CARE HOMES FOR OLDER PEOPLE
Nether Hall Nether Hall Road Hartshorne Swadlincote, Derby Derbyshire DE11 7AA Lead Inspector
Steve Smith Unannounced Inspection 2nd November 2005 01:09 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 DS0000002122.V263580.R01.S.doc Version 5.0 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. DS0000002122.V263580.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Nether Hall Address Nether Hall Road Hartshorne Swadlincote, Derby Derbyshire DE11 7AA 01283 550133 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) Ashbourne (Eton) Limited Mrs Sheila Elizabeth Smith Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (47), Physical disability (3) of places DS0000002122.V263580.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Persons aged 50 years and over with PD (3) to be accommodated in Bedroom No`s 1, 3 and 8. 25th January 2005 Date of last inspection Brief Description of the Service: Nether Hall Nursing Home provides personal care with nursing, and can accommodate 50 people, all of whom must be over 65 years of age. However, the Home can also provide places for 3 people with disabilities, aged 50 years and over, within the total of 50 places. The Home is in a rural setting, near to the village of Hartshorne. The property was originally a private dwelling that has been extensively converted and extended into a care home. Accommodation is provided to a good standard across two floors. The upper floor is accessible via a passenger lift, a chair lift or via staircases. Bedrooms are attractively decorated and have been personalised by the current occupants. All except two bedrooms have ensuite facilities. Communal areas are bright and decorated to a good standard. The Home provides a number of lounges and dining areas, as well as a separate smoking area. Residents have access to a well-tended garden. DS0000002122.V263580.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place in just over 6 hours. Discussion was held with the Home’s Manager and two Residents. Some of the Home’s records were examined, some of the bedrooms were seen, and the public areas of the Home were looked at. What the service does well: What has improved since the last inspection?
At the time of the last inspection the Inspector set 10 Requirements and 6 Recommendations for the Home to address. All but two of these had been addressed or had considerable work done upon them.
DS0000002122.V263580.R01.S.doc Version 5.0 Page 6 Residents care plans are now shared with Residents and are signed by them or their Representative. Reviews of care are now provided at 6 monthly intervals. A confidential section is provided within each file, when this is needed. It is planned that the Home will become a non-smoking home in the very near future. As a result only non-smoking Residents are now admitted. The Manager said that all Residents, with the capacity, are now aware of who is their keyworker. Staff now assist one Resident at a time at all meal times in the Home. Residents who need this assistance are only brought to the table at the time they can receive the necessary help. Staff also no longer end their shifts in the middle of a meal. Residents are now informed in the Residents Guide that all complaints will be addressed within at least 28 days. Wheelchairs are no longer stored in the corridors of the Home, so access to bedrooms and toilets was always maintained. All bedrooms are now provided with locks and the key has been given to each Resident, in appropriate cases. The Manager said that the two bedrooms with a poor odour were now clear of the odour. In January 2005 the Environmental Health Officer had left issues for the Manager to address and these had all been met. What they could do better:
The Manager was required to provide details to Residents, or their Representatives, of the limitations made by they Home of the Residents choice of freedom and decision-making when the Resident is suffering with dementia. Residents’ files should also contain details of whom the keyworker is. The Manager should also review the frequency of baths and showers provided for Residents, and if at all possible provide baths and showers at the intervals of time requested by each Resident. The Manager also needed to ensure that all Residents, in the new wing, are provided with a copy of the Residents Guide to the Home. The senior staff in the Home need to ensure that attention is paid to the notes placed in the record of each Resident, and ensure that requests for action by staff, from the previous shift, are acted upon and recorded. If monitoring was
