurse, eight residents, three relatives of residents visiting and three staff. The operations manager arrived and spent time with the inspector and manager during feedback at the end of the inspection. What the service does well: What has improved since the last inspection? There have been substantial changes at the home since the last inspection of November 2005. Southern Cross Healthcare has purchased the home and the previous manager retired. A new manager Mrs Jan James has been in post since June 2006. Residents and relatives spoken with have been concerned about the deterioration in the service being provided at the home, however were confident that the new manager was working hard to improve the quality of the service. Eleven requirements had been made at the last inspection. Evidence was seen that their had been some improvements made. The statement of purpose and service user guide now contains information about the complaints procedure. Complaints have been investigated and the outcomes reported back to the complainants. Staff have attended adult protection training and staff files reflect that all necessary paperwork had been completed prior to commencing employment. Nayland House Care Home DS0000066407.V304503.R02.S.doc Version 5.2 Page 6 Assessments identifying health and safety risks have been completed. However there has been little improvement with the implementation of care plans and administration of medication. 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. Nayland House Care Home DS0000066407.V304503.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nayland House Care Home DS0000066407.V304503.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5,6, Quality in this outcome area is adequate. Prospective residents can expect to have detailed information about the home, however people moving into the home cannot expect to have a full assessment of their needs undertaken. This judgement has been made using available evidence including a visit to this service. The service does not offer intermediate care. EVIDENCE: A copy of the Statement of Purpose and Service User Guide were available in the entrance to the home, which provides good detailed information about the services provided in the home, including the complaints procedure. Each resident has been issued with a copy of the new Service User Guide reflecting ownership by Southern Cross. The home has recently admitted a resident with very limited sight; consideration should be given to providing information in a format that they can read. Each resident is issued with a contract stating the terms and conditions of residence; evidence was seen that these had been signed and dated by the resident or their representative. A copy of a contract for a new resident recently moved to the home was seen, the original copy was with their power of attorney to sign and return on their behalf. Nayland House Care Home DS0000066407.V304503.R02.S.doc Version 5.2 Page 9 The care plans of three residents were inspected to track their care and the level of support they required. The pre-admission assessments for one resident had been partially completed, but had not been signed or dated by the person completing the assessment. The two other residents had no pre admission assessment in place. New care plans are in the process of being introduced and are at various stages of completion. At the front of the care plans there is a section for physical and social assessment. This section is aimed at covering the residents needs in more detail as highlighted in the pre admission assessment. One resident who had stayed at the home for respite care on a previous occasion has chosen to move to the home on a permanent basis. Their previous assessment had shown their mobility as a low risk, however an entry in the daily living notes described their mobility as deteriorating, the new assessment did not reflect this. Discussion with residents and their relatives reflected that they had the opportunity to visit prior to making the decision to move into the home. One resident informed the inspector they had visited and had decided to move to Nayland House, as it appeared to be like a ‘hotel for the elderly’ with no unpleasant odours. The manager had raised their concerns prior to the inspection that they had residents living in the home with dementia outside of their category of registration. They are in the process of liaising with the local general practitioner (GP) to assess identified residents for a formal diagnosis. They have been advised by the Commission for Social Care Inspection (CSCI) that following the assessments they must make an application for a variation to their registration with the names of the residents with dementia. They must also provide a Statement of Purpose and Serve User Guide, which reflect the number of people with dementia living in the home and details of staff training to how they intend to meet the needs of the residents. The home does not provide intermediate care, however they do provide respite for people who need time to convalesce after illness or surgery or who may need a break. Nayland House Care Home DS0000066407.V304503.