Inspection on 05/12/07 for Nayland House Care Home

This inspection was carried out on 5th December 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 10/01/07

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 5th December 2007 09:30 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.V356176.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.V356176.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 naylandhouse@schealthcare.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 (13), Old age, not falling within any registration, with number other category (54) of places Nayland House Care Home DS0000066407.V356176.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th January 2007 Brief Description of the Service: Nayland House is owned by Southern Cross Healthcare and is registered to provide care for a maximum of 54 older people. Within this number the home is also registered to provide care for up to thirteen people 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 good standard. All bedrooms are for single occupancy with en-suite toilet and washbasin facilities. 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 £640.00 per week. Further details about charges are available in the Statement of Purpose. This was the information provided at the time of the key inspection, people considering moving to this home may wish to obtain more up to date information from the care home. Additional charges not covered by the fees include hairdressing, chiropody, manicures, toiletries, magazines and papers. Nayland House Care Home DS0000066407.V356176.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 nine and a quarter hours on a weekday. 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, including a selection of residents, relatives and health professionals ‘Have Your Say’ surveys and the Annual Quality Assurance Assessment (AQAA). This document is issued by the Commission for Social Care Inspection (CSCI) and gives providers the opportunity to inform the Commission about their service and how well they are performing. A number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. During a tour of the home, time was spent talking with eleven residents, six staff and two visitors. The manager was available and fully contributed to the inspection process. The Operations Manager and Operations Director for Southern Cross arrived at the home to receive feedback at the end of the inspection. What the service does well: What has improved since the last inspection? Fifteen requirements and three recommendations were made following the previous inspection in January 2007. Information gathered at this inspection confirmed the home has complied or partially complied with twelve of these requirements. All people living in the home have been consulted and issued with new contracts, which clearly reflect the terms and conditions of residence with Southern Cross Healthcare and the individual’s current fees. Nayland House Care Home DS0000066407.V356176.R01.S.doc Version 5.2 Page 6 The home was previously found to be providing care to people with dementia, which was outside their category of registration. The home has changed their conditions of registration to reflect they are now able to provide care to 13 people with a diagnosis of dementia. The ends of life needs of people living in the home are in the process of being discussed and documented in their care plan. These need to be expanded further to take into account their wishes at the time of dying and/or terminal illness. This will ensure that staff will treat them and their relatives with care, sensitivity and respect. The new manager has completed training presented by the Primary Care Trust, for falls prevention. People’s care plans now contain a risk assessment, in conjunction with their moving and handling assessments, which identify and manage the risk of falls. Examination of the incident/accident book identified that there has been a reduction in the number of falls. The home has introduced more stringent auditing of medication. Examination of the Medication Administration Record (MAR) charts confirmed that there were no errors. Training records and files confirmed that staff have attended welfare training, which guides them to recognise and respond to allegations of abuse. 38 of staff have a recognised qualification. Although this figure has improved since the previous inspection, where the figure was 23 , the home still does not meet the recommended ratio of 50 of the National Minimum Standards. Discussion with the activities co-ordinator, residents and observations throughout the inspection confirmed that residents are enjoying an improved level of activities. People were observed taking part in activities that were meaningful to them and which met their expectations. In line with the recommendations made by the Environmental Health Officer (EHO) in December 2006, the cooker has been thoroughly cleaned. The chef and manager confirmed that a new cooker is in the process of being purchased, which they are hoping to have installed before Christmas. A tour of the home confirmed that unused moving and handling equipment and wheelchairs have been removed from corridors and fire exits. Those that are in use are being stored appropriately. Security issues raised as a result of a recent adult safeguarding incident at the home have been partially addressed. The front door is to be fitted with a keypad lock to prevent people being able to enter the building without staff knowledge. In the mean time the doorbell has been connected to the staff’s pagers and doors are locked out of office hours. Nayland House Care Home DS0000066407.V356176.