DS0000002122.V263580.R01.S.doc Version 5.0 Page 7 requested, the staff member who requested this needs to cancel it, when it is no longer required. Staff in the Home needed to review the frequency of baths and showers and ensure they are provided at the frequency requested by each Resident. Residents should also be provided with staff or relatives to accompany them to visit the nearest town or shopping centre. Residents should be enabled to take part in local and national elections, when the opportunity arises. When staff are visiting able Residents in their bedrooms, they must always knock and await an invitation to enter the room. The administration of medication, in the new part of the Home, was found to be poor and needed considerable attention. When employing new staff, the Manager needed to ensure that all the requirements listed in Schedule 2 of the Care Homes Regulations, as amended during 2004, are always addressed. The Manager needed to review the length of time care staff are allowed to work in the Home, and where possible limit this to no more than 40 hours each week. 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. DS0000002122.V263580.R01.S.doc Version 5.0 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 DS0000002122.V263580.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3. New Residents moving to the Home were always provided with an assessment of need completed by either a Care Manager, from Social Services Depts, or the Manager to ensure all needs of Residents could be met by the Home. EVIDENCE: When new Residents were admitted to the Home, the Manager was provided with a summary of needs of each person, completed by the Care Manager, from Social Services Depts supporting each Resident. She also visited those potential Residents and undertook her own assessment of need before agreeing to their admission to the Home. If the Resident was self-funding, and therefore not supported by Care Managers, the Manager completed her own summary of need. Standard 6 does not apply to this Home. DS0000002122.V263580.R01.S.doc Version 5.0 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): Standards 7, 8, 9 & 10. Residents’ health and personal care needs were being fully met, as demonstrated within care plans. Medication, in one part of the Home, was poorly administered and needed attention to appropriately ensure that Residents needs were met. EVIDENCE: To help assess Standard 7, the Resident’s Plan of Care, the records of four Residents were examined, for the purpose of case tracking. Almost all of the basic information concerning each Resident was found to be in the files examined. However, only one of the files contained details of the keyworker allocated to the Resident. All of the files contained the initial assessment completed by the Care Manager that placed each Resident at the Home. The Manager had also completed her own initial assessment of needs for the four Residents. There were also copies of the ongoing care plan and risk assessment available in each file examined. DS0000002122.V263580.R01.S.doc Version 5.0 Page 11 The Manager had not provided details of each Resident’s possible limitations of choice, freedom and decision making ability. The Manager ensured that 6 monthly reviews of care were carried out on each Resident, and relatives or the Representative were invited to these reviews. The Residents Guide had been made available to most Residents, although one of the Residents interviewed, as part of this report, was not aware of the document and the document was not available within the Resident’s bedroom. The files showed that good records of events affecting each Resident were kept by the Home. All of the files examined were found to be well organised. The files also showed that the head of care had read each file at regular intervals. The Manager said that a confidential section was added to those files that required this. Lastly, all of the files contained a copy of a letter given to the Resident, before admission, to say that the Home was suitable to meet the Resident’s needs in respect of their health and welfare. In two places in the recording of daily events, in one of the files looked at, staff had written ‘please observe’ or something similar. However, staff had not responded to this in the notes they chose to record. The member of staff who requested the ‘observation’ did not eventually say when the ‘observation’ was to end. Similarly, it was noted in another file that a member of staff requested that cream be applied to the Resident. However, although a long note was entered into the record the following day, it did not say that cream had been applied as requested. Staff of the Home were appropriately maintaining the records of Residents health needs, which included a record of meals provided for Residents. All medication and the method of distributing it to Residents were examined, and a good record was found. However, in the new unit in the Home, a large number of signature gaps were found on the Medication Administration Record (MAR) sheets; medications with instruction to administer 2, 3 or 4 times a day, if required, were being only administered once per day and at the same time of day. Also in this new unit many prescriptions were hand written by staff of the Home on the MAR sheet, although the Manager was able to produce the typed copy of the prescription, provided by the pharmacy. The records maintained by the other section of the Home were well kept. Two Resident were spoken to about life in the Home. They said that staff were