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11, Quality in this outcome area is adequate. Residents do not have care plans that accurately reflect their care needs, however they can be assured that they will be supported to have access to healthcare professionals. Residents cannot expect to be protected by the home’s procedure for storage and administration of medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: New service user care file index care plans were introduced in June 2006. Three residents plans were inspected, various sections relate to the residents health, personal and social care. Plans consist of a front page, physical and social assessments; care plan, risk assessments and supplementary observations. The front sheet has a space for the residents photograph although none of the plans had a photograph in place on the day of the inspection. All three residents plans had a physical and social assessment completed identifying the resident’s needs in relation to pressure area care, dependency, moving and handling, nutrition, continence and falls. Each topic is assessed using a score rating, for example high, medium or low and is accompanied by a risk assessment where there is a high score. Nayland House Care Home DS0000066407.V304503.R02.S.doc Version 5.2 Page 11 Two residents had parts of the care plan sections completed, which set out aims and objectives to eliminate factors, which would result in pressure sores. However, the care plan section for the third resident was blank. One resident’s physical and social assessment recorded they had a history of aggression and repeated urinary infections. The plan noted that being incontinent and uncomfortable often triggered their aggression. Although they had a risk assessment and a plan identifying actions staff should take, their condition was not being monitored. The supplementary section was missing, there was no observation sheets being completed, for example fluid input and output chart, elimination chart and a behavioural management plan Relatives spoken with during the inspection raised their concerns about the level of personal care. One person’s spouse had not had a bath for six weeks and another person commented when visiting their relative had noticed they had been given a pot of tea, which they had been unable to pour which had gone cold. The personal needs should be reflected in the care plan with regard to frequency of bathing and assistance required to eat and drink. Relatives were not aware of the care plans, the manager informed the inspector that they would be inviting relatives to meet and have input to review the new care plans. An area the home does well is to recognise and support residents to access the general practitioner (GP) and other health professionals. Evidence was seen during the inspection that two residents were unwell and a home visit by the GP had been requested. Another resident spoken with told the inspector they were waiting for transport to take them to hospital for a routine check-up. The manager informed the inspector that an appointment has been arranged a resident with the condition Parkinson’s disease to see the Parkinson nurse for a reassessment of their condition and medication. The district nurse and continence advisor both visited during the inspection to attend to the health needs of the residents. A referral for one resident had been made to the Ear, Nose and Throat (ENT) consultant at the hospital to investigate hearing problems, however the resident had declined the treatment. The manager has instigated a register for contact with the GP; two entries were seen for appointments requesting referrals to the Community Mental Health Team (CMHT) due to changes in their behaviours and other routine appointments with the nurse practitioner. The accident book and analysis for July 2006 showed that forty incidents of residents falling had been recorded. Thirty incidents were recorded for the same resident. The manager explained that the resident’s health has been deteriorating and they have a nursing needs assessment arranged with a view to supporting the resident and their family to finding an alternative nursing home placement. The manager informed the inspector that they had contacted a falls co-ordinator and has arranged for them to visit the home to undertake assessments of the residents and staff training. Nayland House Care Home DS0000066407.V304503.R02.S.doc Version 5.2 Page 12 The inspector observed a senior member of staff administering the lunchtime medication. The home uses the Monitored Dosage System (MDS). Each medication administration record (MAR) chart had a profile and a small photo of the resident for identification, however it was noticed that one resident’s profile was not completed and had no photograph. The MAR charts for three residents were reviewed. During the current four-week period there were 15 occasions where a record was not made of administration of medication. A chart was observed in one residents room for the application of double base cream which was to be applied twice daily, the last recorded signature was on the 7th August, indicating the cream had not been applied for a week. The room where all medication is stored is very small and not suitable to safely lock away medication. The door had an ordinary domestic lock providing very little security; medication is stored on shelves within the room. The home has two lockable portable medication trolleys; with two more on order, however there is only room for one in the medication room the other is located in the hallway. The room is very warm with temperatures reaching 80 degrees