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Nayland House Care Home DS0000066407.V356176.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.V356176.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, 6, People who use the service experience good quality outcomes in this area. People who move into this home will have their needs assessed and will be issued with a contract, which clearly tells them about the service, however information about the home does not currently reflect the range of services provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People considering moving into the home are provided with a Statement of Purpose, Service Users Guide and a Southern Cross Healthcare brochure. However, amendments need to be made to the Statement of Purpose and Service User Guide to ensure they provide up to date and accurate information about the service provided. The Service User Guide must reflect the home can provide care to 13 people with dementia. The Statement of Purpose makes reference to charges for nursing, however the home is not registered with the Commission to provide nursing care. Additionally, these documents need to reflect the names and contact details of the new operations manager and new manager. Nayland House Care Home DS0000066407.V356176.R01.S.doc Version 5.2 Page 10 The AQAA states that there are 18 people living in the home with impaired vision, (one of these spoken with is registered blind) 4 people have impaired hearing and 2 people whose first language is not English. Consideration should be given to providing information about the home in a format suitable for people with a visual and/or other sensory impairments. Examination of resident’s files at the previous inspection identified that a number of residents contracts were with the previous owners of the home. All people living in the home have been consulted and issued with new contracts, which clearly reflect the terms and conditions of residence with Southern Cross Healthcare and the individual’s current fees. Information provided in the AQAA and verified at the inspection confirmed that before people move in to the home a detailed assessment is carried out to identify the needs of the individual. This enables the manager to make a decision as to whether or not the home will be able to meet that person’s needs. The home does not provide intermediate care. Nayland House Care Home DS0000066407.V356176.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, People who use the service experience adequate quality outcomes in this area. People living in the home can expect to have their health, personal and social care needs set out in a care plan, however they cannot be assured that their health needs will be monitored, to reflect where appropriate action or intervention is required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of three people’s care plans confirmed that a new format has been introduced. The documentation is generally well organised and provides a good overview of the individuals health, personal and social care needs. They identify the level of support required by staff, including decisions about who delivers their personal care and the support they need to be as self-managing as possible. However, some of the care plans need to be revisited to ensure they contain accurate and up to date information about the individual. For example, in the section relating to ‘expressing sexuality’, entries seen did not correspond with needs of the individual evident from the daily recording notes. Nayland House Care Home DS0000066407.V356176.R01.S.doc Version 5.2 Page 12 Resident’s health and well being must be monitored in accordance with information in the care plan. For example, the moving and handling and pressure area assessments, identified an individual as having a history of dehydration and pressure areas developing. The assessments clearly state that they required regular two hourly changes of position, whether in their bed or in their wheelchair and that they require regular fluids. The supplementary health charts are not being used to record that these tasks are being completed. The inspector was informed that staff regularly monitor the fluid intake of residents, but without the completed documentation there was no evidence to confirm this. Where the individual has been provided with pressure relieving equipment for their bed, they still require repositioning whilst sitting in the wheelchair during the day. An entry seen in their care plan reflects that they currently have a grade 1 pressure area. Healthcare needs of the residents are managed by visits from the local General Practitioner (GP) and district nurses. The GP and a nurse practitioner were visiting during the inspection. Discussion with the nurse confirmed they have been visiting the home for a number of years and they have seen the impact the changes of ownership and frequent changes of manager have had on the home. They complimented the staff who have remained at the home during these changes for providing continuity in the service to the residents and relatives. They felt the delivery of personal care within the home was of a good standard and that staff were quick to identify and seek advise where there were changes in a persons health. A previous requirement was made for an