Inspection on 16/07/08 for Nethercrest Nursing Home

This inspection was carried out on 16th July 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Nethercrest Nursing Home 14/08/06

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Heathlands

Aston Court Nursing Home

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Ravenhurst

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Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Nethercrest Nursing Home Brewster Street Netherton Dudley West Midlands DY2 0PH Lead Inspector Sara Gibson Key Unannounced Inspection 16th July 2008 08:30 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 Nethercrest Nursing Home DS0000066287.V368292.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. Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nethercrest Nursing Home Address Brewster Street Netherton Dudley West Midlands DY2 0PH 01384 212785 01384 251615 nethercrestnursing@mimosahealthcare.com 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) Mimosa Healthcare Group Limited Manager post vacant Care Home 41 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (41), of places Physical disability (22) Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 41 OP, 6 DE(E) and 22 PD The category of PD applies only to intermediate care places and the 2 permanent placements already approved. 14th August 2006 Date of last inspection Brief Description of the Service: Nethercrest Care Home is privately owned by Mimosa Healthcare Group Ltd, it provides nursing care and accommodation, on a shared site with its sister home Nethercrest Residential Home. First registered in 1991 up to forty-one older persons can be accommodated, six of which may require dementia care and up to twenty receiving intermediate care which is for patients discharged from hospital but not sufficiently recovered to go home. The home is situated on the outskirts of Netherton within the local community and is near to local shops and amenities. It is on an accessible public transport route to local areas and there are adequate car parking facilities available. The premises consist of a two-storey purpose built building with access to the first floor by a passenger lift. The accommodation consists of 33 en-suite single bedrooms and 4 double rooms. Currently the 2 double rooms are furnished as single rooms, making the homes capacity 39. A large lounge/dining room with a conservatory and a further linked small sitting area with a second conservatory provide communal space. The communal areas are serviced with a 4 suite assisted toilet room. Three bathrooms and two shower rooms are located within the Home. CSCI inspection reports are available to read in the reception area, along with the homes service user guide and statement of purpose. Information on fees charged is not available in the service user guide but can be gained from the Administrator or Manager of the home. Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. The focus of our inspection is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. One inspector undertook the key fieldwork visit to the home, and the staff assisted throughout. The home did not know we were visiting on that day. There were thirty-eight people living at the home on the day of the visit. Information was gathered from speaking to and observing the care people who lived at the home received, four people were “case tracked”, and this involved discovering their experiences of living at the home by meeting and observing them, looking at medication and care files, and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also reviewed. Random questionnaires were sent out to people who live at the home in order to gain their views about the service. During our visit we spoke to six people who live at the home, four staff members and two relatives. Comments received about the home were generally positive. These will be included throughout the report. Prior to the inspection the home had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about the home, staff and people who live there, improvements made, and plan for further improvements, which was taken into consideration. Regulation 37 reports about accidents and incidents in the home were reviewed in the planning of this visit. What the service does well: Full needs assessments involving the individual and their family are carried out prior to the individual being admitted to the home. The assessment is very comprehensive and once completed gives a very good picture of the individual and their specific needs and preferences, allowing staff to provide a good standard of care. Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 6 Throughout the inspection staff were observed interacting well with the people living at the home, supporting them and talking to them in a friendly, relaxed manner demonstrating that staff respect them and their dignity is promoted. People living at the home are supported to maintain contact with family and friends so that relationships that are important to them are maintained. Meals are served in a relaxed and unhurried manner so that people living at the home enjoy the social aspects of mealtimes. Adult protection strategies are robust, and staff have a clear understanding of the procedures, to ensure people at the home are safe and protected from harm. A confidential helpline is available for all to access if they have any concerns about adult protection. Staff training is very good and ensures that skilled, competent staff care for people living at the home. What has improved since the last inspection? What they could do better: Medicine records for the administration of medication must be clear and accurate in order to ensure that the people who use the service are safeguarded. Medicines must be safely stored to further safeguard the people living at the home. The activities programme should be developed to ensure all the people living at the home are provided with activities and interests to improve the quality of their lives. Repairs to equipment must be carried out promptly to enable people to live in a safe, well-maintained environment. The communal areas need to be more user friendly to allow people to socialise in smaller groups, or to spend time on their own as they choose. Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 7 Bathrooms must be free from hazards, and locked if they are out of order to prevent accidents occurring. A more suitable location should be found for the hairdresser to use to ensure the privacy and dignity of the people living at the home is maintained. 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. Nethercrest Nursing Home DS0000066287.V368292.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 Nethercrest Nursing Home DS0000066287.V368292.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, 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems in place ensure that people admitted to the home can be confident their needs will be met. EVIDENCE: The home understands the importance of having sufficient information when choosing a care home. They have developed clear information to help prospective individuals choose a home that will meet their needs and preferences. The information is contained in the home’s Statement of Purpose which clearly sets out the home’s aims and objectives, and is supported by a Service User Guide that details what services the home can provide, the qualifications and experience of the staff, and what levels of service the prospective resident can expect, it also includes photographs of the home and is laid out in an easy to Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 10 read guide. The guide can be made available in other formats such as large print, other languages and Braille. Prospective residents are given a copy of the guide, and people living at the home also have a copy for them to refer to if needed. The certificate of registration and public liability insurance certificate are on display, and a copy of the previous inspection report is available for people to access if they wish. Trial visits are offered to prospective residents to allow them to see what the home has to offer them and to ensure their needs can be met. Full needs assessments are carried out during the visit involving the individual and their family. Admissions are not made to the home until a full needs assessment has been undertaken. This assessment is carried out by a senior member of staff, and involves the individual and their family. The assessment is very comprehensive and once completed gives a very good picture of the individual and their specific needs. The assessment takes into account the individuals diagnosis and reason for admission, and looks at their mobility, cognitive reasoning, skin integrity, continence, and communication, eating habits and sleep pattern plus numerous other areas. Four assessments were looked at and were comprehensively completed by members of the nursing staff. The home has twenty beds dedicated for intermediate care and these are fully utilised by the hospital. A rehabilitation room has been developed for the Physiotherapists and Occupational therapists to work with service users. A senior carer has recently been designated to lead the intermediate carer team to assist in co-ordination and communications to maximise the rehabilitation process. The hospital provides the home with a detailed discharge summary about the individual, which is supplemented with the homes own comprehensive assessment. Comments from people living at the home included: “My son chose this home for me, I came to visit for a day to see if I liked it” “I was asked a lot of questions about what I can and cant do, and what I like doing” “I remember when I arrived I had to answer a lot of questions about my health and what I needed doing for me”. Nethercrest Nursing Home DS0000066287.V368292.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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health care needs are being well met so that their health and well-being is promoted. Medication is not always recorded accurately to ensure the well being of people who live in the service. EVIDENCE: People living at the home receive individualised personal and healthcare support based on their specific needs as discussed during the pre-assessment. Their needs including specialist health, nursing and dietary requirements are identified and clearly recorded in a care plan to ensure that staff have the information required to meet those needs. Staff said: “The care plans are very detailed and give us a good picture of the service user and their needs”. During the inspection the care plans of the four people being case tracked were examined in detail. Health and personal care needs are identified by thorough assessment, involving the individual and their families. Each care Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 12 plan looked at had a review form signed by the family stating that they are to be involved in planning the care and subsequent reviews of the care provided, and have access to the care plan as they wish. A relative said: “We have been involved in making sure mum gets the care she needs, the staff consult us and we read the care plan. We are very satisfied with the care provided”. The care plans were detailed, informative and provided good guidance for staff to enable them to meet the needs of the individual person. Each care plan has areas relating to the tasks care staff carry out and tasks for the nursing staff. The care plans seen stated the individual