Fahrenheit, which is unsuitable for storing medication. The controlled drug cabinet has glass-fronted panels and is used to store other stocks of medication. The manager informed the inspector that a new controlled drugs cupboard has been ordered. Evidence was seen throughout the day that residents were treated with dignity and respect with regards to their personal care. Staff were observed calling residents by their chosen name and were supported to choose items of their own clothing to wear. However, it was reported to the manager during the inspection that a member of staff had been overheard talking inappropriately to a resident, the manager informed the inspector they would investigate the incident. Evidence was seen in one residents’ care plan that their wishes had been taken into consideration and discussed with their relatives and documented that they did not wish to be resuscitated. However other care plans which had a space to record resident’s wishes in the event of their death these had not been completed. Nayland House Care Home DS0000066407.V304503.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is adequate. Residents can expect to live in a home that supports a lifestyle that matches their needs, however residents have mixed views about the quality and variety of the food. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new fulltime activities co-ordinator has been appointed. They have responsibility for organising the leisure and social activities. An activities board in the hallway was advertising activities for the week which residents could take part in including board games, a quiz night and a film showing ‘The best of Ronnie Barker’. They hold fortnightly coffee mornings and facilitate the mobile library. Activities are planned for the afternoon’s with art and cookery proven to be most popular. The co-coordinator also spends one to one time with residents helping them to write letters and talk in general about their families and escorting the resident out for lunch or tea. Resident’s were observed spending time in their rooms reading the newspaper, doing crosswords and puzzles or watching their own television. A discussion took place with the co-ordinator about activities available for residents with special needs. They informed the inspector that one resident has Nayland House Care Home DS0000066407.V304503.R02.S.doc Version 5.2 Page 14 very limited vision and had arranged for listening tapes to be provided through the mobile library. They were also in the process of trying to obtain large sized and large printed playing cards. They were aware of reminisance work, as they had attended a course a year ago, which focused on activities that used all the senses. Evidence was seen during the inspection that residents are able to maintain contact with family and friends and many of the residents have their own telephones in their room although there are also public telephones for use in the home. Three relatives visiting were spoken with during the inspection and the visitor’s book reflected there had been other visitors to the home during the day. The home does not act as appointee for any residents. Thirty of the residents have a power of attorney that helps them manage their finances. Other resident’s manage their own money with the support of their families. The court of protection supports one resident. Residents, when they move in, are given the option of having a small amount of pocket 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. Residents have a lockable draw in the rooms for small personal items of value. One resident has recently had the support of an advocate who has helped to renegotiate their placement at the home. Meals are served in a choice of two dining rooms; alternatively residents can choose to have their meals in their rooms. Menus are circulated to each resident for the week. Sample menus were provided with the pre inspection questionnaire, which reflected that residents are able to make choices for their lunch and evening meals. There are generally two options at each meal. The cook informed the inspector that the menu consisted of braised lamb and vegetables or pepper risotto, however the menu had mushroom stroganoff as the alternative. There was a list of residents that were diabetic or required a soft food diet on the wall in the kitchen. The cook explained they would be serving fish or an alternative and potatoes puréed for residents on a soft diet. They had prepared a diabetic crumble and fruit crumble and custard for desert. Comments from residents and relatives about the food were mixed. Some residents thought the quality of food had suffered since the food was being purchased from wholesalers and not locally. Residents spoken with at lunchtime described the food as adequate. Some felt the food was overcooked one resident commented “the lamb was very old” another thought the vegetables were undercooked. However a relative who had recently had lunch at the home thought the standard of food was quite good. The level and support residents receive at mealtimes needs to be given consideration. One resident who was described as being able to feed themselves sometimes was observed sitting in the dinning room at 11.10am having their breakfast, a bowl of cereal had been placed in front of them, which they had not touched, Nayland House Care Home DS0000066407.V304503.R02.S.doc Version 5.2 Page 15 and two flies were hovering around the residents and their food. There was no care staff around to support the resident to have their breakfast. Nayland House Care Home DS0000066407.V304503.R02.