investigation to be made into the high number of falls and for these to be managed through the risk assessment process. Examination of the care plans confirmed falls risks assessments, in conjunction with moving and handling assessments, have been implemented. The incident/accident book confirmed there has been a reduction in the number of falls. A medication room houses both medication trolleys and a small fridge. The home uses the Monitored Dosage System (MDS). At the front of each person’s Medication Administration Record (MAR) chart there is an information sheet with a photograph for identification purposes. Examination of the (MAR) charts confirmed that there were no errors. The new manager has introduced more stringent auditing of medication. They have also developed a medication competency checklist to observe and assess staff administering medication. These are to be completed on a three monthly basis to check staff are recording and administering medication safely and in line with the homes policies and procedures. No one living at the home is currently prescribed controlled drugs. Nayland House Care Home DS0000066407.V356176.R01.S.doc Version 5.2 Page 13 The MAR folder contained risk assessments for three residents who are assessed as being able to self medicate. These are being reviewed on a monthly basis to ensure they are confident to continue managing their own medication. People spoken with, and observation throughout the inspection confirmed that staff supports residents’ dignity, by supporting them to maintain their independence and to make choices and have control over their daily lives. The interactions between residents and staff were observed to be friendly and appropriate. Residents were observed being called by their preferred name. New plans are in the process of being developed to reflect the end of life needs of the residents. These need to be expanded further to include an established plan of care as the individuals health deteriorates, which constantly monitors pain, distress and other symptoms, in accordance with their religious and spiritual beliefs. This will ensure that at the time of death, dying or terminal illness staff treat them and their relatives with care, sensitivity and respect. Nayland House Care Home DS0000066407.V356176.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, People who use the service experience good quality outcomes in this area. People who use this service can expect to be involved in daytime activities of their own choice, however, the decision to change food suppliers has resulted in a marked decrease in satisfaction of the food being served. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A previous requirement was made for consideration to be given to the lifestyle of people living in the home, particularly those with dementia and other cognitive impairments. Information provided in the AQAA and verified at the inspection confirmed that an activities programme has been developed. An activities folder contains resident’s interests and hobbies, a range of activities available and an activity sheet of what activities people have taken part in. Activities are advertised in a newsletter. The newsletter for December 2007, included art sessions, flower arranging, cooking and cake decorating, bell ringing, birthday and Christmas parties, a Carol service and a New Years Eve cheese and wine party. Other regular activities include hairdresser visits twice a week, weekly communion and a daily sherry club. A recent addition to activities on offer, is a monthly evening of ‘Pimms and Games’, where residents can choose to take part in a variety of card, board games and quizzes. Nayland House Care Home DS0000066407.V356176.R01.S.doc Version 5.2 Page 15 Discussion with the activities co-ordinator, residents and observations throughout the inspection confirmed that people living in the home are enjoying an improved level of activities. They were observed taking part in activities that were meaningful to them and which met their expectations. However, the AQAA states that an area the home could do better is to plan more visits for residents to access the community, for example going to the shops and the theatre. Feedback received in residents ‘Have your say’ surveys, confirmed this. Comments included “I would like more outings” and “I would like to be able to be taken out each day for a short walk”. 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. Feedback from surveys and discussion with people raised concerns about the organisation’s decision to change food suppliers. This has resulted in a marked decrease in satisfaction of the food being served. This in particular relates to the quality of meat. One person commented, “the chef does very well with supplies, but the standard of food has deteriorated”. The operations manager advised they are currently looking into finding an alternative supplier. Residents also spoke of the evening meal being repetitive and not being able to have a cooked alternative. This was discussed with the chef, who explained that due to a cut in the kitchen assistant’s hours there is no one available to provide a cooked tea. 