very good at listening to their views on how they wished to be cared for and always carried out their wishes. They said that their care needs were always met with dignity and respect. As a result, they said they felt very safe in the Home, and appeared to have a strong sense and appearance of well being. DS0000002122.V263580.R01.S.doc Version 5.0 Page 12 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): Standards 12, 13, 14 & 15. Residents’ preferred lifestyles were respected by the Home. They were able to receive visitors and to exercise choice and control over their lives. Residents were given a wholesome and appealing diet in pleasant surroundings. EVIDENCE: The two Residents spoken to during the inspection said that they felt very safe in the Home. Staff respected their confidences and all their needs were met with dignity, respect and choice. The Residents said that they could go to bed and get up at times of their own choosing. Both Residents said bathing times were provided at weekly intervals. One was happy with this, but the other said that they were used to taking a daily shower before moving to the Home and now missed this since moving to the Home. Both of the Residents said that they had not left the Home, for example to go shopping, since moving to the Home. One was happy with this, but the other felt it would be nice to be given the opportunity to do so from time to time. One of the Residents spoken to had been resident at the Home at the time of the general election, earlier this year. The Resident said that they had not DS0000002122.V263580.R01.S.doc Version 5.0 Page 13 been given the opportunity to take part in the election, which caused considerable disappointment. Entertainment was provided in the Home at regular intervals, and during the inspection a game of bingo was observed being played. Relatives and friends of the Residents were able to visit at any time, and the Residents said they could always be seen in private. The Residents very clearly said that staff always knocked, paused and entered their bedrooms, without waiting to be invited in. They said that their mail was always delivered unopened, and said that as far as they were concerned the Home was a non-smoking Home. The Manager later explained that the Home would become totally non-smoking in the very near future. Both Residents were able to describe the choices they had at meal times, and both said how much they enjoyed the meals. It was pleasing to observe that the Home had a ‘tuck’ trolley that allowed Residents to purchase sweets, drinks and small personal items. DS0000002122.V263580.R01.S.doc Version 5.0 Page 14 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): Standards 16 & 18. Complaints made to the Registered Providers were appropriately addressed to meet Residents needs. The protection policies and procedures provided by the Home meant that Residents were well protected. EVIDENCE: The Residents spoken to said that if they had any issues of complaint they would take them to the Manager or the most senior carer. Records of complaints were examined and good records of both verbal and written complaints were maintained. The procedure to follow was also looked at and this showed that all complaints were to be completed within 28 days. The Registered Providers had a good policy to protect Residents from abuse and the Manager was aware of the Derbyshire Adult Protection Procedures sponsored by the Local Authority. The Manager agreed that she would refer unsuitable staff to the Protection of Vulnerable Adults register, now that it was operational. The Home had polices and procedures for handling Residents money, which included a section preventing staff from benefiting from or assisting in the making of Residents wills. DS0000002122.V263580.R01.S.doc Version 5.0 Page 15 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): Standards 19, 20, 21, 22, 23, 24, 25 & 26. The Home was well maintained throughout, providing all Residents with a safe, comfortable environment in which to live. EVIDENCE: These Standards were not fully examined during this visit to the Home. However, with the expansion of the Home wheelchairs were no longer stored in corridors blocking access to bedrooms. All bedroom doors were now provided with locks and, where appropriate, Residents also had keys. Residents were provided with safe, comfortable surroundings. All bedrooms were naturally ventilated, and centrally heated, the heating being controlled in each Resident’s bedroom. Radiators were appropriately guarded and the temperature of water in the Home’s baths was appropriately monitored. The Home was found to be very clean, pleasant and hygienic. The laundry floor finish was found to be impermeable and the walls were readily cleanable. The Home had a number of sluicing facilities and sluicing disinfectors. The