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, Quality in this outcome area is adequate. Residents can expect to have their complaints listened to and responded to however, cannot expect to be protected from abuse until all staff have received training in 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 on the notice board near the dining area, however the print is small making it difficult for residents with a visual impairment to see. Residents and relatives spoken with were not aware of the complaints procedure but felt they could discuss any concerns directly with the home’s manager. The pre inspection questionnaire reflects that there have been five complaints received since the last inspection in November 2005. The operations manager informed the inspector that they have dealt with and responded to the complaints. These have been resolved and the complainants satisfied with the outcome. A requirement was made at the last inspection for all staff to attend training for the protection of vulnerable adults in order to recognise and report allegations of abuse. Twenty-eight of the thirty-eight staff currently employed attended Resident Welfare training held on the 10th and 11th of August. There have been three incidents of allegation of abuse at the home, which have been referred to Social Services customer first team in line with the Vulnerable Adult Protection Committee (VAPC). This has resulted in the dismissal of a member of staff. Investigations are in process of the other two incidents. Nayland House Care Home DS0000066407.V304503.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25,26, Quality in this outcome area is good. Residents can expect to live in a wellmaintained and welcoming environment, which provides a high standard of communal and personal accommodation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Nayland House is set in grounds made up of individual gardens and courtyards. These have been landscaped and planted providing areas of interest throughout the year. A tour of the environment was made; the home is nicely decorated throughout with fresh bright colours creating a comfortable and homely atmosphere. On the ground floor there are two dinning rooms and two lounges and a conservatory, offering comfortable seating areas with televisions and a video. Each resident has their own bedroom, which has en-suite toilet and washing facilities. Evidence was seen that residents have been able to bring their own items of furniture and rooms looked comfortable and personalised to meet the individual tastes of the residents. There are seven large bathrooms with showers, for both assisted and unassisted bathing. Residents were observed walking freely around the home Nayland House Care Home DS0000066407.V304503.R02.S.doc Version 5.2 Page 18 making use of all the different seating areas. Residents were observed wearing pendants linked to the nurse call system for them to ring for assistance in an emergency. Several comment cards received prior to the inspection commented on the time staff took to respond to call bells. The call system on display in one of the corridors was monitored; three calls were circulating on the display, which took 15 minutes to be answered. Evidence was seen that the home provides equipment to meet the needs of the residents, for example pressure relieving equipment had been provided and mobile hoists were observed being used to transfer residents where required. The majority of the residents living at the home are mobile and can move around independently, with walking aids, however one resident was observed walking along the corridor using their hand to hold on to the walls, doors and door frames to steady themselves. Handrails are fitted in bathrooms, toilets and some parts of the corridors, however these need to be positioned in all areas of the home that the residents access to help them maintain their mobility and independence. A suitable place needs to be found to store equipment and wheelchairs when not being used, walking frames and other equipment was being stored in bathrooms and two wheelchairs were blocking a fire escape route. The premises, on the day of inspection were clean and hygienic and free from offensive odours. Residents comment cards complimented the home on the hygiene in the home and the efficiency of the laundry. The laundry room was clean and tidy. Soiled linen is placed into red dissolvable bags and placed in the washing machine with a sluice cycle. All sheets and pillowcases are changed daily and sent to an outside contracted laundrette. Liquid soap dispensers and paper towels are situated in all the bathrooms and staff have access to disposable gloves and aprons. The cleaning cupboard contained tarnish and stain remover that had been decanted into a spray bottles. Other cleaning materials being used did not have health and safety data printed on the containers. Domestic staff spoken with were not aware of the procedures for dealing with spillages of chemicals and had no knowledge or training for the Control of Substances Hazardous to Health (COSHH). 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. The range of temperatures seen was between 38 degrees centigrade to 43 degrees centigrade. Nayland House Care Home DS0000066407.V304503.