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. The AQAA states residents are provided with weekly menus, plus the chef visits each resident daily to establish their choice of meal. Residents confirmed that they are provided with a choice for their midday meal and there is always an alternative if they do not like what is on offer. The chef is aware of the individual needs of residents. A diabetic alternative is always available. Individuals that require soft food diet have their meal puréed, the meat and vegetables are pureed separately, so that the individual can taste the individual flavours as well as identify the vegetable by colour and texture. The lunchtime meal was observed in the main dining room and the dining room in ‘The Cottage’. Tables were nicely laid with flowers and napkins. The food served looked appetising and was nicely presented. Where an individual required assistance to eat their meal staff were observed supporting them sensitively and at a pace that made the individual comfortable and unhurried. Nayland House Care Home DS0000066407.V356176.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18, People who use the service experience adequate quality outcomes in this area. People who use this service are able to express their views and have access to a robust complaints procedure, however due to the high turn over of the managers and operations managers these have not always been acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that the home operates an open culture. Weekly surgeries are held providing relatives with the opportunity to meet with the manager to discuss, issues, worries or concerns relating to the care of their relative or the service. Additionally, the home has a residents and relatives’ meeting bi monthly. The most recent meeting was held in November. There have been significant changes in the management structure within Southern Cross. The meeting provided a forum for the new managing director, operations director, operations manger and project manager to introduce themselves to residents and relatives. The minutes confirmed that residents and their relatives were able to express their views and concerns. The AQAA states there have been eight complaints received by the home in the last twelve months. This was verified in the home’s complaints log. Six out of the eight complaints, received had been investigated and action taken to ensure the complainant was satisfied with the outcome. Nayland House Care Home DS0000066407.V356176.R01.S.doc Version 5.2 Page 17 However, due to changes in the management structure two complaints did not have the final outcome recorded. One of these has been an ongoing concern for approximately 18 months. The complaints procedure is included in the Service User Guide, which is supplied to people when moving into the home. It is also displayed in a number of areas around the home. However, as mentioned in the choice of home section of this report, this information needs to be made available in an appropriate format for people with a visual and/or other sensory impairments. Residents and staff spoken with during the inspection confirmed that if they needed to make a complaint, they would do so to the new manager and felt confident that they would have their concerns listened and responded to. A previous requirement was made for all staff to access training for the protection of vulnerable adults. Training records and staff files seen confirmed that 82 of the staff have attended Resident Welfare training, in the last 12 months. 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. This will need to be updated to reflect the Adult Safeguarding Board, which replaced the former Suffolk County Council policy in February this year. A previous requirement was made for behavioural support plans to be implemented, for residents who’s behaviour can be challenging to others. Examination of care plans confirmed plans are now in place, which have agreed strategies for supporting the individual whilst managing their behaviour. Additionally, staff have received dementia awareness training, called Yesterday, Today and Tomorrow and welfare training to support them when dealing with verbal and physical aggression. Nayland House Care Home DS0000066407.V356176.R01.S.doc Version 5.2 Page 18 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, 21, 24, 26, People who use the service experience good quality outcomes in this area. The home provides a physical environment that meets the needs of the people who live there, however they are unhappy with the decline in the appearance and cleanliness of the home and lack of gardening maintenance. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that the home provides a safe and friendly environment and that the internal décor and furnishings are maintained to an acceptable level. Nayland House has been divided into two parts to provide a designated unit for people with dementia, renamed ‘The Cottage’. The unit has 13 separate bedrooms, each with en suite facilities. There is a dining room, two lounges and corridors, which provide a square around a central enclosed garden. Nayland House Care Home DS0000066407.V356176.R01.S.doc Version 5.2 Page 19 There are two additional bathrooms, one has a walk in shower and an additional toilet for communal use. The doors to people’s personal rooms have been painted different colours and have distinguishing features, for example, doorknockers, pictures and photographs to make them recognisable to the individual. The main part of the house has it’s own separate dining room, lounge and a large and spacious conservatory. Christmas trees and decorations were seen throughout the home, making the home look festive and welcoming. People’s personal rooms looked comfortable and personalised to meet their individual tastes. All