DS0000002122.V263580.R01.S.doc Version 5.0 Page 16 Home’s washing machines were able to provide a washing sequence of over 650 C, and the Manager was aware of the Water Supply (Water Fittings) Regulations of 1999. DS0000002122.V263580.R01.S.doc Version 5.0 Page 17 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): Standards 27, 29 & 30. The Registered Providers were found to be providing more than adequate staffing in the Home to ensure that Residents needs were met. EVIDENCE: Staffing provided in the Home was compared with the details provided by the Residential Forum. This showed that during the four weeks beginning 10 to the 31 October 2005, the Home was providing care staffing above that required by the Residential Forum for 25 Residents at the Medium Dependency level and 25 Residents at the High Dependency level. This was judged to be sufficient staffing for the resident group staying in the Home. These figures were calculated without the Manager’s working time included, as recommended by the Residential Forum. However, it was found that two care staff, across two weeks, each worked double shifts that amounted between 54 and 62 hours of work each week. This does not encourage staff to meet the needs of Residents in a kindly, understanding and patient manner. The staffing records of two staff employed since April 2002 were examined. These showed that the Manager had obtained almost all of the requirements necessary, although one was missing. All highly significant date was obtained but a photograph of one of the staff was missing. DS0000002122.V263580.R01.S.doc Version 5.0 Page 18 Staff induction and foundation training was provided for all new staff that came to work in the Home. The Manager also said that all care and nursing staff were provided with at least three paid days training a year, and went on to say that usually more was provided. All staff also had an individual training and development assessment and profile. DS0000002122.V263580.R01.S.doc Version 5.0 Page 19 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): Standards 33 Residents benefited from a well run and managed establishment. EVIDENCE: The Manager was able to say that the Home had an annual development plan and a quality assurance system that was reviewed annually. Residents also completed questionnaires with the results being published. The Home also obtained the views of family and friends of Residents on how well the Home was achieving goals for the Residents. DS0000002122.V263580.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X X DS0000002122.V263580.R01.S.doc Version 5.0 Page 21 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. Standard Regulation Requirement Each file must contain details of the limitations made by the Home, and agreed by each Resident or their Representative, on the Resident’s choice, freedom and decision-making ability. (This Standard should have been addressed from the inspection report dated 2 December 2003) All Residents must be given access to the Residents Guide to the Home. When the Home’s staff use the Resident’s record to ask other staff to monitor the condition of a Resident, or carry out a task, staff must respond to such requests when making entries in the record. The staff member who made the request must eventually sign it off, i.e. if the requested was to observe the Resident, when it is no longer needed. The recording of the administration of medication in the new unit in the Home must be greatly improved.
DS0000002122.V263580.R01.S.doc Timescale for action 1 OP7 17 Sch 3 28/12/05 2 OP7 5 28/12/05 3 OP7 12 28/12/05 4 OP9 13 28/12/05 Version 5.0 Page 22 5 OP12 12 6 OP29 19 The Manager must ensure that staff are aware of the need to knock and await a response from Residents before entering their bedrooms. The Manager and care team need to decide which Residents this must apply to, given Residents differing abilities. (This Standard should have been addressed from the inspection report dated 25 January 2005) The Manager must check, and hold documentary evidence, that all staff employed in the Home since April 2002, have satisfied the requirements listed in Regulation 19 and Schedule 2 of the Care Homes Regulations 2001, as amended during 2004. 28/12/05 28/12/05 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 2 Refer to Standard OP7 OP12 Good Practice Recommendations Each Residents file should contain details of the keyworker who is currently working with each Resident. The Manager should review the frequency of baths and showers provided for Residents, and if at all possible provide baths and showers at the intervals of time requested by each Resident. Residents should be given the opportunity to go out from the Home, to do shopping for example, with either staff or relatives. The Manager should enable Residents to take part in local and national elections by ensuring that Residents names are on the electoral role and by giving opportunity to make a postal vote at the specified times. The Manager should review the length of time care staff are allowed to work in the Home, and where possible limit this to no more than 40 hours each week.
DS0000002122.V263580.R01.S.doc Version 5.0 Page 23 3 OP12 4 OP12 5 OP27 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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