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, Quality in this outcome area is adequate. Currently residents cannot expect to be cared for by a team who are available in sufficient numbers or suitably trained to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Concerns were raised with the Commission for Social Care Inspection (CSCI) prior to today’s inspection by residents in comment cards and telephone calls from relatives and an ex employee regarding staffing shortages. Evidence was gathered during the day, talking to the manager, staff, relatives and residents that an urgent review of staffing numbers needs to take place. Staffing numbers have been reduced since the last inspection in November 2005. At the time of the inspection the home had 47 residents. Staff roster reflected that there are 6 staff working between the hours of 8am – 2pm and 5 staff between 2pm – 8pm with 3 on the night shift between 8pm – 8am. Normally 2 staff from the afternoon shift will stay on until 10pm to help assist residents to bed. Staffing numbers previously were 7 care staff and 1 general assistant on duty during the morning and 6 care staff and an activities co-ordinator with 7 care staff on duty from 4 in the afternoon. The pre inspection questionnaire reflects that 21 staff have left employment in the last year, some recruitment has taken place however existing and agency staff are covering the vacant hours. Nayland House Care Home DS0000066407.V304503.R02.S.doc Version 5.2 Page 20 Three staff files were inspected; evidence was seen that all necessary paperwork had been obtained prior to staff commencing employment, including two written references, completed job application forms, identification and a Criminal Records Bureau check (CRB). However, the file of a new employee contained evidence that a Protection of Vulnerable Adults (POVA) first check had been obtained, but their CRB had not been returned. The manager was advised that a risk assessment must be completed relating to the potential risk to residents and that the member of staff is supervised at all times until the CRB clearance is obtained. Staff training was discussed with the manager, Southern Cross have induction and foundation booklets linked to the Skills for Care, Common Induction Standards which is issued to all new staff, however one employers file seen showed they had been in post since March 2006 and had only completed the local induction and fire safety training as part of their induction. The pre inspection questionnaire reflects that 34.48 of staff holds a recognised National Vocational Qualification. The manager has implemented a programme of training, most recently staff have attended a Resident Welfare course and six senior staff attended an administration of medication course. Basic food hygiene and fire safety were scheduled to take place in august but the trainer from Southern Cross has had to postpone due to other priorities with in the company. Infection control training was taking place on the day of the inspection. Moving and handling training took place on different dates throughout 2005 and 2006 so that all staff have received training. Nayland House Care Home DS0000066407.V304503.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,34,35,36,38, Quality in this outcome area is adequate. Residents can be assured that the home is run in their best interests but cannot expect to be protected by the home’s procedures for health and safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The previous manager has retired. A new manager, Mrs Jan James has been appointed. They have been in post since the 19th June 2006. The manager is a qualified nurse and has worked in a variety of National Health Service (NHS) settings, which include mental health, care of the elderly and orthopaedics. She has experience of working in nursing and residential homes. The Commission for Social Care Inspection advised of the need for an application to become the Registered Manager for the home. The home has been through significant changes with the change of manager and takeover by Southern Cross and before this Ashbourne Healthcare. A Nayland House Care Home DS0000066407.V304503.R02.S.doc Version 5.2 Page 22 significant amount of staff has left which has stretched resources in the home. Feedback from residents and relatives is that they have seen a decline in the standards previously provided at the home. However discussions with residents, relatives and staff during the inspection felt positive that the new manager has started to make improvements. People spoken with described the new manager as very approachable one staff member commented “I have a lot of faith in the new manager, they are always about and they put in a lot of hours”. Another member of staff commented, “The new manager is firm but fair”. There have been a number of adult protection issues raised at the home. The manager held a meeting with senior staff in August to discuss roles and responsibilities and issued each senior with a copy of the General Social Care Councils Code of Practice. All other staff will be issued with a copy at the next scheduled staff meeting. The administrator manages the personal allowance for approximately twenty residents. They hold small amounts of money on their behalf in separate wallets locked in the safe. 