identified need, the plan for meeting the need, the agreed goals or outcomes and the date for review of the plan and covers all aspects of daily living. Short-term plans are introduced into the individuals file for their care if they have a chest infection or urinary infection, or are being treated with a course of antibiotics. Included in the care files are completed forms documenting the preferred choices of the individual, what choices they can make, and where they need help to make choices. To give a full picture of the individual the family complete a life history form and a day in the life form, this gives the staff an idea of the persons life before they came into the home, their childhood, family life, employment, hobbies and interests, and how the person usually spends a typical day. This provides points of interest to talk about, particularly during reminiscence sessions. Risk assessments for moving and handling, pressure area care including a body map, a dependency assessment, falls assessment, and a detailed nutritional assessment, with a screening tool which monitors the weight of the person, particular diets and any special needs for nutrition. Risk assessments are comprehensive and specific to the individual person. Reviews are undertaken monthly or as changes occur to ensure people living at the home are safe, potential risks are minimised and staff have the current guidance to follow. The home maintains good contact with other health professionals such as tissue viability nurses, continence nurses, physiotherapists and occupational therapists. The contact with the health professionals extends to advice, information and training for staff and the people living at the home. People living at the home also have access to social workers, community psychiatric nurses, opticians and dentists. Their own GP can be retained on admission to the home if they wish. Overall medication was being carefully handled to ensure that people who use the service were safeguarded from harm. We saw a medication policy for the ‘Administration of Drugs and Medicines’ dated 1/3/07. It contained information about the control and handling of Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 13 medication for residents who live permanently within the home, however there was no information about how medication was handled for residents who are staying as part of the ‘step down’ service with the Dudley Group of Hospitals. This means that staff can follow a safe written procedure for some residents but not all of the residents are safeguarded with a written procedure. We saw that the medication was administered safely and with care to the residents. The majority of medication seen was stored safely in an office and also a nurse store. The medication was stored in locked cupboards, a locked refrigerator and two locked medicine trolleys. We did see that one of the cupboards was not locked during the inspection, which the manager also noticed and agreed that this was not good practice. We saw daily temperature records for the refrigerator and office room temperature. The refrigerator temperatures were sometimes too low for the safe storage of medication (should be between 2-8°C) particularly for insulin. The nurse store upstairs was very hot and the medicine trolleys were stored in this room. This means that residents medication is being stored at high temperatures which may harm the medication, however following the inspection the two trolleys were moved back downstairs to ensure safe storage of medication. We saw written records to ensure that medication was documented when it arrived into the home and also when medication was no longer needed and disposed of. This helped to ensure that safe levels of medication were stored within the home. We saw two different types of medication record to document administration both of which can cause some problems for staff. The first medicine record chart was for residents who live permanently at the home, which is printed by the supplying pharmacy. Sometimes the medicine chart documented the names of medicines that had been stopped by the doctor. This means that there is an increased risk that medication no longer prescribed could be given as it was still written on the chart and this increases the risk of harm to residents’. The second medicine chart was for residents who have been admitted from hospital as part of the ‘step down’ programme. The service continues to use the medicine chart from the hospital, and this has caused some problems for the home. For example, we saw a medicine chart that had been written using an abbreviation for a named medication and very often the charts had not been recorded accurately whilst the resident was in hospital. The medicine chart is then returned to the hospital and the home keeps a photocopy and not an original document. These issues cause concern because the home has to accept responsibility for the records kept for the residents and original records Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 14 should be retained by the home. This was discussed with the manager and also the Intermediate Care Lead Nurse at the hospital who agreed that changes could be made to ensure the safety of residents’ medication records. The majority of the medicine records seen for the permanent and ‘step down’ residents were well documented with staff signatures to record that medication had been administered to people living in the service or a code was recorded to explain why medication had not been administered. Throughout the inspection staff were observed interacting well with the people living at the home, supporting them and talking to them in a friendly, relaxed manner. People living at the home appeared well cared for in appearance and were dressed appropriately for their age, gender and the time of year. People living at the home were addressed by their preferred name by the staff, and the care plans recorded the individual’s preferences regarding the gender of staff assisting them with personal care. One person said: “I need quite a bit of help and they always have time for me, I don’t feel rushed at all. I don’t mind who helps me to get ready in the morning”. Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 15 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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A planned programme of varied activities should be developed to ensure all the people living at the home are provided with activities and interests to improve the quality of their lives. A wholesome and varied diet is offered and specialist diets are catered for to meet the needs of the individuals. EVIDENCE: The reception area of the home has an information board on display for the people living at the home. The board displays information on dates of residents meetings, minutes of the last residents meeting, the complaints policy and information on advocates so that people know what is happening in the home. Numerous thank you cards and letters are also on display. There is also information about the Protection Of Vulnerable Adults helpline, which allows anyone who has concerns to report them confidentially via the helpline. A Senior Carer is responsible for organising activities at the moment, although the home is in the process of recruiting an activity co-ordinator. There is no formal plan of activities listed, though records show that games, sing-a-longs, Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 16 reminiscence sessions, film shows, card games and dominoes have taken place in the last four weeks. Comments from people living at the home included: “We sometimes have a sing-a-long and do some exercises but not much else, as the staff are too busy” “I like sitting in the lounge and watching what’s going on, we sometimes have a game of cards or dominoes, but I like watching the TV”. Participation in the activities is recorded in the activity log and onto individual’s records. At the last residents meeting held in June, people living at the home stated they would like more activities. Residents and relatives meeting are held every two months. At the last meeting ten residents and relatives participated, and the minutes of the meeting were documented. Staff listen and respond to queries raised, for example, the home is expanding the range of activities they provide following consultation with the people living at the home. The family involvement at the home is very good. Family and friends are encouraged to visit, to have a meal at the home and to participate in the activities. This allows close relationships to be maintained, and gives the people living at the home a sense of “family life”. “My family visit me quite often which is nice” “ My daughter visits me regularly and I’m hoping my son will be coming at the weekend”. Varied diets are catered for at the home including diabetic, soft, and gluten free and cultural meals. The menu’s are extensive and are changed every four weeks. On the day of inspection the menu included: Lamb chops, sauté potatoes, and beans, with apple sponge and custard or ice cream on offer for lunch with alternatives available from the Chefs pantry such as chilli and rice, cheese and potato pie, cottage pie, salads, jacket potatoes with various fillings, soup and sandwiches. Afternoon tea offered a choice of sandwiches and various snacks on toast, puddings and pastries. The day is rounded off with a late supper available consisting of various hot drinks, sandwiches, cakes and biscuits, cheese and biscuits, and toast. Resident’s comments included: “The food is lovely, always lots of choice” “The food is very good, nicely cooked and there is always a choice” “I don’t eat much, but I like the soup and the sandwiches”. Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who raise concerns or make a complaint are confident that these will be dealt with effectively and their views listened to. Staff receive training to ensure that they possess the knowledge and skills to respond appropriately to allegations of abuse. EVIDENCE: The complaints procedure at the home is robust. There is a clear complaints policy on display in the home and in the service user guide, which each resident has a copy of to refer to if needed. All complaints are taken seriously, and documented in the complaints log. Since January 2008 the home has received seven complaints, all of which have been investigated and resolved. An audit of the complaints is sent to the head office each month to allow for trends to be identified and to ensure complaints are being investigated thoroughly. No complaints about the home have been received by CSCI. One person said: “I’ve got no complaints at all. I’ve never had to complain but if I did I would talk to the manager. It’s a good atmosphere here, I don’t know anybody who has complained”. Relatives spoken to said: “We had a lot of information given to us when mum first came here, and yes I think we did have the complaints procedure but so far we have not had to complain about Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 18 her care” “We have not had to complain but I would talk to the manager if need be”. The home has a robust Adult Protection policy, and would refer any concerns to the Vulnerable Persons team for further investigation. A flow chart has been produced for staff on reporting allegations of abuse to ensure they are clear on the process. No adult protection referrals have been made since the last inspection. Staff have received training in adult protection, and were aware of what to do if a potentially abusive situation arose. Staff commented: “We have had training on adult protection and abuse” “If we had any concerns about abuse we would go to the Manager” “There is a confidential helpline we can phone if we had any concerns”. The company that owns the home have set up a confidential helpline for reporting any concerns regarding the protection of vulnerable adults, which anyone can access; information about the helpline is on display around the home. Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A homely and comfortable living environment has been achieved for the people who live there so that they feel safe and well cared for. EVIDENCE: The home is a purpose built two-storey building set in pleasant grounds. People living at the home were happy with their environment and said they were very comfortable. Comments from people living at the home included: “I like it here very much” “My bedroom is very nice, I’ve got everything I need. I’ve got some lovely photos of my family in there and some china from home” “Its very nice here, very comfortable”. There is a large communal lounge for resident’s use that is very pleasantly decorated, although the armchairs were very close together and pushed back against the wall, all facing the television. This did not give people living at the Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 20 home enough space or privacy when receiving visitors, nor did it give the opportunity for smaller social groups to meet. A relative commented: “The chairs are very close together and do not offer much personal space for the residents. They would benefit from their own table by the side of them to put their belongings on”. A conservatory leads off the lounge; again this was nicely decorated with lighting, window blinds, covered radiators and fans for use in the warmer weather. During the inspection the visiting hairdresser, who wheeled people through the lounge from the bathroom with wet hair, was using the conservatory. A number of ladies were sitting in the conservatory with their hair in curlers and this again did not seem to offer much privacy. Two of the ladies spoken with said they didn’t like sitting in full view of everyone while their hair was being done but there was nowhere else to do it. A more suitable location for hairdressing needs to be found within the home that offers more privacy for the people there. Toilet areas were clean and odour free, with wash hand basins complete with paper towels and liquid soap to safely manage infection control. One of the bathrooms was out of order and due to be repaired soon, while it is out of order, it should be kept locked as it is still accessible to the people living at the home and there is a potential risk of harm occurring as there are chairs stacked in there, a television on the floor and a portable electric fan leaning against the bath. The bath in the ground floor bathroom was stacked full of towels and could pose a risk of cross infection, and there were also two armchairs and a slide board in the bathroom that could prove hazardous. The disinfector in the ground floor sluice room was also out of order and awaiting repair, and the lower part of the communal corridor walls were scuffed and dented where wheelchairs had dented the walls. The Manager must ensure that repairs are carried out promptly to enable people living at the home to live in a safe and well-maintained environment. The bedrooms seen during the inspection were comfortable and had been personalised with the individuals own photos and ornaments, and in some cases items of their own furniture to reflect their personal taste, gender and culture. A relative said: “Dads room is nice, we brought a lot of his bits and pieces from home with us to make it nice for him. We can come and visit any time we like which is good”. The garden area’s seen were well tended and accessible for the people living at the home to use. Nethercrest Nursing Home DS0000066287.V368292.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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are maintained to ensure people living at the home receive care from appropriately trained and robustly recruited staff in a competent and safe manner. EVIDENCE: Staffing levels at the home are maintained to meet the needs of the people living at the home. The rota was seen for the month and shows that eight care assistants plus two Registered Nurses, the Administrator and Manager are on duty during the day. Robust recruitment procedures safeguard the people living at the home. Three care assistants and nurse’s recruitment files were sampled and all the relevant checks had been carried out prior to the staff member starting work at the home. New staff undergo an induction programme and work with a more experienced staff member until they feel confident to work on their own. The culture and gender mix of the staff team reflected the culture and gender mix of the people living at the home so that care is provided in an understanding way. From talking to staff and observing them during the day it Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 22 was evident that staff morale was good, and the interaction with the people living at the home was excellent. Comments from people living at the home and their relatives included: “We are very pleased with the care mum gets here. The staff are very nice and always have time to explain things to you. Mum has no complaints, she likes the food and is very well cared for” “The staff are very friendly and welcoming and always make time to talk to us” “I like it here very much, the staff are very friendly, I am well cared for” “The staff are lovely, very caring”. Staff spoken to said that there was a good staff team at the home and they all worked well together to achieve the best outcomes