residents’ rooms are single occupancy with en-suite toilet and washing facilities. Additionally, there are five 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. Feedback obtained through discussion with residents and relatives, ‘Have Your Say’ surveys and the homes own quality assurance raised concerns about the decline in the physical environment and lack of gardening maintenance. Comments included, “there could be a lovely garden, but nothing is ever done to it” and “there has been no gardener, no window cleaner and general maintenance of building has deteriorated since take over of Southern Cross” and “there appears to have been little expenditure on the environment, if I viewed the home now, I would not choose to move here”. These issues were discussed with the new manager who has already started to make the necessary improvements. The windows have now been cleaned and will be done on a monthly basis in the future. A start has been made to tidy up the gardens. They have also obtained authorisation to replace carpets throughout the home and for maintenance to commence on the outside of the building in Spring 2008. A previous requirement was made for equipment to be stored appropriately when not in use. A tour of the home confirmed that unused moving and handling equipment and wheelchairs have been removed from corridors and fire exits. Security issues raised as a result of a recent adult safeguarding incident at the home have been partially addressed. The front door is to be fitted with a keypad lock to prevent people being able to enter the building without staff knowledge. In the mean time the doorbell has been connected to the staff’s pagers and doors are locked out of office hours. The premises on the day of inspection were clean and free from offensive odours. However, feedback received in surveys and the home’s quality assurance reflects people are concerned about the standard of cleanliness. Comment’s included, “my relatives room smelt far from fresh” and “general cleanliness is less than it was when first moved to the home in 2005”. There are four housekeepers in total, one of whom is responsible for the laundry. Nayland House Care Home DS0000066407.V356176.R01.S.doc Version 5.2 Page 20 Time was spent talking with the head housekeeper, who confirmed that there are additional hours available for a fifth person, however recruitment is difficult due to rural positioning of the home. Inspection of the laundry facilities confirmed the home has good procedures in place to prevent and control the spread of infection. The laundry was clean and tidy with appropriate equipment to launder soiled linen, clothing and bedding. Outside the kitchen area a hole has appeared in the floor, this is unhygienic and is a safety risk where the floor covering has cracked and is not properly fixed to the floor. Appropriate hand-washing facilities of liquid soap and paper towels are situated in all bathrooms and toilets where staff may be required to provide assistance with personal care. Random testing of water temperatures reflected that the water supply is within the recommended 43 degrees centigrade, which minimises the risk of people living in the home scolding themselves when taking a bath or shower. Nayland House Care Home DS0000066407.V356176.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, People who use the service experience adequate quality outcomes in this area. People using the service are generally satisfied with the care they receive to meet their personal care needs however, insufficient staffing levels means there are times when they have to wait for support and attention. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that the home is staffed by a senior and a five carers on the morning and evening shifts, with a senior and three carer’s on at night. In addition there are a team of domestic staff, catering staff and a maintenance person. Examination of the duty roster confirmed that ongoing recruitment problems have resulted in the use of up to 50 agency to fill vacancies, sickness and holidays. This has had a knock on effect to the continuity of service. Comments in surveys received by the Commission and the home’s own quality assurance, state “there have been times when the home has not been able to give appropriate care, due to under staffing” and “it is a lovely home, but staffing difficulties mean there has been a gradual deterioration, since Southern Cross has taken over”. Additionally, the dementia unit has increased the overall support needs of the service, however there has been no increase in staffing levels to reflect this. This is supported by comments received in surveys and through discussions with people living in the home, who confirmed that, at times they are having to wait, as long as 15 minutes for assistance to go to the toilet. Nayland House Care Home DS0000066407.V356176.R01.S.doc Version 5.2 Page 22 Discussion took place with the manager, operations manager and the operations director about staffing levels. The manager explained staff recruitment has been a recurring problem. They confirmed they have recently recruited two new members of staff and were interviewing another person the following day. Information provided in the AQAA and verified at the inspection confirmed that the home ensure all the appropriate checks are undertaken before a person commences employment. Three staff files seen confirmed the home operate a thorough recruitment process, which includes obtaining all