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. The administrator demonstrated that they have a good knowledge of the accounting procedures of the home and systems in place to manage homes budget. They work with the manager to ensure expenditure is in line with their budget. The monthly variance sheet reflects that they are not overspent on their budget, however they do have a shortfall in income due to empty beds. The operations manager undertakes an audit of the homes finances at their regular monthly visits. The home’s public and liability insurance certificate was seen and is valid until September 2006. Staff spoken with had not received any recent supervision. Evidence was seen that supervision had taken place on a three monthly basis in the form of a performance and development appraisal. The new manager has devised new supervision forms and has started to supervise staff to meet the recommended six supervisions a year. Evidence was seen on one senior member of staff’s file that supervision had taken place; an action plan has been developed with objectives and targets within set timescales. The home’s maintenance manual was seen. The previous maintenance person left employment in June 2006. A new maintenance person has been in post for a week. The records showed that there had not been recordings for daily, weekly and monthly checks since March and April. This includes regular fire safety checks including emergency lighting, fire doors, nurse call system and water temperatures of the boilers. Nayland House Care Home DS0000066407.V304503.R02.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 3 3 1 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 2 X 3 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X 3 3 3 X 2 Nayland House Care Home DS0000066407.V304503.R02.S.doc Version 5.2 Page 24 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 OP3 Regulation 14 Requirement All prospective residents, including those for respite care, must have an assessment of needs completed prior to admission. The registered person must consult with the resident, or their representative and prepare a written care plan as to how the residents’ needs in respect of their health and welfare are to be met. This must also include a photograph of the resident. This is a repeat requirement from 03/11/05 3 OP8 12 (1-3) The home must ensure that care plans identify the planned interventions, which meet the day-to-day care needs of the residents and have systems in to place to monitor residents’ health and welfare. 30/09/06 Timescale for action 30/09/06 2 OP7 15 Sch 3 (2) 30/09/06 Nayland House Care Home DS0000066407.V304503.R02.S.doc Version 5.2 Page 25 4 OP9 13 (2) 5 OP11 12 (3) 6 OP15 16 (g)(i) The registered person shall make 14/08/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This is a repeat requirement from 03/11/05 A record of service users wishes 30/09/06 and feelings must be made in their care plan and taken into account at the time of their death. This is a repeat requirement from 03/11/05 The provision of food needs to 30/09/06 looked at with regards to: 1. The consistency of the standard of food being served. 2. Assessments need to reflect resident’s individual needs and the level of support required to eat their meal. 3. Residents who have poor dexterity must be provided with additional support, suitable crockery, cutlery and utensils. 4. Take into account the specific nutritional needs of people who are confused or have dementia. 7 OP18 13 (6) All staff must have training to prevent residents from suffering abuse or placed at risk of harm or abuse. Where staff have received training, measures are taken to remind staff what constitutes abuse and their duty within the whistle blowing procedures to report allegations of abuse. This is a repeat requirement from 03/11/05 Staffing levels and routines must DS0000066407.V304503.R02.S.doc 30/09/06 8 OP22 18 (1)(a) 30/09/06 Page 26 Nayland House Care Home Version 5.2 12 13 (c ) be reviewed to ensure that residents call bells are answered within acceptable time limits. All parts of the home must be free from hazards for the safety of the resident’s 1. Suitable provision must be made for storage of wheelchairs and equipment so that they are not stored in corridors and bathrooms. 2. The home must provide handrails and other aids in corridors to assist resident’s mobility and independence. 30/09/06 9 OP22 13 (4) (a) 23 (2( (l) (n) 10 OP26 18 (c) 12 OP27 18(1)(a) 14 OP38 13 (4) Domestic staff employed in the 30/09/06 home must have training appropriate to their work, which include Control of Substances Hazardous to Health (COSHH) A review of staffing levels in 30/09/06 conjunction with the residents’ dependency levels must be undertaken to ensure that there are adequate staff rostered to meet needs. Regular health and safety checks 30/09/06 must be undertaken and findings recorded and actions taken to minimise risks to the health safety and welfare of residents and staff. Risk assessments must be carried out for the safe working practices. Nayland House Care Home DS0000066407.V304503.R02.S.doc Version 5.2 Page 27 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 OP28 Good Practice Recommendations 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. Nayland House Care Home DS0000066407.V304503.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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