for the people living at the home. Comments included: “It is a very busy home but we work well as a staff team” “We have lots of training and find it very useful” “We have regular supervisions and staff meetings, and are able to discuss any issues or problems”. The staff training and development programme at the home is very good. Training for staff in the last year has included: Health & Safety, Food Hygiene, First Aid, Manual Handling, Basic Life Support, Fire Awareness, and Continence Care. Future training planned includes: Manual Handling, Infection Control, Medication Awareness, Dementia Care, Protection Of Vulnerable Adults, Medication Administration, Basic Life Support, and Health & Safety. Specialist training is accessed for the nursing staff including drug competency tests, use of syringe drivers for pain medication, PEG feeds and wound care. Nethercrest Nursing Home DS0000066287.V368292.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, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager is experienced and possesses the skills and knowledge to oversee the day-to-day management of the home, and ensures that residents needs and views are responded to. EVIDENCE: The Manager has been in post for the last six months, and has made a number of improvements to the service, such as, monthly audits and introducing nurse supervisions, and staff and resident meetings. These systems were in place but were not being followed by the previous Manager. Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 24 The Manager has empowered staff to take a pride and responsibility in their jobs, making staff aware of their roles and informing them of the role of the CSCI. The Manager is capable, efficient, and proactive and has a number of years experience in care. Staff feel well supported by the Manager. Comments from staff included: “I enjoy working here very much, the Manager is very supportive” “Things are now improving with the Manager in place”. Staff and resident/relative meetings are held monthly and minutes are documented. Resident and relative satisfaction questionnaires are sent out and a full report on the responses has been compiled and is available in reception. The overall results show that people living at the home are very satisfied with their care. People living at the home have access to their personal monies. Finances are secure, with receipts and transactions listed. A robust audit trail is maintained. There is a well-planned staff supervision programme in place, with monthly supervisions taking place. The supervision sessions are well documented, and cover all areas of care practice, policies, standards of care, and identify staff training and development needs. This further safeguards the people living at the home by ensuring that staff have the skills, knowledge and support they need to meet people’s needs. General arrangements for health and safety are good. Maintenance checks are carried out on schedule to ensure equipment is safe to use. Weekly tests of the fire alarm take place, and staff had recently undertaken a fire drill and were familiar with the procedure to follow in the event of a fire. A programme of internal quality audits takes place during the year, looking at all areas of the home, from maintenance to grounds, to care files and training. Areas for improvements are identified, action plans are made, which the Manager signs off when identified improvements have been completed. Each area is audited every three months. No major issues were identified in the last audits seen. Reports of accidents involving residents are completed, and appropriate actions are taken following accidents to ensure good outcomes for the individual. A falls report and accident audit is undertaken monthly in order to reduce the risk of similar accidents occurring again. Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 25 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 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 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 2 2 2 X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13 Requirement Medicine records for the administration of medication must be clear and accurate in order to ensure that the people who use the service are safeguarded. A planned programme of varied activities should be developed to ensure all the people living at the home are provided with activities and interests to improve the quality of their lives. Timescale for action 16/09/08 2. OP12 16 16/09/08 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 OP9 Good Practice Recommendations Suitable arrangements must be made to ensure that all medicines are stored safely and securely at the required temperature with restricted access to authorised members of staff to ensure that people who use the service are DS0000066287.V368292.R01.S.doc Version 5.2 Page 27 Nethercrest Nursing Home 2. OP9 3. 4. 5. OP19 OP20 OP21 protected from harm. The medicine policy should be reviewed and updated in order to ensure it is specific to the service, particularly with regard to the ‘step down’ arrangements to ensure that the health and welfare of residents taking medication are safeguarded. Repairs to the home and the equipment within it must be carried out promptly to enable people to live in a safe, well-maintained environment. The communal areas need to be more user friendly to allow people to socialise in smaller groups, or to spend time on their own as they choose. Bathrooms must be free from hazards, and locked if they are out of order to prevent accidents occurring. Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Nethercrest Nursing Home DS0000066287.V368292.R01.S.doc Version 5.2 Page 29 - 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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