the appropriate paper work including Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks. The AQAA states that five care staff have obtained National Vocational Qualification (NVQ) at level 2, with two staff currently working towards completion. Therefore, the home has 38 of staff holding a recognised qualification. Although this figure has improved since the previous inspection, where the figure was 23 , the home still does not meet the recommended ratio of 50 of the National Minimum Standards. A trainer tracker confirmed staff are receiving training in moving and handling, food hygiene, Control of Substances Hazardous to Health (COSHH), medication, resident welfare and fire safety. Additional training to meet the specific needs of residents has included a certificate in the provision of activities for people with dementia in the care setting and dementia awareness training, yesterday, tomorrow and today. People spoken with were complimentary about the staff and were confident that they met their needs. Comments included “the staff are fabulous, they go out of their way to do things for us” and “staff are very good, caring and compassionate”. Nayland House Care Home DS0000066407.V356176.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, 36, 38, People who use the service experience adequate quality outcomes in this area. The high turn over of managers and operations managers has resulted in no long term planning and direction in the home, which has led to a decline in the standard of the service provided. 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 manger resigned in September, as did the operations manager. A new project manager has been appointed and commenced employment on the 12th November 2007. Feedback obtained through discussion with residents and relatives, ‘Have Your Say’ surveys and the home’s quality assurance process reflected that on the whole people thought Nayland House is a good home. However, they are concerned about the lack of a permanent manager and the deterioration in the service, regarding cleanliness, maintenance of the environment and the quality of the food. Nayland House Care Home DS0000066407.V356176.R01.S.doc Version 5.2 Page 24 Residents, visitors and staff spoken with were positive about the new manager. They described them as approachable and supportive. Comments included, “they have made a noticeable difference” and “there is a different vibe around the home”. However, people expressed concern that the term ‘project manager’ reflected yet another temporary position. The operations director for Southern Cross confirmed that the person currently covering the post of operations manager and the newly appointed project manger are now permanent positions. Discussion with the manager confirmed that they have the required qualifications and experience to manage the home. They demonstrated a clear understanding of the work required to improve and develop the service. Information provided in the AQAA and verified at the inspection confirmed that the home has an effective quality assurance monitoring process. The role of the operations manager is to visit the home monthly to review the services and facilities being provided. Residents and relatives are invited to attend regular meetings and weekly surgeries are held for people to voice any issues, worries and concerns. Additionally, customer surveys are issued to residents and relatives’ to obtain the views about the service they receive. Analysis of surveys received by the Commission and the homes own quality assurance reflects people have mixed views about the service provided at Nayland House. Comments included “ We are generally unhappy about the home and the lapse of information about the move, to incorporate the dementia unit” and “major areas of concern are cleanliness” and “we hope the overall general appearance of the home will improve, when all the changes are completed”. Alternatively, more positive feedback included “I am delighted at the care, love and support the home has given my relative and myself” and generally, my relative is well cared for, staff could not be kinder, however the staff are very stretched”. The minutes of a relatives and resident meeting, held in November, reflected people are concerned that the fees are due to be increased again in February 2008, and wanted to know how the organisation could justify the increase when they were not getting any more for their money. The organisation’s decision to change food suppliers has resulted in a marked decrease in satisfaction of the food. A recent residents’ survey regarding food provided a mixed response. Of the twenty surveys returned, 50 of residents were satisfied with the food, the other 50 stated they were not always happy with the quality of the food they received. Comments included, “food is not as good as it used to be” and “sometimes the soup and night time drinks are cold”. Other issues raised were about the accuracy of their breakfast menu, quality of the meat, request for more fresh fruit and supper sandwiches are often rather dry and there is no option of a hot suppertime meal. Nayland House Care Home DS0000066407.V356176.R01.S.doc Version 5.2 Page 25 The administrator manages small amounts of money for approximately thirty residents. The administrator keeps a record of all transactions. 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. 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 have a lockable draw in the rooms for small personal items of value. In line with the recommendations made by the Environmental Health Officer (EHO) in December 2006, the cooker has been thoroughly cleaned. The chef and manager confirmed that a new cooker is in the process of being purchased, which they are hoping to have installed before Christmas. A recent, food premises inspection has been undertaken by the EHO. Their report reflects that they made two requirements for a deep clean of the kitchen to be undertaken and for a loose tap to the washbasin to be fixed. Inspection of the kitchen confirmed these had been completed. Time was spent with the cook, who demonstrated a good understanding of the needs of the people living in the home, the importance of good food hygiene and health and safety. All foods are being stored in accordance with food safety standards and that the required documentation of temperature checks for fridges, freezers and food delivered to the home are being kept. The AQAA identifies that all staff are supervised and trained appropriately. Staff personnel records seen confirmed that a formal supervision process has been implemented. Records confirmed that work issues and performance, training and further development needs had been discussed. The home takes steps to safeguard the health, safety and welfare of people living and working in the home. The most recent Gas and Electrical Safety Certificates, including Portable Appliances Testing (PAT) were seen and records showed that equipment is being regularly checked and serviced. The building complies with enviromental health standards and the local Fire service requirements. The Fire alarm system is serviced on a regular basis. The fire logbook confirmed that regular training and drills are taking place. Nayland House Care Home DS0000066407.V356176.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 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 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 2 17 X 18 3 2 X 3 X X 3 X 3 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 2 3 X 3 3 X 3 Nayland House Care Home DS0000066407.V356176.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 OP1 Regulation 4 Requirement Amendments must be made to the statement of purpose and service user guide. This will ensure information about the home is up to date and provides accurate information about the services provided. After consultation with the individual and/or their representative, the residents care plan must be kept under review and amended. This will ensure the care plan reflects the individual’s current needs in respect of their health and welfare, and how these are to be met. The home must ensure that they make proper provision for the monitoring of service users health and welfare. For example, where specific health needs, such as fluid intake are identified to maintain the individual’s health, these are recorded on the supplementary health charts, monitored and where concerns arise advice is sought from health care professionals. DS0000066407.V356176.R01.S.doc Timescale for action 18/01/08 2. OP7 15 (2) (b) (c) 18/01/08 3. OP8 12 (1-3) 18/01/08 Nayland House Care Home Version 5.2 Page 28 4. OP15 16 (2) (i) Steps must be taken to address residents concerns about the deterioration in the quality of the food. This will ensure that residents receive a varied, appealing and nutritious diet, which is suited to their assessed needs and choices. 18/01/08 5. OP16 22 (3) Complaints made under the 18/01/08 complaints procedure must be fully investigated within the given timescales. This will ensure that complaints are dealt with promptly and effectively. There must be a schedule of planned, cleaning, maintenance and decoration to interior and exterior of the home. This will ensure people living in the home live in a safe, clean, pleasant, hygienic and well-maintained environment. 18/01/08 6. OP19 23 (2)(b)(d) (o) 7. OP27 18(1)(a) 12 13 (c) A review of staffing levels in 18/01/08 conjunction with the residents’ dependency levels must be undertaken to ensure that ensure that residents call bells are answered within acceptable time limits. This will ensure there is adequate staff rostered to meet the personal needs of the residents. This is a repeat requirement from 14/08/06 and 0/01/07 Nayland House Care Home DS0000066407.V356176.R01.S.doc Version 5.2 Page 29 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. Palliative care and end of life needs of the residents need to be further expanded to ensure that at the time of their death or dying, staff will treat them and their relatives with care sensitivity and respect. The home’s policies and procedures for the protection of vulnerable adults needs to be changed to reflect the local authority, Adult Safeguarding Board, which replaces the Suffolk County Council, Vulnerable Adults Protection Committee (VAPC) 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. There needs to be clear sense of direction and leadership of the home, which residents, relatives and staff understand, which relate to the aims and objectives and purpose of the home and to ensure that planning and development of the home is carried out within agreed timescales. 2. OP11 3. OP18 4. OP28 5. OP32 Nayland House Care Home DS0000066407.V356176.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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.V356176.R01.S.doc Version 5.2 Page 31 - 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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